Association for Medical Education and Research in Substance Abuse
Jeffrey H. Samet
Professor of Medicine and Public Health
Boston University Schools of Medicine and Public Health
Chief, Section of General Internal Medicine
91 E. Concord Street
Tel: (617) 414 7288
The Association for Medical Education and Research in Substance Abuse (AMERSA) is a multi-disciplinary organization committed to health professional faculty development in substance abuse. In 1976, members of the Career Teachers Training Program in Alcohol and Drug Abuse, a US federally funded multi-disciplinary faculty development program, formed AMERSA. The organization grew from 59 founding members, who were primarily medical school faculty, to over 300 health professionals from a spectrum of disciplines including physicians, nurses, social workers, dentists, allied health professionals, psychologists and other clinical educators who are responsible for advancing substance abuse education. AMERSA members promote substance abuse education among health professionals by developing curricula, promulgating relevant policy and training health professional faculty to become excellent teachers in this field. AMERSA influences public policy by offering standards for improving substance abuse education. The organization publishes a peer-reviewed, quarterly journal, Substance Abuse, which emphasizes research on the education and training of health professions and also includes original clinical and prevention research. Each year, the AMERSA National Conference brings together researchers and health professional educators to learn about scientific advances and exemplary teaching approaches. In the future, AMERSA will continue to pursue this mission of advancing and supporting health professional faculty who educate students and trainees to address substance abuse in patients and clients.
The Association for Medical Education and Research in Substance Abuse (AMERSA) is a multi-disciplinary organization committed to health professional faculty development in substance abuse (Table 1). It is the only multi-disciplinary national organization in the United States with this explicit educational mission. During its 29 years in existence, AMERSA has attracted health professionals including physicians, nurses, social workers, psychologists, public health practitioners, dentists, other allied health professionals and clinical educators from a broad spectrum of disciplines. Curriculum materials used in much of the addictions teaching for health professionals were developed by AMERSA members. Its members have been responsible for advancing an agenda in the United States focused on curriculum development in substance abuse health professional education [1–7].
Table 1. AMERSA's mission statement.
|AMERSA, founded in 1976, is a multi-disciplinary organization of health-care professionals dedicated to improving education in the care of individuals with substance abuse problems. AMERSA's mission is to:|
|• Provide leadership and improve training for all health-care professionals in the management of problems related to alcohol, tobacco and other drugs|
|• Disseminate state-of-the-art scientific information about substance abuse education and research, through means such as the National AMERSA conference and the organization's journal, Substance Abuse|
|• Provide mentoring for health professionals interested in becoming teachers, clinicians and researchers in the field|
|• Promote cultural competence and inclusiveness among health-care professionals in their work with individuals affected by alcohol, tobacco and other drug problems|
|• Promote collaboration among multiple professions including, but not limited to, medicine, nursing, social work, psychology, dentistry, pharmacology and public health|
|• Build a national network of substance abuse experts who can advise local, national and international organizations on health professional substance abuse education through representation at national forums|
FOUNDING OF AMERSA
Since its inception, AMERSA's goal has been to improve the substance abuse education of health professional trainees related to prevention, intervention and treatment of individuals and families. Advancing the knowledge and skills of faculty at academic professional schools has been seen as the most effective means. In 1976, members of the Career Teachers Training Program in Alcohol and Drug Abuse  formed AMERSA. The Career Teachers Program (1972–82), sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), was one of the first multi-disciplinary health professional faculty development programs. Over the course of this program's existence, 59 career teachers, faculty in medical and public health schools, were challenged by the problems they encountered in pursuit of their goal: implementing curriculum changes to enhance substance abuse education within their own professional schools. Within the structure of the Careers Teachers Program, they were able to develop common strategies and support each other as they encountered common barriers to achieving this goal. Barriers included resistance from curriculum committees, faculties and deans who did not support inclusion of substance abuse issues in the curriculum. Despite the resistance, these substance abuse educator pioneers recognized the benefits of the support network of this national faculty development program. When it became clear that the effective federally funded Career Teachers Program was coming to an end, the faculty recipients of this support decided to broaden the group beyond the career teachers and form a new national organization. Thus, AMERSA was established with Marc Galanter MD, leading the organization as the first president. The founding members also initiated the AMERSA journal, Substance Abuse, which has continued to be published and grow since its inception. Members of the organization and AMERSA staff continue to work closely with NIDA, NIAAA and other federal agencies to carry on and strengthen the mission of the organization. Originally housed at the Brown University Center for Alcohol and Addiction Studies, AMERSA's national headquarters are now independently located in Providence, Rhode Island .
IMPACT ON FACULTY DEVELOPMENT IN SUBSTANCE ABUSE
As stated on the organization's website:
AMERSA members from diverse departments at health professional schools have developed, implemented, and evaluated state-of-the-art curricula, educational programs, and faculty development programs. [Its] members have developed clinical and research measures for substance abuse services and professional education. They are actively engaged in research related to substance abuse education, clinical service, and prevention .
AMERSA has pursued the advancement of substance abuse education among health professionals by developing and promulgating appropriate policy and by supporting health professional faculty to become more knowledgeable and skillful about teaching in this field. AMERSA has been instrumental in setting educational standards for essential knowledge and skills required of primary care physicians and more recently a whole spectrum of health professions. The organization and its members have clearly articulated the rationale for inclusion of substance abuse health professional education [7,10].
In 1985, AMERSA sponsored a conference with the Betty Ford Center, NIAAA and NIDA to develop consensus on the knowledge, skills and desirable educational experiences necessary for primary care physicians in alcohol and drug abuse, the optimal roles and responsibilities of the involved organizations and the best strategies for implementation. The result of this landmark conference was a delineation of the subjects and necessary skills that should be taught, the role of medical schools and government, and the development of specialty-specific guidelines. This meeting was the forerunner of several subsequent US efforts in faculty development such as the US Health Services and Resources Administration (HRSA) Faculty Development Programs in alcohol and other drug abuse, targeting general internal medicine, family medicine and pediatrics , and several faculty development programs in the 1990s funded by the Center for Substance Abuse Prevention (CSAP), SAMHSA, targeting nursing, social work, medicine and public health. Most recently, US federal agencies supported AMERSA in the creation of the 2002 Strategic Plan for Interdisciplinary Faculty Development in substance abuse and the newest faculty development program, Project MAINSTREAM (MultiAgency INitiative for Substance abuse TRaining and Education for AMerica) . Members have worked closely with the Center for Substance Abuse Treatment (CSAT) and HRSA in Project MAINSTREAM for continuing development of multi-disciplinary addiction faculty. As part of Project MAINSTREAM, health professionals from a variety of disciplines attend the annual National AMERSA Conference. Because of its long-standing commitment to substance abuse training, AMERSA has been instrumental in establishing addiction training in medical, nursing and other health professional institutions nationally.
Thus, one of AMERSA's greatest contributions is the clear articulation of critical curriculum content including skills training. Through its consensus statements , AMERSA has advanced the concept that primary care clinical teams are in a critical position to detect and treat patients with substance abuse problems, yet they continue to struggle, due in part to lack of training. Therefore, a focus of the organization is to incorporate substance abuse clinical and research activities into mainstream clinical practice. AMERSA pursues its goal of setting educational standards by presenting a showcase of model programs at its annual national meeting and publishing educational research in its journal, Substance Abuse. Internationally, AMERSA was not alone in its early efforts to effect change in the education of medical professionals. Advances in training and curriculum design were taking place in many countries; prominent among these were Australia, England, Sweden and Canada [13–15].
IMPACT ON SUBSTANCE ABUSE EDUCATION POLICY
AMERSA affects public policy by offering standards that inform the federal government and others on how to improve substance abuse health professional education. AMERSA led the development of standards for a spectrum of generalist health professionals with multi-agency federal support. Its members developed a strategic plan for the nation, released at the National Press Club in 2002, addressing substance abuse health professional education . The strategic plan includes recommendations to the US Department of Health and Human Services and other federal agencies as well as recommendations to legislators. The Strategic Plan highlights the need for faculty development and the impact that routine substance abuse screening and intervention by generalist health professionals can have in linking patients and family members to services to facilitate treatment and recovery. The Strategic Plan identifies additional methods for building a national infrastructure for faculty development in substance abuse. Most recently, AMERSA was invited by the White House Office of National Drug Control Policy (ONDCP) to participate with national experts in the 2004 Leadership Conference on Medical Education in Substance Abuse. An ONDCP report is expected in 2005 that will outline a strategy that, in part, builds upon the 2002 Strategic Plan for Interdisciplinary Faculty Development.
SUBSTANCE ABUSE: THE OFFICIAL PUBLICATION
AMERSA publishes Substance Abuse, a peer-reviewed, quarterly journal that emphasizes research on health professional education in substance abuse and also includes original clinical and prevention research. It is a recognized source of empirical findings for health professionals and addiction specialists in teaching, clinical care and service delivery. It features original research and review articles on a variety of related topics: the education and training of health professionals in substance abuse; clinical care for substance abusers in a variety of settings; the organization of substance abuse treatment services; pre-clinical and clinical research, including therapeutic interventions and behavioral studies; medical complications associated with drug abuse; substance abuse among specific groups or populations; applied science research; and policy issues. The journal publishes timely editorials and book reviews, as well as abstracts from the AMERSA National Conference. Substance Abuse is distributed to all AMERSA members. The journal has a multi-disciplinary Editorial Board that represents the full strength and range of AMERSA's experience and teaching.
The annual AMERSA National Conference has been the central exceptional product of the organization, as it brings together researchers and health professional educators to learn about scientific advances and exemplary teaching approaches. The conference fosters collaboration of health professionals within and among diverse disciplines, backgrounds and professional environments in a particularly supportive atmosphere encouraging peer mentoring and career development. It attracts presenters with national and international reputations to share new developments in substance abuse education, treatment, prevention and research. New research presented in both poster and oral formats is subsequently published as abstracts in Substance Abuse. This national meeting is held regularly during the fall in the Washington, DC area to take advantage of speakers from NIAAA and NIDA as well as to enhance networking with leaders of the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA).
AWARDS SPONSORED BY AMERSA
AMERSA sponsors several awards to support and recognize outstanding individual achievements in the field of substance abuse. The premier awards given to members or non-members of the organization are The John P. McGovern Award for Excellence in Medical Education and The Betty Ford Award. The John P. McGovern Award is given to an individual who has made important contributions to substance abuse education and research. The Betty Ford Award is given to an individual who has played a significant role in the treatment and recovery of drug-dependent individuals, particularly women. Each Ford and McGovern awardee is invited to speak at the national conference. The New Investigator/Educator Award is given to an AMERSA member who has made significant contributions to substance abuse education or research at an early stage in his or her career, and demonstrates the potential for future achievements in the field. The Excellence in Mentorship Award is given to an AMERSA member from any discipline who has provided outstanding mentoring to junior faculty and/or trainees, resulting in those individuals’ increased scholastic productivity and career advancement in the area of substance abuse education or research.
SOURCES OF FUNDING
Sources of funding are primarily through membership dues and registration fees from the annual conference. In recent years other funds have been obtained from foundation and federal grants (the Endowment of the John P. McGovern Foundation, CSAT, HRSA, NIAAA and NIDA), most of which are directed at improving health professional substance abuse training. Funding for the annual conferences has included support from NIDA and NIAAA to ensure high quality presentations for plenary sessions and recruitment of attendees who are promising diverse health professional faculty.
As described previously, AMERSA was comprised originally of medical school faculty. During the early years of the organization's development, however, members realized the need to involve a broader spectrum of health professionals in order to have a more substantial impact on the care of patients with addictive disorders. Addressing substance abuse issues among patients required multi-disciplinary efforts and thus multi-disciplinary training was required to achieve this goal. The recognition that other health-care professions had a direct stake in clinical education led to the broadening of AMERSA's multi-disciplinary base to faculty in all medical, nursing, social work and other health professional training programs. Gradually, nurses, social workers, dentists, allied health professionals and others became part of the organization. They started as active participants in the annual conference, then active members, and then active Executive Committee members—the leaders of the organization. Being multi-disciplinary is one of the great strengths of the organization, distinguishing AMERSA from organizations with physician-only or psychologist-only membership. This organizational hallmark encourages clinicians to take a patient-centered or family-centered perspective and enables members to discuss interdisciplinary training, a focus not consistently pursued by other substance abuse organizations. AMERSA's members come from a range of disciplines and health professions and membership has grown to over 300; the organization's President (2003–05) is a senior faculty leader in a School of Social Work.
AMERSA's Executive Committee, represented by a variety of professions, is responsible for setting the direction of the organization. The Executive Committee consists of President, Vice President, Immediate Past President, Secretary, Treasurer and Substance Abuse Journal Editor-in-Chief, four Members-at-Large, Director and two Co-Directors. Officers take office at the conclusion of the national meeting following an election that has occurred a few months prior, and serve for a period of 2 years. No officer can serve on the Executive Committee for more than 8 consecutive years, excluding the 2-year term as Immediate Past President. For a current listing of officers see the website http://www.amersa.org.
Full membership is open to people engaging in substance abuse research or education and to faculty of health professional schools. AMERSA also offers associate, corporate and emeritus membership. Members’ range of benefits include the following: reduced rates for the annual national conference; a subscription to Substance Abuse; and a national voice supporting academic programs in universities, professional schools, and organizations that emphasize substance abuse education and research.
As in many non-profit organizations, AMERSA faces the ongoing challenge of limited financial resources. In general, support in the addiction area is directed at treatment and research rather than education and training. Training is likely to be conducted by people involved in treatment and research, but only limited sources of funding have been traditionally available specifically for teaching efforts. Because of this, AMERSA members, through their commitment to the organization's educational mission, must creatively garner cooperation from many faculty members and operate with limited resources to fulfill their goals.
Compared to other organizations in the United States that focus on substance abuse AMERSA has always had a relatively small membership, in part reflecting funding for educational efforts. The organization's strength is that this group is committed, talented, collaborative and imbued with the spirit to provide guidance to junior and peer colleagues. It has survived and flourished, in part, because it is the only organization that focuses on the educational mission in the way that it does. Many within its committed membership are the leaders within health professional schools nation-wide; they are the teachers of substance abuse at the nation's major universities, hospitals and health-care institutions. They educate and mentor future clinicians, researchers and educators, creating an impact well beyond their direct sphere of influence. They are in the forefront leading this effort. Even though AMERSA's numbers are not in the thousands, the organization has a big ripple effect on health professional substance abuse professional training.
FUTURE OF AMERSA
Members of AMERSA will continue to pursue the organization's education and training goals, including the development of a national infrastructure for interdisciplinary faculty development. Teaching about substance abuse needs to become mainstream and rooted securely in health professional schools. New faculty at these institutions must be inspired, well trained and supported so that students have a respected faculty source and role model for integrating substance abuse prevention, intervention and treatment into their daily work. These goals are the essence of what AMERSA will pursue in the coming years through its conferences, journal and training programs.
AMERSA was a leading participant in the development of a strategic planning document  to guide the improvement of health professional education on substance abuse. The future of AMERSA depends on the wide recognition of the problems of alcohol and drug abuse and dependence in society. It depends on the shift away from stigmatizing and towards understanding these problems as health issues, which has been occurring over the last 30 years. The efforts towards competency-based education , with a focus towards outcomes rather than process, should bring more attention to the field because the problems of substance abuse are so commonplace in clinical practice. The high prevalence of alcohol and other drug problems in both hospital and ambulatory practice will be a potent motivating force, as it has not yet been addressed adequately. As the trend toward skills training and competency based health professional education continues and the stigma of alcohol and drug abuse decreases, it is hoped that the training of doctors, nurses, social workers, dentists, allied health professionals and other clinicians about substance abuse will be more widely recognized as essential to a quality education in these disciplines. At that time, the human resources that the AMERSA membership and organization provide will become even more valued.
The current younger generation of students seems to recognize the importance of appropriate training in substance abuse. A recent and encouraging illustration is the effort by students to form their own multi-disciplinary group called Health Professional Students for Substance Abuse Training. They have taken initiatives to expand substance abuse education in their institutions and have created their own website (http://www.HPSSAT.ORG) in order to provide curriculum and training opportunities. These students are now forming an alliance with AMERSA. Thus it is anticipated that AMERSA will see a cohort of younger members in the next 5 years that will eventually become the leadership. AMERSA welcomes such change as the organization views mentorship as a core organizational value. The new generation of leaders will come from a different style of health professional education than the current generation of AMERSA members. The continuing challenge is to integrate substance use disorders effectively into the traditional curriculum so that students will gain competence in these common problems that take a heavy toll on the health of individuals and families in our society.
We gratefully acknowledge the contributions of Richard Saitz MD, MPH, President-Elect, AMERSA, Maryann Amodeo MSW, PhD, President, AMERSA and Isabel Vieira Co-Director, AMERSA who either critically reviewed or assisted with the gathering of material for the preparation of this manuscript.
To contact AMERSA or to request reprints, the address is Association for Medical Education and Research in Substance Abuse, 125 Whipple Street, 3rd Floor, Suite 300, Providence, RI 02908, USA. The website address is http://www.amersa.org