Reflections of an Academic Clinical Researcher on the past 40 Years of Addiction Development

DOI10.1177/002204260903900103
AuthorSidney H. Schnoll
Published date01 January 2009
Date01 January 2009
Subject MatterArticle
© 2009 BY THE JOURNAL OF DRUG ISSUES
JOURNAL OF DRUG ISSUES 0022-0426/09/01 21-28
__________
Sidney H. Schnoll, M.D., Ph.D., is Vice President for Pharmaceutical Risk Management at Pinney
Associates and Clinical Professor of Internal Medicine and Psychiatry at Virginia Commonwealth
University School of Medicine. He has been actively involved in addictions and pain research with a
focus on perinatal addiction and prescription drug abuse.
REFLECTIONS OF AN ACADEMIC CLINICAL RESEARCHER
ON THE PAST 40 YEARS OF ADDICTION DEVELOPMENT
SIDNEY H. SCHNOLL
This paper ref‌l ects on three areas of addiction: prescription drug abuse, perinatal
addiction, and the clinical f‌i elds of addiction medicine and addiction psychiatry.
The concerns about the abuse and misuse of prescription drugs date back over
a century with numerous laws passed to address these problems. Despite these
laws, there has been increasing concern over the past decade about the increases
in the nonmedical use and abuse of prescription drugs. This begs the question
of whether the passing of laws addressing the supply side of the problem is the
correct approach. Abuse of licit and illicit drugs by pregnant women creates concern
because of the effects of drugs and alcohol on the fetus and future development
of the child. Most of the studies have addressed newborn development without
adequate studies of the effects of the drugs and withdrawal on pregnancy and the
fetus. In addition, studies of long-term effects on the development of the child are
needed. The only way to adequately address these important clinical issues will
be to have well-trained clinicians and clinical investigators in addiction medicine
and addiction psychiatry.
INTRODUCTION
Addiction medicine is a complex area that is slowly emerging as a recognized
medical specialty. When I f‌i rst decided, during my residency in neurology, to make
the study of addictions my career direction, most of my professors and mentors told
me I was wasting my time. They would say, “Why do you want to treat them? They
just take up space in the hospital. They can’t be treated.” When making rounds,
the attending physicians would skip over the alcoholics and drug addicts without
paying much attention to anything but their acute medical problems.
Over the past 40 years this has gradually changed. Many recognized medical
specialties now require some training in addictions, and many medical schools have

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