Addiction Medicine

Addiction medicine is a medical specialty that deals with the treatment of addiction. The specialty often crosses over into other areas, since various aspects of addiction fall within the fields of public health, psychology, social work, psychiatry, and internal medicine, among others. Incorporated within the specialty are the processes of detoxification, rehabilitation, harm reduction, abstinence-based treatment, individual and group therapies, oversight of halfway houses, treatment of withdrawal-related symptoms, acute intervention, and long term therapies designed to reduce likelihood of relapse . Some specialists, primarily those who also have expertise in family medicine or internal medicine, also provide treatment for disease states commonly associated with substance use, such as hepatitis and HIV infection.

Physicians specializing in the field are in general agreement concerning applicability of treatment to those with addiction to drugs, such as alcohol and heroin, and often also to gambling, which has similar characteristics and has been well described in the scientific literature. There is less agreement concerning definition or treatment of other so-called addictive behavior such as sexual addiction and internet addiction, such behaviors not being marked generally by physiologic tolerance or withdrawal.

Doctors focusing on addiction medicine are medical specialists who focus on addictive disease and have had special study and training focusing on the prevention and treatment of such diseases. There are two routes to specialization in the addiction field: one via a psychiatric pathway and one via other fields of medicine. The American Society of Addiction Medicine notes that approximately 40% of its members are psychiatrists while the remainder have received medical training in other fields.

In several countries around the world, specialist bodies have been set up to ensure high quality practice in addiction medicine. For example within the United States, there are two accepted specialty examinations. One is a Certificate in Added Qualifications in Addiction Psychiatry from the American Board of Psychiatry and Neurology. The other is a certificate from the American Board of Addiction Medicine following a peer-reviewed Board-type examination. The latter approach is available to all physicians, while the former is available only to board-certified psychiatrists. The American Board of Addiction Medicine is not currently a member of the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists. Doctors of Osteopathic Medicine may also seek board certification via the American Osteopathic Association (AOA). The Doctor of Osteopathic Medicine must have a primary board certification in Neurology & Psychiatry or Internal Medicine from the American Osteopathic Association and complete an AOA approved addiction medicine fellowship. Successful completion of a board examination administered via the AOA will grant a certificate of added qualification (CAQ) in addiction medicine.

Within Australia, addiction medicine specialists are certified via the Chapter of Addiction Medicine, which is part of the Royal Australasian College of Physicians. They may alternatively be a member of the Section of Addiction Psychiatry, Royal Australian & New Zealand College of Psychiatrists.

The International Society of Addiction Medicine also can provide certification of expertise.

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David E. Smith
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