Addiction Medicine and Addiction Psychiatry in America: The Impact of Physicians in Recovery on the Medical Treatment of Addiction

Abstract

Two distinct medical disciplines treat addiction in the United States: Addiction medicine and addiction psychiatry. This article argues that physicians recovering from alcoholism or drug abuse played a key role in creating the field of addiction medicine, and that the development of addiction medicine inadvertently contributed to the formation of addiction psychiatry. Addiction medicine's undercurrent of recovery, specifically questions about the knowledge that recovering physicians call on to treat addiction, remains central to an ongoing professional conflict between addiction medicine and addiction psychiatry.

Prevalence of co‐occurring mental illness and substance use disorder and association with overdose: a linked data cohort study among residents of British Columbia, Canada

“…Fatal and non‐fatal overdoses were concentrated in people with an SUD and the incidence rate was highest among people with a dual diagnosis. In Canada and the United States mental illness and SUD treatment services are often siloed, resulting in clients receiving care for only one health problem or receiving parallel treatments with inadequate continuity or coordination [47,48]. While there can be difficulties in implementing integrated treatment [49] and the quality of research on integrated care has limited firm conclusions on its benefits [50,51], previous research has shown that integrated mental illness and SUD treatment can improve health outcomes and reduce substance use [52,53].…”

Addiction Medicine and Addiction Psychiatry in America: Commonalities in the Medical Treatment of Addiction

“…Freed (2007) recently identified the widespread but inaccurate belief that most American physicians have expertise on addiction. In actuality, two competing medical disciplines treat addiction in the United States: addiction medicine and addiction psychiatry.…”

“…The New York Society promoted the modern concept of alcoholism as an illness that Alcoholics Anonymous invented. Indeed, a number of physicians in the New York Society were themselves recovering alcoholics who turned to Alcoholics Anonymous for care (Freed, 2007; Galanter, 2005), a trend that continued in the 1970s and 1980s as doctors from American medicine’s impaired physician movement (see, e.g., Steindler, 1984; Talbott, 1988) and self-described “addictionologists” (doctors in recovery who committed their medical careers to drug treatment) joined physicians with a strictly professional interest in drug abuse to help addiction medicine grow nationally. Today, the leading organization in addiction medicine, the American Society of Addiction Medicine (ASAM), has about 3,000 members, one third of whom are recovering alcoholics and addicts (Freed, 2007).…”

“…In 1991, troubled that “within the treatment system, [physicians in recovery] … have supplanted psychiatrists on the front lines” (Group for the Advancement of Psychiatry Committee on Alcoholism and the Addictions, 1991:1292), the psychiatrists used their scholarship on drug abuse, the comorbidity literature that linked addiction and mental illness, and exclusive training programs in addiction psychiatry to persuade the American Board of Medical Specialties, the “gold standard” of physician credentialing, that they possessed specialized knowledge on addiction. Recognition from the American Board of Medical Specialties gave addiction psychiatrists the “right to responsibility” (Goode, 1960) for the medical treatment of addiction, especially since addiction medicine failed to attain comparable professional standing (Freed, 2007). 1 …”

“…have supplanted psychiatrists on the front lines" (Group for the Advancement of Psychiatry Committee on Alcoholism and the Addictions, 1991Addictions, :1292, the psychiatrists used their scholarship on drug abuse, the comorbidity literature that linked addiction and mental illness, and exclusive training programs in addiction psychiatry to persuade the American Board of Medical Specialties, the "gold standard" of physician credentialing, that they possessed specialized knowledge on addiction. Recognition from the American Board of Medical Specialties gave addiction psychiatrists the "right to responsibility" (Goode, 1960) for the medical treatment of addiction, especially since addiction medicine failed to attain comparable professional standing (Freed, 2007). 1 ASAM still seeks recognition for addiction medicine from the American Board of Medical Specialties (American Society of Addiction Medicine, 2006), a mission that suggests a substantive distinction between addiction medicine physicians and addiction psychiatrists.…”