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Stonington Institute North Stonington, Conn

I applaud Dr Prozialeck on the development of his comprehensive program surrounding the neurobiology, pharmacology, identification, and treatment of substance use disorders. I also appreciate his positive remarks concerning our article ("Medical education in substance abuse: from student to practicing osteopathic physician." J Am Osteopathic Assoc. 2005;105[6 suppl 3]:S18–S25). My concern is that a program such as his should remain elective.

There is increasing evidence that current treatment modalities for a variety of medical illnesses are now at a level where improvement in treatment is resulting in limited yield. Although I fully support further research in improving medical treatment, there is strong reason to now look to prevention as the area that will most significantly impact the future health of our patients—and colleagues, as Dr Prozialeck notes. All osteopathic physicians can make a valuable impact in this area by being competent in the screening and brief intervention of substance use problems.

Substance use disorders contribute significantly to a wide variety of medical problems in the United States and around the world. For this reason alone, the screening and brief intervention of substance use disorders should be a mandatory part of the core competencies of all graduating osteopathic medical students. Graduating students should also be aware of recent significant advances in the medical treatment of patients with these illnesses. To this end, an effort is currently under way in the osteopathic medical profession, led by the American Osteopathic Academy of Addiction Medicine (AOAAM) and encouraged by various federal organizations, to ensure that the following areas are well covered in our medical schools:

• screening, prevention, and brief intervention;
  
• evaluation and management of substance use disorders;
  
• management of co-occurring disorders;
  
• legal and ethical issues surrounding the treatment of patients with a substance use disorder;
  
• proper prescribing of drugs with abuse potential; and
  
• issues surrounding impaired health professionals.
  

I strongly support Dr Prozialeck's call for others in osteopathic medical education—either currently teaching addiction medicine or seeing the importance of enhancing their programs—to speak up and share their curricula and insights. This action could have a tremendous impact on the care delivered by our graduating students. I believe greater competence and confidence in the understanding of addictive illnesses will result in a more fulfilling career for our students no matter what specialty area of medicine they pursue.

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