A model didactic and clinical substance abuse curriculum developed for schools of nurse anesthesia
MODULE 2 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS
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- MODULE 3 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTS
- Substance Abuse Curriculum
- Substance Abuse Pretest
- DIDACTIC UNIT 2A: Introduction to substance abuse and commonly used terms
- DIDACTIC UNIT 2B: Defining commonly abused substances and their characteristics
- DIDACTIC UNIT 2C: Basic pharmacology - I. Acute and Chronic Abuse
- DIDACTIC UNIT 2D: Defining the Diagnostic and Statistical Manual of Mental Disorders
- DIDACTIC UNIT 2E: Epidemiology of substance abuse
- DIDACTIC UNIT 2F: Etiology of substance abuse
- Substance Abuse Case Presentation 1
- DIDACTIC UNIT 2G: Introduction to the legal, ethical and moral issues of SA
- DIDACTIC UNIT 2H: Basic assessment and diagnostic skills in the SA patient
- DIDACTIC UNIT 2I: Multisystem physiology in SA - Level I
- DIDACTIC UNIT 2J: Attitudes and Self-assessment concerning SA
- CLINICAL UNITS A-G: Introduction to clinical assessment and diagnostics of SA
- Formative Evaluation of Module 1
MODULE 2 OUTLINE OF DIDACTIC AND CLINICAL COMPONENTSModule 2: Increased Special Skills in the Planning, Recognition, Diagnosis, and Treatment of SA. Didactic Units IV. Planning, Recognition, Diagnosis and Treatment of SA sequelae A. Multisystem physiology in SA - II B. Pharmacology - II C. Prevalence and Patterns of SA D. Tolerance, toxicity, and withdrawal from SA E. Planning for intervention, intervention and aftercare F. Central concepts and Research Issues in SA G. Assessment and screening of SA patients H. Individual, family, and group dynamics related to SA I. Identifying community resources and treatment options Module 2: Increased Special Skills in the Planning, Recognition, Diagnosis, and Treatment of SA. Clinical Units V. Clinical Planning, Recognition, Diagnosis and Treatment of SA sequelae A. Barriers to accurate assessment and data collection from patient, family and physical examination B. Interview techniques for extraction of SA information C. Identifying signs and symptoms of SA at all levels D. Appropriate treatment options for all SA stages E. Demonstrate intervention plan, basic intervention and aftercare skills F. Demonstrate basic treatment and/or referral skills G. Examining the importance of the professional role of the nurse anesthetist H. Reflection of personal attitudes and beliefs concerning SA I. Solidify SA research project
VI. Advanced clinical medical sequelae, diagnosis, and treatment of SA. A. Multisystem physiology - III 1. Maternal and neonatal 2. Fetal and newborn addiction B. Pharmacology - III C. AIDS and SA D. Special at risk populations E. Interprofessional networking F. Methods of Prevention G. Impaired practitioners and recovery Module 3: Professional Responsibilities, Advanced Knowledge, and Demonstrated Skills in Substance Abuse. Clinical Units VII. Advanced clinical medical sequelae, etiology and effects of SA A. Development of advanced communication and assessment skills B. Advanced intervention skills (in anticipation of resistance from family or patient) C. Development and practice of advanced prevention methods D. Utilization of knowledge for identification, intervention, and aftercare E. Demonstration of interprofessional collaboration F. Demonstrate abilities in SA educational methodology G. Current and logical discussion of SA H. Presentation of SA research project I. Demonstration of attitudinal change concerning SA
MODULE 1DIDACTIC UNIT 1 A-D: Introduction to the modulesTotal Time: 15-30 min Overview: This unit serves as an introduction for the modules and the educational process in substance abuse. This exercise should be reintroduced at the beginning of each new group and meeting site. Terminal Objective: The student will understand the objectives, goals, and syllabus for the modules. In addition the student will be given references and other pertinent information. The student will have the opportunity to network with others in the group with introductions. Recommended Teaching Methods: Group Process Lecture Discussion Pre-test - Reference sheet 1.0 Materials: Syllabus
Pre-test Substance Abuse PretestModule 1 Didactic Unit 1 Reference Sheet 1.0
Low Moderate High Skill Skill Skill
Total Time: 1 hour Overview: This unit serves as an introduction for the glossary of SA terms and their definitions. The unit will also serve as a introduction to organizations and other resources concerning substance abuse. Terminal Objective: The student will understand the many of the commonly used terms, organizations and resources in SA. In addition the student will be given references for further exploration. Recommended Teaching Methods: Group Process Lecture Discussion Content Outline: VIII. Common terms related to SA A. Addiction B. Dependence C. Use vs. misuse D. Experimentation E. Tolerance F. Additional terms IX. Organizations A. Local
B. State C. National X. Resources A. Written materials B. Audiovisual materials C. Professional networking D. Experiential learning References: American Nurses' Association, Drug and Alcohol Nursing Association, and National Nurses Society on Addictions. (1988) The care of clients with addictions: Dimensions of nursing practice. Kansas City, Mo.: American Nurses Association. American Nurses' Association and National Nurses Society on Addictions. (1988). Standards of addictions nursing practice with selected diagnoses and criteria. Kansas City, Mo.: American Nurses' Association. American Psychiatric Association. (1997). Diagnostic and statistical manual (DSM-IV). Washington, DC: APA, American Psychiatric Association. American Psychiatric Association. (1975). A psychiatric glossary. Washington, DC: American Psychiatric Association. Burns, E.M., Thompson, A. & Ciccone, J.K. (Eds.) (1993) An addictions curriculum for nurses and other helping professionals. Vol. 1 & 2. New York: Springer Publishing Co. Flynn, S.P., Davis, A.K., & Fleming, M.F. (1989). Teaching about substance abuse: A resource manual for faculty development. (NIDA & NIAAA No. PH 276). Rockville, MD: U.S. Dept. of Health and Human Services. Kalish, R.A. (1982). Late adulthood: Perspectives on human development. Monterey, CA: Brooks, Cole Publishing Co. Nelson, J.E., Pearson, H.W., Sayers, M. & Glynn, R.J. (1982) Guide to drug abuse and research terminology. Research Issue 26. Rockville, MD: National Institute on Drug Abuse. Rinaldi, R.C., Steindler, E.M. Wilford, B.B., & Goodwin, D. (1988) Clarification and standardization of substance abuse terminology. Journal of the American Medical Association 259(4), 555-557. Resources for Substance Abuse: Alcoholics Anonymous P.O. Box 459 Grand Central Station New York, NY 10163 (212) 686-1100
222 South Prospect Ave. Park Ridge, Ill. 60068 (708) 692 7050 American Council for Drug Education 6193 Executive Boulevard Rockville, MD 20852 (301) 984-5700 American Medical Association Department of Health Education 535 North Dearborn St. Chicago, Ill. 60610 (312) 645-5000
c/o Brown University P.O. Box G Providence, RI 02912 (401) 863-1109
Morehouse School of Medicine 720 Westview Drive, S.W. Atlanta, GA 30310 Food and Drug Administration Office of Consumer Affairs 5600 Fischer Lane Rockville, MD 20857 (301) 443-6500
Pleasant Valley Road Box 176 Center City, MN 55012 (800)328-9000 Johnson Institute 7151 Metro Blvd. Minneapolis, MN 55439 (800) 231-5165 National Clearinghouse for Alcohol and Drug Information Department PP - P.O. Box 2345 Rockville, MD 20852 (301) 469-2600 National Council on Alcoholism 733 Third Ave. New York, NY 10017 (212) 986-4433 National Council on Alcoholism and Drug Dependence, Inc 12 West 21st St. New York, NY 10010 (212) 206-6770 National Highway Traffic Safety Administration 793 Elkridge Landing Road Linthicum, MD 21090 (301) 962-3877 National Library of Medicine Collection Access Section 8600 Rockville Pike Bethesda, MD 20894 National Nurses Society on Addictions 5700 Old Orchard Road, First Floor Skokie, Ill. 60077 (708) 966-5010 Native American Research Information Service (NARIS) The American Indian Institute The University of Oklahoma 555 Constitution Ave. Norman, OK 73037 (405) 325-4127 Resources for Substance Abuse (cont.): Office of Minority Health Resource Center (OMHRC) P.O. Box 37337 Washington, DC 20013 (800) 444-6472
Dartmouth Medical School Hanover, NH 03756 (603) 646-7540 Rutgers University, Center of Alcohol Studies Smithers Hall, Busch Campus Piscataway, NY 98854 (201) 932-4442 Education and Training Van Nest Hall, Room 301 New Brunswick, NJ 081903 (201) 932-2190 Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2B: Defining commonly abused substances and their characteristicsTotal Time: 1-2 hours Overview: This unit serves as an introductory study of the substances commonly used and their characteristics. The session is intended to familiarize the participant with the major mood altering drugs and provide the framework that will allow comparison of the substances of abuse. Terminal Objective: The student will understand the many of the commonly abused substances, their characteristics, and clinical manifestations. Recommended Teaching Methods: Group Process Lecture Discussion Readings Drug Content Area: from Adger, H., DeAngelis, C., & McDonald, E.M. Course Outline: XI. Common drugs of abuse A. Alcohol B. Marijuana 1. Hashish C. CNS stimulants 1. Amphetamines D. Cocaine 1. Crack E. CNS depressants 1. Barbiturate 2. Non-barbiturate 3. Anti-anxiety agents F. Narcotics/Heroin/other controlled substances 1. opiates a. morphine b. codeine a. heroin b. hydromorphone 3. synthetic a. methadone b. meperidine c. fentanyl d. sufentanyl G. Hallucinogens 1. LSD 2. Mescaline 3. MDMA H. Phencyclidine (PCP) I. Volatile Inhalants 1. Amyl and isobutyl nitrites J. Nicotine K. Caffeine L. Anabolic steroids M. Over-the-counter drugs XII. Content Area for each drug A. Generic and trade name B. Street names C. General information D. Methods of use E. Clinical manifestations F. Formulation and Paraphernalia G. Treatment for acute abuse References: Adger, H., DeAngelis, C., & McDonald, E.M. (1986). Model program and curriculum in alcohol and other drug abuse for pediatric medical students, residents and faculty. (National Institute on Drug Abuse. ADM 281-86-0009). Washington, DC: U.S. Government Printing Office. Ahmad, G. (1987). Abuse of phencyclidine (PCP): A laboratory experience. Journal of Clinical Toxicology. 25(4), 341-346. Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co. Boning, J. (1985). Benzodiazepine dependence: Clinical neurobiological aspects. Advances in Biochemical Psychopharmacology. 40, 185-192. Buffum, J. (1982). Pharmacosexology: The effects of drugs on sexual function. Journal of Psychoactive Drugs. 14(1-2), 5-44. Clouet, D.H. (1986). Phencyclidine: An update. (DHHS publication no. ADM 86-1443) Washington, DC: U.S. Government Printing Office. Cushman, P. (1986). Sedative drug interactions of clinical importance. Recent Developments in Alcohol. 4, 61-83. Freund, G. (1984). Biomedical causes of alcohol abuse. Alcohol. 1(2), 129-131. Gawin, F.H., & Ellingwood, E.H. (1988). Cocaine and other stimulants: Action, abuse and treatment. New England Journal of Medicine. 318(18), 1173-1182. Giannini, A.J., Price, W.A., et al. (1986). Contemporary drugs of abuse. American FamilyPhysician .33(3), 207-216. Goldstein, D.B. (Ed.) (1983). The pharmacology of Alcohol. New York: Oxford Press. Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co. National Institute on Drug Abuse. (1990). NIDA Capsules: CAP01-CAP38. Rockville, MD: National Clearinghouse for Alcohol and Drug Information. Peterson, R.G. & Rumack, B.H. (1977). Treating acute acetaminophen poisoning with acetylcysteine. Journal of the American Medical Association. 237, 2406-2407. Spitz, H. & Rosecan, J. (Eds.) (1987). Cocaine abuse: New direction in treatment and research. New York: Brunner/Mazel. Stoelting, R.K. (1987). Pharmacology and physiology in anesthetic practice. Philadelphia: J.B. Lippincott Co. West, R.J. & Russell, M.A. (1985). Dependence on nicotine chewing gum. Journal of the American Medical Association. 256(23), 3214-3215. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2C: Basic pharmacology - I. Acute and Chronic AbuseTotal Time: 2-3 hours Overview: This unit serves as an introductory to the pharmacology of the substances commonly abused. The session is intended to familiarize the participant with the pharmacokinetics and pharmacodynamics of major mood altering drugs. Terminal Objective: The student will understand the pharmacologic basis and principles of many of the commonly abused substances, their characteristics, and clinical manifestations. The student will be able to generally relate these principles to anesthesia. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XIII. Basic Pharmacology of Commonly Abused Substances A. Overview of the Effects of drugs 1. Signs and symptoms 2. Tolerance 3. Pharmacologic effects B. Alcohol C. Marijuana 1. Hashish D. CNS stimulants 1. Amphetamines E. Cocaine 1. Crack
F. CNS depressants 1. Barbiturate 2. Non-barbiturate 3. Anti-anxiety agents G. Narcotics/Heroin/other controlled substances 1. opiates a. morphine b. codeine 2. semi-synthetic a. heroin b. hydromorphone 3. synthetic a. methadone b. meperidine c. fentanyl d. sufentanyl H. Hallucinogens 1. LSD
2. Mescaline 3. MDMA
I. Phencyclidine (PCP) J. Volatile Inhalants 1. Amyl and isobutyl nitrites K. Nicotine L. Caffeine M. Anabolic steroids XIV. Origins of drug use, abuse and dependence A. Addiction B. Dependence D. Vulnerability E. Clinical characteristics F. Symptoms G. Tolerance and withdrawal References: Adger, H., DeAngelis, C., & McDonald, E.M. (1986). Model program and curriculum in alcohol and other drug abuse for pediatric medical students, residents and faculty. (National Institute on Drug Abuse. ADM 281-86-0009). Washington, DC: U.S. Government Printing Office. Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co. Grabowski, J. (Ed.). (1984). Cocaine: Pharmacology, effects, and treatment of abuse, NIDA Research Monograph 50. (National Institute on Drug Abuse. ADM 87-1326) Rockville, MD: National Institute on Drug Abuse. Jacobs, M.R. & Fehr, K.O. (1987). Drugs and drug abuse: A reference text. Toronto, Canada: Addiction Research Foundation. Miller, R.D. (Ed.). (1990). Anesthesia. New York: Churchill Livingstone. Rogers, M.C., Tinker, J.H., Covino, B.G. & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book. Waugaman, W.R., Rigor, B.M., Katz, L.E., Bradshaw, H.W. & Garde, J.F. (1988). Principles and practice of nurse anesthesia. Norwalk, Conn.: Appleton and Lange. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2D: Defining the Diagnostic and Statistical Manual of Mental DisordersTotal Time: 1-2 hours Overview: This unit serves as an introductory to the problem of substance abuse. The session will provide insight into the nature of substance abuse and familiarize the participant with the DSM manual. Terminal Objective: The student will understand the nature and principles of drug use as related to substance abuse. In addition the student will be able to identify patterns and factors which predispose one to substance abuse. Recommended Teaching Methods: Group Process Lecture Discussion Readings Small group role playing Course Outline: XV. Introduction to the nature of substance abuse A. Overview of drug use 1. Healthful 2. Recreational B. Drugs used and potential for abuse 1. Marijuana 2. CNS stimulants 3. Cocaine 4. CNS depressants 5. Narcotics/Heroin/other controlled substances 6. opiates 7. semi-synthetic 8. synthetic 9. Hallucinogens 10. Phencyclidine (PCP) 11. Volatile Inhalants 12. Nicotine 13. Caffeine 14. Anabolic steroids XVI. Defining drug use, abuse and dependence A. Individual perceptions 1. Personal beliefs 2. Personal experimentation 3. Circumstances for drug use 4. Vulnerability for abuse B. Determination of use, misuse, or abuse 1. Personal definition 2. Social definition 3. Medical definition C. Social perceptions of drug use, abuse or dependence 1. Frequent use 2. Social use 3. Responsible use 4. Substance abuse 5. Drug dependence a. Physical dependence b. Psychological dependence c. DSM diagnostic criteria D. Patterns for substance abuse 1. Family history and genetic theory 2. Social learning 3. Dysfunctional family 4. Patterns of communication 5. Family role modeling
American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists. American Nurses' Association. (1988). Standards of addictive nursing practice with selected diagnoses and criteria. Kansas City, MO: American Nurses' Association. American Psychiatric Association. (1987). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association. Anspaugh, D.J., Hamrick, M.H., & Rosato, F.D. (1991). Wellness: Concepts and applications. St. Louis, MO: Mosby Year Book. Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co. Blechman, E. (1982). Conventional wisdom about familial contribution to substance abuse. American Journal of Drug and Alcohol Abuse. 9(1), 35-54. Frances, R.J. & Miller, S.L. (Eds.) (1991). Clinical textbook of addictive disorders. New York: The Guilford Press. Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St. Louis, MO: Mosby Year Book. Ray, O. & Ksir, C. (1990). Drugs, society, and human behavior. St. Louis, MO: Times Mirror/Mosby College Publishing. U.S. Department of Health and Human Services. (1987). Sixth special report to the U.S. Congress onalcohol and health: From the Secretary of Health and Human Services. (USDHHS Publication No. ADM 87-1519). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. U.S. Department of Health and Human Services. (1990). Seventh special report to the U.S. Congress on alcohol and health: From the Secretary of Health and Human Services. (USDHHS Publication No. ADM 90-1656). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Wegscheider-Cruse, S. (1989). Another chance: Hope and health for the alcoholic family. Palo Alto, CA: Science and Behavior Books. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2E: Epidemiology of substance abuseTotal Time: 1-2 hours Overview: This unit will discuss the incidence, prevalence, morbidity, mortality and demographics differences regarding substance abuse. The session will provide insight into prominent patterns of substance abuse. Terminal Objective: The student will understand the incidence, prevalence, morbidity, mortality, demographics, and prominent patterns of substance abuse. Recommended Teaching Methods: Group Process Lecture Discussion Readings Course Outline: XVII. Epidemiology of substance abuse A. Overview of the incidence and prevalence of SA 1. Overall trend of alcohol consumption 2. Overall trend of other substance use/abuse B. Incidence of substance abuse by age groups 1. Addicted Infants 2. Youth (12-18 years) 3. Young adult (19-25 years) 4. Middle Adult (26-34 years) 5. Older Adult (35+ years) C. Other abused substances 1. Growth of illicit drugs 2. Marijuana use 3. Nicotine 4. Caffeine D. Trends in substance use, misuse and abuse 1. 1970-1980 2. 1980-1990 E. Morbidity and Mortality of substance abuse 1. Factors which define morbidity 2. Causes of mortality 3. Most common physical findings of the abuser 4. Polysubstance abuse References: American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists. American Nurses' Association. (1988). Standards of addictive nursing practice with selected diagnoses and criteria. Kansas City, MO: American Nurses' Association. Anspaugh, D.J., Hamrick, M.H., & Rosato, F.D. (1991). Wellness: Concepts and applications. St. Louis, MO: Mosby Year Book. Haack, M.R. & Harford, T.C. (1984). Drinking patterns among student nurses. International Journal of Addictions. 19(5), 577-583. Haberman, P.W. (1987). Alcohol use and alcoholism among motor vehicle driver fatalities. International Journal of the Addictions. 22(11), 1119-1128. Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St. Louis, MO: Mosby Year Book. Knox, J.M. (1988). Drinking, driving and drugs. New York: Chelsea House Publications. National Center for Health Statistics. (1981). National health interview survey: Current estimates, United States, 1981. Washington, DC: U.S. Government Printing Office. National Institute on Drug Abuse. (1990). National household survey on drug abuse: Highlights 1988. (NIDA publication no. ADM 90-1681). Rockville, MD: U.S. Department of Health and Human Services. Pinto, R.P., Abrams,D.B., Monti, P.M. & Jacobus, S.I. (1987). Nicotine dependence and likelihood of quitting smoking. Addictive Behaviors. 12(4), 371-374. Ray, O. & Ksir, C. (1990). Drugs, society, and humanbehavior. St. Louis, MO: Times Mirror/Mosby College Publishing. Sanchez,-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem drinking. American Journal of Public Health. 75(2), 178-180. Seigel, R.K. (1982). Cocaine and sexual dysfunction: The course of mama coca. Journal of Psychoactive Drugs. 14(1-2), 17-74. U.S. Department of Health and Human Services. (1987). Sixth special report to the U.S. Congress on alcohol and health: From the Secretary of Health and Human Services. (USDHHS Publication No. ADM 87-1519). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. U.S. Department of Health and Human Services. (1990). Seventh special report to the U.S. Congress on alcohol and health: From the Secretary of Health and Human Services. (USDHHS Publication No. ADM 90-1656). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Wechsler, H. & Rohman, M.E. (1981). Patterns of drug use among New England college students. American Journal of Drug and Alcohol Abuse. 8(1), 27-37. Williams, G.D., Gant, B.F., Stinson, F.S., Zobeck, T.S., Aitken, S. S. & Noble, J. (1988). Trends in alcohol-related morbidity and mortality. Public Health Reports. 103(61), 592-597. Wilsnack, S.C. (1987). Drinking and drinking problems in women: A U.S. longitudinal survey and some implications for prevention. In: T. Loberg, W.R. Miller, P.E. Nathan, & G.A. Marlatt. Addictive Behavior: Prevention and Early Intervention. Amsterdam, Netherlands: Swets and Seitlinger. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2F: Etiology of substance abuseTotal Time: 2-3 hours Overview: This unit will discuss the predisposing risk factors for the substance abuser as well as some of the mechanisms for reducing these at risk populations. The session will delve into environmental influences, genetic influences, and the dysfunctional family as possible relationships to prominent patterns of substance abuse. Terminal Objective: The student will understand the various valid theories predisposing patients to substance abuse. Recommended Teaching Methods: Group Process Lecture Discussion Readings Case Presentation # 1 Reference Sheet 1.1 Course Outline: XVIII. Etiology of substance abuse A. Factors which may contribute to SA behavior 1. Individual/Personal a. genetic b. family pressures c. living patterns d. personal reflection 2. Environmental a. demographics of use and availability b. cultural patterns c. socioeconomic patterns d. profession/occupation 3. At risk behavior a. dysfunctional families b. stress c. personality d. healthy coping strategies B. Methods for reducing the incidence of SA for the at risk patient 1. exercise 2. nutrition 3. smoking cessation 4. reducing drug and alcohol intake 5. reducing the incidence of AIDS 6. stress reduction a. biofeedback b. hypnosis c. reflexology d. support groups e. directions in problem-solving 7. community support 8. self-help C. Health education in SA 1. Needs assessment 2. Goal formulation 3. Plan for implementation 4. Adult education philosophy 5. Implementation 6. Evaluation D. Personal reflection and self-evaluation 1. Case presentation # 1 2. ethical issues concerning SA 3. stereotypical assessment of SA References: American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists.
McDonough, J.P. (1990). Personality, addiction, and anesthesia. Journal of the American Association of Nurse Anesthetists. 58(3), 193-200. National Institute on Drug Abuse. (1990). National household survey on drug abuse: Highlights 1988. (NIDA publication no. ADM 90-1681). Rockville, MD: U.S. Department of Health and Human Services. Pinto, R.P., Abrams,D.B., Monti, P.M. & Jacobus, S.I. (1987). Nicotine dependence and likelihood of quitting smoking. Addictive Behaviors. 12(4), 371-374. Ray, O. & Ksir, C. (1990). Drugs, society, and human behavior. St. Louis, MO: Times Mirror/Mosby College Publishing. Sanchez,-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem drinking. American Journal of Public Health. 75(2), 178-180. Scott, C. & Hawk, J. (1986). Heal thyself: The health of health care professionals. New York: Brunner/Mazel. Seigel, R.K. (1982). Cocaine and sexual dysfunction: The course of mama coca. Journal of Psychoactive Drugs. 14(1-2), 17-74. Summerfield, L.M. (1991). Drug and alcohol prevention education. ERIC Digest (Office of Educational Research and Improvement. RI 88062015). Washington, DC: Department of Education U.S. Department of Health and Human Services. (1990). Seventh special report to the U.S. Congress on alcohol and health: From the Secretary of Health and Human Services. (USDHHS Publication No. ADM 90-1656). Rockville, MD: National Institute on Alcohol Abuse and Alcoholism. Wechsler, H. & Rohman, M.E. (1981). Patterns of drug use among New England college students. American Journal of Drug and Alcohol Abuse. 8(1), 27-37. Williams, G.D., Gant, B.F., Stinson, F.S., Zobeck, T.S., Aitken, S. S. & Noble, J. (1988). Trends in alcohol-related morbidity and mortality. Public Health Reports. 103(61), 592-597. Wilsnack, S.C. (1987). Drinking and drinking problems in women: A U.S. longitudinal survey and some implications for prevention. In: T. Loberg, W.R. Miller, P.E. Nathan, & G.A. Marlatt. Addictive Behavior: Prevention and Early Intervention. Amsterdam, Netherlands: Swets and Seitlinger. Substance Abuse Case Presentation #1Module 1 Didactic Unit 2F Reference Sheet 1.1 Jay Johnson, is a 23 year old graduate of a leading school of nurse anesthesia and presents with complaints of stress and requests something to help him relax. He is an anesthesia practitioner working full-time and studying for an advanced degree in the evenings. He has little time for socialization and is currently divorced and has one child. His parents are divorced and his father has had a chronic drinking problem. Jay has also recently been named in litigation. He has two brothers, one which has had frequent history of DWI and a second which used illicit drugs while in the service. Jay does not drink or use street drugs. He clearly states his position as an anti-drinker and anti-drugs. He attends Al-Anon meetings every couple of months. Risk Factors to consider for this Young Adult:
Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2G: Introduction to the legal, ethical and moral issues of SATotal Time: 2-3 hours Overview: This unit will discuss the legal, ethical and moral issues of SA. This will include discussion of the impaired professional. Terminal Objective: The student will understand the various ethical, legal, and moral issues related to substance abuse. Recommended Teaching Methods: Group Process Lecture Discussion Readings Role Playing Field trips to agencies for observation and/or limited interaction Course Outline: XIX. Legal issues related to SA A. Roles of State Boards of Nursing B. Disciplinary actions C. Diversion of controlled substances D. Professional/administrative responsibilities E. Knowledge of Drug enforcement agencies F. Screening for recovering abuser G. Criminal and civil liabilities H. Patient confidentiality XX. Ethical issues related to SA A. AANA code of ethics B. AANA Peer Assistance statement C. Professional codes D. Ethical considerations for reporting E. Ethical considerations for intervention F. Impaired professionals G. Other issues related to SA XXI. Moral issues related to SA A. Impaired professionals 1. Prevalence of SA 2. Attitude of professionals 3. Availability of substances for abuse 4. Behaviors of impaired professionals, employers, co-workers, and family which encourage SA. 5. Recovery of impaired professionals 6. Returning impaired professionals to work XXII. Peer Assistance A. SA Education B. Intervention for SA of colleague C. Intervention organizations and treatment D. Aftercare and employment 1. Department policies and procedures 2. Motivation of abusers to seek treatment 3. Support groups 4. Peer assistance E. Changing attitudes toward impaired professionals References: American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists. American Nurses' Association. (1988). Standards of addictive nursing practice with selected diagnoses and criteria. Kansas City, MO: American Nurses' Association. Bissell, L. & Haberman, P. (1984). Alcoholism in the professionals. New York: Oxford University Press. Bissell, L. & Royce, J. (1987). Ethics for addiction professionals. Center City, MN: Hazelden Foundation Cannon, B.L. & Brown, J.S. (1988). Nurses' attitudes toward impaired colleagues. Image, Summary 20, 9-101. Caracci, K.O. (1992). The relationship between alcohol use and knowledge among nurses. Journal of Alcohol and Drug Education. 37(3), 66-73. Clarke, M. (1984). Stress and coping: Constructs for nursing. Journal of Advanced Nursing. 9, 3-13. Connell, C.C. & Murphy, J.F. (1987, Aug.). New dimensions of regulating the practice of professional nursing. Nursing Management, 18(8), 62-64 Dogoloff, L. & Angarola, R. (1985). Urine testing in the workplace. New York: American Council for Drug Education. Foster, S.D. & Jordan, L.M. (Eds.). (1994). Professional aspects of nurse anesthesia practice. Philadelphia: F.A. Davis Co. Gallagher, W. (1986, August). The looming menace of designer drugs. Discover. pp 24-35. Gerber, L.A. (1983). Married to their careers: Career and family dilemmas in doctor's lives. New York: Tavistock Publications. Haack, M.R. & Harford, T.C. (1984). Drinking patterns among student nurses. International Journal of Addictions. 19(5), 577-583. Hutchinson, S. (1988). Self-care and job stress. Image. 19, 192-196. Hutchinson, S.A. (1987, Nov./Dec.). Toward self-integration: The recovery process of chemically dependent nurses. Nursing Research. 36(6), 339-343. Kilty, K. (1975). Attitudes toward alcohol and alcoholism among professionals and non-professionals. Journal of Studies on Alcohol. 35(3), 327-347. Leiker, T. (1989). The role of the addictions nurse specialist in a general hospital setting. Nursing Clinics of North America. 24(1), 137-149. Lexy, S. (1983). Managing the drugs in your life: A personal guide to the responsible use of drugs, alcohol, medicine. New York: McGraw-Hill. McDonough, J.P. (1990). Personality, addiction, and anesthesia. Journal of the American Association of Nurse Anesthetists. 58(3), 193-200. Moore, G. & Hogan, R.L. (1987). Substance abuse and the nurse: A legal and ethical dilemma. Journal of Professionals Nursing. 3(1), 5. Naegle, M. (1985, Apr./May). Impaired nursing practice: Ethical and legal issues. Imprint. 32(2), 48-56. National Institute on Drug Abuse. (1990). National household survey on drug abuse: Highlights 1988. (NIDA publication no. ADM 90-1681). Rockville, MD: U.S. Department of Health and Human Services. Ray, O. & Ksir, C. (1990). Drugs, society, and human behavior. St. Louis, MO: Times Mirror/Mosby College Publishing. Sanchez,-Craig, M. (1985). Patterns of alcohol use associated with self-identified problem drinking. American Journal of Public Health. 75(2), 178-180. Scott, C. & Hawk, J. (1986). Heal thyself: The health of health care professionals. New York: Brunner/Mazel. Swenson, I., Havens, B. & Chamagne, M. (1989). State boards and impaired nurses. Nursing Outlook. 37(2), 94-96. Twerski, A.J. (1982). It happens to doctors, too. Center City, MN: Hazelden Co. Wechsler, H. & Rohman, M.E. (1981). Patterns of drug use among New England college students. American Journal of Drug and Alcohol Abuse. 8(1), 27-37. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2H: Basic assessment and diagnostic skills in the SA patientTotal Time: 2-3 hours Overview: This unit will discuss the skills related to clinical assessment and diagnosis of the SA patient. Terminal Objective: The student will understand the various basic techniques required to obtain a history and physical from substance abuse patients. These basic interviewing skills will enable the student to obtain the groundwork for planning, treatment or referral of the SA patient. Recommended Teaching Methods: Group Process Lecture Discussion Readings Role Playing Field trips to agencies for observation and/or limited interactions Case examples Course Outline: XXIII. Defining addiction A. Dependence 1. Psychological 2. Physiological feelings B. Addiction 1. Manifestations a. Physiological changes b. Tolerance c. Cross tolerance d. Multiple or dual diagnosis 2. Behavioral effects a. Gambling b. Sexual disorders c. Physical problems d. Emotional e. Professional f. Social g. Family C. The disease concept of addiction 1. Impairment a. Early
b. Middle c. Late
2. Denial of addiction a. Family support for denial b. Social support for denial c. Professional support for denial D. Diagnosis of addiction 1. Acute medical sequela a. Physical findings 2. Chronic medical sequela a. Physical findings 3. Engaging patient a. Patient who accepts disease b. Patient who denies disease 4. Establishing a supportive relationship a. Using interviewing skills b. Showing respect and empathy for patients 5. Understanding the impact of SA 6. Things to avoid during an interview a. Comparisons b. Value-laden terms c. Scare tactics d. Arguments e. Hostility f. Enabling References: Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co.
Skinner, H.A., Holt, S., Schuller, R., Roy, J., & Israel, Y. (1984). Identification of alcohol abuse using laboratory tests and a history of trauma. Annals of Internal Medicine. 101, 847-851. Stillman, P.L., Burpeace-DiGregorio, M.Y., Nicholson, G.I., Sabers, D.L., & Stillman, A.E. (1983). Six years of experience using patient instructors to teach interviewing. Journal of Medical Education. 58, 941. Tarter, R. & Hegedus, A. (1991). The drug use screening inventory. Alcohol Health and Research World. 15(1), 65-75. Werner, A. & Schneider, J.M. (1974). Teaching medical students interactional skills: A research based course in the doctor-patient relationship. New England Journal of Medicine. 290, 1232. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2I: Multisystem physiology in SA - Level ITotal Time: 2 hours Overview: This unit will discuss the physiology related to the early stages of substance abuse. The systems will be introduced in an extensive manner as a supplement to the assessment and diagnostic skills segment. Terminal Objective: The student will understand the physiologic basis of the early stages of substance abuse. This enhanced knowledge will provide a foundation for supporting the assessment and diagnostic skills of the student. Recommended Teaching Methods: Group Process Lecture Discussion Readings Pathology Case examples Course Outline: XXIV. A. Cardiovascular 1. Cardiac response to selected drugs 2. Hematologic changes 3. Vascular changes B. Digestive system 1. Esophagus 2. Stomach 3. Small bowel 4. Large bowel C. Endocrine 1. Pancreas 2. Liver
3. Spleen 4. Immunologic D. Pulmonary E. Neuromuscular References: Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co. Anspaugh, D.J., Hamrick, M.H. & Rosato, F.D. (1991). Wellness: Concepts and applications. St. Louis, MO: Mosby-Year Book. Burton, A.C. (1972). A physiology and biophysics of the circulation. Chicago: Year Book Medical Pub. Clark, W.G. et al. (1988). Goth's medical pharmacology. St. Louis, MO: C.V. Mosby Co. Cohen, S. & Callahan, J. (Eds.). (1986). A specific approach to the treatment of alcohol abusing patients. New York: Hayworth Press. Frances, R.J. & Miller, S.L. (Eds.). (1991). Clinical textbook of addictive disorders. New York: Guilford Press. Ganong, W.F. (1989). Review of medical physiology. Los Altos: Lange Medical Publications. Goodman, L.S. & Gilman, A. (1975). The pharmacologic basis of therapeutics. New York: Macmillan Publishing Co. Goudsouzian, N.G. Karamanian, A. (1984). Physiology for the anesthesiologist. New York: Appleton-Century-Crofts. GuytoPhiladelphia: W.B. Saunders Co. Kinney, J. & Leaton, G. (1991). Loosening the grip: A handbook of alcohol information. St. Louis, MO: Mosby-Year Book. Michenfelder, J.D et al. (1969). Neuroanesthesia. Anesthesiology. 30, 65. National Institute on Drug Abuse. (1990). NIDA Capsules: CAP01-CAP38. Rockville, MD: National Clearinghouse for Alcohol and Drug Information. Project Cork Institute of Dartmouth Medical School. (1981). Alcohol use and its medical consequences: A comprehensive slide teaching program for biomedical education. Timonium, MD: Milner-Fenwick. Rogers, M.C., Tinker, J.H., Covino, B.G., & Longnecker, D.E. (Eds.). (1993). Principles and practice of anesthesiology. St. Louis, MO: Mosby Year Book. Stoelting, R.K. (1987). Pharmacology and physiology in anesthetic practice. Philadelphia: J.B. Lippincott Co. Substance Abuse Curriculum: MODULE 1 DIDACTIC UNIT 2J: Attitudes and Self-assessment concerning SATotal Time: 1 hour Overview: Students should be sensitive to the influence CRNAs attitudes have on recognition, patient relationships, and diagnosis of SA. They should recognize SA as a disease process and their professional role in providing prevention. Terminal Objective: The student will understand their professional responsibility concerning SA. They will provide a nonjudgmental and nonmoralistic approach to SA. Establish appropriate optimism about their prognosis. Can accept substance abusers as appropriate to provide medical attention. Recommended Teaching Methods: Group Process Lecture Discussion Readings Case examples Course Outline: XXV. Contemporary Issues of drug use A. History of substance use, misuse, and abuse. B. Legal addictive substances 1. Alcohol 2. Caffeine 3. Nicotine C. Societal patterns of drug use D. Drug use among special populations E. Aging and substance use F. Life use patterns XXVI. Reasons for Using drugs A. Peer pressure B. "Euphoric Seeking" or "Pain Relief" C. Choices concerning use XXVII. Attitudes concerning the topic of SA A. Biased and non-biased attitudes B. The disease model of SA C. Influence of attitudes on patient relationships D. Influence of attitudes on patient care E. Attitude development 1. Personal 2. Family 3. Society 4. Cultural F. Stereotypes XXVIII. Impaired professionals A. Patterns for CRNAs B. Factors which determine impairment C. Legal implications D. Willingness to learn about substance abuse XXIX. Employing methods for inducing positive attitudes and recognizing negative attitudes. A. Evaluation of personal attitudes, values, morals and beliefs B. Learning about the SA disease model C. Recognize and practice prevention D. Understand that your professional role places you in a powerful position for producing change References: American Association of Nurse Anesthetist. (1992). Peer Assistance Manual. Chicago, IL: American Association of Nurse Anesthetists. American Nurses' Association. (1988). Standards of addictive nursing practice with selected diagnoses and criteria. Kansas City, MO: American Nurses' Association. American Psychiatric Association. (1997). Diagnostic and statistical manual (DSM-IV). Washington, DC: APA, American Psychiatric Association. American Psychiatric Association. (1975). A psychiatric glossary. Washington, DC: American Psychiatric Association. Barber, J.G. & Grichting, W.L. (1987). Assessment of drug attitudes among university students using the short form of drug attitudes scale. International Journal of Addictions. 22(10), 1033-1039. Baum, C.D., Kennedy, M. & Jones, J. (1984). Drug use in the United States. Journal of the American Medical Association. 251(10), 1293-1297. Bluhm, J. (1987). When you face the chemically dependent patient: A practical guide for nurses. St. Louis, MO: Ishiyaku EuroAmerica, Inc. Bureau of National Affairs. (1986). Alcohol and drugs in the workplace: Costs, controls, and controversies. Washington, DC: Bureau of National Affairs. Cafiso, J., Goodstadt, M.S., Garington, W.K., et al. (1982). Television portrayal of alcohol and other beverages. Journal on Studies on Alcohol. 43, 964-989. Califano, J.A. (1979, Feb. 19). How alcohol damages America. Life and health. Chappel, J., Veach, T.L. & Krug, R. (1985). The substance abuse attitude survey: An instrument for measuring attitudes. Journal of Studies on Alcohol. 46(1), 48-52. Cohen, S. (1982). Cannabis and sex: Multifaceted paradoxes. Journal of Psychoactive Drugs. 14(2), 55-58. Cook, J. & Fontaine, K. (1991). Essentials of mental health nursing. Menlo Park, CA: Addison-Wesley. Cornish, R.D. & Miller, M.V. (1976). Attitudes of registered nurses toward the alcoholic. Journal of Psychiatric Nursing and Mental Health Services. 14(2), 19-22 Foster, S.D. & Jordan, L.M. (Eds.). (1994). Professional aspects of nurse anesthesia practice. Philadelphia: F.A. Davis Co. Hanna, E. (1978). Attitudes toward problem drinkers. Journal of Studies on Alcohol. 1, 98-109. Hatterer, L. (1979). The pleasure addicts: The addictive process, food, sex, drugs, alcohol, work and more. South Brunswick, NJ: Barnes, Co. Hingson, R.W. (1983). Impact on legislation raising the legal drinking age in Massachusetts from 18-20. American Journal of Public Health. 73, 163-170. Lyttle, T. (1988). Drug based religions and contemporary drug taking. Journal of Drug Issues. 18(2), 271-284. Jack, L. (Ed.). (1990). The core curriculum of addictions nursing. Skokie, IL: Midwest Education Association, Inc. Jellinek, E.M. (1952). Phases of alcohol addiction. Quarterly Journal for the Study of Alcoholism. 13, 673-684. Jones, C. & Battjes, R. (Eds.). (1985). Etiology of drug abuse: Implications for prevention. (DHHS Publication No. ADM 87-1335). Washington, DC: U.S. Government Printing Office. Kamerow, D.B., Pincus, H.A. & Macdonald, D.I. (1986). Alcohol abuse, other drug abuse, and mental disorders in medical practice. Prevalence, costs, recognition, and treatment. Journal of the American Medical Association. 255(15), 2054-2057. Keltner, N., Schwecke, L., & Bostrom, C. (1991). Psychiatric nursing: A psychotherapeutic management approach. St. Louis, MO: Mosby-Year Book. McAndrew, M. (1990). People who depend upon substances other than alcohol. In: E. Varicarolis. Foundations of psychiatric mental health nursing. Philadelphia: W.B. Saunders Co. pp. 632-676. Nurco, D.N., Shaffer, J.W., Hanlon, T.E., Kinlock, T.W. Duszynski, K.R. & Stephenson, P. (1987). attitudes toward narcotic addiction. The Journal of Nervous and Mental Disease. 175(11), 653-660. Peele, S. (1982). Love, sex, drugs and other magical solutions to life. Journal of Psychoactive Drugs. 14(1-2), 125-131. Richman, J. (1988). Sociological perspectives on illegal drug use: Definitional, reactional and etiologic insights. Behavioral Sciences of the Law. 3(3), 249-258. Sadler, D. (1984, June/July). Physicians' attitudes on alcohol abuse are changing. American Medical News. Stabenau, J. (1990). Addictive independent factors that predict risk for alcoholism. Journal of Studies on Alcohol. 51(2), 164-174. Stephens, R. (1985). The sociocultural view of heroin use: Toward a role-theoretical model. Journal of Drug Issues. 15(4), 433-446. Swanson, A. & Hurley, P. (1983). Family systems: Values and value conflicts. Journal of Psychosocial Nursing and Mental Health Services. 21(7), 25-30. Szasz, T. (1974). Ceremonial Chemistry. New York: Doubleday. Turner, T.B. Bennett, V.L. & Hernandez, H. (1981). Beneficial side of moderate alcohol use. Johns Hopkins Medical Journal. 148(2), 53-63. Vaillant, G. (1970). The natural history of narcotic drug addiction. Seminars in Psychiatry. 2, 486-498. Voss, H. & Clayton, R. (1987). Stages in involvement with drugs. Pediatrician. 14, 25-31. Wechlser, H. McFadden, M., & Bohman, M. (1980). Drinking and drug use among college students in New England. Journal of the American College Health Association. 18, 275-279. Werch, C.E. & Gorman, D.R. (1987). Relationship between self-control consumption patterns and problems of college students. Journal of Studies on Alcohol. 49(1), 30-36. Substance Abuse Curriculum: MODULE 1 CLINICAL UNITS A-G: Introduction to clinical assessment and diagnostics of SATotal Time: 15 hours Overview: The clinical units will provide the student with the experience to apply scientific knowledge in caring for the SA patient. There will also be an extensive opportunity for analyzing and challenging personal attitudes concerning SA. Additionally, there will be an opportunity to engage in multidisciplinary collaboration for SA. Terminal Objective: a) The student will be able to conduct a basic screening, history, and physical for the SA patient. b) Discuss the diagnosis of SA. c) Recommend support groups for a basic prevention and intervention process. d) Examine personal values, beliefs, and attitudes concerning SA. e) Begin the development of a SA research project. Recommended Teaching Methods: Group Process Lecture Discussion Readings Videos
Role Playing Case presentations Instructional Activity Sequence: First hour is dedicated to conference time conducted by a clinical faculty member. Second hour includes an introduction to the methods for history and physical using a variety of instruments (e.g. CAGE). Third hour is for taking the Short MAST or other SA self-examination and for demonstrating techniques used for obtaining a history and physical (consider role playing with variety of patients). Fourth hour through the ninth hour provides contact with patients in the clinical setting for structured learning experiences. Tenth hour provides an opportunity for students to discuss and research ideas for the SA research project. Eleventh hour through the fifteenth hour provides the student an opportunity to share time with a clinical counselor. Course Outline: XXX. Introduction to clinical assessment and diagnostics of SA A. Self-examination and challenging personal prejudices, beliefs, and attitudes on SA B. Performing basic clinical assessment and diagnostic procedures C. Learning the relationship between SA and anesthesia D. Familiarization with patient and family dynamics 1. Observation and participation in prevention and treatment programs 2. Learn the role of support groups in treating substance abuse E. Listing the predisposing risks and progressive stages of SA 1. Physical responses 2. Psychosocial responses 3. Physiological responses 4. Cognitive changes F. Exploration of the etiology and progression of SA G. Ideas for SA research project
Arif, A., & Westermeyer, J. (Eds.) (1988). Manual of drug and alcohol abuse. New York: Plenum Medical Books Co. Block, M.R. & Coulehan, J.L. (1987, Jan.). Teaching the difficult interview in a required course on medical interviewing. Journal of Medical Education. 62(1), 35-40. Bluhm, J. (1987). When you face the chemically dependent patient: A practical guide for nurses. St. Louis, MO: Ishiyaku EuroAmerica, Inc. Cavanaugh, R.M. (1986, Mar.). Obtaining a personal and confidential history from adolescents. An opportunity for prevention. Journal of Adolescent Health Care. 7(2), 118-122. Clark, W.D. (1985, Nov.). The medical interview: Focus on alcohol problems. Hospital Practice. pp. 59-68. Clark, W.D. (1981). Alcoholism: Blocks to diagnosis and treatment. American Journal of Medicine. 71, 275-286. Cox, A. (1981). Training guidelines and workbook for the behavioral management of intoxicated and disruptive clients. Toronto, Canada: Addiction Research Foundation. Craig, R.J. (1988). Diagnostic interviewing with drug-abusers. Professional Psychological Research Practice. 19(1), 14-20. Ewing, J.A. (1984). Detecting alcoholism: The CAGE Questionnaire. Journal of the American Medical Association. 252, 1905-1907. Holt, S. Skinner, H.A. & Israel, Y. Early identification of alcohol abuse: Clinical and laboratory indications. Canadian Medical Association Journal. 124, 1279-1299. Johnston, L.D., O'Malley, P.M. & Bachman, J.G. (1987). National trends in drug use and related factors among American high school students and young adults, 1975-1986. (DHHS Publication No. ADM 87-1535). Washington, DC: U.S. Government Printing Office. Keltner, N., Schwecke, L., & Bostrom, C. (1991). Psychiatric Nursing: A psychotherapeutic management approach. St. Louis, MO: Mosby-Year Book. Lipkin, M., Quill, T.E. & Napodano, R. (1984). The medical interview: A core curriculum for residencies in internal medicine. Annals of Internal Medicine. 100, 277. Milhorn, H.T. (1988). The diagnosis of alcoholism. American Family Physician. 37, 175-183. Mumford, E., Anderson, R. Cuerden, T. & Scully, J. (1984). Performance-based evaluation of medical student' interviewing skills. Journal of Medical Education. 59, 133. National Council on Alcoholism. (1972). Criteria for the diagnosis of alcoholism. Annals of Internal Medicine. 77, 249-258. Skinner, H.A., Holt, S., Schuller, R., Roy, J., & Israel, Y. (1984). Identification of alcohol abuse using laboratory tests and a history of trauma. Annals of Internal Medicine. 101, 847-851. Stillman, P.L., Burpeace-DiGregorio, M.Y., Nicholson, G.I., Sabers, D.L., & Stillman, A.E. (1983). Six years of experience using patient instructors to teach interviewing. Journal of Medical Education. 58, 941. Tarter, R. & Hegedus, A. (1991). The drug use screening inventory. Alcohol Health and Research World. 15(1), 65-75. Tiebout, H.M. (1953). Problems of addiction and habituation. New York: Grune and Stratton. Werner, A. & Schneider, J.M. (1974). Teaching medical students interactional skills: A research based course in the doctor-patient relationship. New England Journal of Medicine. 290, 1232. Formative Evaluation of Module 1Substance Abuse Curriculum Reference Sheet 1.3 Using the following scale please rate your accomplishments of the objectives in Module 1 including the didactic and clinical components of the substance abuse curriculum. 1-------2-------3-------4-------5 Low Moderate High Accomplishment
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