The Addiction Psychiatrist as Dual Diagnosis Physician: A Profession in Great Need and Greatly Needed

Abstract

Addiction is the number one cause of premature illness and death in the U.S., especially among people with mental illness. Yet American medicine lacks sufficient workforce capacity, expertise, training, infrastructure, and research to support treatment for people with co-occurring addictions and mental illness. This essay argues that the addiction psychiatrist is essential in dual diagnosis care.

Keywords: addiction psychiatry; physician workforce shortages; public health crisis.

Figure 1

Histogram of the states grouped by numbers of addiction psychiatry fellowship positions offered by state per 100,000 population. Data in the figure was compiled from 2010 U.S. census data (U.S. Census Bureau, 2010) and 2009 addiction fellowship census data from the Center for Medical Fellowships in Alcoholism, and Drug Abuse (Galanter, 2011).

Figure 2

Indices of workforce vitality across major physician specialties. MGMA data from 2012 reveals psychiatry to be A) among the lowest reimbursed medical specialties (as with other primary care specialties) with B) the most advanced age of workforce suggestive of a medical profession in decline.