Addiction Psychiatry addresses assessment and treatment where substance use disorders intersect with mood, anxiety, psychosis, trauma, and personality conditions. This page focuses on decision points psychiatrists face daily: differentiating substance-induced syndromes from primary disorders; sequencing psychopharmacology alongside MOUD/AUD medications; and matching CBT/MI/CM to stage of change. For readers considering an Addiction Psychiatry Conference, we translate evidence into practical pathways—how to manage suicidality with recent use, when to start antidepressants in early recovery, and how to stabilize sleep without perpetuating dependence. We also emphasize collaborative care with primary care, nursing, pharmacy, and peers, because continuity across detox, inpatient, PHP/IOP, and outpatient improves safety, retention, and real-world functioning. Throughout, equity and cultural responsiveness guide language, engagement, and shared decisions for adolescents, perinatal patients, older adults, and marginalized groups.

Clinically, comorbidity is the rule. Psychiatrists integrate risk assessment, toxicology interpretation, and ASAM-aligned level-of-care decisions with relapse-prevention planning. Psychopharmacology must account for hepatic/renal issues, QTc, and interactions with buprenorphine, methadone, naltrexone, disulfiram, and acamprosate, while avoiding benzodiazepine overreliance. Skills include contingency strategies for stimulants, exposure-based care for trauma, and cognitive remediation for attention/executive deficits. We highlight brief interventions in EDs and medical floors, CL-psychiatry bridges, and warm handoffs into community support. When psychiatric symptoms obscure substance patterns, structured timelines, collateral, and iterative trials clarify diagnosis. For differential diagnosis and integrated care planning, see Co-Occurring Disorders, which complements this page’s focus on medication safety, psychotherapy selection, and system design.