An Interview with Emmanuel Pothos, PhD

Dr. Emmanuel Pothos is an Assistant Professor of Pharmacology & Experimental Therapeutics at Tufts School of Medicine and the Sackler School of Graduate Biomedical Sciences. He is also the medical school's "Addiction Medicine" course director.  The School of Medicine Office of Educational Affairs interviewed Dr. Pothos as the featured faculty member for their most recent newsletter.

How does training in addiction medicine differ at Tufts compared to other schools?

Addiction medicine is rarely part of the formal medical school curriculum. This is due to a variety of reasons including the “unpleasantness” of the subject, the lack of resources to deal with addiction, and bureaucratic difficulties for physicians and hospital administrations in obtaining insurance coverage for addiction-related problems for their patients. In addition, drug addicts are often stigmatized patients of limited means that many health care providers simply prefer to avoid. If the health care industry is not focusing on treating addiction, it is difficult to focus medical education on addiction. As a result, most new physicians are not trained to evaluate and treat addicted patients, and this creates a vicious circle between clinical practice and medical education. Finally, many medical schools consider training in addiction as more appropriate for the later stages of clinical education (clerkships, subinternships) where this may occur in a more opportunistic and fragmentary manner. The need for a more systematic foundation in addiction training during the medical school years is often not appreciated.

Emmanuel Pothos, PhDTufts University School of Medicine (TUSM) has recognized that its graduates will frequently encounter problems in addiction medicine. Tufts is currently one of fifteen U.S. medical schools committed to providing properly organized and formalized training in addiction medicine during both the preclinical and clinical years. Tufts made that commitment very early on, in the early 1990s, through the establishment of the Addiction Medicine course.

Through this course, TUSM invites leading world experts in addiction medicine, whether at Tufts or other Boston institutions, to teach our students on issues ranging from the neurobiology of addiction to clinical practice as it applies to different drugs of abuse. The course is innovative in that it incorporates the issues of the chemically dependent physician, group recovery programs and adolescent substance abuse as main topics. In addition to lectures and discussion, the course includes presentations by current and former patients who share their experience with the students and engage them in live discussion.

TUSM actively participates in the Massachusetts Consortium on Physician Information in an effort to develop educational products on addiction medicine that can be incorporated into the medical school curriculum. Also, through an intramural educational award, TUSM has committed to integrate training in addiction medicine throughout the four years of medical school. According to this integration plan, students in Year 1 are trained in interviewing patients for their prescribed and illicit drug use history and each student visits 12-step recovery group meetings. In Year 1, each student participates in the Addiction Medicine module, encompassing current main themes of the field and principles of basic science and clinical practice in addiction medicine. Addiction medicine is incorporated as a core concept in PBL sessions. The integration plan calls for lectures and interactive teaching as part of the core clerkships across Tufts-affiliated hospitals. In year 4, students can rotate through Tufts and affiliated hospital laboratories that work on addiction research. An online database of patient interviews and addiction-related quizzes will be developed to complement the curriculum.

You are co-investigator on the Massachusetts Consortium National Institute of Drug Abuse Center of Excellence project. Please describe the overall project and the specific component taking place at Tufts.

The Massachusetts Consortium for Physician Information received funding from the National Institute of Drug Abuse (NIDA) to survey the educational needs of the biomedical community in addiction training. The intent is to develop and disseminate educational products related to addiction medicine with a special focus on prescription drug abuse. Other members of the Consortium include Boston University, the Cambridge Health Alliance and the University of Massachusetts. The educational products produced are intended to serve as prototypes for any medical school in the country. Other institutions can either readily adopt the developed products into their curriculum or develop new ones based on the prototypes. A key component of this effort is product dissemination. Through continuous partnership with NIDA and the AMA, we strive to publicize and spread the use of our educational products through professional meetings (e.g., AAMC conferences) and on-site visits to medical schools that have not yet included addiction training in their curriculum.

At Tufts we have leveraged our Problem-Based Learning course (PBL). In collaboration with Dr. Ralph Aarons, the PBL director, the OEA, and several of the teaching faculty in Addiction Medicine, we work to develop and expand PBL-related products that facilitate student learning in areas related to prescription drug abuse. Patient interviewing, diagnosis and treatment of patients addicted to pain-relieving drugs involve many medical specialties and constitute a daily routine in hospital wards. By encouraging self-directed learning in these areas and by starting during the preclinical years, the goal is to instill a professional attitude and create a solid background in addiction medicine that will help our students throughout their career.

The products of the consortium will be presented this coming Fall at the AAMC annual conference in Boston, November 6-11, 2009.

Tell us about your research.

I am a neuroscientist and neuropharmacologist and have focused on the study of synaptic plasticity of central dopamine systems. These pathways originate in the midbrain and are closely linked to addictive disorders. My research has dealtextensively with issues related to drug addiction, such as the neurochemical basis of opiate withdrawal and the relation between caloric restriction and the intake of psychostimulants. Recently, we opened up another field of experimental work to consider whether common dietary obesity is actually an addictive disorder that involves the same pathways in the brain as those involved with drugs of abuse. Astonishingly similar deficits in dopaminergic neurotransmission characterize animal models of drug addiction and obesity, as well as in both drug addicts and obese human patients. It seems that such deficits may drive addictive behavior and we are in the midst of testing this hypothesis through different tools, including monitoring ofchanges in real-time neurotransmission and associated behavioral changes in animals.

How did you end up at Tufts?

Following completion of the graduate program in Neuroscience at Princeton University and a successful funding record through a NIDA B/START award and private foundations while being a postdoctoral fellow and junior faculty at Columbia University, I decided to become an independent investigator focusing on the basic science of addiction and hedonic behavior. I chose to come to Tufts and the Department of Pharmacology and Experimental Therapeutics in late 2000 to capitalize on the opportunity to develop this area for the department, to take advantage of the excellent space and core facilities offered by the institution and to benefit from collaboration opportunities in the wider Boston area. My commitment to Tufts was only strengthened by my involvement in the medical school curriculum through the Addiction Medicine course and the recent expansion of the Neuroscience program that will allow additional opportunities for collaboration and innovative research.

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