Addiction psychiatry: where we are and challenges in the UK

This piece is a personal and evidence-informed perspective on the current status and future direction of addiction psychiatry in the UK, based on my 30 years as a clinical academic addiction psychiatrist. Alcohol and drug addictions are associated with immense burdens to the individual and society, and this is likely to endure. Challenges facing addiction services to overcome include under-investment, changes in workforce composition with less psychiatric input, improving integration with mental and physical health services as well as stigma. Supporting those with addiction requires a multidisciplinary approach and consideration of neurobiological, psychological and social factors. The progress and limitations in treatment development are reviewed, noting that psychological therapies remain the mainstay, while relatively few new pharmacological treatments have become available in recent decades. Emerging approaches, including novel pharmacological targets, psychedelics and neuromodulation show promise but require larger, better-designed trials, particularly in clinically representative populations with polydrug use and comorbid mental illness. Neuroimaging is highlighted as a key tool for understanding mechanisms, identifying biomarkers, and accelerating treatment development. To drive innovation and ultimately improve outcomes for people affected by addiction senior strategic leadership, robust research infrastructure, global collaboration, reduced stigma, and a research-capable workforce is required.