Addiction medicine

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 behaviors such as sexual addiction and internet addiction, such behaviors not being marked generally by physiologic tolerance or withdrawal.

Over centuries, addiction has been recognized as an issue to be treated, and has been addressed with the creation of a multitude of organizations, the passage of certain acts, and the development of various drugs in the medical field all to help those who struggle with addiction.

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 (MD/DO) while the remainder have received primary medical training in other fields.

History of Addiction Medicine

1750s–early 1800s

Addiction first became well known and seen as a major issue between the 1750s and early 1800s with alcoholism running rampant and being the main contributor to this. Dr. Benjamin Rush first began to discern alcoholism as an illness to be addressed when he published his writing “Inquiry into the Effects of Ardent Spirits on the Human Mind and Body” in 1784. Because of his writing on alcoholism, the beginnings of the temperance movement came shortly after in the early 1800s.

1800s

The first inebriate homes for alcoholics opened around the 1850s. These homes and asylums provided a segregated place for alcoholics to stay while they withdrew from the alcohol, along with integration into sobriety groups. In 1864, Dr. Joseph Edward Turner opened the New York State Inebriate Asylum, which was the first rehabilitation center for alcoholism. In the late 1800s, around 1890, alcoholics were sent to hospital wards and drunk tanks as inebriate homes began shutting down.

1900–1950

Throughout the first half of the 1900s, many hospitals and organizations opened to assist addicts, such as the Charles B. Towns substance abuse Hospital (1901), the Emmanuel Clinic/the Emmanuel movement (1906), morphine maintenance clinics (1919–1924), narcotics farms (1935), Alcoholics Anonymous (1935), etc. In addition to this, certain state laws were passed to try to sterilize disabled people, addicts, and people with mental disorders (1910). During this time, various drugs also came out to attempt to cure alcoholism like barbiturates, amphetamines, LSD, and disulfiram (1948–1950).

1950–2000

Within these years, multiple advancements were made, certain laws or acts were passed, and more organizations came about to help people with addiction. In 1957, treatment units for alcoholics were developed by the Veterans Administration. Shortly thereafter, a multitude of associations opened. These include but are not limited to the Halfway House Association (1958), the Betty Ford Clinic (1982), Cocaine Anonymous (1982), Secular Organizations for Sobriety and Rational Recovery (1985–1986), and SMART Recovery (1994). Along with that, drugs like methadone (1964), Narcan (1971), and naltrexone (1994) were developed to fight against opioid withdrawal and alcoholism. As for the legal side of things, the Controlled Substances Act passed in 1970, which classified all controlled substances into five classes, and the Drug Addiction Treatment Act passed in 1999, enforcing a stricter version of the Controlled Substances Act.

2000–present day

In the past 25 years, further developments have been made in the field of addiction medicine such as the FDA approval of a treatment called buprenorphine for opioid use disorder, along with The Mental Health Parity and Addiction Equity Act (2008) and the Affordable Care Act (2010) being passed. The MHPAEA of 2008 made it mandatory for insurance organizations to give people coverage for the cost of substance-abuse-related treatments, while the ACA of 2010 further expanded the coverage offered for substance-abuse-related treatments through state health insurances.