Overview of the university-based addiction studies programs in the United States

Background: The field of addiction studies (AS) has grown in the last several decades. However, little is known about the structure and conditions of current academic programs. Only two studies have examined AS programs in the U.S., and both were conducted almost 15 years ago. The current study was designed to identify AS programs existing in the U.S. universities.

Methods: We conducted an Internet search to identify university-based programs according to defined key words. The university program websites were then subjected to content analysis.

Results: A total of 333 U.S. universities were identified that offered 392 different academic programs in AS of which 302 were degree programs. Out of these, 161 (53%) programs were offered at the associate degree level, 48 (15,9%) at the bachelor’s level, 55 (18.2%) at the master’s level, and 5 (1.6%) at the doctorate level. The largest number of programs was in California. Two states in the U.S. had no identifiable programs. Only one university located in the state of New York offered comprehensive academic programs across the educational spectrum. Many of the academic programs offered certificates. The most common phrases used in program titles were “substance abuse”, “addiction studies/counseling”, and “chemical dependency”.

Conclusions: There is a wide range of academic AS programs in the U.S., although their focus is mostly on clinical training rather than on research or drug policy. Future surveys such as this one would benefit from greater attention to issues related to certification, licensing, and academic curricula.     

Emergency Medicine/Critical Care Medicine (EM/CCM) Trainees’ Performance on Standardized Critical Care Medicine Examinations: A Ten-Year Review

BackgroundEmergency Medicine/Critical Care Medicine (EM/CCM) trainees may obtain board certification through Internal Medicine (American Board of Internal Medicine [ABIM]), Surgery (American Board of Surgery [ABS]), and Anesthesiology (American Board of Anesthesiology [ABA]). However, EM/CCM trainees experience challenges, including: 1) additional training requirements and 2) an unwillingness to accept EM graduates by many programs.ObjectivesWe sought to: 1) compare EM/CCM knowledge acquisition to medicine (Internal Medicine [IM]/CCM), surgery (surgical critical care [SCC]), and anesthesiology (anesthesiology critical care medicine [ACCM]) Fellows at the local and national level using the Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP) in-service examination as an objective measure; and 2) compare American Board of Medical Specialties (ABMS) pass rates for EM/CCM.MethodsSingle-center retrospective analysis comparing scores obtained by EM/CCM on the MCCKAP examination with SCC and ACCM over a 10-year period. Scores are presented as means with standard deviations. We performed similar analysis on ABMS examination pass rates.ResultsThere were 117 MCCKAP scores (37 EM/CCM; 80 SCC and ACCM) evaluated. EM/CCM mean score 562.4 (SD 67.4); SCC and ACCM mean score 505.3, (SD 87.5) at the institutional level (p < 0.001). Similarly, EM/CCM scored higher than the national mean (562.4, SD 67.4 vs. 500 SD 100, p < 0.001). Nationally, ABIM-CCM board certification rate was 91.2% for 137 EM/CCM, compared with 93.2% for IM/CCM (p = 0.22); 28 EM/CCM have obtained ABA-CCM board certification with rates similar to ACCM (90.4 vs. 89.3%; p = 0.85).ConclusionsEM/CCM Fellows demonstrate successful knowledge acquisition both locally and at a national level. EM/CCM achieve ABMS pass rates similar to other CCM trainees. The current arbitrary additional training requirements placed on EM/CCM should be removed.     

从武汉抗疫看中医药文化认同与新的医学模式

从武汉抗疫中医药的投入使用情况,反思现代临床和国人所呈现出的中医药文化认同和就医习惯,探索其历史文化根源及社会因素与医学发展的内在关联。回顾历史,中医屡次临危受命,不负重托,如今大疫当前,中医药再次发挥了重要作用。故新时代探讨如何遵循中医药发展规律,传承精华、守正创新,坚持中医药原创优势,形成中医药学科优势整体化呈现的新模式医学,对提升全社会的中医药认知度具有重要意义。     

Disrupting the System: An Innovative Model of Comprehensive Care

Despite health care reform, our nation continues to struggle containing health care costs while meeting the needs of persons with behavioral health disorders and comorbid chronic care conditions. The purpose of this article is to propose that dually certified primary care and psychiatric mental health nurse practitioners may be the disruptive innovation that becomes the solution for improving the coordination and care for high-need patients while containing costs. The concepts of disruptive innovation, integrated care, and whole person care are discussed followed by an introduction to the innovative primary care and psychiatric mental health nurse practitioner’s role and its potential for health care system disruption. Finally, a call to nursing is proffered to seize current opportunities to meet the Triple Aim challenge by providing whole person care that is high-quality, cost-effective, and satisfactory to patients because it is truly patient centered and meets their needs.     

L’adolescent aux diagnostics multiples ou le trouble dissociatif de l’identité à l’adolescence

ObjectiveTo evoke the notion of dissociative identity disorder in adolescence requires a nuance so many questions arise among others on the relevance of the juxtaposition of a complex disorder fluctuating at an age group marked by transition. In other words, is it appropriate to speak of dissociation of identity or multiple personality at this specific time of existence? It should also be noted that this diagnosis is controversial both because there is no consensus on definitions such as personality or identity and because some cultures take into account the possibility of possession to explain these tables without reference to pathology.MethodsTo illustrate our point, we will draw on the situation of a young person admitted to our institutional therapy centre located in a general hospital. The structure accommodates young people aged between fourteen and twenty for six to nine months. As we have also developed, these are usually directed in the course of ambulatory and/or residential therapeutic follow-ups, after experiencing moments of crisis or decompensation. The evaluation then carried out consolidates the prospect of a medium-term stay in a psychotherapeutic centre before considering a possible reintegration into daily life and activities. This clinical case illustrating the path of a teenager in prey to the tumults of wobbling of his identity causing confusion and uncertainty in the chief of the professionals encountered. The difficult situation experienced by this young person and his family questions on the one hand the relevance, the very basis of the diagnosis at this time of existence and on the other the notion of dissociative identity disorder in adolescence.ResultsThe dissociative identity disorder meets a number of criteria, the first of which is identity disturbance characterized by several distinct personality states. Clinically, we first observe a discontinuity in the integration of consciousness, of self-meaning. Registers of affects and sensory-motor functioning (perception, representation of the body) are also concerned. There are then disturbances of the agentivity (motor control, behaviors). In some cases, non-epileptogenic seizures and other conversive manifestations may be at the forefront of these complex clinical tables. The dissociative disorder of identity is also noticed by memory failures (dissociative amnesia) concerning the recall of daily events, personal information, which do not correspond to ordinary forgetfulness. This then leads to signs of impairment of social, professional or other relational functioning. Being an interruption in the tranquility of growth, adolescence is characterized by extreme conflicting positions, changing, fluctuating that give this period of life its appearance of tumult and crisis without being able to speak of frank psychic disturbances. Differential diagnosis between teen upheaval and true pathology is a difficult task.ConclusionsConsequently, we think it is important to pay attention to the diachronic and synchronic litters of what the young person in question is deploying. In order to do so, we advocate repeated clinical interviews with the patient and his or her entourage beside rigorous anamnesis. Time is an important element, the time of observation and encounter. Let us avoid precipitation without adopting an attitude of fatalism or even laxity, recalling that, for Winnicott, there is only one remedy for adolescence and only one; it is the passing time and gradual maturation processes that ultimately lead to the appearance of the adult person. Accompany a dissociative identity disorder, proven or suspected, includes the mobilization of a partnership envelope involving experienced institutional structures ready for the necessary clinical flexibility allowing continuous therapeutic adjustment.     

Transidentités et réassignation de sexe : le rôle des psychologues au sein d’une équipe pluridisciplinaire spécialisée

This interview is the continuation and supplement of the article “Transidentity and sex change: The sociologist's point of view, the psychiatrist's role”. Psychologists Sandrine Coussinoux, Eirini Rari and psychiatrist Thierry Gallarda discuss the issue of sex reassignment for transidentitarian people as well as the role of psychologists who work on this subject in the Parisian multidisciplinary team specialized in “Gender dysphoria and mental health”.     

Professional Steps: The Certification Path

Obtaining certification is a critical step on the road to professionalism. There are many questions to consider in this decision. Included among these are cost, preparation, and return on the investment. Important answers to these questions are discussed.