Tobacco, alcohol, substance abuse, and substance dependency are issues routinely encountered in emergency departments, trauma services, and obstetrics/gynecology clinics. Such issues are frequently encountered within the fields of internal medicine, family practice, and psychiatry as well as by most health care practitioners on a daily basis.
Addiction medicine is focused on the reconciliation and integration of multiple and sometimes conflicting forces and beliefs. For example, a fundamental debate continues in the field about the merits of two different theoretical models of the origins of addiction. The “disease” model posits that addiction is a neurobiological and physiological illness. The “moral failing” model contends that substance abuse disorders are caused by a combination of social factors, environmental forces, poor judgment, and loss of willpower on the part of the substance user.1 Moreover, in part because neither model is comprehensive,1 addiction treatment addresses both potential etiologies of this disease by integrating medical management of biological and physiological dependence with therapies designed to modify behavior and environmental influences that may predispose individuals to substance abuse. Furthermore, physicians specializing in addiction, perhaps more than those in any other medical specialty, endeavor to help individuals who consistently deny that they are sick and refuse medical treatment.