Country Profile - Germany

The education of medical students in addiction medicine is extremely variable from one university to another. It depends very much on the personal research and treatment interests of the academic teachers. Addiction medicine topics are dealt with in different specialities of medicine such as biochemistry, physiology, pharmacology and toxicology, internal medicine, neurology and psychiatry. An interview of 91 medical students at the University of Tuebingen revealed that, with the exception of psychiatry, students feel that the quality and quantity of teaching in addiction issues are not satisfactory (1). A similar survey among psychology students produced almost identical results (2).

During residency there is no formalised curriculum for education in addiction of future medicaI doctors in Germany. Most specialities do not deal with these issues at all. Even general practitioners and internists do not have to gain experience with addicted patients. This is true to a lesser extent for psychiatrists also. Again there are differences between universities and other education Institutes. The situation is somewhat better at the universities of Berlin, Essen, Lübeck, Munich, Tuebingen, Mannheim, and Heidelberg.

Since 5 per cent of the adult male German population is alcohol dependent and about 2 per cent of the female population, the diagnosis and treatment of alcoholism plays an important role in daily medical practice. This is in sharp contrast to the shortcomings in addiction education. First attempts are being made to establish a curriculum ("Fachkunde Suchttherapie") for practising doctors. The state of Baden-Württemberg in the southwest of Germany is the first and only to have implemented this curriculum already. It consists of 34 hours of practical training with the focus on drug addiction and substitution treatment. It is now being enlarged to about 52 hours which then will include diagnosis and treatment of alcoholism and nicotine dependence as well. Similar attempts are being made in Bavaria too. A second project aims at establishing an additional qualification in addiction medicine which should take between 2-3 years whilst practising medicine. This "Zusatzitel Suchtmedizin" is still a matter of extensive debate.

The disastrous situation as regards the education of medical students and doctors is fortunately becoming more apparent to the authorities, the professionals, and the general public. The self-governing bodies of doctors (Ärztekammern), following the example of the state of Baden-Württemberg, have initiated programmes for continued medical education in the field of addiction.

There is additional momentum from research since the Federal Ministry of Research and Education earmarked 20-25 million Deutsch-Marks over a period of five years. This will be specifically aimed at improving the delivery of medical and psychological care to those with alcohol or other drug problems, including nicotine, by raising the standards of of the doctors' own training in these fields. Only those grant applications which can show a considerable outreach from university research institutes to family practitioners, community counsellors, and self-help groups will be funded.

It is also noteworthy that the German Government has widened its focus to include all the addictions. Ten years ago only illegal drugs received political attention. Now tobacco and alcohol have been added.

By these measures we hope to make some progress in improving medical education in alcohol and hence alcohol problems in Germany.

Pr K. Mann

References

1 Mann, K., Kapp, B. (1995) Zur Lehre in Suchtmedizin. Eine Befragung von Studenten und Professoren. In: Mann, K., Buchkremer, G. (Hrsg.) Suchtforschung und Suchttherapie in Deutschland. SUCHT, Sonderband, S.38-40.
2 Küfner , H., Haf, C.m., Miehle, K. (1989) Ausbildung von Psychologen im Bereich der Suchterkrankungen. Psychologische Rundschau (Berichte) 40:227-232.