Addictive disorders through the lens of the <scp>WPA</scp> Section on Addiction Psychiatry

The practice of addiction psychiatry and the relevant training vary among different world regions and countries. Despite the challenges that the subspecialty has been facing, the past decade has witnessed new insights and advances in the field. In particular, the rapid development of technologies has contributed to a better understanding of addiction and its mechanisms and to the development of new therapeutics, but has also facilitated the emergence of new forms of behavioral addiction as well as the accessibility and dissemination of a variety of substances of abuse. The WPA Section on Addiction Psychiatry was established to provide a global platform to discuss national, regional and international challenges and solutions for substance use and other forms of addictive disorders among psychiatrists and their colleagues in the related clinical disciplines. During the World Congress of Psychiatry held in Vienna in 2023, the renovated section was officially launched. The Section chair, A. Baldacchino, shared the Section's vision based on the values of collegiality, democracy, transparency, inclusion, diversity and global representativeness. The key aim is to establish collaboration with other WPA Sections, scientific societies and organizations. The Section, therefore, plans to support global surveys, discussion panels, advocacy initiatives, and development of intersectional guidelines, consensus statements, best practices and policy documents to support such a vision. New members are being actively attracted. The Section has strived to identify pressing topics for the next triennium action plan. It acknowledged various areas of needs, including regional drug situations, behavioral addictions, forced displacement in light of the current geopolitical disputes, as well as the impact of the COVID-19 pandemic1, 2. However, in order to ensure a wider scope that covers advances, challenges, recent trends and training needs, we finally identified four main themes to focus on. First, there is an ongoing effort to develop mechanism-informed therapeutics and preventive tools for substance use disorders3. The approval or clearance by the US Food and Drug Administration (FDA) of neuromodulatory interventions – including auricular vagus nerve stimulation to reduce the symptoms of opioid withdrawal, and deep transcranial magnetic stimulation of prefrontal cortex for smoking cessation – opened up doors for efforts to identify and target addiction neurocircuits to develop new treatments. Repurposing medications based on mechanistic understanding has shown promises to contribute to addiction recovery by targeting N-methyl-D-aspartate (NMDA), orexin, kappa opioid, and other receptors. The next generation of mechanism-informed therapeutics for substance use disorders and their comorbidities will include neuroimaging-informed individualized neuromodulation, biomarker-informed digital therapeutics, mechanism-informed pharmacotherapeutics, neuroscience-informed behavioral interventions, and neuroscience-based individualized preventive strategies. The Section is interested in supporting global contribution to these technological advances, while discussing how patients and addiction psychiatrists around the world may have equal access to these new advancements. The Section is working to shape international working groups and consortiums to support these efforts4. Second, the rise of telemedicine and its rapid development with the COVID-19 pandemic has extended to addiction psychiatry. The Section is interested in exploring this field, focusing on the development and implementation of innovative digital solutions to meet the needs of people facing addiction. This will be pursued through creating a network of shared knowledge and a design philosophy based on person centredness and inclusive communication. The essence of this effort is to add value to the opportunities arising from digital platforms and to promote accessibility by marginalized populations. The process will not only aim to improve inclusion, but also to embrace complexity and facilitate systems change5. Third, neurodiversity has been a topic of growing interest over the past few years. In the field of addiction psychiatry, emerging evidence is indicating a link between substance use disorders and a variety of neurodevelopmental disorders. Attention-deficit/hyperactivity disorder (ADHD) and autism have been associated with increased risk of substance misuse6, as well as of behavioral addictions such as gaming disorder7. The fourth identified priority is training in addiction psychiatry. The training gap is currently a major challenge in addressing addiction as a global public health problem. Several countries have taken initiatives in this area. However, the lack of standardization and human resources are limiting scaling up of training programmes. A recent global survey by the International Society of Addiction Medicine (ISAM) among early career addiction medicine professionals highlighted these issues. The ISAM also developed a training need assessment tool and conducted a survey to assess training needs. The close collaboration between the ISAM and the WPA will foster developments in this area. The WPA has developed training modules for various psychiatric disorders, including addiction disorders, which have potential to contribute to the reduction of this gap8-11. A working group will implement the Section's collaboration with different stakeholders to formulate a global strategy in this respect12. Discussions with other WPA Sections, national and international associations and scientific societies are also ongoing to explore further areas of potential collaborations. The Section is looking forward to a fruitful triennium with activities aiming at improving practice, bridging gaps, and fostering an inclusive and diverse learning environment for all generations of professionals.