Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and recovery of persons with

addiction Addiction is a neuropsychological disorder characterized by a persistent and intense urge to use a drug or engage in a behavior that produces natural reward, despite substantial harm and other negative consequences. Repetitive drug use can ...

, of those with substance-related and addictive disorders, and of people who show unhealthy use of substances including

alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

, nicotine, prescription medicine and other illicit and licit drugs. The medical subspecialty often crosses over into other areas, since various aspects of addiction fall within the fields of

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...

psychology Psychology is the scientific study of mind and behavior. Its subject matter includes the behavior of humans and nonhumans, both consciousness, conscious and Unconscious mind, unconscious phenomena, and mental processes such as thoughts, feel ...

social work Social work is an academic discipline and practice-based profession concerned with meeting the basic needs of individuals, families, groups, communities, and society as a whole to enhance their individual and collective well-being. Social wo ...

mental health Mental health is often mistakenly equated with the absence of mental illness. However, mental health refers to a person's overall emotional, psychological, and social well-being. It influences how individuals think, feel, and behave, and how t ...

counseling,

psychiatry Psychiatry is the medical specialty devoted to the diagnosis, treatment, and prevention of deleterious mental disorder, mental conditions. These include matters related to cognition, perceptions, Mood (psychology), mood, emotion, and behavior. ...

, and

internal medicine Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of ...

, among others. Incorporated within the specialty are the processes of

detoxification Detoxification or detoxication (detox for short) is the physiological or medicinal removal of toxic substances from a living organism, including the human body, which is mainly carried out by the liver. Additionally, it can refer to the period o ...

, rehabilitation,

harm reduction Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. H ...

, abstinence-based treatment, individual and group therapies, oversight of halfway houses, treatment of withdrawal-related symptoms, acute intervention, and long term therapies designed to reduce likelihood of relapse. Some specialists, primarily those who also have expertise in family medicine or internal medicine, also provide treatment for disease states commonly associated with substance use, such as

hepatitis Hepatitis is inflammation of the liver parenchyma, liver tissue. Some people or animals with hepatitis have no symptoms, whereas others develop yellow discoloration of the skin and whites of the eyes (jaundice), Anorexia (symptom), poor appetite ...

and HIV infection. Physicians specializing in the field are in general agreement concerning applicability of treatment to those with addiction to drugs, such as

and

heroin Heroin, also known as diacetylmorphine and diamorphine among other names, is a morphinan opioid substance synthesized from the Opium, dried latex of the Papaver somniferum, opium poppy; it is mainly used as a recreational drug for its eupho ...

, and often also to

gambling Gambling (also known as betting or gaming) is the wagering of something of Value (economics), value ("the stakes") on a Event (probability theory), random event with the intent of winning something else of value, where instances of strategy (ga ...

, which has similar characteristics and has been well-described in the scientific literature. There is less agreement concerning definition or treatment of other so-called addictive behavior such as

sexual addiction Sexual addiction is a state characterized by compulsive participation or engagement in sexual activity, particularly sexual intercourse, despite negative consequences. The concept is contentious; sexual addiction is not a clinical diagnosis in ...

and internet addiction, such behaviors not being marked generally by physiologic tolerance or withdrawal. Over centuries,

has been recognized as an issue to be treated, and has been addressed with the creation of a multitude of organizations, the passage of certain acts, and the development of various drugs in the medical field all to help those who struggle with addiction. Doctors focusing on addiction medicine are medical specialists who focus on addictive disease and have had special study and training focusing on the prevention and treatment of such diseases. There are two routes to specialization in the addiction field: one via a psychiatric pathway and one via other fields of medicine. The American Society of Addiction Medicine notes that approximately 40% of its members are psychiatrists (MD/DO) while the remainder have received primary medical training in other fields.

History of Addiction Medicine

1750s-early 1800s:

Addiction first became well known and seen as a major issue between the 1750s and early 1800s with alcoholism running rampant and being the main contributor to this. Dr. Benjamin rush first began to discern alcoholism as an illness to be addressed when he published his writing “''Inquiry into the Effects of Ardent Spirits on the Human Mind and Body''” in 1784. Because of his writing of alcoholism, the beginnings of the

temperance movement The temperance movement is a social movement promoting Temperance (virtue), temperance or total abstinence from consumption of alcoholic beverages. Participants in the movement typically criticize alcohol intoxication or promote teetotalism, and ...

came shortly after in the early 1800s.

1800s:

The first inebriate homes for alcoholics opened around the 1850s. These homes and asylums provided a segregated place for alcoholics to stay while they withdrew from the alcohol, along with integration into sobriety groups. In 1864, Dr. Joseph Edward Turner opened the New York State Inebriate Asylum, which was the first rehabilitation center for alcoholism. In the late 1800s, around 1890, alcoholics were sent to hospital wards and drunk tanks, as inebriate homes began shutting down.

1900-1950:

Throughout the first half of the 1900s, many hospitals and organizations opened to assist addicts, such as the Charles B. Towns substance abuse Hospital (1901), the Emmanuel Clinic/the Emmanuel movement (1906), morphine maintenance clinics (1919-1924), narcotics farms (1935),

Alcoholics Anonymous Alcoholics Anonymous (AA) is a global, peer-led Mutual aid, mutual-aid fellowship focused on an abstinence-based recovery model from alcoholism through its spiritually inclined twelve-step program. AA's Twelve Traditions, besides emphasizing anon ...

(1935), etc. In addition to this, certain state laws were passed to try to sterilize disabled people, addicts, and people with mental disorders (1910). During this time, various drugs also came out to attempt to cure

alcoholism Alcoholism is the continued drinking of alcohol despite it causing problems. Some definitions require evidence of dependence and withdrawal. Problematic use of alcohol has been mentioned in the earliest historical records. The World He ...

like barbiturates, amphetamines, LSD, and disulfiram (1948-1950).

1950-2000:

Within these years, multiple advancements were made, certain laws or acts were passed, and more organizations came about to help people with addiction. In 1957, treatment units for alcoholics were developed by the Veterans Administration. Shortly thereafter, a multitude of associations opened. These include but are not limited to the Halfway House Association (1958), the Betty Ford Clinic (1982), Cocaine Anonymous (1982), Secular Organizations for Sobriety and Rational Recovery (1985-1986), and SMART Recovery (1994). Along with that, drugs like methadone (1964), Narcan (1971), and naltrexone (1994), were developed to fight against opioid withdrawal and alcoholism. As for the legal side of things, the Controlled Substances Act passed in 1970, which classified all controlled substances into five classes, and the Drug Addiction Treatment Act passed in 1999, enforcing a stricter version of the Controlled Substances Act.

2000-present day:

In the past 25 years, further developments have been made in the field of addiction medicine such as the FDA approval of a treatment called buprenorphine for opioid addicts, along with The Mental Health Parity and Addiction Equity Act (2008) and the Affordable Care Act (2010) being passed. The MHPAEA of 2008 made it mandatory for insurance organizations to give people coverage for the cost of substance abuse related treatments, while the ACA of 2010 further expanded the coverage offered for substance abuse related treatments through state health insurances.

Schooling to Become an Addiction Specialist

To become an addiction specialist, one would typically obtain a bachelor’s degree in a field related to

first before obtaining a more common master’s degree in the field of

therapy A therapy or medical treatment is the attempted remediation of a health problem, usually following a medical diagnosis. Both words, ''treatment'' and ''therapy'', are often abbreviated tx, Tx, or Tx. As a rule, each therapy has indications a ...

with addiction as the focal point. If one would want to advance further, they could go to school for a doctorate degree in addiction counseling or a degree related to addiction medicine. One might do this if they wanted to dive into the depths of addiction medicine as a subspecialty and learn all of what there is to know about the topic, which might include a career as a professor in addiction studies or a job in an administrative position at a rehabilitation center. A more hands-on approach that one could take to gain more experience in the field of addiction medicine include clinical hours, internships, or entry-level positions where one can gain a better understanding of the field.

Accreditation in the United States

In October of 2015, the American Board of Medical Specialties (ABMS) officially recognized addiction medicine as a subspecialty. In several countries around the world, specialist bodies have been set up to ensure high quality practice in addiction medicine. For example, within the

United States The United States of America (USA), also known as the United States (U.S.) or America, is a country primarily located in North America. It is a federal republic of 50 U.S. state, states and a federal capital district, Washington, D.C. The 48 ...

, there are two accepted specialty examinations. One is a Board Certification in Addiction Psychiatry from the American Board of Psychiatry and Neurology. The other is a Board Certification in Addiction Medicine from the American Board of Preventive Medicine. The latter approach is available to all physicians with primary Board certification, while the former is available only to board-certified psychiatrists. Doctors of Osteopathic Medicine may also seek board certification via the American Osteopathic Association (AOA). The Doctor of Osteopathic Medicine must have a primary board certification in Neurology & Psychiatry,

Internal Medicine Internal medicine, also known as general medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of diseases in adults. Its namesake stems from "treatment of diseases of ...

, or Family PracticeFamily Practice certification
from the American Osteopathic Association] from the American Osteopathic Association and complete an AOA approved addiction medicine fellowship. Successful completion of a board examination administered via the AOA will grant a certificate of added qualification (CAQ) in addiction medicine.

Accreditation internationally

Within Australia, addiction medicine specialists are certified via the Chapter of Addiction Medicine, which is part of the Royal Australasian College of Physicians. They may alternatively be a member of the Section of Addiction Psychiatry, Royal Australian & New Zealand College of Psychiatrists. The International Society of Addiction Medicine also can provide certification of expertise.

Medical societies

* American Society of Addiction Medicine (ASAM)

Medical journals

* '' Journal of Addiction Medicine'' (JAM) * '' Journal of Addictions Nursing'' * '' JAMA Neurology''

References

External links

ISAM — International Society of Addiction MedicineABPN — American Board of Psychiatry and NeurologyABAM — American Board of Addiction MedicineASAM — American Society of Addiction MedicineAOAAM — American Osteopathic Academy of Addiction Medicine
{{Antiaddictives Substance-related disorders