CORE CURRICULUM ELEMENTS ON 

SUBSTANCE USE DISORDER

FOR EARLY ACADEMIC CAREER

MEDICAL AND HEALTH PROFESSIONS EDUCATION PROGRAMS

April 2024
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Preface

Government estimates indicate the nation’s behavioral health workforce, including those who treat 

patients with substance use disorders (SUD), will continue to experience staffing shortages and that it is 

imperative to address future workforce needs for several behavioral health occupations (USDHHS, 2023). 

Enhanced training is needed across medical, nursing, and physician associate (PA) professions to detect and 

treat patients with SUDs. 

The 2022 National Drug Control Strategy (NDCS) includes, among other efforts, one activity to expand the 

SUD health professions workforce through development of a core curriculum on SUD for all medical and 

health professions programs so that so that every student is educated early in their academic careers on 

SUD and has basic knowledge of strategies to identify, assess, intervene in, and treat addiction, as well as 

support recovery. This activity builds on work started in 2019 by the American Association of Medical 

Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) to support 

medical schools to develop core curriculum to advance educational content related to pain and addiction.

To achieve this goal, in partnership with the Substance Abuse and Mental Health Services Administration

(SAMHSA), the federal agency responsible for training on SUD, and other federal partners, the Office of 

National Drug Control Policy (ONDCP) launched a “Cascade Of Care” initiative in 2023, an approach 

combining three National Drug Control Strategy (NDCS) workforce expansion efforts:

• Increasing SUD screening and case-finding by all health professionals; 

• Increasing training on SUDs by a broader representation of all health professionals; and

• Developing core SUD curriculum elements for all health professions programs.

This report is designed to promote comprehensive education among those training in medical, physician 

associate, nurse practitioner, nurse, social worker, public health and counselor academic programs. Such 

programs are urged to:

• Provide training early in their students’ academic careers about SUD to help address stigma related 

to addiction; 

• Educate that SUD is a treatable, chronic disorder, akin to diabetes and heart disease, and

• Increase access to SUD screening, assessments and services for the approximately 46 million 

Americans with SUDs, who are family, friends, and neighbors, and deserve access to care. 

The launch of the Cascade of Care initiative resulted in the foundation of an interagency group to 

implement workforce expansion efforts included as part of that initiative. An outgrowth from this 

interagency group was a convening of experts to draft Core Curriculum elements. 

SAMHSA, in collaboration with ONDCP, convened a panel of experts (list of participants included in 

Appendices) in August 2023, to review draft Core Curriculum elements. These elements built on previous 

work by SAMHSA on Core Curriculum elements developed in response to Section 1263 of the Consolidated 

Appropriations Act, 2023 (CAA, 23), more commonly known as the Medication Access and Training 

Expansion (MATE Act). The overall goal was to gain concurrence on essential elements or categories of 

information that should be included in a SUD Core Curriculum, with a resulting deliverable that is publicly 

available, and through which any health profession academic program could adopt elements in full or in 

part to integrate into their programming. 
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Table of Contents 

Background on the Curricular Recommendations........................................................................................ 4

Core Content Recommendations.................................................................................................................. 4

General and Historical Context................................................................................................................. 5

Overview of SUD ....................................................................................................................................... 5

Screening and Assessment for Patients with SUD.................................................................................... 6

Treatment of SUD ..................................................................................................................................... 6

Pain Management and Substance Misuse................................................................................................ 7

Inter-professional Education and Practice................................................................................................ 7

Discipline-Specific Recommendations.......................................................................................................... 8

Nursing/Nurse Practitioners..................................................................................................................... 8

Physician Associates.................................................................................................................................. 8

Pharmacists............................................................................................................................................... 9

Social workers........................................................................................................................................... 9

Physicians.................................................................................................................................................. 9

Models of Integration of Content into Curriculum....................................................................................... 9

Modular Format...................................................................................................................................... 10

Use of Simulations, Case Examples and Presentations by People with Lived Experience .....................10

Service and Experiential Learning........................................................................................................... 10

Promoting Institutional-level Integration of SUD Curriculum .................................................................... 11

Encourage students to take the lead ...................................................................................................... 11

Ensure There Are Well-trained Faculty and Mentors............................................................................. 11

Engaging Boards to Develop Competencies and Standards................................................................... 11

Summary ..................................................................................................................................................... 12

Recommended Core Curriculum Topics for Substance Use Disorder in Early Academic Career 

Healthcare Education Programs................................................................................................................ 13

Appendices.................................................................................................................................................. 15

Federal Participants................................................................................................................................. 15

Field Expert Participants.......................................................................................................................... 15

References ............................................................................................................................................... 17

Resources................................................................................................................................................. 19

Educational Accrediting Bodies ............................................................................................................... 19
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Background on Curricular Recommendations 

On August 10 and 17, 2023, the Substance Abuse and Mental Health Services Administration (SAMHSA) and 

the Office of National Drug Control Policy (ONDCP) hosted two meetings with subject matter experts to 

gain concurrence on essential elements or categories of information that should be included in core 

curriculum on substance use disorder (SUD) and integrated into graduate healthcare education programs. 

The first meeting focused on gathering input from the experts regarding content and materials to support 

incorporation into current curricula. The second meeting built upon the input from the initial meeting, 

identifying best practices and strategies for integrating content into existing curricula as well as at an 

institutional level. 

Subject matter experts across disciplines agreed on several common themes and topics that should be 

considered as the curriculum is developed and implemented. Participants considered strategies for 

integrating SUD curriculum into existing clinical academic content from four perspectives: didactic content 

as required learning, clinical rotation, case review, and their respective expertise. Panelists noted the 

challenge of finding room for additional curricular elements alongside existing curriculum, and the need to 

assure adherence to curriculum standards and licensing exams. Suggestions for addressing these 

challenges emerged, such as reviews of current curriculum leading to discovery of outdated content that 

could then be replaced with SUD content. Above all, the experts highlighted that the needs of persons with 

SUD should be considered the primary priority, and stressed that interprofessional efforts, rather than one 

discipline practicing alone, are most effective at assisting people in attaining recovery as defined by the 

person. 

The experts identified several key factors to affecting change in the curriculum content. This included the 

importance of having motivated practitioners to encourage and support the integration of SUD curricula, 

and who can act as peer leaders in their discipline, while also promoting the buy-in of academic leadership. 

This summary and the corresponding recommended outline for core SUD content are meant to support the 

efforts of both peer leaders and academic leadership. The summary will explain the experts’ 

recommendations for key areas of the outline and offer suggestions for ways to incorporate the content 

into healthcare education programs. 

 

Core Content Recommendations 

The participants urged provision of content pertaining to SUDs beginning early and then throughout the

students’ educational journey, to address and minimize bias and stigma regarding use disorders. 

Perceptions about use of medications for the treatment of SUD is a primary barrier for people in need of 

treatment and in terms of practitioners’ willingness to prescribe, especially for special populations such as 

adolescents and pregnant people. These perceptions feed into stigma, biases, stereotypes, and 

discrimination that discourages people from seeking or to follow through with care. 

Introducing students to concepts pertaining to SUDs early in their clinical experience will empower them to 

see positive changes in patients and appreciate that SUD is as treatable as any other chronic disease. As an 

example, the Boston Medical Center provides multi-disciplinary early exposure to SUD and uses peer 

advocates to provide opportunities for integrating learning; this can help students experience the urgency 

of learning about SUD and help them recognize the impact they can have on someone’s life. 
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General and Historical Context 

The experts noted that understanding the history, policy, and regulations related to SUD and treatment 

constitute critical topics to provide a context for students’ knowledge and practical interventions. The 

trainings should include an introduction to current drug use and trends. At times, patterns of tolerance and 

prohibitive policies have led to fragmented care and criminalization of SUD, which, in turn results in 

structural stigma. The panelists voiced that students should understand current SUD treatment regulations

that impact clinical practice, to ensure they understand the legal and treatment implications of federal, 

state, and local laws related to SUD, and to help mitigate structural stigma. This might inform their own 

positive responses to patients with SUD. For example, policies of intolerance of substance use can cause 

people to avoid health care for fear of arrest or stigmatized judgement, exacerbating health disparities and 

risking overdose. This affects whether and how people in the criminal justice system are cared for and 

supported. 

Another recommended topic that arose concerns the broad impact of technology on the current 

environment. This applies to technology of drug delivery devices, such as vaping instruments that can 

deliver different substances, including fentanyl. This topic also includes the use of digital technology, such 

as use of smartphone applications in the treatment and prevention of SUDs. 

Overview of SUD 

The expert panelists concurred that curriculum content should include a foundation that addresses 

evidence-based determinants of SUD, specific substances, legal and ethical issues and prevention. Among 

determinants of SUD, students be able to speak to genetic factors related to SUD, the neurobiology of 

substance use, misuse and use disorders, and SUD as a chronic disease. The impact of the unequal access to 

general health care, lack of education, stigma, and biases about SUD and long-term recovery supports 

arose as being critical content. 

Panelists felt that the need for information about relevant legal and ethical issues was important to ensure 

students are familiar with the implications of care of patients with SUD, such as privacy protections specific 

to SUD (42 CFR Part 2) and the medical and legal complications of not providing care. Content of specific 

laws and regulations such as the Controlled Substances Act, 42 CFR Part 8, and the Medication Access and 

Training Expansion (MATE Act) (as codified in the CAA, 23) should be included. The experts recommended 

that content should be sufficient to enable students to fully consider the nuances of issues such as use of 

lab testing to support clinical care versus screening for work-related issues in safety and security-sensitive 

positions, or issues related to conducting research with patients in treatment settings and the need for fully 

informed consents.

The panelists emphasized that healthcare professionals have a key role in preventing SUD in any clinical 

setting and stated the need for prevention to be a large part of the curriculum as well. Generally, 

prevention is thought of in terms of risk factors like Adverse Childhood Experiences (ACEs), which are critical,

but there is also a need to talk about prevention and specific interventions that can take place in clinical 

settings. As noted, assessing for mental health issues is a matter of prevention as it can mitigate selftreatment of undiagnosed or untreated mental health issues. However, screening is often focused on 
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patients with SUD. Screening for mental health issues and conducting suicide assessments are matters of 

prevention. 

Content on prevention should include review of specific interventions that address alternatives to use, the 

relationship between mental health and prevention of SUD and need to address unmanaged mental health 

issues. Panelists stressed the inclusion of an emphasis on the role of trauma-informed care as prevention 

and as a source of diagnostic information. 

Screening and Assessment for Patients with SUD 

The experts recommended Screening, Brief Intervention, and Referral to Treatment (SBIRT) as an approach to 

the delivery of early intervention and treatment services for persons with or at risk of developing SUD. 

This screening quickly assesses the severity of substance use and identifies the need for further assessment 

and potentially an appropriate level of treatment using evidence-based screening tools. Brief intervention 

focuses on increasing insight and awareness regarding substance use and motivation toward behavioral 

change, and referral to treatment provides those identified as needing more extensive treatment with 

access to specialty care. SBIRT is easily used in any setting to quickly assess the severity of substance use, 

followed by brief intervention to motivate behavioral change and referral to treatment as needed. Lab 

testing for drugs and other related medical issues can be used to confirm or inform initial screening 

conducted. 

Panelists also recommended that screening and assessment content include consideration of co-occurring 

issues, such as polysubstance use, medical co-morbidities and mental health disorders, especially anxiety, 

depression and Attention-Deficit/Hyperactivity Disorder (ADHD); these are major factors in the 

development of and recovery from SUD. Even in primary care, if the provider is addressing someone with 

SUD, they should know to look for mental health issues that are potentially very treatable and could 

positively affect outcomes. As noted above, the experts recommended the inclusion of content on trauma, 

such as assessment for ACEs, and suicide risk. Experiences of trauma and SUD are directly related; 

conducting trauma assessments can bring to light information about substance use that might not have 

been otherwise shared. 

Treatment of SUD 

The panelists recommended robust content on the treatment of SUD. This includes content on modalities 

for treatment like pharmacotherapies, initiation and management of FDA-approved medications for SUDs, 

medication pharmacodynamics, brief interventions, crisis management, and long-term SUD care, as noted 

the outline attached to this summary. 

Of primary concern to the panelists were: 

• Treatment approaches and language

• Prevention 

• Peer support and involvement of people with lived experience

• Understanding the role of recurrence 

In terms of person-centered care, panelists underscored that critical content should include use of shared 

decision-making and treatment goals that are meaningful to the patient, along with the use of patient-
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centered language and the need to approach each person respectfully. Understanding how SUD is viewed 

and discussed in different communities and cultures, the influence of religious practices, and how they all

might influence a person’s attitudes and perspectives around certain substances is important. Panelists 

thought that knowledge of harm reduction strategies will enhance communications, recognizing that 

different individuals need different approaches. 

Other topics discussed included the role of case management and counseling in recovery, review of 

Evidence-Based Practices, such as Motivational Interviewing and Contingency Management, and the need 

for coordination of care and collaboration with other disciplines. Panelists strongly recommended that the 

role of peers in treatment and recovery be established as a section within Treatment Approaches to ensure 

due attention is given to the topic. It was thought this content should include a description of the working 

relationships between colleagues who became part of the SUD workforce through their academic 

experiences and those who entered it through personal experience. The experts also thought that it would 

be most helpful to engage people with lived experience to interact with students early in their education. 

This would help students understand that recovery paths differ, and that pharmacotherapy can help. Other 

recommended content includes the role of mutual help groups. 

The panelists urged that students learn that SUD is a chronic disease in which recurrence may arise. 

Understanding that recurrence is a part of the recovery process can counter burn-out resulting from 

feelings of helplessness and preventing students from feeling they were not able to affect meaningful 

change when they observe recurrence. 

Pain Management and Substance Misuse 

The experts discussed the importance of the intersection of chronic pain and SUD, identifying the 

assessment of patients with pain and corresponding effective treatment as a core content topic. The 

panelists noted that the matter of pain management overlaps with many topics in the curriculum, such as 

prevention, legal, and ethical principles. The panelists recommended that the topic of pain management 

and substance misuse include a full explanation of the processes involved with initiation of pain 

medications, such as fully informing patients of the risks, obtaining their consent to treatment and 

providing training on the use of overdose reversal medications. The recommendation also arose that that

students should be aware of the differences in considering prevention interventions for patients starting 

pain management versus patients with SUD or a history of SUD who are engaged in pain management. 

Inter-professional Education and Practice 

The panelists identified that the role of interdisciplinary practice and inter-professional teams is critical to 

providing comprehensive care on behalf of people with SUD. Many academic programs already have some 

inter-professional programs integrated into their respective curricula, but when providing treatment in the 

context of a person’s life, it is important to assure that students recognize the various roles of team 

members and the respective values and practice competencies each profession lends to the team. 

Moreover, the curriculum about inter-professional teams should include peer support specialists, recovery 

coaches and people with lived experience. 

A literature review conducted in anticipation of these panel meetings provided an example of an 

interdisciplinary course offered through the Duke University School of Medicine; this is a 21-week 
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Foundations of Patient Care class to prepare students for the clinical learning environment (Muzyk et al., 

2023). Enrolled students engaged in learning through a mixture of synchronous and asynchronous 

activities, including live lectures, lecture recordings, team case-based learning, interviewing of a 

standardized patient, and an opioid overdose simulation exercise. The design of the course involved 

community advocates, interdisciplinary faculty, and persons with an SUD. More information about this 

course is provided in the Resources section of this document. 

Discipline-Specific Recommendations 

Among the three professions, only the Accreditation Review Commission on Education for the Physician 

Assistant (ARC-PA) requires the inclusion of SUD in their curriculum. ARC-PA introduced required SUD 

content into their didactic curriculums starting in 2020 (ARC-PA, 2023). However, clinical curriculum 

requirements are still not required across the three professions. 

When introducing the curriculum into academic programs, it is important to recognize that some 

healthcare professions do not require graduate-level training to be licensed to practice. For example, 

nursing programs are offered on a bachelor’s or pre-graduate level. Curriculum should be appropriate for 

the bachelor’s level, as well as graduate. There was concurrence that in all disciplines, content should be 

integrated as early as possible in the students’ studies as it will impact stigma, biases, stereotypes, and 

discrimination.

Nursing/Nurse Practitioners 

The experts felt that the suggested content provides a solid foundation for nursing and can normalize SUD 

when it is integrated into the remaining nursing curriculum. Because there are many nursing specialties, 

and nurses engage in a wide variety of clinical practices, nurses and Nurse Practitioners (NPs) can educate 

families and patients in a range of settings. Pre-licensure and advanced practice nursing curricula have 

three core courses focusing on health assessment, physiology/pathophysiology, and pharmacology into 

which SUD content can be integrated. As an example, Oklahoma State University integrated neurobiology, 

SBIRT, and FDA-approved medications into these courses. This content is sufficient for the advanced 

practice nurses to self-attest to the current eight-hour requirement for DEA registration.

Physician Associates 

The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA, 2023)

included SUDs within the standard requirements of didactic education. While the PA 

profession has made SUD education a requirement, the decision of how this is incorporated 

into the schools’ curricula is at the discretion of each training program. The PA curriculum is 

very compact, due to common competencies that make up the foundation, and accreditation 

standards require SUD content. Yet, the timelines for curricular content in PA programs are all 

different. As a result, the experts noted that it is important to consider where in the program 

SUD content is integrated. The recommendation arose that the content provided for early 

career learning should not be too long, but it should be foundational and that the content be 

delivered in several modalities, including clinical settings. Experts noted that PAs are licensed 
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with their undergraduate degrees, but some continue their studies to a master’s level, 

creating an opportunity to incorporate the content at both levels of education. 

Pharmacists 

Most students studying pharmacy have completed an undergraduate course in a health-related field or

nursing. Integrating SUD content in undergraduate programs and early in the pharmacy program would 

inform biology studies and discussions about medications. For pharmacy students and all learners early in 

their studies, it is important for students to understand the neurobiology of SUD. 

Social workers 

Social worker education focuses on providing services in the context of the person’s life, including their 

medical and mental health, family and social life, employment, legal involvement and spiritual well-being. 

Social work training includes policy, program administration, clinical intervention and research. Social 

workers are trained in assessment, treatment planning, and a range of approaches. SUD is required as 

content for accreditation purposes. Didactic content is complemented by incorporating it into field 

practicum experience. 

Physicians 

The panelists recommended that all medical students understand the basic concepts of SUD as outlined. In 

addition to these, recommendations arose to include management of alcohol withdrawal and 

pharmacotherapeutic treatment for tobacco or nicotine use disorder for smoking cessation treatment in 

the curriculum, as they are in the PA standards. 

Currently, there are no required curriculum standards within medical schools for SUD/addiction (Ayu et al., 

2017; Servis et al., 2021; Welsh et al., 2020). The Liaison Committee on Medical Education (LCME), which 

accredits all U.S. allopathic medical schools, currently only requires that each school include “behavioral 

subjects” in its medical curricula, but there is no specific mention of requirements for SUD training (Ram & 

Chisolm, 2016). Key words in SUD training such as “addiction,” “substance,” and “drug,” are absent from 

the 2023-2024 LCME standards (Liaison Committee on Medical Education, 2022). The Commission on 

Osteopathic College Accreditation Administration (COCA) standards now mirror many aspects of the LCME 

(Ahmed et all,2023). 

To increase medical school graduates’ competence in SUDs and addiction, several states have enacted 

state legislation and established work groups to ensure medical student trainees receive SUD education. 

For example, the six medical schools of the University of California (UC) System appointed an opioid crisis 

workgroup to develop educational strategies and competencies for adoption across all UC medical schools 

that address pain, SUDs, and public health issues stemming from the opioid crisis (Servis et al., 2021). 

 

Models of Integration of Content into Curriculum 

Recent literature on integration of SUD content to training programs suggests that availability of 

educational resources on addiction, such as faculty development workshops, individual mentorship, and 
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availability of didactic curricula, are necessary facilitators (Schwartz et al., 2018). Infusing SUD curricula 

into existing course topics, content, case studies, vignettes, and simulations (Poon et al., 2016; Ram & 

Chisolm, 2016) is recommended as a means of mitigating limited time allotted in programs (Lembke & 

Humphreys, 2018).

 

Modular Format 

The panelists recommended use of a modular format for didactic content as these enable educators in 

different programs to take all or some components and integrate them into their classes to create 

programs of varying lengths for several disciplines. Modules allow faculty to incorporate the core 

information into multiple classes to reach a larger number of students. Digital content that could be 

downloaded by educators would be helpful, especially if it contained a preamble or other explanation of 

how to use the curriculum. Having an annotated curriculum, guide, or other tools to complement the 

elements of the curriculum for faculty use will encourage wide use of the curriculum. 

Use of Simulations, Case Examples and Presentations by People with Lived Experience 

The experts have found use of simulations and incorporation of case examples in other academic 

coursework to be helpful to reinforce learning. Including people in recovery in simulations and clinical 

rotations can provide firsthand knowledge to students that SUD is treatable, and people can recover; this 

approach also helps correct biases and stigma. Similarly, arranging visits to programs and clinics that 

dispense methadone or buprenorphine for opioid use disorder (OUD) provides an opportunity for 

students to see the positive impact medications for opioid use disorder (MOUD) has on patients, such as 

the University of Pennsylvania’s MOUD shadowing program, which conveys hope and confirms treatment 

works. 

Service and Experiential Learning 

Integrating theory into practice is a well-recognized teaching and learning technique. The sustained 

success of integrating SUD into the social work curriculum was thought to be due to application of the 

content in field experience. This model can be adapted to other healthcare disciplines. As an example, 

nursing students at the University of Missouri Kansas City visit SUD treatment facilities. Service-learning

programs provide an excellent way to get volunteer/clinical experience for students. 

In some schools, opportunities for service learning in the first two years of medical curriculum engaged 

students in low-income clinics, elder care clinics, provided mentorship with high school students and

enabled access to individuals in homeless shelters. In psychiatric rotations of some 3rd year medical 

students, students spend a day at a recovery house and attend a group meeting, and then reflect on the 

experience. Other experiential learning can occur through rotating in a Community Health Center or 

through an opioid treatment program (OTP) or other addiction treatment center. Naloxone trainings 

proved to be an excellent educational opportunity in which early learners became excited to learn more 

about SUD and related clinical skills; the University of Pennsylvania hosted trainings at first year student 

orientation that was led by peers and substance use navigators and gave students hands-on experience 

with naloxone and dispensed naloxone to them. 
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Promoting Institutional-level Integration of SUD Curriculum 

Encourage students to take the lead 

Students as stakeholders in SUD curriculum can provide the impetus to change. For example, students in 

the medical, nursing, and pharmacy schools at University of California (UCSF) started the Harm Reduction 

Interest Group. This group conducts a lot of work in the community for which they requested electives 

credits and further clinical learning opportunities. 

Ensure There Are Well-trained Faculty and Mentors 

Because SUD content has not been taught across healthcare disciplines, panelists highlighted the need for 

faculty who are well-versed in, and comfortable teaching SUD. They recommended that programs develop 

materials for faculty development purposes. Where faculty with experience are not available, additional 

tools, guides and resources are particularly important. One such example is the SBIRT curriculum 

developed and published to help both medical and family medical residency faculty teach residents how to 

identify, approach, and respond to patients using drugs. As an example, Boston University has a very 

effective curriculum for developing medical faculty, the Chief Resident Immersion Training. And as a

resource, SAMHSA’s Addiction Technology Transfer Center Network (ATTCs) continue to help faculty 

develop SUD expertise, and many of the tools have been expanded beyond the addiction workforce to 

anyone who could treat people with, or at risk for, SUD. 

Studies assessing the feasibility of integrating OUD content into graduate nursing curricula point to the 

importance of faculty and stakeholder buy-in to successful curricular modifications (Kameg et al., 2018). 

Faculty members who identify as champions of OUD training and who enthusiastically engage in the 

curriculum are more likely to elicit positive student responses with high participation levels (Kameg et al., 

2018; Kameg et al., 2021). 

Engaging Boards to Develop Competencies and Standards 

The participants encouraged collaborative engagements to explore the development of a core curriculum

and standards and competencies for the professions and recommended that any effort toward 

standardizing competencies should be approached as a community, whether a community board or 

advisory board of a college or even a board of regents at a university or an accreditation board. 

One example of successful public/private partnerships in establishing competencies offered was AAMC and 

the Accreditation Council for Graduate Medical Education (ACGME). The collaborative work of AAMC and 

AACOM, in partnership with, ACGME resulted in development of a shared set of foundational 

competencies for undergraduate medical education.

Although there are no SUD requirements in graduate level nursing education, there are existing SUDrelated competencies that align with national nursing specialty certifications. Increased endorsement and 

implementation of these competencies during graduate nursing education programs could be used to 

guide future development of SUD content and immersion into training curricula (Tierney et al., 2020). 
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Healthcare programs may want to encourage their state to promote SUD content in programs. As an 

example, most California-licensed physicians and surgeons must complete a one-time CME course in pain 

management and the treatment of terminally ill and dying patients. (Radiologists and pathologists are 

exempt.) This course must also include the subject of the risks of addiction associated with the use of 

Schedule II drugs. 

Summary 

Incorporating SUD content into education programs, providing readily accessible training guides and 

resources, and increasing interprofessional collaboration across disciplines to create service-learning

opportunities offer pathways for expanding the emerging workforce capable of providing SUD diagnoses 

and treatment services. Continued and expanded availability of educational opportunities in and beyond 

the classroom offer trainees greater opportunities to broaden their knowledge and expertise in SUD 

treatment. Some factors that facilitate SUD content integration include students’ interest in learning how 

to treat SUDs, faculty development workshops, and OUD and faculty and stakeholder advocacy inclusion 

of SUD content in curriculum standards and SUD treatment competencies. 
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Recommended Core Curriculum Topics for Substance Use Disorder in Early Academic 

Career Healthcare Education Programs 

I. General and Historical Context 

A. Introduction to drug use and trends over time 

B. History of Drug Control Policies in the U.S. 

C. Impact of diagnosis (criminalization of a medical diagnosis)

D. Impact of structural stigma

 

II. Overview of SUD

A. Determinants of SUD

1. Genetic factors

2. Neurobiology of substance use, misuse, and addiction as a chronic disease

3. Impact of the unequal access to any health care, lack of education, stigma, and biases on 

SUD and recovery

B. Substances of Concern

1. Opioids 

2. Stimulants 

3. Depressants

4. Alcohol

5. Tobacco

6. Cannabis

7. Emerging Substances (e.g., xylazine, nitazene ) 

C. Prevention

1. Discussing prevention in clinical settings

2. Specific interventions

3. Mental health and preventing substance use; mitigating unmanaged mental health

D. Legal and ethical issues involved in the care of patients with SUD

1. Professional responsibilities of caring for patients with SUD

a. Complications of not addressing SUD (“Do no harm”), including medical/legal 

complications of not providing care

b. Responsibilities for advising patients about marketing of unapproved medications 

and interventions 

2. Recognizing and addressing discrimination and prejudicial treatment and stigma and bias in 

the community and in the healthcare professions 

3. Lab testing for work-related issues (safety-sensitive and security-sensitive positions); 

balancing caring for persons and environmental safety and occupational issues

4. The role of research in treatment settings

5. 42 CFR Part 2, Controlled Substances Act (CSA), and the Medication Access and Training 

Expansion (MATE Act) (as codified in the Consolidated Appropriations Act, 2023) 
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III. Screening and Assessment for Patients with SUD

A. Screening (“SBIRT”)

B. Assessing for trauma and social determinants of health

1. Trauma assessments should be included as well as references to Adverse Childhood

Experiences (ACEs)

2. Include suicide risk assessment

C. Diagnosis and Assessment

1. Lab testing (drugs and other related-medical issues)

2. Consideration of co-occurring issues

a. polysubstance use

b. medical 

c. mental health disorders (e.g., anxiety, depression, ADHD)

3. SUD and related medical co-morbidities

4. Special Populations 

IV. Treatment of SUD

A. Modalities for treatment

B. Pharmacotherapies for SUD: The initiation and management of FDA-approved medications for 

SUDs, including the impact of unique, individual physiology and metabolism on medication 

pharmacodynamics, including technological delivery systems (such as electrified patches and 

vaping)

1. Alcohol Use Disorder 

2. Opioid Use Disorder

3. Tobacco Use Disorder

C. Integrating pharmacotherapy into care

1. Effective Treatment Planning – and use of person-centered, collaborative approaches and 

decision making, using techniques such as motivational interviewing, conflict resolution, 

and redirection to address anchoring

2. Managing other substances

3. Managing associated medical conditions

4. Patient and family education on safety and overdose prevention (diversion control; safe 

storage; use of naloxone)

5. Toxicology Testing in MOUD/initial and ongoing assessment

6. Diversion management

D. Treatment Approaches 

1. Person-centered care

a. Shared decision-making; treatment goals tailored to the patient

b. Use of patient-centered language and cultural humility

c. How SUD is viewed and discussed in different communities and cultures, such as 

understanding religious practices and how they might influence the attitudes and 

perspectives about certain substances
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Appendices 

Federal Participants 

Twyla Adams, MHS Senior Public Health Advisor, Office of the Director (OD), Center for 

Substance Abuse Treatment (CSAT), Substance Abuse and Mental 

Health Services Administration (SAMHSA)

Robert Baillieu, MD, MPH, FAFFP Physician and Senior Advisor, OD, CSAT, SAMHSA

Esther “Esty” Callens Public Health Advisor, Provider Support Branch (PSB), Division of 

Pharmacologic Therapies (DPT), CSAT, SAMHSA

Christine A. Cichetti Supervisory Public Health Advisor, Office of the Assistant Secretary, 

National Mental Health and Substance Use Policy Laboratory, Policy 

Analysis, Development and Implementation Team, SAMHSA

Neeraj Gandotra, MD Chief Medical Officer, SAMHSA

Belinda Greenfield Public Health Analyst, DPT, CSAT, SAMHSA

CDR Teresa Grund, RPn, NCPS, Behavioral Health Clinical Pharmacist, Red Lake Indian Health 

 BCPS, BCPP Services Hospital

Capt. Ted Hall, PharmD Advanced Practice Pharmacist II, U.S. Public Health Services, Indian 

Health Services, Ho-Chunk Nation Health Department

Patti Juliana, PhD, LCSW Director, DPT, CSAT, SAMHSA

Fola Kayode Public Health Advisor, DPT, CSAT, SAMHSA

Sylvia Las, MPH Public Health Analyst, PSB, DPT, CSAT, SAMHSA

Joseph Liberto, MD National Mental Health Director, Substance Use Disorders

Office of Mental Health and Suicide Prevention, Veterans Administration 

Michele LaTour Monroe Branch Chief, PSB, DPT, CSAT, SAMHSA 

Yngvild Olsen, MD, MPH Director, CSAT, SAMHSA

Karran Phillips, MD, MSc Deputy Director, CSAT, SAMHSA

LaVencia Sugars. MPH Public Health Advisor, DPT, CSAT, SAMHSA

June S. Sivilli, MA Senior Public Health Advisor, Office of Public Health, Office of National 

Drug Control Policy, Executive Office of the President

Marta Sokolowska, PhD Deputy Center Director for Substance Use and Behavioral Health, Center 

for Drug Evaluation and Research, Food and Drug Administration

Patricia Sullivan DNP, APRN, Advanced Practice Nurse Consultant, Division of Nursing Services, 

 FNP-BC Indian Health Service

Field Expert Participants 

Jim Anderson, PA President of American Academy of Physician Assistants, Society of 

Physician Associates in Addiction Medicine; Commissioner, Washington

State Medical Commission 

Richard Bottner, PA Colorado Hospital Association

Natasha Bray, DO Dean, Oklahoma State University College of Osteopathic Medicine, 

Cherokee Nation, Tahlequah, Oklahoma

Keme Carter, MD Pritzker School of Medicine

Anthony Dekker, DO Chief Medical Officer, Developmental Disabilities, State of Arizona
16 | Page

Deborah Finell, PhD, CARN-AP Johns Hopkins School of Nursing; President, Association for 

Multidisciplinary Education and Research in Substance Use and Addiction, 

Inc.

Megan Fujita, MSW, PhD, Director of Accreditation, Council on Social Work Education

Holly Hagle, PhD University Missouri, Kansas City, School of Nursing and Health Studies

Lisa Howley Senior Director, Medical Education, American Association of Medical 

Colleges

Alicia Kowalchuck, DO Baylor College of Medicine, School of Social Work

Frances Levin, MD Professor of Psychiatry, Columbia University/New York State Psychiatric 

Institute 

Paula Lum, MD University of California, San Francisco; American College of Academic 

Addiction Medicine; Association for Multidisciplinary Education and 

Research in Substance Use and Addiction, Inc.

Jean-Marie Perrone, MD Perelman School of Medicine, University of Pennsylvania

Robert Sterling, PhD Associate Professor, Division of Substance Abuse Programs, Thomas 

Jefferson University

Stephen Taylor, MD President, American Society of Addiction Medicine

Luis R. Torres-Hostos, PhD Founding Dean and Professor, School of Social Work, University of Texas 

Rio Grande Valley

H.F. Ofahengaue Vakalahi, PhD President and CEO, Council on Social Work Education

Jenifer Van Deusen, MEd Consultant for SAMHSA’s Core Curriculum Project; Coalition on Physician 

Education
17 | Page

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Schnurman, K., Osborne-Leute, V., Zweben, A., Cary, A., & Moore, B. A. (2022). Substance use–related 

continuing education course objectives: Alignment with professional competencies. Substance Abuse, 

43(1), 1363–1369. 

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Kameg, B., Kaufman, R., Lindsay, D., & Mitchell, A. M. (2018). Integration of Medication Assisted 

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Lembke, A., & Humphreys, K. (2018). The Opioid Epidemic as a Watershed Moment for 

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Resources 

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Abus. 2019;40(4):412-420.

• Bratberg J. Pharmacy: addressing substance use in the 21st century. Subst Abuse. 2019;40(4):421-

434.

• Levy S, Seale JP, Alford DP. Medicine, with a focus on physicians: addressing substance use in the 

21st century. Subst Abuse. 2019;40(4):396-404.

• Mattingly JR. Medicine, with a focus on physician assistants: addressing substance use in the 21st 

century. Subst Abuse. 2019;40(4):405-411. 

• Osborne-Leute V, Pugatch M, Hruschak V. Social work: addressing substance use in the 21st 

century. Subst Abuse. 2019;40(4):435-440.

• Kicking the Stigma. https://www.colts.com/community/kicking-the-stigma/ 

• National Institute on Drug Abuse. Words Matter – Terms to Use and Avoid When Talking About 

Addiction. https://nida.nih.gov/nidamed-medical-health-professionals/health-professionseducation/words-matter-terms-to-use-avoid-when-talking-about-addiction

• National Academy of Medicine. The 3Cs Framework for Pain and Unhealthy Substance Use: 

Minimum Core Competencies for Interprofessional Education and Practice. (https://nam.edu/wpcontent/uploads/2022/06/The-3Cs-Framework-for-Pain-and-Unhealthy-Substance-Use.pdf

• Organizing Around Vital Conditions Moves The Social Determinants Agenda Into Wider Action. 

https://www.healthaffairs.org/content/forefront/organizing-around-vital-conditions-moves-socialdeterminants-agenda-into-wider-action

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https://amersa.org/specific-disciplines-addressing-substance-use-amersa-in-the-21st-century/ 

Educational Accrediting Bodies 

Medicine (including Doctor of Medicine and Doctor of Osteopathic Medicine) 

• Liaison Committee on Medical Education (LCME)

• Accreditation Council for Continuing Medical Education (ACCME) 

• American Medical Association (AMA) 

• American Osteopathic Conjoint Examination Committee on Addiction Medicine (AOCECAM)

• Accreditation Council for Graduate Medical Education (ACGME) 

• Commission on Osteopathic College Accreditation (COCA) 

• Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) 

• National Board of Osteopathic Medical Examiners (NBOME)

Nursing (including undergraduate and graduate degrees in nursing) 

• Accreditation Commission for Education in Nursing (ACEN) 

• Commission on Collegiate Nursing Education (CCNE) 

• Consortium for Advanced Practice Providers

• National League for Nursing, Commission for Nurse Education Accreditation (NLC CNEA)

• American Association of Colleges of Nursing (AACN)
20 | Page

Physician Associates

• Accreditation Review Commission on Education for the Physician Assistant (ARC-PA)

• National Commission on Certification of Physician Assistants (NCCPA)

• American Academy of Physician Associates (AAPA)