The trouble with training: substance misuse education in British medical schools revisited. What are the issues?

My 1987 survey of substance misuse education in British medical schools hig hlighted inadequacies in the quality of undergraduate substance misuse trai ning. The continuing difficulty in engaging generalists in the care of subs tance misusers suggested it was time to revisit the issue. Deans, Heads of Departments of Psychiatry and 13 other specialities in 23 medical schools w ere surveyed. The response rate fr om Deans and Heads of Psychiatry was 70% . Psychiatry provided a mean of 6.7 (range 2-14) hours formal training (lec tures/seminars), excluding one model department which provided 30 hours and co-ordinated an additional 30 hours of undergraduate substance misuse educ ation. In 10 (45.5%) schools training is very limited, while 10 (45.5%) sch ools provide average (three) or above average (seven) training hours. Avera ge or above average undergraduate training was found in schools with an aca demic department of addiction behaviour. These centres were associated with the most comprehensive services and the most postgraduate substance misuse training opportunities. These findings may partially explain why most doct ors are ill-equipped to deal with substance problems. Since 1987, psychiatr y has doubled input, but this is offset by diminished input from other depa rtments. The establishment of academic departments of addiction studies in medical schools would influence decision making within university and servi ces, promote scientific credibility and benefit communities.