Substance use and addiction

Many Australians consume substances such as alcohol and other drugs in their lifetime —sometimes heavily, sometimes regularly, sometimes occasionally, sometimes once. Clinicians working in mental health need to understand the actions of drugs and alcohol and expertly assess patients who use them. Substance use may be an obvious principal issue at presentation; it may be a covert problem, or it may just present together with other psychological problems, with its contribution to them being initially unclear. The clinician’s tasks are multiple: to determine the role substance use plays in the psychopathology, to formulate an understanding with the patient as to how this arose, and then to shape a tailored management plan. The biopsychosocial framework, which underpins all areas of psychiatric practice, is never more relevant than in the drug and alcohol field. Drug and alcohol problems are an everyday part of psychiatric practice, and professional attitudes to the contrary are an anomaly, arising as mental health and drug and alcohol services have become separated from each other administratively and organisationally.