Background to addictions psychiatry
The problems and consequences of
illicit drug use and excessive alcohol use are an apparently
universal and persistent source of concern for the media and
public. Within addiction psychiatry you will work with individuals
who have a range of addictions as well as, commonly, mental
illness. Particular skills are required to work with people in
order to stop or limit use and then, from that position, to
maintain their healthier state. This requires a good knowledge of
physical health issues along with both psychological and physical
treatment approaches.
Given the likelihood of social
problems in this group, it is likely that you will be working
alongside courts and probation services as well as social and
children’s services.
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Personal perspective
As part of my general practice
training, I had a placement in psychiatry which I found to be
totally fascinating and so I decided to abandon general practice as
a career. I was fortunate that my five years of specialist
psychiatric training was academically orientated and left me with
the expectation that a good clinical service would also engage in
training and research.
In choosing addiction psychiatry, I
think I was most influenced by a wish to make good use of my
medical training and in the range of physical illnesses caused by
substance misuse as well as the many primary care level problems
that come up. Second, I enjoy the scope of addictions – at one
extreme there is the fascination of what drugs do at the receptor
and at the other extreme substance misuse cuts across major areas
of social policy. Third, I like studying human psychology and
seeing the links with substance misuse. Finally, I like the
multi-disciplinary nature of addictions work and I like the people
who work in the field – the field is relatively small and most
people know each other. Working with agreeable colleagues
around the country has been both a support and a source of new
ideas that have helped sustain my enthusiasm for Addiction
Psychiatry.
The glamorous world of rock stars
and supermodels has little to do with practice in an NHS clinic.
Addiction problems do, however, affect all sections of society and,
while it is true that many individuals come from areas of social
deprivation, many people have ordinary jobs and come from
professions including medicine and nursing. In a typical
clinic I will likely see someone with schizophrenia who uses drugs
to deal with the symptoms of their mental illness, someone who has
acquired hepatitis or HIV as a consequence of injecting drugs,
someone who is pregnant and subject to a child protection enquiry
because of their substance misuse, or someone who is epileptic,
diabetic and in need of careful detoxification. In short,
addiction psychiatry includes a bit of general medicine, quite a
bit of general psychiatry, and a lot of psychology.
It is something of an historical
accident that addictions belong to psychiatry. It is quite
likely that in future addictions will break away and there will be
separate addiction trusts – this is a very exciting possibility for
young, enterprise-minded doctors. Psychiatry was a great
career choice for me - psychiatry in the future will pose new
challenges but will, I am sure, be equally rewarding.
Duncan Raistrick
Addiction psychiatrist
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Page updated on 8
December 2010