Addiction encompasses a broad spectrum of disorders. These include substance use disorders (SUDs) for alcohol, tobacco and other drugs. It also encompasses behavioural addictions, such as addictions to gambling, food, sex, internet use and video gaming.1 The severity of these disorders can be classified as mild, moderate or severe.2 For many, they are chronic, relapsing disorders that require ongoing management, with lasting recovery seen in about half of all patients.3
SUDs are one of Australia’s leading causes of both fatal and non-fatal burden of disease. Tobacco smoking is Australia’s leading cause of cancer and preventable disease burden. Data also show that those living in the most disadvantaged socioeconomic areas are 3.6 times as likely to smoke daily when compared with people living in the most advantaged socioeconomic areas. Around one-third of Australian adults drink at levels that increase their risk of disease or injury. More than two in five Australians have used an illicit drug in their life, including prescribed medications used for non-medicinal purposes (eg benzodiazepines and opioids).4
The aetiology of SUDs and other addictive behaviours is complex and includes, but is not limited to, individual genetics, personality, comorbid conditions, and the social and environmental determinants of health.5 While all patients may be at risk of substance use and addiction disorders, some patient groups are at increased risk, including:4,6
- Aboriginal and Torres Strait Islander peoples
- people with mental health conditions
- people identifying as lesbian, gay, bisexual, transgender, intersex, queer or questioning (LGBTIQ+)
- people with experiences of trauma.
General practitioners (GPs) play a variety of roles in addiction management, from screening and diagnosis to primary prevention, treatment and referral, as required. GPs should familiarise themselves with the types of substances and behavioural addictions that are problematic in their community, and should screen all patients for use of tobacco, alcohol and other drugs (AOD), including prescribed medications, such as benzodiazepines and opioids. They should also be aware of the psychological therapies and pharmacological treatments (eg methadone, buprenorphine) that are available for patients experiencing addiction.6,7
Given the intersection between addiction, comorbidity and social determinants of health, treatment involves taking a patient-centred, whole-person-care, chronic disease approach. Trauma often accompanies addiction. The provision of trauma-informed care is therefore essential, as is the consideration of barriers to access and engagement with treatment,5,6 such as rural or remote location and lack of access to addiction specialist services. Treatment should use a strengths-based approach and recognise that recovery is possible. Established family and community supports are considered protective factors and should be included in treatment plans. As with all chronic diseases, treatment and ongoing reviews of substance-related and addictive disorders should be regular, planned and long term. Facilitating patient autonomy, consent and confidentiality in treatment is also essential.5
Many people with addiction have experienced discrimination and/or had negative experiences when interacting with health services. A non-judgemental, stigma-free approach is therefore essential when screening and treating patients with substance-related and addictive disorders.5,6 Stigma and health literacy can form barriers to seeking treatment.8,9 GPs should reflect on their own practice, the role of stigma and discrimination, and familiarise themselves with appropriate accepted language within addiction medicine.
Clinical governance and ethical issues are important in addiction medicine. Prescribing addictive scheduled medications is highly regulated.10 GPs therefore need to understand the legalities around these, as well as prescription monitoring software in their jurisdiction. GP collaboration with regulatory bodies, specialists and patient groups will also continue to inform these regulations.