Teaching postgraduates about managing drug and alcohol misuseBMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5816 (Published 04 September 2012) Cite this as: BMJ 2012;345:e5816
All rapid responses
This is to thank the editorialists for their interest in our report(1), and to echo Ms.Goslar's rapid response, from two other angles.
The editorial has the headline "Teaching...managing drug and alcohol misuse", emphasizes alcohol in its earlier paragraphs, and, later on, the stereotypical doctor-patient interaction (with the latter having the substance abuse problem). But that is only part of it.
Firstly, this report is just as much by doctors for doctors. Our profession has access to a wide variety of abusable substances, of which alcohol is just one. The competancies that are set out include intra-profession situations, and workplace issues.
Secondly, the stereotypical clinical context suggested by the editorial might lead doctors in the more vicarious specialties (e.g., pharmaceutical medicine, legal medicine, medical journalists, some types of pathologist, etc.) to under-estimate the relevance of this report to them. Not only does the doctor-doctor relationship assume at least as important a role in their professional lives, but also 'Good Medical Practices' applies to them just as much as anybody else on the GMC register. This report addresses several aspects of probity within that framework.
Lastly, the editorialists are quite correct that a report is one thing while implementing it, crucially, is quite another. The Working Group is indeed now engaged in an implementation phase.
01.Royal College of Psychiatrists. Alcohol and other drugs: core medical competencies. Final report of the Working Group of the Royal Colleges. 2012. www.rcpsych.ac.uk/publications/collegereports/op/op85.aspx.
Competing interests: Member of the Working Group mentioned (1)
Firstly, I am pleased that this item appeared in the editorial and has had a positive and encouraging response. However, as the service user member of the working group who compiled this report on the core competencies of "alcohol and other drugs", I would just like to mention that I feel it is a shame that the editorial, when introducing the report, used the title "... about managing drug and alcohol misuse".
We deliberated the actual title of the report very carefully and eventually settled on "alcohol and other drugs" as the terminology to be used. So, the report title leads with alcohol (which is often seen as secondary to drugs and almost always mentioned afterwards) and, by its inference to "other" drugs, makes it plain that alcohol itself is indeed a drug - something which is often glossed over.
I think it's a shame that the order was changed in the editorial to the more usual "drugs and alcohol" as I feel that this title loses much of the original intended reasoning and impact. I wonder if other readers agree with me?
Competing interests: No competing interests
Many apologies to my distinguished former student Julia Sinclair (who chaired the AoMRC working group) for confusing her in a 'Senior Moment' with another distinguished former student, Julia Lawton.
I remain an admirer of the work of them, both.
Competing interests: Have taught about alcohol and drugs for about 25 years
The working group chaired by Julia Lawton for the Academy of Medical Royal Colleges  deserves congratulation for its excellent work in achieving consensus on 12 alcohol competencies for all trainees. Following recent work on alcohol for the Academy of Social Sciences  I was delighted to see the inclusion of Knowledge on:
* Effects of alcohol and other drugs on the unborn child, children and families.
Risk and actual harm to health in family members of drinkers, is common and possibly affects more people than the population directly harmed by ethanol. Nonetheless, it is unwise just to see these family members as victims of collateral damage. Care by clinicians is often greatly enhanced when one or more relatives collaborate with the doctor. Long term and valued relationships can make a big difference to motivation and perseverance for alcohol treatment. 
Sometimes a different Significant Other can help more effectively than, say, a family member who has suffered abuse or betrayal. The working group  included a representative of the Faculty of Occupational Medicine, and a trusted work colleague may also add a significant enhancement to employee alcohol programmes. Anecdotally, other long term relationships (e.g. with probation officers or pastors) may also help. In situations where the drinker feels friendless and worthless, mutual aid in peer groups is not only compatible with medical care but adds benefit. 
1. Academy of Medical Royal Colleges. Alcohol and other drugs: core medical competencies. London: Royal College of Psychiatrists, 2012.
2. Caan W. Alcohol and the family. Contemporary Social Science 2012; 7: in press.
3. Baldacchino A, Caan W, Munn-Giddings C. Mutual aid groups in psychiatry and substance misuse. Mental Health and Substance Use 2008; 1: 104-117.
Competing interests: An advisor to the All Party Parliamentary Group on alcohol misuse and academic member of the East of England MUSE regional group for substance use.