Showing papers on "Addiction medicine published in 2008"

Psychiatric symptoms in adolescents with Internet addiction: Comparison with substance use.

Abstract: Aims: The aim of the present study was to compare psychiatric symptoms between adolescents with and without Internet addiction, as well as between analogs with and without substance use. Methods: A total of 3662 students (2328 male and 1334 female) were recruited for the study. Self-report scales were utilized to assess psychiatric symptoms, Internet addiction, and substance use. Results: It was found that Internet addiction or substance use in adolescents was associated with more severe psychiatric symptoms. Hostility and depression were associated with Internet addiction and substance use after controlling for other symptoms. Conclusions: This result partially supports the hypothesis that Internet addiction should be included in the organization of problem behavior theory, and it is suggested that prevention and intervention can best be carried out when grouped with other problem behaviors. Moreover, more attention should be devoted to hostile and depressed adolescents in the design of preventive strategies and the related therapeutic interventions for Internet addiction.

Addiction and Substance Abuse in Anesthesiology

Abstract: Despite substantial advances in our understanding of addiction and the technology and therapeutic approaches used to fight this disease, addiction still remains a major issue in the anesthesia workplace, and outcomes have not appreciably changed. Although alcoholism and other forms of impairment, such as addiction to other substances and mental illness, impact anesthesiologists at rates similar to those in other professions, as recently as 2005, the drug of choice for anesthesiologists entering treatment was still an opioid. There exists a considerable association between chemical dependence and other psychopathology, and successful treatment for addiction is less likely when comorbid psychopathology is not treated. Individuals under evaluation or treatment for substance abuse should have an evaluation with subsequent management of comorbid psychiatric conditions. Participation in self-help groups is still considered a vital component in the therapy of the impaired physician, along with regular monitoring if the anesthesiologist wishes to attempt reentry into clinical practice.

Recovery management and recovery-oriented systems of care: scientific rationale and promising practices

Abstract: This monograph is written for those on the frontlines of addiction treatment. It is written for the addition service professionals, the clinical supervisors, and the clinical and administrative directors whose daily decisions widen or narrow the doorways of entry to long-term recovery for those they serve. You are being asked in this monograph to take a searching and fearless professional inventory of addiction treatment as currently practiced by yourself and others. This monograph is also written to the policymakers, purchasers of care, monitors, and evaluators of addiction treatment. You are being asked to look at the scientific and system-performance data that support growing calls for â?orecovery-focused systems transformationâ? and to explore new approaches to funding and monitoring local addiction treatment programs. This monograph is also written for the new generation of recovery advocates and recovery support specialists who are collectively calling for a reconnection between addiction treatment and the larger and more enduring process of addiction recovery.

What is addiction

Abstract: This issue of Alcohol Research & Health examines addiction to multiple substances--that is, combined dependence on alcohol and other drugs (AODs), including marijuana, cocaine, and opioids. It seems fitting, then, to begin the issue with a look at what constitutes "addiction." The Oxford English Dictionary (pp. 24-25) traces the term addiction to Roman law, under which addiction was a "formal giving over by sentence of court; hence, a dedication of person to a master." This notion of relinquishment of control by the addicted person is the central feature of many lay and professional definitions of the term. The study of addictive behavior crosses several disciplines, including, among others, behavioral neuroscience, epidemiology, genetics, molecular biology, pharmacology, psychology, psychiatry, and sociology. Articles in this issue examine aspects of AOD use disorders from the perspective of some of these varied disciplines.

The disease of addiction: origins, treatment, and recovery.

Abstract: ddiction can be defined as the continued use of mood-altering addicting ubstances or behaviors (e.g., gambling, compulsive sexual behaviors) espite adverse consequences. We have learned that alcoholism is a rimary, chronic disease with genetic, psychosocial, and environmental actors influencing its development and manifestations. It is characterized y continuous or periodic impaired control over drinking, preoccupation ith the alcohol, use of alcohol despite adverse consequences, and istortions in thinking, most notably denial. This is a definition forarded in JAMA in 1992, and includes the thinking of the American ociety of Addiction Medicine and the National Council on Alcoholism nd Drug Dependencies. Since that time, continued exploration of the ature of addiction includes other mood-altering substances aside from lcohol, as well as a number of highly reinforcing behaviors. The common pathways in reward circuitry that affect memory and earning, motivation, control, and decision making are also involved in he addictive process. With the more global understanding of addiction ome more treatment strategies, such as meditation and mindfulness raining, psychosocial interventions, and pharmacologic approaches. Inerestingly, our growing understanding of addiction as a disease has not iminished the value of the spiritually driven approaches, such as 2-step-oriented treatments, that are outlined in this article. An undertanding of the disease of chemical dependency, and the multiple pproaches to treatment, can assist the primary care physician (PCP) in he treatment of addiction. The PCP is an essential member of the xtended treatment team and at the forefront of patient care. Substance abuse negatively impacts public safety, reduces workers’ roductivity, and contributes to higher healthcare costs, premature deaths, nd disability for millions of Americans. Despite this massive health

Use of Buprenorphine for Addiction Treatment: Perspectives of Addiction Specialists and General Psychiatrists

Abstract: Objective: In 2002 buprenorphine (Suboxone or Subutex) was approved by the U.S. Food and Drug Administration for office-based treatment of opioid addiction. The goal of office-based pharmacotherapy is to bring more opiate-dependent people into treatment and to have more physicians address this problem. This study examined prescribing practices for buprenorphine, including facilitators and barriers, and the organizational settings that facilitate its being incorporated into treatment. Methods: Addiction specialists and other psychiatrists in four market areas were surveyed by mail and Internet in fall 2005 to examine prescribing practices for buprenorphine. Respondents included 271 addiction specialists (72% response rate) and 224 psychiatrists who were not listed as addiction specialists but who had patients with addictions in their practice (57% response rate). Results: Three years after approval of buprenorphine for office-based addiction treatment, nearly 90% of addiction specialists had been approved to prescribe it and two-thirds treated patients with buprenorphine. However, fewer than 10% of non–addiction specialist psychiatrists prescribed it. Regression-adjusted factors predicting prescribing of buprenorphine included support of training and use of buprenorphine by the physician’s main affiliated organization, less time in general psychiatry compared with addictions treatment, more time in group practice rather than solo, ten or more opiate-dependent patients, belief that drugs play a large role in addiction treatment, and patient demand. Conclusions: Office-based pharmacotherapy offers a promising path to improved access to addictions treatment, but prescribing has expanded little beyond the addiction specialist community. (Psychiatric Services 59:909–916, 2008)

Drug Addiction in China

Abstract: Drug addiction in China began with the importation of Indian opium by the British in the 16th century and brought severe social and health problems. While drug abuse abated following the establishment of People's Republic of China, modernization and Westernization in the 1980s led to the reemergence of this problem. Drug abuse in China became epidemic, facilitating the spread of HIV/AIDS. The Chinese government has made great efforts to address these problems, focusing both on treatments of drug addiction and on harm-reduction programs. Although the new trends of drug addiction in China pose great public health challenges, these government interventions are likely to successfully stem the problem of drug abuse in the future.

Adolescent addiction:: Epidemiology, assessment, and treatment

Abstract: "Adolescent Addiction: Epidemiology, Assessment, and Treatment" presents a comprehensive review of information on adolescent addiction, including prevalence and co-morbidity rates, risk factors to addiction, and prevention and treatment strategies. Unlike other books that may focus on one specific addiction, this book covers a wide range of addictions in adolescents, including alcohol, cannabis, tobacco, eating, gambling, internet and video games, and sex addiction. Organized into three sections, this book begins with the classification and assessment of adolescent addiction. Section two has one chapter each on the aforementioned addictions, discussing for each the definition, epidemiology, risk factors, co-morbidity, course and outcome, and prevention and intervention. Section three discusses the assessment and treatment of co-morbid conditions in greater detail as well as the social and political implications of adolescent addictions. Intended to be of practical use to clinicians treating adolescent addiction, this book contains a wealth of information that will be of use to the researcher as well. Contributors to the book represent the US, Canada, the UK, New Zealand, and Australia. About the Editor: Cecilia A. Essau is professor of developmental psychopathology at Roehampton University in London, UK. Specializing in child and adolescent psychopathology, she has been an author or editor of 12 previous books in child psychopathology and is author of over 100 research articles and book chapters in this area. This title is comprehensive with the state-of-the-art information on important and the most common adolescent addiction. It includes easy to understand and organized chapters. It is written by international experts.

The Issue of Consent in Research that Administers Drugs of Addiction to Addicted Persons

Abstract: In addiction, impaired control over drug use raises questions about the capacity of addicted persons to consent to participate in research studies in which they are given their drug of addiction. We review the case for doing such research, and the arguments that addiction does, and does not, prevent addicted persons from consenting to such research. We argue for a more nuanced view that acknowledges that while in some situations addiction impairs decision-making capacity, it does not eliminate such capacity. We conclude with some suggestions for recruiting addicted subjects and designing experiments in ways to obtain free and informed consent.

Heroin: The Treatment of Addiction in Twentieth-century Britain

Abstract: Heroin, often viewed as the 'hardest drug', looms large in the popular consciousness. Heroin addiction in Britain first began to cause concern during the 1920s, yet while one group of doctors regarded the addiction as a disease which required treatment, other physicians viewed it as a vice which demanded strict control. The medical community and the government have debated both the definition of addiction - medical condition, moral failing or social problem - and the method of dealing with addiction - medical treatment vs. legal controls.In "Heroin", Alex Mold examines the interaction of the different approaches to heroin addiction and argues that the treatment of the addiction as a disease and the control of heroin as a social problem could, in practice, rarely be separated. Treatment became a way of controlling the addiction and the addicts themselves, but debates about the nature of addiction treatment and the methods used resulted in politicisation of the topic. During the late 1960s Drug Dependence Units (DDUs) were established as a means to combine both medical treatment and social control.The 'British System' essentially treated addiction as a disease and offered maintenance - the administering of heroin or an opioid substitute on a long-term basis - as treatment. Maintenance proved to be a source of tension between psychiatrists specialising in addiction treatment and private and general practitioners who operated outside the DDUs. This conflict manifested itself in heated disputes on the pages of medical journals, in government committees and in disciplinary hearings before the General Medical Council.The same debates, conflicts and tensions which have beset drug addiction treatment since the beginning of the 20th century persist today. Despite international laws and codes concerning addiction and treatment, there is much that is peculiar and significant about the British case. Drawing on government papers, private archival collections, medical journals, oral history sources and official reports, Mold presents the first detailed historical analysis on the subject. Historians, sociologists, addiction specialists and contemporary policy-makers can look to this groundbreaking study to learn from the past and shape the future response to heroin addiction.

Update in addiction medicine for the primary care clinician

Abstract: The United States Preventive Services Task Force recommends that primary care clinicians assume a major role in screening, identification, treatment, and referral to treatment of unhealthy alcohol and other drug (AOD) use—the spectrum from use that risks health consequences to AOD disorders (abuse and dependence)—in generalist settings.1 In the United States, nicotine dependence, alcohol use, and drug use are the first, third, and ninth leading causes, respectively, of preventable deaths.2 Despite the harmful effects of addiction and improved options for office-based treatments and referral, not all primary care clinicians routinely address AOD use in their patients. The objectives of this paper are to identify and examine important recent advances in addiction medicine that have implications for primary care clinicians and that emphasize primary care clinicians’ role in the identification, treatment and/or referral of patients with addictions. We conducted an electronic database (PubMed) search to systematically identify recent (June 1, 2006 to January 1, 2008) human subject, English language, peer-reviewed, research publications that are relevant to generalist care for patients with addiction disorders. We also surveyed the publications that were reviewed by a NIH-funded newsletter that, in an attempt to identify articles that address the health impact of alcohol and drugs, systematically reviews the core general medical, infectious disease, public health, and addiction subspecialty journals.3 Similar to our prior review,4 authors (A.G., D.F., R.S.) were provided a title listing of articles with addiction-related key words within the reference time frame, and then secondary searches and consensus deliberations were used to identify articles that may impact the care provided by primary care clinicians in the categories of 1) alcohol use and disorders and 2) opioid use and dependence. Articles were categorized as impacting primary care clinicians if they studied primary care settings or could impact such settings and had practice-changing findings or implications.

The Teen Addiction Severity Index around the globe: the Tower of Babel revisited.

Abstract: The objectives of this article are, first, to provide a brief review of screening and assessment of adolescents substance use and substance use disorders; second, to describe the work done with the Teen Addiction Severity Index (T-ASI) in different countries; and third, to address challenges and opportunities in order to improve international collaboration between health professionals responsible for providing substance abuse services for youth and families. It is recommended that the International Society of Addiction Medicine (ISAM) sponsor and coordinate the efforts to disseminate the benefits accrued from already developed assessment and treatment of substance use disorders of youth into different countries and regions. Addiction professionals representing a myriad of cultures, ethnic, and racial groups would be encouraged to translate the assessments into relevant languages and dialects and with the support of the original authors conduct reverse translation and then test the psychometric pr...

Should Opioid Abusers Be Discharged from Opioid-Analgesic Therapy?

Abstract: Editor's Note: This editorial by Dr. Peggy Compton, and the three papers in this issue by Drs. Webster, Fishbain, Zacny, and their colleagues, initiate the Opioids, Substance Abuse & Addiction Section of Pain Medicine. Under the leadership of section co-editors Steve Passik, PhD, and Lynn Webster, MD, PhD, and their distinguished colleagues, this section will inform our readership about this critically important area of our scholarship and clinical management. “Do no harm”— primum non nocere —is probably the best-known mandate implied by (but not literally stated in) the original Hippocratic Oath [1]. Although it is debated in certain modern contexts (i.e., abortion, capital punishment, end-of-life issues), this tenet is reflected in medical practice to the degree that healthcare is increasingly guided by evidence-based guidelines that are both effective and safe (i.e., do no harm). Unfortunately, an ongoing clinical practice with the potential to cause much harm to patients with chronic pain is that of discharging them from opioid therapy because of concerns about opioid-analgesic abuse or addiction. Like diabetes or heart disease, addiction is a chronic progressive disease that, if present and left untreated, may result in significant morbidity and death. Reactive discharge from opioid-analgesic therapy because of concerns about opioid addiction or abuse can do significant harm, not just at the level of the individual, but also affecting families, the healthcare system, and the society at large. Such practice should be avoided. Clearly, not all discharges from opioid therapy are due to the presence of addictive disease (or substance-use disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) [2]. Addiction concerns arise when the patient appears to be drug seeking, noncompliant with opioid therapy, or using other illicit drugs. Yet, none of these behaviors provide evidence of addiction, and …

Addiction and addiction medicine: exploring opportunities for the general practitioner.

Abstract: Addiction medicine deals with problems arising from the use of psychoactive substances, and encompasses the disciplines of general practice and primary care, psychiatry, psychology, internal medicine, public health, pharmacology and sociology. Addiction is a chronic, relapsing illness that is difficult to cure. There are now effective, evidence-based interventions for the prevention and treatment of substance misuse disorders. Harm minimisation and treatment are more cost-effective than policing and supply-reduction methods of responding to substance misuse.

Toward a Philosophy of Choice: A New Era of Addiction Treatment

Abstract: Being given choices of institutions, levels of care, treatment goals/methods, service personnel, and service duration has historically not been part of the personal experience of addiction treatment in the United States. This article describes why addiction treatment professionals have been reticent to offer choices to their alcohol and drug dependent clients and why that philosophy is now undergoing reevaluation. Addiction treatment has for more than 150 years been more a process of professional diagnosis, direction, and indoctrination than a process of guided self-reflection and self-change. Since the advent of program accreditation standards in the 1970s, clients entering addiction treatment have been asked to sign a treatment plan. This ritual has conveyed the illusion of participation and choice, but anyone familiar with the process knows that the choices available to clients have, until recently, been narrowly prescribed by each program’s treatment philosophy, available levels of care, coercive dictates from referral sources, or by the external care managers who governed reimbursement decisions. Another factor concerning limited choice in addiction treatment is the perception that those entering addiction treatment have lost the power of choice—that the state of addiction is the very antithesis of choice (Michael Flaherty, personal communication). Slogans heard within traditional treatment and recovery circles suggest that people addicted to alcohol and other drugs:  Possess an elaborate cognitive defense structure (grandiosity, denial, minimization, rationalization, intellectualization, projection of blame, preoccupation with power and control) that seriously distorts reality and undermines decision-making (e.g., Utilize, don’t analyze, Identify, don’t compare).

Putting 'addiction' back into psychiatry: the RANZCP Section of Addiction Psychiatry.

Abstract: Objective: The aim of this paper is to provide an overview of the history and activities of the RANZCP Section of Addiction Psychiatry, as well as its current challenges and opportunities.Conclusions: From initial exclusion to an active and growing membership, the Section of Addiction Psychiatry continues to ensure that problematic substance use and gambling remain core issues within Australasian psychiatry. In addition to commenting and contributing to ongoing clinical and policy initiatives, the Section has recently introduced an advanced training curriculum and maintains a strong partnership with the relatively new Australasian Chapter of Addiction Medicine. Its active input into education, training, media and policy development within the College guarantees that psychiatry is represented within the addiction field, and that tomorrow's psychiatrists are competent to assess and treat comorbid addiction issues.

Dual Diagnosis Enhanced Programs

Abstract: In 2001, the American Society of Addiction Medicine Patient Placement Criteria, Second Edition, Revised (ASAM PPC-2R) (American Society of Addiction Medicine, 2001) introduced the concepts of dual ...

Heroin addiction: the past and future

Abstract: Substance misuse, in particular heroin addiction contributes to health and social problems. Although effective medical treatment was available, earlier efforts confined the treatment of heroin addicts to in-house rehabilitation which required them to be estranged from the community and their families for 2 years. The in-house rehabilitative programme, implemented for at least three decades has produced low abstinence rates. On the other hand, being ‘away’ meant that many heroin addicts faced employment problems and family relationship difficulties upon completing the in-house rehabilitation. However, recently, the concerted efforts by various government and non-government organisations, and the acknowledgement that heroin addiction is a medical illness has resulted in a revamp to approaching treatment of heroin addiction. At present, methadone substitution programmes have been offered as part of treatment programme for heroin addicts in Malaysia. This new programme has been shown to be effective in treating heroin addiction and would need support and cooperation from all groups involved.

Practice patterns of osteopathic physicians providing end-of-life care: a survey-based study.

Abstract: Context: In 1996, the American Medical Association drafted and organized the Education for Physicians on End-of-Life Care (EPEC) curriculum. Leadership in the osteopathic medical profession has similarly recognized the goals of EPEC-resulting in the development of Osteopathic-EPEC, which incorporates the core tenets of osteopathic medicine. Objective: To assess the impact of EPEC training and the integration of osteopathic principles and practice in end-of-life care provided by osteopathic physicians (DOs). Methods: Osteopathic physicians who participated in the 2002 and 2003 AOA (American Osteopathic Association) End-of-Life Care-National Osteopathic Workshops were surveyed (N=100) on the use of advance directives and on their application of the tenets of osteopathic medicine, including the use of osteopathic manipulative techniques, for terminally ill patients. Results: More than 90% of responding DOs (n=66) ranked each of the four core tenets of osteopathic medicine as important. Among completed responses, 58 DOs (89%) said they believed the tenets and philosophy of osteopathic medicine better prepared them to provide end-of-life care. Forty-eight DOs (79%) agreed that the use of osteopathic diagnostic and treatment skills augmented their ability to provide quality care for terminally ill patients. Conclusion: Osteopathic physicians indicated that the tenets of osteopathic medicine improve their effectiveness in providing quality end-of-life care to patients. However, fewer than half of surveyed DOs who used osteopathic manipulative techniques to relieve pain and manage the physical symptoms associated with the dying process reported that the techniques are often or always effective.

Pain and addiction interface.

Abstract: Opiophobia must go! This was the battle cry for the pain management community for well over a decade. And while a lot of good has come from the “liberalization” of opioid prescribing (and the willingness to aggressively employ our whole armamentarium to treat pain), unfortunately, there has been a tendency to trivialize the downside of opioid exposure, particularly the risk of addiction. Thus, the belief that opioids prescribed for chronic nonmalignant pain rarely cause harm guided much of recent clinical practice. Leaders in the pain field never intended complacency with regard to the prescribing of strong analgesics; as prescribing proliferated, however, insufficient attention was paid to the employment of the necessary safeguards that must be employed to manage risk in some higher-risk patient subgroups. A correction was inevitable—and now there has been a necessary acknowledgment that a certain segment of the patient population will eventually abuse the medications that they are prescribed for pain. Unfortunately, some in the public and political arenas (even within the medical establishment) now desire to “push back” against opioid prescribing with a strength that has become an ideology. Our challenge is to ensure that adjustments to the clinical art and science of opioid prescribing are driven instead by rational empiricism so that, perhaps, the pendulum might be stopped in the middle. Rather than swinging from out-and-out avoidance to widespread use and back, perhaps the middle ground where sound prescribing is paired with the employment of data and principles from the world of addiction medicine might put opioids in their proper place. This new section of Pain Medicine explores the point where pain, abuse, and addiction intersect. As co-editors, …

Speciality recognition of addiction medicine in Australia.

Abstract: In May 2007, the Australian Health Minister accepted a recommendation from the Australian Medical Council to recognize addiction medicine as a distinct medical speciality. The Australasian Chapter of Addiction Medicine (AChAM) is now undergoing accreditation of its training programme, and if accreditation is achieved, fellowship of the Chapter will be recognized as a specialist qualification. Training in addiction medicine is open to people with an initial basic training in several branches of medicine—including general practice, psychiatry and internal medicine. In most English-speaking countries, consultants in addiction are generally psychiatrists. In the United Kingdom, the Royal College of Psychiatry offers advanced training in addiction psychiatry. In the United States, addiction psychiatry is an approved and examinable subspeciality of psychiatry. In the United States, the American Society of Addiction Medicine (ASAM) provides professional support, training and certification by examination for (non-psychiatry-trained) medical practitioners who practise at a specialist level in addiction medicine. Although not yet a Board-certified speciality, ASAM was admitted to the American Medical Association (House of Delegates) as a voting member in 1988. In 1990 the American Medical Association added addiction medicine to its list of designated specialities. In the Netherlands and Portugal, attempts to establish addiction medicine as a speciality have been opposed by general practitioners and in Australia, too, the impact of speciality recognition on primary care was seen as the greatest potential negative impact of speciality recognition. General practitioners (GPs) are readily accessible and are well placed to provide a range of interventions, including brief advice [1], monitoring, referral and prescribing methadone and buprenorphine [2]. If speciality recognition meant that GPs would no longer manage addictive disorders, this would be a retrograde step. Currently, alcohol and other drug use are seldom addressed in primary care settings [3–5]. This is partly attitudinal, arising from a belief that alcohol and drug issues are matters of personal responsibility, or from fear of antagonizing patients by asking about smoking and drinking. It may be due in part to lack of knowledge and skills, and pessimism about outcomes of intervention [4,5]. Declining to be involved in treating drug dependence is disappointing, but failing to diagnose is dangerous. Prescription drug dependence is a growing public health problem in many jurisdictions [6]. An Australian study of 203 fatal opioid overdose deaths among people aged 15–24 years reported that prior to death these subjects had accessed medical services at six times the rate of the general population, usually obtaining prescriptions for benzodiazepines and opioids. Prescription drugs were detected in more than 90% of subjects at autopsy [7]. Many doctors appear to be disengaged, preferring not to respond to, nor even recognize, alcoholand drugrelated problems. This is not a new phenomenon. The first hospital for alcoholics was founded in 1841 in Boston because alcohol-dependent people could not obtain treatment in mainstream hospitals. George Vaillant has suggested that there remains an unwritten rule at the entrance to general hospitals—‘Alcoholics need not apply’. Instead, we have had specialist services for treatment of alcohol and drug problems; marginalized services for marginalized patients. The primary objective of establishing a medical speciality in addiction is to support the health system—from undergraduate training, postgraduate training, general practice, hospitals, mental health services—to engage with addictive disorders and respond more constructively. Medicine is based on specialities, and a discipline as distinctive (and for many doctors, as alien) as addiction medicine needs representation as a speciality, or it risks remaining a peripheral, optional activity for many doctors. Speciality recognition provides role legitimacy— and imposes responsibility—on doctors, promoting, rather than diminishing, GP involvement with drug and alcohol problems. In Australia, as elsewhere, doctors make up a small component of the addictions work-force; currently medical salaries are 4–7% of publicly funded treatment budget in the largest Australian State, New South Wales. Despite the small numbers, there is a risk that bringing addiction services into mainstream health care will diminish the role of other professionals. Quite apart from competition for professional ‘turf ’, bringing addiction treatment under the prevailing medical hegemony may be another step in the ‘medicalization’ of experience, creating pathology out of people’s life choices. Addiction treatment may come to be dominated by the unholy alliance of doctors and pharmaceutical companies, relentlessly expanding the areas of life in which ‘treatment’ is indicated. This challenge faces communities whether or not doctors working in addiction services have specialist training. Indeed, training might even help. Training in addiction medicine is based in multi-disciplinary teams, EDITORIAL doi:10.1111/j.1360-0443.2007.02121.x