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The Royal College of Psychiatrists Improving the lives of people with mental illness

Addictions psychiatry

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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