Substance use disorders disproportionally contribute to the global burden of disease (Rehm et al., 2009); however, their treatment has been hindered in large part because of a long-standing "bench to practice" gap in which competencies for assessing, treating, and preventing substance use disorders are often lacking from health care education curricula (The National Center on Addiction and Substance Abuse at Columbia University, 2012). Immediate and effective translation of recent advances in addiction research into routine clinical practice requires specialized training programs for health professionals involved in the care of patients and families affected by substance use disorders.

Nurses play an essential role in assessing and treating the full range of substance use disorders. For instance, a Cochrane review found that patients who had received nurse-administered brief interventions for tobacco cessation were 1.3 times more likely to stop smoking compared with control patients (Rice & Stead, 2008). Other innovative nurse-led and case-managed models of care may be successful alternative strategies for treating patients with opioid addiction (Alford et al., 2011; LaBelle, Han, Bergeron, & Samet, 2016). Unfortunately, there is a systemic lack of curricula and comprehensive training programs for nurses to learn and practice evidence-based addiction care (The National Center on Addiction and Substance Abuse at Columbia University, 2012).

Interdisciplinary education between physicians, nurses, and other allied health providers can promote collaboration and improve decision-making to optimize approaches to patient care (Maxson et al., 2011). Although health care training is gradually transitioning toward more multidisciplinary training models, traditionally, nurses and physicians have been trained through separate programs despite working closely together in real-world practice. This disconnect between training and practice may further deepen the division between nurses and physicians, which may ultimately compromise patient safety, nurse-physician communication, staff retention, and job satisfaction (O'Leary et al., 2010; Rosenstein, 2002). Although the unique roles, responsibilities, and scopes of practice of nurses and physicians often require separate training programs, blended interdisciplinary training may play a particularly important role in effectively managing substance use disorders and related harms, such as mitigating the risk of fatal overdose associated with overprescribing in the midst of the current opioid epidemic (Gugelmann, Shofer, Meisel, & Perrone, 2013).

Recently, a new interdisciplinary fellowship in addiction nursing, social work, and medicine has been established in Vancouver, Canada. This unique fellowship-which is embedded within North America's largest addition medicine training program-currently trains eight physicians, four nurses, and two social workers each year, who engage in specialty clinical addiction skills training in addition to research and leadership skill development. Interdisciplinary fellows learn and teach together in a variety of educational settings including clinic site rotations, didactic lectures, journal clubs, case study discussions, and attendance at addiction medicine conferences.

To evaluate the impact of this interdisciplinary fellowship on clinician competence and confidence, the Better Addiction Medicine Education for Doctors study was established, which involves 50-minute voluntary qualitative interviews with clinicians who have completed the addiction fellowship. Preliminary findings from nurse fellows participating in the study signal a beneficial effect of interdisciplinary training on their knowledge and skills in addiction nursing. For instance, one nurse stated:

So often [nurses] get training that is, you know, separate. So nurses get their own workshops and their own conferences, and physicians are somewhere else doing their own learning. So it was really valuable to learn next to physicians and to get that same training that they get[horizontal ellipsis]. I think it also helps build more of a respect and collaboration when there's interdisciplinary learning. Sometimes as nurses we feel segregated, or there's a bit of a power dynamic between physicians and nurses. But when you're learning together in the same room you're on an equal level, and I think that really helped-for me, I felt a sense of empowerment, and I felt that it was more of a collaborative learning environment.

Participants also highlighted the systemic issue of interdisciplinary teaching that is lacking in many health care settings. One nurse commented, "Physicians don't know how to train nurses," whereas another nurse stated: "There's not as much of a culture of teaching in nurses[horizontal ellipsis]when I went to some of the clinical settings, often the nurses there didn't really know what my role was[horizontal ellipsis]. They hadn't heard of what a 'nursing fellow' was before." Therefore, nurses emphasized the need to expand nurse-specific education in interdisciplinary addiction teaching settings and to foster interdisciplinary fellowships that capitalize on the teaching and learning styles of nurses.

Thus, although addiction medicine fellowships for physicians exist in many settings and play an important role in bridging the gap between science and practice in clinical care, the impact of these fellowships may be increased by training nurses and other allied health professionals alongside physicians. In addition, given the immense potential of nurses to improve access to care, reduce harms, and improve the quality of life for individuals with substance use disorders, further development of nurse-specific fellowships, basic undergraduate curricula in addiction nursing, and interdisciplinary training opportunities is greatly needed.

Acknowledgments

We wish to acknowledge Carmen Rock, Deborah Graham, and Tricia Collingham for their administrative support.

REFERENCES