Addiction psychiatry

Last updated
Addiction Psychiatrist
Occupation
NamesPhysician, Psychiatrist, Addiction Psychiatrist, Addictionologist
Occupation type
Profession
Activity sectors
Medicine, Psychiatry
Description
Education required
M.D./ D.O. and certification through the American Board of Psychiatry and Neurology in Adult Psychiatry
Fields of
employment
Hospitals, Clinics
Related jobs
Addiction Medicine

Addiction psychiatry is a medical subspecialty within psychiatry that focuses on the evaluation, diagnosis, and treatment of people who have one or more disorders related to addiction. This may include disorders involving legal and illegal drugs, gambling, sex, food, and other impulse control disorders. Addiction psychiatrists are substance use disorder 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. [1] [2] [3]

Contents

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 (ABMS), with support of the American Psychiatric Association, 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 (ACGME) recognized. Currently the ACGME recognizes 45 different residency programs in the United States. [4] [5] [6]

Profession

Qualifications

In order to become a certified addiction psychiatrist, one must first have completed medical school 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. [7] [8] 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. [9] [10] As of June 2018, the average reported salary of addiction psychiatrists was $250,000. [11] 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. [12]

Treatment

Background

Addiction psychiatry aims to treat individuals with addiction issues along with co-occurring psychiatric disorders, otherwise known as patients with dual diagnosis. [13] 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. [14] Addiction psychiatrists must recognize the numerous factors that tie into each individual's struggle with an addiction. [15]

For example, substance use often occurs among individuals dealing with mood disorders and other social stresses. 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, 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. [16] Moreover, addiction psychiatrists recommend the benefits of 12-Step programs such as Narcotics Anonymous and Alcoholics Anonymous 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. [17] [18] [19]

See also

Related Research Articles

<span class="mw-page-title-main">Neurology</span> Medical specialty dealing with disorders of the nervous system

Neurology is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the nervous system, which comprises the brain, the spinal cord and the peripheral nerves. Neurological practice relies heavily on the field of neuroscience, the scientific study of the nervous system.

A psychiatrist is a physician who specializes in psychiatry. Psychiatrists are physicians who evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments or strictly mental issues. Sometimes a psychiatrist works within a multi-disciplinary team, which may comprise clinical psychologists, social workers, occupational therapists, and nursing staff. Psychiatrists have broad training in a biopsychosocial approach to the assessment and management of mental illness.

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 38,000 members who are involved in psychiatric practice, research, and academia representing a diverse population of patients in more than 100 countries. The association publishes various journals and pamphlets, as well as the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM codifies psychiatric conditions and is used mostly in the United States as a guide for diagnosing mental disorders.

<span class="mw-page-title-main">Forensic psychiatry</span> Subspeciality of psychiatry, related to criminology

Forensic psychiatry is a subspeciality of psychiatry and is related to criminology. It encompasses the interface between law and psychiatry. According to the American Academy of Psychiatry and the Law, it is defined as "a subspecialty of psychiatry in which scientific and clinical expertise is applied in legal contexts involving civil, criminal, correctional, regulatory, or legislative matters, and in specialized clinical consultations in areas such as risk assessment or employment." A forensic psychiatrist provides services – such as determination of competency to stand trial – to a court of law to facilitate the adjudicative process and provide treatment, such as medications and psychotherapy, to criminals.

<span class="mw-page-title-main">Emergency psychiatry</span> Clinical application of psychiatry in emergency settings

Emergency psychiatry is the clinical application of psychiatry in emergency settings. Conditions requiring psychiatric interventions may include attempted suicide, substance abuse, depression, psychosis, violence or other rapid changes in behavior.

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 use of substances including alcohol, 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, psychology, social work, mental health counseling, psychiatry, and internal medicine, among others. Incorporated within the specialty are the processes of detoxification, rehabilitation, harm reduction, 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 and HIV infection.

A mental health professional is a health care practitioner or social and human services provider who offers services for the purpose of improving an individual's mental health or to treat mental disorders. This broad category was developed as a name for community personnel who worked in the new community mental health agencies begun in the 1970s to assist individuals moving from state hospitals, to prevent admissions, and to provide support in homes, jobs, education, and community. These individuals were the forefront brigade to develop the community programs, which today may be referred to by names such as supported housing, psychiatric rehabilitation, supported or transitional employment, sheltered workshops, supported education, daily living skills, affirmative industries, dual diagnosis treatment, individual and family psychoeducation, adult day care, foster care, family services and mental health counseling.

A combined internal medicine and psychiatry residency program is a post-graduate medical education program in the United States, which leads to board eligibility in both internal medicine and psychiatry. That is, a graduate of the residency is both an internist as well as a psychiatrist. The program takes five years of post-graduate medical training. There are 12 such programs in the country, and around eighteen positions available for new applicants.

In the United States, a psychiatric-mental health nurse practitioner (PMHNP) is an advanced practice registered nurse trained to provide a wide range of mental health services to patients and families in a variety of settings. PMHNPs diagnose, conduct therapy, and prescribe medications for patients who have psychiatric disorders, medical organic brain disorders or substance abuse problems. They are licensed to provide emergency psychiatric services, psychosocial and physical assessments of their patients, treatment plans, and manage patient care. They may also serve as consultants or as educators for families and staff. The PMHNP has a focus on psychiatric diagnosis, including the differential diagnosis of medical disorders with psychiatric symptoms, and on medication treatment for psychiatric disorders.

Child and adolescent psychiatry is a branch of psychiatry that focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. It investigates the biopsychosocial factors that influence the development and course of psychiatric disorders and treatment responses to various interventions. Child and adolescent psychiatrists primarily use psychotherapy and/or medication to treat mental disorders in the pediatric population.

Dual diagnosis is the condition of having a mental illness and a comorbid substance use disorder. There is considerable debate surrounding the appropriateness of using a single category for a heterogeneous group of individuals with complex needs and a varied range of problems. The concept can be used broadly, for example depression and alcohol use disorder, or it can be restricted to specify severe mental illness and substance use disorder, or a person who has a milder mental illness and a drug dependency, such as panic disorder or generalized anxiety disorder and is dependent on opioids. Diagnosing a primary psychiatric illness in people who use substances is challenging as substance use disorder itself often induces psychiatric symptoms, thus making it necessary to differentiate between substance induced and pre-existing mental illness.

Geriatric psychiatry, also known as geropsychiatry, psychogeriatrics or psychiatry of old age, is a branch of medicine and a subspecialty of psychiatry dealing with the study, prevention, and treatment of neurodegenerative, cognitive impairment, and mental disorders in people of old age. Geriatric psychiatry as a subspecialty has significant overlap with the specialties of geriatric medicine, behavioural neurology, neuropsychiatry, neurology, and general psychiatry. Geriatric psychiatry has become an official subspecialty of psychiatry with a defined curriculum of study and core competencies.

<span class="mw-page-title-main">Psychiatry</span> Branch of medicine devoted to mental disorders

Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of deleterious mental conditions. These include various matters related to mood, behaviour, cognition, perceptions, and emotions.

David M. McDowell (1963–2014) was an American psychiatrist, author and creative consultant. He co-founded the Substance Treatment and Research Service at Columbia University and served as its medical director. He also founded Columbia's Buprenorphine Program, the first such treatment program for opiate addiction in the United States, which according to The New York Times had an 88% success rate. His scholarly work has focused on co-occurring psychiatric disorders and substance abuse problems, particularly club drugs and marijuana. McDowell's book Substance Abuse: From Principles to Practice, is one of the more highly regarded and accessible books on the subject, and is excerpted in the American Psychiatric Association's textbook on substance abuse treatment.

Herbert David Kleber was an American psychiatrist and substance abuse researcher. His career, centered on the evidence-based treatment of addiction, focused on scientific approaches in place of punishment and moralisms. His career focused on pathology of addiction to help patients reduce the severe discomforts of withdrawal, avoid relapse and stay in recovery.

The following outline is provided as an overview of and topical guide to psychiatry:

The American Osteopathic Board of Neurology and Psychiatry (AOBNP) is an organization that provides board certification to qualified Doctors of Osteopathic Medicine (D.O.) and non-osteopathic physicians who specialize in disorders of the nervous system (neurologists) and to qualified Doctors of Osteopathic Medicine and physicians who specialize in the diagnosis and treatment of mental disorders (psychiatrists).

<span class="mw-page-title-main">Charles P. O'Brien</span> American research scientist, medical educator (born 1939)

Charles P. O'Brien is a research scientist, medical educator and a leading expert in the science and treatment of addiction. He is board certified in neurology, psychiatry and addiction psychiatry. He is currently the Kenneth E. Appel Professor of Psychiatry, and vice chair of psychiatry, in the Perelman School of Medicine at the University of Pennsylvania.

The American Academy for Addiction Psychiatry (AAAP) is a professional organization and an accredited Continuing Medical Education (CME) provider, based in East Providence, Rhode Island, USA. Its members are specialists in addiction psychiatry and other health care professionals who treat patients with addictions. AAAP provides medical education programs in the field of addiction psychiatry.

Ayana Jordan is an American addiction psychiatrist and immunopathologist. She researches treatments for substance use disorders in marginalized communities. She is the Barbara Wilson Associate Professor of Psychiatry at NYU Langone Health and was a professor at Yale School of Medicine. She served as an attending psychiatrist in the Yale University Department of Psychiatry. She was elected to the Board of Trustees of the American Psychiatric Association in 2018. She attended Hampton University and received her MD and PhD from the Albert Einstein College of Medicine.

References

  1. American Academy of Addiction Psychiatry, "What is the Addiction Psychiatry Subspecialty?", 2012, "", 2/2/2013
  2. American Society of Addiction Medicine, "Definition of Addiction", April 19, 2011, " Archived 2018-06-14 at the Wayback Machine ", 2/15/13
  3. Abuse, National Institute on Drug (2023-09-19). "Commonly Used Drugs Charts | National Institute on Drug Abuse (NIDA)". nida.nih.gov. Retrieved 2023-11-27.
  4. ACGME, "Programs by Speciality- Addiction Psychiatry", 2012, "", 2/2/13
  5. American Board of Psychiatry and Neurology, "Addiction Psychiatry", 2012, " Archived 2013-01-27 at the Wayback Machine ", 2/2/13
  6. "Addiction Psychiatry: Training, Certification, Online Resources". Medscape. Retrieved 2023-11-27.
  7. John T. Pichot, MD, Luz Starck, MD, John T. Harris, MD, Jeffrey M. Benzick, MD, Medscape Psychiatry & Mental Health eJournal, "Addiction Psychiatry: Training, Certification, and Internet Resources", 1997, ""
  8. ACGME, "Programs by Speciality- Addiction Psychiatry", 2012, "", 2/2/13
  9. American Society of Addiction Medicine, "Federal Funding for Addiction Prevention, Treatment and Rehabilitation", April 1, 1995, "", 2/15/13
  10. American Academy of Addiction Psychiatry, "Trainee FAQ", 2012, " "Trainee FAQ | American Academy of Addiction Psychiatry". Archived from the original on 2013-02-18. Retrieved 2013-02-16.", 2/2/13
  11. ZipRecruiter, "Addiction Psychiatrist Annual Salary", 2018, "", 7/21/18
  12. U.S. News & World Report, "Best Addiction Psychiatrists", 2012, "", 2/2/13
  13. Kathleen Brady M.D., Ph.D., "The Role of Addiction Psychiatry", 2013, "", 2/2/13
  14. National Institute on Drug Abuse, "Health Effects", December 2012, "",2/15/13
  15. Whitelightbh
  16. "Medications for Substance Use Disorders".
  17. Cedars-Sinai, "Addiction Psychiatry Program", 2013, "", 2/2/13
  18. National Institute on Drug Abuse, "Health Effects", December 2012, "", 2/15/13
  19. Canadian Psychiatric Association, "What do psychiatrists do?", 2012, " Archived 2013-04-14 at archive.today ", 2/15/13