Supporting medical students and resident doctors in addictions psychiatry
Here medical students and resident doctors in addictions psychiatry can find out more about the specialty and explore learning resources we've collated.
Training in addictions psychiatry
Through broad consultation among our members, we developed the following brief description of the role of an Addictions Psychiatrist:
“We are medical doctors who have completed extensive training in psychiatry (including the use of mental health legislation) and addiction. In combining these skills, we have unique expertise in the management of addiction problems in complex cases, particularly co-morbid mental health problems.
Our extensive knowledge extends to all aspects of addiction, including individual brain mechanisms, behaviour and its overall effect on the family, society and the economy. Combined with excellent communication skills, this enables us to offer a holistic approach that considers how biological, psychological and social factors impact on a person’s life and recovery journey.
We are the clinical leads for addiction teams and bear the ultimate clinical responsibility for the people we see. Our training has prepared us for formal leadership roles enabling us to take on senior management positions within addiction teams, and to provide consultation on issues of service development, clinical governance, commissioning, public health, interpretation of research findings, training and evidence based practice.”
See more about what it takes to be an addictions psychiatrist.
Addictions psychiatry learning resources
These learning resources are for medical students as well as resident doctors.
These resources have been collated to support students and resident doctors, and will be developed over time. If you have any suggestions or would like to contribute to the resources yourself please contact the Addictions Faculty via Stephanie Whitehead at stephanie.whitehead@rcpsych.ac.uk.
Please note, although we have selected useful resources, where links direct to external websites, the Faculty/RCPsych cannot be responsible for content.
Web resources
ATOMIC is a free, evidence-based, mobile-learning application aimed at clinicians and other practitioners who want to improve their knowledge of the acute and chronic clinical harms of non-medical prescription drug use.
Drug misuse and dependence: UK guidelines on clinical management
There are a number of clinical guidelines around the management of substance use disorders, which can be found here:
- NICE Guidelines & Pathways
- Review of Drugs in the UK (2020)
- UK Drug Policy Commission
- eLearning for healthcare, including modules on Addiction
- British Association of Psychopharmacology (BAP) updated guidelines (PDF)
- Seminars in addictions psychiatry
- The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
- Society for study of addictions
- The Drugs Wheel: a new model for substance awareness
Further reading
- The Globalization of Addiction: A Study in Poverty of the Spirit. Bruce K Alexander
- Rethinking Substance Abuse: What the Science Shows and What we Should do About it. Edited by William Miller & Kathleen Carroll. Guilford Press, 2006
- Treating Addiction: A Guide for Professionals. William Miller, Alyssa Forcehimes, Allen Zweben. Guilford Press, 2019 (2nd edition)
- Theory of Addiction. Robert West & Jamie Brown, Wiley Blackwell, 2013
Government guidance
- Guidance for commissioners and treatment providers about recovery support services and the benefits of lived experience recovery organisations (LEROs) within the wider recovery-oriented system of care
- Mutual aid toolkit for alcohol and drug misuse treatment
- Medications in recovery: Re-orientating drug dependence treatment (PDF)
- Scottish Government – Recovery housing literature review
- Scottish Government – Whole Family Approach
Lived experience organisations
- The College of Lived Experience Recovery Organisations (CLERO)
- The Scottish Recovery Consortium and downloadable Scottish recovery workbook (PDF)
Evidence for recovery support services
- The Recovery Research Institute website: stigma-free language, research findings, pathways to recovery and the brain in recovery. What is recovery?
- William White papers
- The project MATCH monograph. Series volume 1: twelve-step facilitation therapy manual (PDF)
- Making Alcoholics Anonymous Easier (MAAEZ) manual (PDF)
Mutual aid organisations
- Alcoholics Anonymous Great Britain
- UK Narcotics Anonymous
- Cocaine Anonymous UK
- SMART Recovery UK
- Recovery Dharma
- Soberistas
- Sober Girl Society
Resources for families
- Adfam are a national UK charity that aim to empower family members and carers, support front-line workers and influence decision makers.
- Scottish Families Affected by Alcohol or Drugs have a helpline, a guide to local support services and bereavement support services.
- Al-Anon Family Groups UK provides resources for anyone whose life is or has been affected by someone else’s drinking, as well as resources for members and professionals.
Resources for students in recovery
- Better Than Well is a student addiction recovery programme at the University of Birmingham.
- The Association for Recovery in Higher Education (ARHE) represents collegiate recovery programs, the staff who support them, and the students who represent them.
Podcasts
Key reading
- Kelly JF & White W (2011) Addiction Recovery Management: Theory, Research & Practice. Humana Press, New York.
- Best D (2019) Pathways to Recovery and Desistance: The role of social contagion and hope. Policy Press, Bristol
- White W & Mojer-Torres L (2010) Recovery-Oriented Methadone Maintenance. Monograph series from the Great Lakes Addiction Technology Transfer Center Chicago, IL
- White, W. (2009). Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation. Chicago, IL: Peer-based Addiction Recovery Support: History, Theory, Practice, and Scientific Evaluation
- White, W. (2008). Recovery Management and Recovery-Oriented Systems of Care: Scientific Rationale and Promising Practices. Pittsburgh, PA: Northeast Addiction Technology Transfer Center, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health & Mental Retardation Services
- White WL, Kurtz E & Sanders M (2006) Recovery Management. Monograph series from the Great Lakes Addiction Technology Transfer Center Chicago, IL
Introduction
Public Health England (PHE)
- Twelve-step facilitation therapy manual (PDF)
- Adult substance misuse treatment statistics 2020 to 2021
European data
Opioid withdrawal
- Basic understanding
- Gov guidelines on opioid detox
- Methadone
- Buprenorphine
- Chasing the Dragon: The Life of an Opiate Addict – patient experience documentary
Assessment of opioid dependence
Initial investigation
Management
- NICE: Opioid dependence – Scenario: Management
- BMJ: Management of dependent use of illicit opioids
- UpToDate: Opioid use disorder – Treatment overview
Naloxone Use Training
Prefilled injection
Nasal Spray
Naltrexone
- Naltrexone (PDF) (Appendix M)
Harm Reduction
Orange Guidelines
Pain
Support groups
Sexual Health
- Chemsex: let's talk about chemsex
- Chemsex and hepatitis C – a guide for healthcare providers (PDF)
- Controlling chemsex
Safer injecting
Pharmacological treatment
- Treatment of stimulant use disorder: A review of reviews
- What do we know about pharmacological treatment of methamphetamine withdrawal?
- Neurobiology, clinical presentation and treatment of Methamphetamine Use disorder
- Pharmacology and pharmacological management of substance misuse (alcohol, opiates, stimulants, nicotine)
- Pharmacological treatment for methamphetamine withdrawal
Synthetic cannabinoids receptor agonists (SCRA)
- Synthetic cannabinoids – effects and risks
- Cannabis pharmacology
- What are synthetic cannabinoid receptor agonists
- Advisory council on the misuse of drugs, SCRA report
- Neptune Guidance on the clinical management of acute and chronic harms of club drugs and novel psychoactive substances
- Spicing it up - synthetic cannabinoid receptor agonists and psychosis - a systematic review
Introduction
- Drugwise
- TalktoFrank
- National Institute of drug abuse (NIDA)
- The Drug wheel was developed as a model for substance awareness
- UpToDate gives a brief overview of the pharmacology of hallucinogens and the pharmacokinetic profile of common hallucinogens
Epidemiology
Screening/Assessment
DSM-5 classification - Hallucinogen related disorders. This comprises of:
- The Hallucinogen Rating Scale (HRS)
- Mystical Experience Questionnaire (MEQ)
- Addiction Research Centre Inventory (ARCI)
Management
Most treatments depend on the individual's clinical presentation. Management of the intoxicated patient is dependent on the specific behavioural manifestation elicited by the drug.
- UpToDate is an online clinical resource provides detailed information on the clinical features of acute intoxication of hallucinogens and its management
- NEPTUNE provides guidance on the Clinical Management of Acute and Chronic Harms of Club Drugs and Novel Psychoactive Substances
- TOXBASE is a well-used resource for acute medicine, the emergency room, and other acute settings for acute management of toxicity
Introduction
- Drugwise including infographic (PDF)
- TalktoFrank
Epidemiology
- EMCDDA
- ONS uses data from the crime survey in England and Wales to provide an overview of the extent and trends of illicit drug use including cannabis use
Screening and Assessment
The following are commonly used self-reported screening instruments:
- CUDIT-R (PDF); Cannabis Use Disorders Identification Test
- Assist-Lite; the Alcohol, Smoking and Substance Involvement Screening Tool
- The cannabis health check-up tool
- Cannabis abuse screening test (CAST) is suggested by the EMCDDA for use in screening for problematic use of cannabis
- The severity of dependence scale (SDS)
- Cannabis use disorder: Clinical features, screening, diagnosis, and treatment
Cannabis and mental health
Cannabis can trigger symptoms of psychosis and contribute to the development and maintenance of enduring mental health problems. The following are useful links to overviews of how cannabis is linked to mental health:
- Cannabis and Mental Health
- Marijuana and mental health
- Cannabis: pleasure-medicine and mental health
- Cannabis use and disorder: Epidemiology, pharmacology, comorbidities, and adverse effects
Management
- Drug misuse and dependence: UK guidelines on clinical management
- Psychosocial interventions for cannabis use disorder can be done using motivational enhancement, cognitive behavioural therapy, and incentive for abstinence
Further links
Cannabis and the law
Introduction
- Health Survey for England, 2021 part 1 - NHS Digital
- NHS Digital - alcohol related news, publications and data
Validated Tools for screening and assessment of alcohol use disorder
- AUDIT: the alcohol use disorders identification test – consumption (AUDIT C)
- FAST (Fast Alcohol Screening Test)
- PAT (Paddington alcohol test ) (PDF)
- CIWA-Ar Scale
(PDF) - SADQ - Severity of Alcohol Dependence questionnaire calculator
Assessment and management
- Managing alcohol withdrawal in acute in-patient psychiatry
- Alcohol self-management during COVID-19 and beyond
Alcohol related brain injury
- Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management
- Signs of preclinical Wernicke's encephalopathy and thiamine levels as predictors of neuropsychological deficits in alcoholism without Korsakoff's syndrome
- Chronic or persisting – Korsakoff’s syndrome
Pharmacological Management
Relapse Prevention
- Long acting Injectable form of naltrexone for alcohol dependence
- Alternative oral medication, nalmefene
- Disulfiram
Psychological Management
- Motivational interviewing Effect of Motivational Interviewing on Reduction of Alcohol Use
- Cognitive Behavioural Approaches to Alcoholism Treatment
- CRA (Community Reinforcement approach)
- SBNT (Social Behaviour Network Therapy)
- Alcoholics Anonymous, BBC Two - I'm an Alcoholic: Inside Recovery
Special Group
- Pregnancy and complex social factors
- Screening questions to identify problem drinking during pregnancy
- Alcohol abuse screening test for women
Recovery management
Introduction
Epidemiology
Screening and assessment
An individual must meet 4 out of 9 of the following criteria in the preceding year to make a diagnosis of gambling disorder:
- Need to gamble with increasing amounts to achieve the desired excitement.
- Restless or irritable when trying to cut down or stop gambling.
- Repeated unsuccessful efforts to control, cut back on or stop gambling.
- Frequent thoughts about gambling (such as reliving past gambling or planning future gambling).
- Often gambling when feeling distressed.
- After losing money gambling, often returning to get even. (This is referred to as "chasing" one's losses.)
- Lying to hide gambling activity.
- Risking or losing a close relationship, a job, or a school or job opportunity because of gambling.
- Relying on others to help with money problems caused by gambling.
Screening instruments
- Problem Gambling Severity Index (PGSI) (PDF)
- Briefs Biosocial Gambling Screen (PDF)
- NORC Diagnostic Screen for Gambling Problem self-administered (NO DS-SA) (PDF)
- The Lie/Bet
National Institute of Health and Care Excellence (NICE) recommend that health professionals ask people about gambling, new draft guidance is out for consultation.
Management
Currently, NHS treatment services for gambling disorder cover:
- North West and North East
- West Midlands
- East Midlands
- East of England
- South East
- South West England
- London
Pharmacological management
Epidemiology
Effects on health
Smoking in Pregnancy
Management
- Department of Health Guidance. The National Centre for Smoking Cessation and Training (NCSCT)
- NHS stop smoking services
- How do I stop smoking? Cancer Research UK
- Quit smoking. NHS Better health - Let‘s do this
- Alcohol and Tobacco Brief Interventions
Advanced reading
- Drug misuse and dependence: UK guidelines on clinical management
- NICE guideline. Tobacco: preventing uptake, promoting quitting and treating dependence
- Improving smoking cessation in drug and alcohol treatment
- A joint report: Smoking and mental health
- E-cigarettes and vaping: policy, regulation and guidance
