Addiction Psychiatry

Addiction psychiatry is a specialised field within the realm of psychiatry that focuses on the assessment, diagnosis and treatment of individuals grappling with substance use disorders (SUDs) and related issues. It represents a crucial component of mental health support, aiming to understand, address and help individuals who struggle with the often debilitating effects of addiction to drugs and alcohol.

In addition to substance use disorders, addiction psychiatry also addresses behavioural addictions. Behavioural addictions are characterised by compulsive engagement in specific behaviours that lead to negative consequences in an individual’s life, resembling the patterns seen in substance addictions. These behavioural addictions can encompass a range of activities, including gambling, internet use, gaming and shopping.

The role of addiction psychiatrists is multifaceted, involving a deep understanding of the complexities of addiction and the ability to provide comprehensive care and support to individuals seeking recovery. This branch of psychiatry goes beyond traditional psychiatric treatment to delve into the intricacies of addiction, including its physiological, psychological and social aspects.


What are Substance Use Disorders (SUDs)?

In addiction psychiatry, it’s essential to recognise that substance use disorders encompass a broad spectrum of behaviours related to the misuse of various substances.

Substance use disorders include but are not limited to:

Alcohol Use Disorder (AUD):

Alcohol addiction is characterised by an individual’s inability to control their alcohol consumption, leading to physical and psychological dependence. Common signs include a strong craving for alcohol, the inability to cut down or control drinking and continued alcohol use despite its adverse effects.

Drug use disorders:

These disorders involve the misuse of illicit drugs, prescription medications, or over-the-counter drugs. Drug use disorders can be associated with specific substances, such as opioids, stimulants, cannabis, or sedatives and manifest as a compulsion to use the substance, tolerance, withdrawal symptoms and a range of negative consequences related to drug use.

Other substance use disorders:

Beyond alcohol and drugs, individuals may develop substance use disorders related to a wide array of substances, including hallucinogens, inhalants and designer drugs. The specific criteria for each substance can vary, but the overarching features of loss of control, craving and negative consequences are shared among these disorders.

What are behavioural addictions?

While substance use disorders are well-recognised in addiction psychiatry, it’s equally important to understand and address behavioural addictions. Behavioural addictions involve compulsive engagement in non-substance-related activities that have a negative impact on one’s life.

Some common examples include:

  • Gambling addiction: Gambling addiction, also known as pathological gambling or gambling disorder, involves an uncontrollable urge to gamble, leading to negative financial, personal and social consequences.
  • Internet and technology addiction: This includes addictions to activities like excessive internet use, online gaming and social media. Individuals may compulsively spend excessive amounts of time online, leading to problems in various areas of their lives.
  • Sex addiction: Sex addiction, also known as hypersexuality, involves a persistent pattern of sexual fantasies, urges and behaviours that become overwhelming and lead to negative outcomes, such as relationship difficulties and risky sexual behaviours.
  • Shopping addiction:Shopping addiction, or compulsive buying disorder, is characterised by excessive, impulsive buying that results in financial problems and emotional distress.
  • Work addiction: Work addiction, also referred to as workaholism, involves an excessive preoccupation with work and an inability to disconnect from professional responsibilities, which can harm personal life and well-being.

Diagnosis of behavioural addictions

Behavioural addictions have gained recognition in recent years, and studies have shown that they can be just as impactful as substance addictions. To diagnose a behavioural addiction, clinicians may use criteria similar to those for substance use disorders. The DSM-5 recognises gambling disorder as a specific behavioural addiction, while other behavioural addictions, like internet and technology addiction, are currently topics of ongoing research and debate.

What is the main aim of addiction psychiatry?

The primary aim of addiction psychiatry is to comprehensively understand, diagnose, treat and prevent a broad spectrum of addictive disorders, encompassing both substance use disorders (SUDs) and behavioural addictions. This specialised field of psychiatry is dedicated to addressing the intricate challenges associated with various forms of addiction, including substance addictions like drugs and alcohol, as well as non-substance-related addictions such as gambling, gaming and compulsive internet use.

The key objectives of addiction psychiatry, which extend to both substance and behavioural addictions, include:

  • Assessment and diagnosis: Addiction psychiatrists meticulously assess and diagnose individuals afflicted by addictive disorders. This entails evaluating the nature and severity of the addiction, identifying any co-occurring mental health conditions and understanding how addiction impacts a person’s life. Addiction psychiatrists will use a number of different tools in order to make precise assessments and diagnoses.
  • Treatment: Addiction psychiatrists provide evidence-based treatment strategies tailored to each individual’s unique needs and preferences. These strategies can encompass medications, psychotherapy and other therapeutic interventions to facilitate recovery and behavioural change.
  • Rehabilitation: Addiction psychiatry plays a pivotal role in addiction rehabilitation programmes, whether inpatient or outpatient, SUD or behavioural. These treatment programmes aim to help individuals achieve and sustain abstinence, enhance their mental well-being and reintegrate successfully into society.
  • Dual diagnosis: Recognising and addressing co-occurring mental health conditions is a crucial facet of addiction psychiatry. Many individuals with addictions also grapple with underlying mental health issues, and addiction psychiatrists are trained to address both concurrently, a practice known as dual diagnosis treatment.
  • Prevention: Addiction psychiatrists are actively engaged in prevention strategies, educating individuals, families and communities about the risks associated with addiction. They are involved in the development of harm reduction measures and prevention initiatives, working to mitigate addiction-related harm.

The differences in treatment

Addiction psychiatry is far from a one-size-fits-all approach. The vast diversity of substances people can become addicted to, combined with the increasingly recognised prevalence of behavioural addictions, highlights the complexity and individuality of addiction treatment. Here, we’ll compare how a person with a SUD might be treated differently from someone with a behavioural addiction:

Aspect of Treatment Substance Use Disorder (SUD) Behavioural Addiction
Diagnosis Process Focuses on identifying the specific substance(s) being used, assessing physical withdrawal symptoms and considering medical complications related to the substance. Diagnosis often adheres to DSM-5 criteria. Concentrates on recognising the specific addictive behaviour (e.g., gambling, gaming, overeating). Behavioural patterns, triggers and consequences are assessed in the context of the specific addiction. Diagnostic criteria are adapted to the nature of the behaviour.
Treatment Goals Typically involves abstinence or harm reduction related to the substance (e.g., alcohol, drugs). Addressing withdrawal symptoms and cravings is a primary objective. Physical health may be of utmost concern. Focuses on behaviour modification, reduced engagement in the addictive behaviour and improved mental health. The goal is to change behaviour patterns and address underlying psychological factors.
Medication Use Commonly includes medication-assisted treatment (MAT) using medications like buprenorphine, methadone, or naltrexone to manage cravings, withdrawal, or overdose risk. Medications may be used in cases of co-occurring mental health conditions or to address underlying factors contributing to the addiction (e.g., antidepressants for co-occurring depression).
Therapeutic Approaches Emphasises therapies that help individuals understand their relationship with the substance, such as Motivational Interviewing, Cognitive-behavioural Therapy (CBT) and contingency management. Behavioural addiction therapies focus on changing thought patterns and coping strategies related to the specific addictive behaviour. CBT is commonly used to address cognitive aspects of addiction.
Support Systems Includes support groups and networks tailored to substance addiction, like Alcoholics Anonymous or Narcotics Anonymous. Education for family and friends may be provided to prevent enabling behaviours. Support systems may involve therapy groups specific to the behavioural addiction (e.g., gambling support groups), family education and building networks that understand and can assist with the addictive behaviour.
Dual Diagnosis Co-occurring mental health conditions are common (e.g., depression, anxiety) and require integrated treatment. Co-occurring mental health conditions are also common and addressed in an integrated manner, recognising that they can contribute to or result from behavioural addiction.
Relapse Prevention Strategies Focuses on avoiding exposure to the substance, managing cravings and coping with physical withdrawal symptoms. Targets specific cues and stimuli that trigger engagement in the addictive behaviour. Emphasises changing thought patterns and coping with psychological triggers.
Outcome Measurement Often includes measures like drug tests and objective physical health assessments to monitor abstinence or reduced substance use. Outcome measurement may involve tracking behaviour changes, such as reduced engagement in gambling or gaming and improvements in mental health indicators.
Recovery Path Length Recovery duration varies widely, but it often involves a longer period of abstinence or harm reduction. The length of recovery may differ depending on the addictive behaviour but typically focuses on sustained behaviour change and maintaining psychological well-being.

How does UKAT London Clinic approach addiction psychiatry?

At UKAT London Clinic, both SUD and behavioural addiction treatments are tailored to your specific needs and the nature of your addiction. Our addiction psychiatrists are trained to address the complex interplay of substance or behaviour with co-occurring mental health conditions and are dedicated to helping you achieve and maintain recovery.

Ready to take the first step towards overcoming addiction and improving your mental health? Contact UKAT London Clinic now to discuss addiction psychiatry. Your journey to recovery starts with a simple call.

Don’t wait. Reach out today. Your brighter, healthier future is just a conversation away.



Works cited

(Click here to see works cited)

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  • Polychronopoulos, G. B., Carlisle, K. L., Carlisle, R. M., & Kirk-Jenkins, A. J. 2014. “The Emergence of Behavioral Addiction in DSM-5.” Educational Foundations & Leadership Faculty Publications, 20. URL: https://digitalcommons.odu.edu/efl_fac_pubs/20. Accessed 17 October 2023.
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