It is based on the time-honored principles of palliative care, where palliative is taken in its broad sense of relieving, alleviating or easing a condition without curing. It does not refer exclusively to care for terminal conditions. Taken this way, most psychiatric treatment is palliative, and non-curative care for chronic conditions is something most psychiatrists are both skilled and comfortable in providing. Applying these principles to addictive disorders is less obvious. To do so requires a new conceptualization of addiction, the goals of treatment and the methods to achieve these goals.
Addiction has many characteristics of a chronic illness.
It has remissions and relapses, its course is highly variable, and its severity varies from very mild and transient to severe and persistent. Patients with different types and severity of substance use disorders respond to different interventions. Substance abuse and dependence are often disorders of adolescence and early adulthood, and most occurrences are mild to moderate and self-limiting. While hazardous use or mild dependence frequently responds to simple advice, specialty addiction treatment is usually indicated for moderate to severe dependence. The purpose of this article is to address the management of the most extreme level of addiction, heretofore not well-delineated or tested in psychiatric settings.