Alcoholics Anonymous and other mutual help organizations: Impact of a 45-minute didactic for primary care and categorical internal medicine residents

ABSTRACT

Background: Substance use disorders (SUDs) are highly prevalent among primary care patients. One evidence-based, cost-effective referral option is ubiquitous mutual help organizations (MHOs) such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and SMART Recovery; however, little is known about how to effectively increase trainee knowledge and confidence with these referrals. The primary aim of this study was to evaluate whether a single 45-minute combined lecture and role play–based didactic for primary care residents could enhance knowledge, improve attitudes, and bolster confidence in referring patients with addictions to community MHOs. Methods: The authors developed a 45-minute lecture and role play addressing the evidence for MHOs, their respective background/content, and how to make effective referrals. Participants were administered a brief survey of their MHO-related knowledge, attitudes, and confidence before and after the session to evaluate the didactic impact. Results: Participants were 55 primary care and categorical internal medicine residents divided among postgraduate year 1 (PGY1; 27.3%), PGY2 (38.2%), and PGY3 (34.5%). They had a mean age of 29 (SD = 2.62); 49% were female, 69% were Caucasian, and 78% reported some religious affiliation. Participants' subjective knowledge about MHOs increased significantly (P < .001), as did their confidence in making referrals (P < .001). Changes in participants' attitudes about the importance of MHOs in aiding successful addiction recovery approached significance (P = .058). The proportion of participants with correct responses to each of 4 knowledge-based questions increased substantially. Conclusions: Primary care and internal medicine residents reported variable baseline knowledge of MHOs and confidence in making referrals, both of which were improved in response to a 45-minute didactic. Role play may be a useful supplementary tool in enhancing residents' knowledge and skill in treating patients with SUD.

KEYWORDS:

• Substance use disorder
• self-help groups
• medical education
• substance addiction
• Alcoholics Anonymous
• mutual help

Funding

This study was supported by Massachusetts General Hospital, Recovery Research Institute; and grant K24AA022136-01 funded by NIAAA (Mentoring in Patient-Oriented Addiction Research). The research was supported financially by the aforementioned sources but neither had any role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Author contributions

All authors contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed in the author byline. Authors are responsible for the design of the study (D.M., J.V.C., J.F.K.), conduct of the study (D.M., J.V.C., J.F.K.), data collection (D.M.), management (J.V.C.), and analysis (D.M., J.V.C., J.F.K.), and manuscript preparation and revision (D.M., J.V.C., J.F.K.).