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Addiction psychiatry is a medical subspecialty within
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. ...
that focuses on the evaluation, diagnosis, and treatment of people who have one or more disorders related to
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 ...
. This may include disorders involving legal and illegal drugs, gambling, sex, food, and other
impulse control disorder Impulse-control disorder (ICD) is a class of mental disorder, psychiatric disorders characterized by impulsivity – failure to resist a temptation, an urge, or an impulse; or having the inability to not speak on a thought. The fifth edition of ...
s. Addiction psychiatrists are
substance use disorder Substance use disorder (SUD) is the persistent use of drugs despite substantial harm and adverse consequences to self and others. Related terms include ''substance use problems'' and ''problematic drug or alcohol use''. Along with substance-ind ...
experts. Growing amounts of scientific knowledge, such as the health effects and treatments for substance use disorders, have led to advancements in the field of addiction psychiatry. These advancements in understanding the neurobiology of rewarding behavior, along with federal funding, has allowed for ample opportunity for research in the discipline of addiction psychiatry. Addiction psychiatry is an expanding field, and currently there is a high demand for substance use disorder experts in both the private and public sector.


History

Addiction psychiatry is a relatively new subspecialty of psychiatry. As of October 1991, the American Board of Psychiatry and Neurology and the
American Board of Medical Specialties The American Board of Medical Specialties (ABMS) is a non-profit organization established in 1933 which represents 24 broad areas of specialty medicine. ABMS is the largest and most widely recognized physician-led specialty certification organi ...
(ABMS), with support of the
American Psychiatric Association The American Psychiatric Association (APA) is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organization in the world. It has more than 39,200 members who are in ...
, established a "Committee on Certification of Added Qualifications in Addiction Psychiatry." This was a way to identify the most educated and experienced psychiatrists in the profession; however, it was not until 1993 when "Addiction Psychiatry" was granted sub-specialization status. Years later, in 1997 the committee's board of trustees along with the ABMS renamed the committee "Committee on Certification in the Subspecialty of Addiction Psychiatry". The committee became more geared toward developing the subspecialty of addiction psychiatry. As of 1997, there were only 13 addiction psychiatry programs that the
Accreditation Council for Graduate Medical Education The Accreditation Council for Graduate Medical Education (ACGME) is the body responsible for accrediting all graduate medical training programs —internships, residencies, and fellowships (subspecialty programs) — for physicians in the United ...
(ACGME) recognized. Currently the ACGME recognizes 45 different residency programs in the United States.


Profession


Qualifications

In order to become a certified addiction psychiatrist, one must first have completed
medical school A medical school is a tertiary educational institution, professional school, or forms a part of such an institution, that teaches medicine, and awards a professional degree for physicians. Such medical degrees include the Bachelor of Medicine, ...
and further be certified as a general psychiatrist by the ABPN. Next, general psychiatrists must commit themselves to an ACGME-accredited residency in addiction psychiatry. The addiction psychiatry residencies are one-year programs set in a hospital or clinical setting where general psychiatrists learn how to diagnose and treat substance-use disorders as well as potential coexisting psychiatric disorders. After completing one of these residency programs addiction psychiatrists are then capable of being hired in either a private or public setting.


Status

An increase in pressure from local and federal governments to provide for patients suffering from addiction has resulted in the increased demand for addiction psychiatrists. Federal funding for the prevention of addiction has been carried out via block grants. These investments in addiction treatment yield savings in overall societal costs, as general health care costs diminish. As of June 2018, the average reported salary of addiction psychiatrists was $250,000. Additionally, 47 addiction psychiatrist appeared on '' U.S. News & World Report''s list of U.S. News Top Doctors. A further 16 addiction psychiatrists were nominated by their peers to an even more selective group of America's Top Doctors.


Treatment


Background

Addiction psychiatry aims to treat individuals with addiction issues along with co-occurring psychiatric disorders, otherwise known as patients with
dual diagnosis Dual diagnosis (also called co-occurring disorders (COD) or dual pathology) is the condition of having a mental illness and a comorbid substance use disorder. Several US based surveys suggest that about half of those with a mental illness will ...
. Addiction psychiatrists treat a wide variety of patients of all ages with varying conditions. Each case of addiction is unique and addiction psychiatrists must cater to each individual patient. Addiction psychiatrists must recognize the numerous factors that tie into each individual's struggle with an addiction. For example, substance use often occurs among individuals dealing with mood disorders and other
social stress Social stress is stress that stems from one's relationships with others and from the social environment in general. Based on the appraisal theory of emotion, stress arises when a person evaluates a situation as personally relevant and perceives ...
es. Addiction psychiatrists must be able to recognize, diagnose, and treat the disorders concurrent with the substance use issues. Furthermore, addiction psychiatrists must also recognize certain health effects from illicit drugs in order to properly treat each individual.


Methodology

Addiction psychiatry encompasses both medicine and
psychotherapy Psychotherapy (also psychological therapy, talk therapy, or talking therapy) is the use of Psychology, psychological methods, particularly when based on regular Conversation, personal interaction, to help a person change behavior, increase hap ...
, or professional therapeutic interaction, as the means of treating individuals. In a conventional addiction psychiatry session, addiction psychiatrists will gain a better understanding of their patient's lifestyle by gathering medical history and the patient's mental health concerns. Next, the psychiatrist will identify individualized solutions to the patient's problem; this may include medicines and/or psychotherapy. Addiction psychiatrists are uniquely equipped to handle co-occurring mental health diagnoses and substance use disorders (whether in the context of active use, withdrawal or early/late recovery). While there are many FDA-approved medications for substance use disorder treatment, addiction psychiatrists can attune to the most appropriate medication for their specific patient. Acamprosate, disulfiram, and naltrexone are the most common medications used to treat alcohol use disorder. Buprenorphine, methadone, and naltrexone are the most common medications used to treat OUD. Moreover, addiction psychiatrists recommend the benefits of 12-Step programs such as Narcotics Anonymous and
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 ...
and often encourage patients to seek external support. Addiction psychiatry can also be a method of recovery for those who have been unable to manage their substance use disorder without prior success.Canadian Psychiatric Association, "What do psychiatrists do?", 2012,

", 2/15/13


See also

* American Academy of Addiction Psychiatry *
Addiction Medicine Addiction medicine is a medical subspecialty that deals with the diagnosis, prevention, evaluation, treatment, and recovery of persons with addiction, of those with substance-related and addictive disorders, and of people who show unhealthy u ...
* Addiction psychology


References


External links

*
Addiction and Substance Use DisordersAlcohol And Drug Rehab Guide
{{Psychiatry Substance-related disorders