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Addiction eLearning

AFMC Primer on Biopsychosocial Approach to Addiction

Addictions e-Learning

The Association of Faculties of Medicine of Canada (AFMC) and the Palix Foundation have partnered to provide funding and support for the development of a suite of e-learning tools on early brain and biological development and addictions for undergraduate medical education. The suite of resources includes virtual patients, a primer (e-textbook), and podcast series. Topics that will be covered include core concepts of early child development, epigenetics, intervention and treatment strategies, and system responses to addiction.

In 2010, an environmental scan of pedagogical resources on undergraduate materials on addiction was conducted by the AFMC with funding from the Palix Foundation.

Please note these resources are available in English only

Addiction e-Learning

e-Textbook Primer

Edited by:

Dr. Nancy Brager – Department of Psychiatry & Department of Internal Medicine, University of Calgary Dr. Peter Butt – Department of Family Medicine, University of Saskatchewan Nicole Sherren, PhD, Scientific Director, Palix Foundation

Sponsored by:

Palix Foundation

Download e-Textbook Primer:

QC code to download the Addictions ebook

The AFMC Primer on Biopsychosocial Approach to Addiction provides core concepts related to the basic and social science of addiction including key concepts, science and research. It also addresses Addiction Medicine including reflective practice, basic principles of clinical management and elements of quality care and treatment.

This Primer is tailored for medical students and medical educators but will be beneficial to medical residents, students of other health professions and healthcare professionals interested in improving their knowledge of addiction. Concepts discussed in the Primer are linked to the Medical Council of Canada Objectives for the Qualifying Examination.

Read the Primer from the beginning or jump ahead to a chapter of interest. In addition to providing core concepts on addiction, each chapter includes supplementary text including definitions to explain terms which may be new to readers. "Nerd’s corner" boxes contain material of interest to readers afflicted with an enquiring mind and there are links to supplementary reading resources. Many chapters include case studies or links to interactive virtual patients. A glossary of definitions is available as a quick revision tool.

Addiction e-Learning

Virtual Patients

Image of Miriam

Miriam
Interact with Miriam and her family as a series of five individual cases. If you complete all, you will get a better understanding of addiction beyond being a disorder that affects individuals to one that impacts families and vice versa.
Start a case: Miriam Age 15 | Ethel | Dudley | Miriam Age 42 | Ashley

Marilyn
Assess your clinical reasoning skills and expand your understanding of process and substance addictions. You will meet Jake, a 15-year-old boy, in a state of psychosis who was brought in to the Emergency Department by his parents; Marilyn, a 74-year-old woman who presents to her family doctor's office after a fall at home; and a 32 year old male who comes to his family doctor with marital problems.
Start a case: Female, 74 | Female, 45 | Female, 35 | Male, 9 | Male, 15 | Male, 32 | Male, 48 | Male, 60

You can access these cases all together here.

Acknowledgements

Produced by:

Marcus Law, MD MBA MEd CCFP Faculty of Medicine, University of Toronto

Peter Selby, MBBS CCFP FCFP DipABAM Chief of Addiction,

CAMH Reviewed by: UofT/CAMH Virtual Patient Advisory Committee*

Developed by: The Association of Faculties of Medicine of Canada Sponsored by: Palix Foundation

Medical Careers
A game for workaholic medical students. Students must successfully balance money, reputation and health, according to the winning strategy that each player defines at the outset of the game. Have fun and explore some of the concepts from Early Brain & Biological Development around process addictions and maladaptive behaviours.
Start the case: Medical Careers

Street Drug Guide
Reference the Street Drug Guide for information that is not easily available from traditional medical sites. The reference tool includes a set of short cases on how to engage with patients on their use of street drugs. There is also a personal web notebook to complement the guide. 
Start the case: Street Drug Guide

Image of Miriam

Seven short virtual cases
Seven short virtual patient cases related to street drugs on topics such as delirium, troubled students, deteriorating mental state, prenatal issues, anger and substance issue, vomiting.

Start a case:
Adam | Alice | Ann | Beth | Bruce | Joan | Vince

Image of Polly

Harriet
The Harriet case offers students an opportunity to learn about issues of addiction and mental health within an emergency room setting. This case is broken into three main sections – sad, bad and mad Harriet. The learner is encouraged to investigate, explore, ask questions, and make decisions based on realistic clinical encounters with the patient, members of the patient’s family, and caregiver team.
Start the case: Harriet 

Image of Polly

Polly
The patient is a 45 year old female nurse, Polly, who is on longterm disability following a back injury at work.  Her previous GP has retired and she has come to the office seeking a new primary care physician.  There are limited records from the previous GPs office.  Her chief medical concern is her chronic low back pain.
Start the case: Polly 

Acknowledgements

Produced by:David Topps, MD CCFP FCFP
TIDE, University of Calgary

Developed by: The Association of Faculties of Medicine of Canada

Sponsored by: Palix Foundation

Reviewed by: TIDE Virtual Patient Advisory Committee**

*UofT/CAMH Virtual Patient Advisory Committee Dr. William Greene, Assistant Professor, Division of Addiction Medicine, Department of Psychiatry, University of Florida Dr. Marcus Law, Educational Technology, University of Toronto Dr. Francine Lemire, Associate Executive Director and Director of Professional Affairs, College of Family Physicians of Canada Steve Pennell, Manager, Health Education Technology and Learning, Health Sciences Information & Media Service (HSIMS), Faculty of Medicine, Memorial University of Newfoundland Dr. Jorge Perez-Parada, Assistant Professor; Undergraduate Medical Education Director (Clinical), University of Alberta Lindy VanRiper, Psychiatry Resident, University of Alberta Dr. Peter Selby, Clinical Director, Addictions Program, CAMH Nicole Sherren, Scientific Director & Program Officer, Palix Foundation Irving Gold, Vice President, Government Relations and External Affairs, Association of Faculties of Medicine of Canada Matthew Raegale, Project Manager, e-Learning, Association of Faculties of Medicine of Canada

**TIDE Virtual Patient Advisory Committee: Dr. Dave Campbell, MD Graduate, University of Calgary Dr. Jean Clinton, Associate Clinical Professor, Department of Psychiatry and Behavioural Neurosciences, Associate, Department of Family Medicine, McMaster University John Costa, Information Technology Unit, University of Saskatchewan Dr. Aravind Ganesh, MD Graduate, University of Calgary Dr. David Topps, Faculty, University of Calgary Dr. Bryan Kolb, Faculty, Canadian Centre for Behavioural Neuroscience, University of Lethbridge Nicole Sherren, Scientific Director & Program Officer, Palix Foundation Irving Gold, Vice President, Government Relations and External Affairs, Association of Faculties of Medicine of Canada Catherine Peirce, Project Manager, e-Learning, Association of Faculties of Medicine of Canada

The Association of Faculties of Medicine of Canada (AFMC) developed the virtual patient cases as part of the Addiction e-Learning for Undergraduate Medical Education (UME). The virtual patients include a set of self-directed, interactive cases designed to highlight intergenerational issues related to addiction. There is a point-of-care reference tool with streetwise phrases and virtual patient cases for group based study with teaching guides. These virtual patient cases were developed by e-learning, clinician educators and addictions experts from across Canada and the United States with sponsorship from the Palix Foundation. 

About the Primer

AFMC, with medical educators and addiction experts, has developed a suite of e-learning tools on addiction and its foundations in early brain and biological development. The Suite includes a podcast series, 18 virtual patient cases and this AFMC Primer on Biopsychosocial Approach to Addiction.

The Primer is designed to provide undergraduate medical students and educators with resources that help build base domain knowledge including new research that has changed the way we think about the biological, psychological and social underpinnings and factors of addiction. In addition to the basic and social science of addiction medicine, it is the hope of all of the contributors to this Primer, that the learners and educators will find value in the section on Clinical Practice. This section answers the question of why all physicians should be involved in addiction medicine. It encourages the medical students to address bias and stigma associated with addiction, and provides basic principles for clinical management including history taking, screening, detection and physical examinations. It addresses concurrent disorders and a treatment and continuum of care for individuals and their families. There is information on pharmacological interventions, the chronic disease management model and recovery.

Background

The rational for the project was born of two environmental scans related to addictions curricula and resources in undergraduate medical education in Canada commissioned by the Palix Foundation. These scans, in 2009 and 2010, revealed little dedicated curriculum content related to addictions. It also revealed a gap between the knowledge from new and emerging research on addictions and the existing curricula.

At the time of the study, identified curriculum-based activities were often limited to substance- related addictions (alcohol, tobacco, etc.). Training and information related to behavioural addictions is extremely limited, with gambling addictions more likely to be addressed than any other behavioral or process addictions such as food, sex, internet, video game or work addictions. In addition, the underlying developmental processes involved in the ontology of addiction such as strategies for prevention, screening, comprehensive treatment, and case monitoring were not significantly addressed in undergraduate medical education curricula. As a consequence, the Palix Foundation, in partnership with the Association of Faculties of Medicine of Canada (AFMC), initiated the Addictions- E-learning Medical Education Resource Development Project.

The objectives of the project were to:

  • Align medical education competencies with emerging research on experience-based brain and biological development as it relates to early childhood development and its lifelong impact on addiction
  • Support subject matter experts in Canada
  • Build connections among researchers, subject matter experts, and e-learning experts at Canadian faculties of medicine
  • Create a new, innovative resource relevant to undergraduate medical educators and learners in Canada.

Authors

George Koob, PhD Mark Gold, MD Mahdi Razafsha, MD Benjamin Srivastava, MD Robin Gibb, MD Nicole Letourneau, PhD Judy Cameron, PhD Ruth Lanius, MD, PhD Mischa Tursich, PhD Doris Payer, PhD Glenda MacQueen, MD, PhD Thomas McLellan, PhD Peter Butt, MD David Topps, MD Sonya Lee, MD Nancy Brager, MD Peter Selby, MD Nadia Minian, PhD Hillary Connolly, CAMH Dennis Pusch, PhD Keith Dobson, PhD Laurie Zawertailo, PhD Anna Ivanova, BSc, MA, MPH Derek Puddester, MD, PhD Ralph Earle, PhD Amy Hesler, RN, LMFT Brenda Garrett, RN, MC, LPC Nicole Burma, PhD candidate Erik Fraunberger, MSc candidate Heather Leduc-Pessah, PhD candidate

Project Team

Matt Raegele, AMFC, Project Coordinator Brenda Du Plessis, AFMC, Web Developer Irving Gold, AFMC, Former VP – Government Relations and External Affairs Barbie Shore, AFMC, Former Project Manager Catherine Peirce, AFMC, Former Project Manager

Stylistic Editing

Eva Radford

Addiction e-Learning

Podcasts

Supplementary resources for each of the episodes in a podcast series on early brain and biological development and addiction.

INTRODUCTION

This is the first episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

The Neuro-Developmental Pathway Origins of Addiction is the first in a series of podcasts on early brain and biological development and its connection to addiction. As such, it introduces the themes that will be addressed throughout the series, including adverse childhood experiences; brain architecture; the neuro-developmental origins of addiction; and the prevention, intervention and treatment of addiction. The podcast provides a definition of addiction, which includes substance and process addictions, and begins to explore the impact of adverse childhood experiences on the reward system of the brain.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 1: The Neuro-Developmental Pathway Origins of Addiction - Study Guide

Podcast 1: The Neuro-Developmental Pathway Origins of Addiction

CORE CONCEPTS OF EARLY CHILD DEVELOPMENT

Second episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 2, Brain Architecture and Development, highlights how the brain develops; the effect of early experiences and stress on brain development; how brain architecture regulates biological systems responsible for complex human behaviours; and how social interactions help guide development of the brain.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 2: Brain Architecture and Development - Study Guide

Podcast 2: Brain Architecture and Development

Third episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 3, Early Experiences and Gene Expression, highlights the concept of epigenetics and how genes are expressed through interaction with different environments. The podcast describes the long-term effects of epigenetics, and looks at how early negative experiences harm brain architecture whereas positive interactive relationships (or serve and return experiences) build resilience over time.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 3: Early Experiences and Gene Expression - Study Guide

Podcast 3: Early Experiences and Gene Expression

 

Fourth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 4, Building Cognitive, Emotional and Social Capacities, highlights the importance of building a solid foundation of cognitive, emotional and social skills early in a child’s life; the negative effects of such skills not being developed effectively; and how the serve and return interactions between a caregiver and child are the cornerstone for resilient cognitive, emotional and social capabilities.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 4: Building Cognitive, Emotional and Social Capacities - Study Guide

Podcast 4: Building Cognitive, Emotional and Social Capacities

Fifth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 5, Positive, Tolerable and Toxic Stress, identifies the three types of stress that individuals encounter daily; describes how the body’s allostatic response to situations of toxic stress creates the allostatic load; and identifies the sources and long-term effects of toxic stress on a person’s body and life.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 5: Positive, Tolerable and Toxic Stress - Study Guide

Podcast 5: Positive, Tolerable and Toxic Stress

Sixth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 6, Brain Plasticity and Behavioural Change, describes brain plasticity; its importance in the development of brain structure and processes; and its influence on behaviours. It highlights pre- and postnatal factors that influence the pruning process and brain plasticity during the early developmental years, and how the ability to change brain architecture and behaviours decreases over time.

The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation. 

Podcast 6: Brain Plasticity and Behavioural Change - Study Guide

Podcast 6: Brain Plasticity and Behavioural Change

Seventh episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 7, Intervention and Treatment in Children’s Mental Health, highlights the importance of level, supportive environments during childhood development; examines the negative consequences of maltreatment (such as post-traumatic stress disorder, depression and addiction), which can continue throughout life; and identifies treatment options involving healthcare professionals, parents and children exposed to toxic stress.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 7: Intervention and Treatment in Children’s Mental Health - Study Guide

Podcast 7: Intervention and Treatment in Children's Mental Health

ADDICTION

Eighth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 8, Different Kinds of Addiction, offers a definition of addiction. It highlights the neurobiology and behaviour patterns common to both substance and process addiction. The podcast also addresses concurrent addiction and the consequences of associated interactions.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 8: Different Kinds of Addiction - Study Guide

Podcast 8: Different Kinds of Addiction

Ninth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 9, Prevention, Intervention and Treatment of Addiction, highlights the fact that addiction is a chronic, relapsing brain disease and that, if its treatment is to achieve lasting success, it must be comprehensive and address the individual as a whole. The podcast describes the chronic disease management model of care and explains how a number of its principles can be applied in effective addiction intervention. It also describes the design and characteristics of a successful Physician Health Program.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 9: Prevention, Intervention and Treatment of Addiction - Study Guide

Podcast 9: Prevention, Intervention and Treatment of Addiction

Tenth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 10, Early Trauma in Addiction, highlights the link between childhood trauma and addictions and describes the many ways in which trauma can manifest in an individual. The podcast illustrates how traumatic events can lead to a sensitized nervous system, and how exposure to trauma damages the limbic system, resulting in altered memory and emotional memory.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 10: Early Trauma in Addiction - Study Guide

Podcast 10: Early Trauma in Addiction

This is the eleventh episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

 

Podcast 11, Chronic Disease Management Model of Addiction Treatment: A Healthcare System Response, highlights the principles of the chronic disease management model of care, and examines the successes of Primary Care Networks and how their design and principles apply to addiction treatment.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 11: Chronic Disease Management Model of Addiction Treatment: A Healthcare System Response - Study Guide

Podcast 11: Chronic Disease Management Model of Addiction Treatment: A Healthcare System Response

This is the twelfth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 12, Quality Improvement Strategies and Evaluation for Addiction Treatment Programs, highlights the differences between effectiveness, performance and quality in addiction treatment. The podcast describes the significance of understanding which elements of a program need to be measured and how to measure them in the evaluation process. It also addresses the importance of creating a solid link between expectations and evaluation, in order to produce practical outcomes for a program.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 12: Quality Improvement Strategies and Evaluation for Addiction Treatment Programs - Study Guide

Podcast 12: Quality Improvement Strategies and Evaluation for Addiction Treatment Programs - YouTube

This is the thirteenth episode in a podcast series on Early Brain Development and Addiction for Undergraduate Medical Education.

Podcast 13, Process Improvement in Healthcare Programs to Support Addiction Treatment, identifies the five principles of business process improvement and how these principles can be adopted to enhance addiction treatment programs.

This podcast series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The podcasts were developed by the Association of Faculties of Medicine of Canada with guidance from a project advisory committee, and produced by Hugh Kellam and Colla MacDonald at the University of Ottawa. Narration was done by Hugh Kellam. This project was sponsored by the Palix Foundation.

Podcast 13: Process Improvements in Healthcare Programs to Support Addiction Treatment - Study Guide

Podcast 13: Process Improvements in Healthcare Programs to Support Addiction Treatment - YouTube

 

YouTube play list Early Brain and Biological Development and Addiction, UME

ABOUT THE PODCAST SERIES

The podcast series has been designed to offer an introduction to the subject of early brain and biological development and its connection to addiction. The podcast series includes a set of episodes on core concepts of early childhood development which illustrate how childhood experiences shape brain development to either provide a strong foundation for lifelong health and wellbeing or confer vulnerability to disease. The early childhood development episodes also address interventions and treatments that help ensure children have the best possible start in life. The podcast series also includes a set of episodes that  focus on the neurodevelopmental origins of addiction. These podcasts provide a definition of addiction as a brain disorder, and describes effective strategies to help prevent, intervene, and treat addiction. The goal of the podcast series is to give you both the background knowledge on brain development and addiction, and the reflective skills to apply this knowledge to your practice.

In 10 to 15 minutes, each podcast links specific medical learning objectives with emerging research. To help illustrate the key concepts, several podcasts follow the story of Dr. Ray Baker, a physician who has struggled with addiction.

The Association of Faculties of Medicine of Canada (AFMC) created the podcast series as part of the Addiction e-Learning for Undergraduate Medical Education (UME). The series is based on lectures from the Alberta Family Wellness Initiative, a knowledge mobilization initiative designed to translate scientific research into policy and practice. The lectures have been repurposed, with permission, for undergraduate medical education.

Developed by:
The Association of Faculties of Medicine of Canada

Produced by:
Hugh Kellam, PhD Candidate, Instructional Designer, University of Ottawa
Colla MacDonald, PhD, Project Manager and Education Expert, University of Ottawa

Sponsored by:
Palix Foundation

Advisory Committee:
Niloofer Baria, MD, CCFP, Addiction Medicine Program Committee, College of Family Physicians of Canada
Nancy Brager, MD, FRCPC, Associate Professor, University of Calgary
Peter Butt, MD, CCFP, FCFP, Addiction Medicine Program Committee, College of Family Physicians of Canada
Gary Hnatko, MD, FRCPC, FCPA, Professor, University of Alberta
Lucie Rochefort, MD, MSc, CCMF, FCMF, Addiction Medicine Program Committee, College of Family Physicians of Canada
Nicole Sherren, PhD, Scientific Director and Program Officer, Palix Foundation
Pamela Weatherbee, Medical Student, University of Calgary
Jonathan White, MD, PhD, FRCSC, MSc, Assistant Professor, University of Alberta