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By Rodrigo Muņoz, M.D.
APA President
In the last 20 years, thanks to the efforts of many APA members, psychiatry has regained its leadership in addiction medicine. A list of any size naming individuals who have made major contributions in this area would be incomplete, so I will mention only one name: Dr. Sheldon Miller, chair of the APA Council on Addiction Psychiatry. Dr. Miller, together with many of our best thinkers, researchers, and clinicians, has been in the vanguard of the movement toward giving proper attention to the diagnosis and treatment of addictions. In addition to APA, a number of organizations have also taken the leadership in this area, including the National Institute of Mental Health, National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, Substance Abuse and Mental Health Services Administration, and the Organization of American States.
The major psychiatric disorders can have a direct or indirect connection to chemical dependence. Whether it is because of the relationship between mood disorders and the use of addictive drugs, schizophrenia and the use of stimulants or heroin, or the disorders of adolescence and the use of drugs, clinicians routinely consider drug use and addiction when making almost any psychiatric diagnosis.
Now that most psychiatrists are familiar with the addictions and are prepared to treat them, we find ourselves thinking of many psychiatric and nonpsychiatric factors that influence our strategies for diagnosis and treatment.
First, we have to continue to consider the progression of psychiatric disorders in the same individual. Many patients with an initial diagnosis of a learning disability go on to develop a number of disorders in adolescence and progress to chemical dependence, and antisocial personality. It is not uncommon for such individuals to be imprisoned at some point in their lives.
The settings for care have changed. Too many people with psychiatric disorders, especially drug addiction, are in prison. We could have an APA district branch representing only the psychiatrists working in prisons. These psychiatrists need APA support and giving them that support has become a priority for APA.
The strategies for care are also changing as we treat patients with several diagnoses. They may need multiple interventions and benefit from a focus on psychosocial rehabilitation.
More funds are needed to provide quality care to people with addictions. As we demand parity for coverage of psychiatric disorders, we must insist that treatment for addictions be included.
We also must look at nonpsychiatric factors. We cannot tolerate having our country inundated with drugs produced elsewhere. The teenager in the United States who is seduced into using cocaine or heroin shares much in common with the South American peasant whose misery is exploited by drug traffickers.
In the article below, Dr. Pedro Ruiz describes the work that he and Dr. Miller have done on an APA initiative aimed at reducing drug abuse in the Americas. Interdiction of drugs has never been enough. To reduce the number of people afflicted with addictions, we need to pour resources into prevention, education, early diagnosis and treatment, and rehabilitation services.