My special interest in addictions and substance misuse

My name is Deepak and I am a Higher Trainee ST5 with Forward Leeds, which is Substance Misuse Psychiatry service in Leeds.  

When I first learned about Special Interest Days

 I came to know about Special Interest Day in the life of a Higher Trainee when I started my Higher Training in ST4.

I have always thought that a Special Interest Day gives you a taster about a particular service or sub speciality of psychiatry.

It is up to the higher trainee to see whether they want to pursue a career or do they just want to have some experience about that particular area.

However I have come to feel over time that this day can have long lasting learning implications as well, as the trainee is able to gain some really interesting competences.  

What led to my deciding on my Special Interest 

I have had my psychiatry training in India and I always had an inclination towards Addiction Medicine. It was way back in 2012 that I first started my exposure with Addiction Psychiatry.

As a trainee in the field of psychiatry I was posted in the Deaddiction inpatient unit as well as the Deaddiction clinics.

I have always found it fascinating assessing and managing patients with substance misuse and comorbid mental health conditions.

The intriguing part is the interplay between substance misuse and mental illness. Sometimes it is like a chicken and egg story where what led to what is very difficult to ascertain. 

The most satisfying part of treating patients with substance misuse is the dramatic positive change a clinician can bring about in their lives.

Often I have seen that people suffer from adverse psychosocial circumstances which can be both a cause and an effect of substance misuse. Once our patients recover, we can see the stark difference in their adverse and recovered state. 

Often these patients are cared by third sector providers like voluntary organisations and charities. On the other hand, from a legal perspective, the Mental Health Act does not recognise pure substance misuse as a mental disorder. It is only when substance misuse is associated with significant behavioural disturbances or is associated with cooccurring mental disorder (Dual Diagnosis), then the legal framework of mental health that can be applied for treatment of such patients. 

Why do you find your Special interest exciting? 

As a Higher Trainee in Addiction Psychiatry, I come across patients with Opioid Dependence, Cannabis Dependence, Alcohol dependence along with Co occurring mental illnesses like anxiety, depression schizophrenia and other psychotic spectrum disorders.

Some of these patients are really on the margin of society and it does take a significant amount of effort from medical members, case managers, psychotherapists and other allied professionals to bring about a significant change. This makes this field quite challenging as well as exciting. 

 To me psychiatry has always been a branch of medicine which is a combination of art and science. We as psychiatrists can bring about significant changes in people’s lives. I find it different from other branches of medicine because we deal with the person as a whole and everything with and around him and not just the illness.