title: Alcoholics Anonymous and other mutual help organizations: Impact of a 45-minute didactic for primary care and categorical internal medicine residents.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: a Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.|b MGH/McLean Adult Psychiatry Residency, Massachusetts General Hospital , Boston , Massachusetts , USA.|c Harvard Medical School , Boston , Massachusetts , USA.
authors.forename: David
authors.initials: D
authors.lastname: Marcovitz
authors.affiliation: a Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.|d Massachusetts General Hospital Center for Addiction Medicine , Boston , Massachusetts , USA.
authors.forename: Julie V
authors.initials: JV
authors.lastname: Cristello
authors.affiliation: a Department of Psychiatry , Massachusetts General Hospital , Boston , Massachusetts , USA.|c Harvard Medical School , Boston , Massachusetts , USA.|d Massachusetts General Hospital Center for Addiction Medicine , Boston , Massachusetts , USA.
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
mesh_terms: D000328:Adult; D000436:Alcoholics Anonymous; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D011320:Primary Health Care; D012381:Role Playing; D012657:Self-Help Groups; D055815:Young Adult
keywords: Alcoholics Anonymous; Substance use disorder; medical education; mutual help; self-help groups; substance addiction