In relation to improving medical students' attitudes towards substance use disorders, Ballon & Skinner's [59] non-comparison, qualitative study found that incorporating reflection techniques into psychiatry postgraduates training enhanced understanding of the lived experience of substance use disorders and improved clinical skills for working with people who have these conditions. Silins et al. [70] examined a structured drug and alcohol education and clinical experience program for medical students, which revealed small but significant decreases in the dislike of problem drinkers among the first-year (g = 0.30, SE = 0.10, P < 0.01) and fourth-year (g = 0.34, SE = 0.11, P < 0.01) students. A significant decrease in the dislike of heroin users was achieved only among fourth-year students (g = 0.35, SE = 0.11, P < 0.01). Among fourth-year students, the intervention also produced moderate and significant reductions in the anticipated level of discomfort in working with people who have alcohol use disorders (g = 0.60, SE = 0.12, P < 0.001) but not heroin use disorders. Finally, following the intervention, fourth-year students had a significantly increased sense of responsibility
