Outgoing APA president reflects on successful addiction psychiatry initiative

NEW YORK — The American Psychiatric Association successfully disseminated education among the public and physicians highlighting addiction psychiatry as part of its presidential initiative, the group’s outgoing president said at its annual meeting.

“The message was simple: Dispel myths and misconceptions about substance use disorder and behavioral addictions and state as loudly as possible that treatment is available, safe and effective,” Petros Levounis, MD, MA, told the media.

“There was a great need to bring addiction into the fold,” he said, so the APA created four mini-campaigns: tobacco and vaping, opioids, alcohol, and technology and technological addictions.

“We had very specific messages for physicians, the general public and those who impact policy,” Levounis said. “We ended up with a ‘top 10’ every doctor and every person should know.”

Levounis considers the campaign a success.

“We set out to bring addiction to the table, and we did,” he said. “The general public is more aware of addiction and that addiction treatment works. The needle has moved, and we convened several organizations to keep the needle moving.”

Obstetric/gynecologic, osteopathic and pediatric societies were involved, he said.

“It wasn’t just the presidents; they were also accompanied by the communications people, who will continue the work in the future,” Levounis said. “This kind of collaboration has often been done on the presidential level, but the staff will continue the work.”

He also discussed the recent U.S. Drug Enforcement Administration proposal to move cannabis from a Schedule I to Schedule III drug.

“All schedules should be based on molecules, not a combination of molecules,” Levounis said. “Cannabis has hundreds of cannabinoids in it, some of them problematic, some much less. Cannabis shouldn’t be Schedule anything. If you want to talk about THC, that’s one thing. If you want to talk about cannabinol, that’s another thing. We do have a few Schedule III combinations, some old medications, but it’s maybe two or three molecules at most.”

Levounis referred to the excitement about 5 years ago surrounding the potential therapeutic effects of cannabis, “but since then there’s been a diversion. We’ve become more excited about psychedelics, psilocybin. We’re not ready to support mom-and-pop shops in Oregon and New York. We’re still studying them, but the data are promising.

“With cannabis, we’re becoming more concerned in terms of panic disorder and psychotic disorder,” he continued. “Some studies have shown quite alarming reports in terms of cannabis. A few years ago we were optimistic, but now it’s opened up.”

Levounis also highlighted the comorbidity of substance use and other psychiatric disorders, the prevalence of which have been grossly underestimated.

“Some people believe that if you stop using the drug you won’t have any problems,” he said. “Other rehabilitation specialists say they’ve never seen someone addicted to anything that doesn’t have some type of other psychological disorders. Neither are true.

“One-third to two-thirds of people with substance use disorder will have mental illness,” Levounis added. “Some have just one or the other.”