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For many years the medical profession treated addiction as a subject to be dealt with by those in the psychiatric fields, an issue of the mind. However, new studies linking addiction to heredity and chemical imbalances that may need to be treated by pharmaceutical means are turning the age old assumption on its head. The shift in thinking began about 15 years ago when new technology allowed doctors to see the difference between a normal brain and one afflicted by addiction. They were able to identify physical changes in the brain due to addiction, leading to the conclusion that addiction is not only a psychological issue, but one of the bodies that could be treated with medicine if proper time was devoted to the study of the physical changes caused by addiction.
There are currently 10 institutions that have opened their doors to young doctors who wish to study addiction medicine as a new, recognized field of medicine. Some, like Marworth University Medical Center, have had a residency program for years, operating without accreditation. Others, like St. Luke’s-Roosevelt Hospital in New York, are new to the field, opening their doors in July 2011. The 10 institutions received national accreditation from an organization formed in 2007 to legitimatize addiction medicine, the American Board of Addiction Medicine (ABAM). The board aims to accredit between 10 and 15 more institutions in 2011 and have addiction medicine formally recognized as a specialty field of medicine similar to paediatrics, oncology or dermatology. In order to do that, the board will request that the field be recognized by the Accreditation Council for Graduate Medical Education.
One of the tenets of this field of study is that addiction is a chronic disease in the same way that diabetes, asthma, and epilepsy are all chronic diseases. The same constant treatment required by physical ailments such as diabetes is required by those who suffer from addiction. Supporting this idea are real life cases of people who have been treated using medication who relapse once the medical treatment has ended. Addiction is a disease to be managed by an individual and his or her doctor, but currently doctors are not equipped with the tools or the knowledge of those in the addiction medicine practice to properly diagnose and treat addicts. Most often addicts are referred to psychiatrists, treatment centres’ and group meetings like SMART Recovery to deal with problems that go beyond what these resources are equipped to handle, leading to relapses.
Legitimizing the field has already produced benefits for those seeking to be free of addiction. There are multiple medicines that were created for the treatment of drug addiction such as Suboxone, a medicine used in the treatment of chronic opiate addiction. Though it is understood that to treat addiction completely psychiatry and group support will play a role, the continued legitimization of the field will prompt more studies into how addiction affects the brain will encourage more pharmaceutical companies to develop more treatments for the various types of addictions that afflict the population.
The treatment of addictions of all kinds is changing in large partly due to the technology now available to show complex images of the brain and mapping of DNA. Studies conducted over the past 20 years link addiction not only to heredity but also to physical changes in the brain, tipping off researchers that treatment may not only be for psychiatrists. Medical treatment of drug addiction is a fairly new concept, but it is gaining popularity as more medical training hospitals open their doors to new doctors seeking primary residencies in addiction medicine.
The Canadian Society of Addiction Medicine (CSAM) stated there are 3 Fellowship training programs in Addiction Medicine in Canada. The Centre for Addiction and Mental Health (CAMH) and St. Joseph’s Health Centre, both located in Toronto, and at the University of Calgary. There was an announcement in the past week of a Fellowship to be started shortly at St. Paul’s Hospital in Vancouver and currently in Sherbrooke, they are trying to develop a Fellowship in Quebec. CSAM is a national organization founded in 1989, they strive to provide collegial networking and support for physicians, clinicians, and researchers in Addiction Medicine.
In the United States, there are 10 programs in place that are accredited by the ABAM to train doctors in addiction medicine. The doctors currently participating in these nationwide residency programs are in their second year of residency. They are unable to choose this field as a primary residency because it has not gained the approval of the Accreditation Council for Graduate Medical Education. The rules for approval by the Accreditation Council for Graduate Medical Education are many, but one of the criteria is that there must be 20 institutions that offer the program. The ABAM plans to grant accreditation to between 10 and 15 more institutions within a year. Once the Council has recognized addiction medicine as a legitimate field of practice, the doctors who wish to practice within that field may choose it as a primary residency program.
The underlying concept behind addiction medicine is that addiction is a disease that must be managed, not a choice to be denied. In this concept, the field takes a different stance than the old professional ideology. Even doctors and medical practitioners in detoxification clinics treated patients from the standpoint of giving them tools to overcome what was believed to be a mental compulsion. Now, with the current understanding of the physical changes that an addict has going on in his or her body; the doctors can treat from a place of better understanding. Some cases may require medical interventions such as the prescribing of new medicines developed particularly to ease the withdrawal process and block cravings for drugs. The general consensus among new practitioners is that the psychiatrist still has a place in treatment. There is no “one size fits all” approach to addiction treatment and some will need not only medical treatment but emotional support and psychiatric assistance.
Recent success stories involving hybrid treatment methods lend credence to addiction treatment using both medicine and psychiatric means. The treatment of addictions has most certainly changed in the past decade and will undoubtedly change much more as the field gains acceptance among doctors. In the future more doctors will be able to help addicts on the road to recovery with specialists in the field leading the way.
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