In December 2004, the Office of National Drug Control Policy (ONDCP) in the Executive Office of the President hosted an important Leadership Conference on Medical Education in Substance Abuse. The conference brought together leaders of private sector organizations, Federal agencies, organized medicine, and licensure and certification bodies to discuss ways to enhance the training of physicians in the prevention, diagnosis, and management of alcohol and drug use disorders, including prescription drug abuse. Participants were charged with identifying strategies and action steps to improve physician knowledge and skills through enhanced undergraduate, graduate, and continuing medical education. The conference was co-sponsored by the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration, as well as the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse of the National Institutes of Health, with the assistance of the Robert Wood Johnson Foundation. This report of the Leadership Conference outlines the rationale for greater physician involvement in recognizing and treating patients with substance use disorders (SUDs), describes current barriers to education in this field, and evaluates the impact of prior initiatives to improve physician education about SUDs. In addition, it proposes core clinical competencies for all physicians, based on important work that has been done by a number of organizations over the past 30 years (AMA, 1979; Lewis, 1994; AMERSA, 2002a, 2002b). Finally, it summarizes the recommendations of the leaders in organized medicine, medical education, licensure and accreditation, and Federal health agencies who gathered for the Leadership Conference. Appended are: (1) Conference Agenda; (2) Acknowledgments; (3) Conference Participants and Small Group Assignments; (4) Follow-up Survey of the Conferees; (5) Glossary; (6) Acronyms; and (7) Supporting Literature.