How does the diagnosis and treatment of substance use disorders fit into the general practice of psychiatry? We have invited Dr Laurence Westreich, President of the American Academy of Addiction Psychiatry (AAAP), to address this question.
Dr Westreich notes that although sub-specialists in addiction see the most difficult cases, general clinicians will inevitably assess and treat addicted and dually-diagnosed patients. In fact, large population studies show that 40% to 50% of psychiatric patients also have addiction issues, so it is part of our practice as psychiatrists.
Understanding the basics of addiction—such as the nature of "slips" and relapse prevention—will render the best outcomes. Everyone wants the addicted person to stop using a substance, but of course they cannot and that is why treatment is so essential.
Additionally, it is crucial to recognize patterns of addiction and know the signs and symptoms that necessitate immediate emergency action. Psychiatrists should also be familiar with:
• the basics of the biological and psychosocial treatments for addiction
• how peer-led support groups like AA interact with treatment
• clinicians' attitudes toward addicted/dually diagnosed patients
• when to refer an addicted or dually diagnosed person to a specialist, inpatient treatment, or an intensive outpatient treatment program
• where to find educational opportunities
The 25th AAAP Annual Meeting in December will report on the latest scientific developments in addiction psychiatry.