Who can provide medical addiction treatment? Not just psychiatrists.
I’M NOT A PSYCHIATRIST
When I tell therapists or my patients that I am an Addiction Medicine physician, not a psychiatrist, they frequently respond with a quizzical look. Patients may ask themselves, am I in the right place?
WHAT KIND OF DOCTOR TREATS ADDICTION?
The confusion about addiction medicine versus psychiatry is understandable, especially when people are used to the idea of seeing a psychiatrist for addiction treatment, or if they are fortunate, an addiction psychiatrist.
Over the past decade the opioid epidemic has highlighted the role of pain, especially chronic pain, in addiction. Yet, most medical physicians and psychiatrists don’t treat addiction (or chronic pain) in their practice.
Why is that?
WHAT KIND OF TRAINING IN ADDICTION TREATMENT DO DOCTORS GET?
Until recently, medical education has largely ignored addiction.
Most practicing doctors received no training on addiction treatment in medical school.
I graduated from a top-tier medical school in 2006. I was taught how to recognize and treat many of the medical complications of substance use such as:
- Liver disease
- Hepatitis C
- Blood infection
- Vascular disease
I did not receive any training on how to assess and treat addiction itself.
THE WRONG MESSAGE ABOUT DRUG ADDICTION
Compulsive and dangerous drug use was considered self-destructive behavior that made patients frustratingly sick and more expensive to treat.
The message relayed to my generation of doctors was that these patients just didn’t want to get better, and they didn’t deserve the health care resources the way that people with other diseases did.
Until I started working in the field of addiction, I assumed that psychiatrists treated substance use disorders, but I was wrong. At least most got exposure to addiction treatment as part of their training, even if they never treated a patient for addiction once they went into practice.
Addiction Psychiatry became an official subspecialty of psychiatry in 1993. This is shockingly late given how much sickness and premature death were caused in the 20th century by alcohol, tobacco, opioid and cocaine use.
Few psychiatrists pursued specific training in addiction. At the time it was not as in-demand as other specialties, and as now, there was tremendous stigma around “those patients”.
So for over 20 years the only pathway to board certification in the field of addiction required completion of 3-5 years of psychiatry training and after that additional in-depth training in addiction. Physicians who were not psychiatrists were excluded from this training and certification.
EXPANDING OPTIONS FOR ADDICTION TREATMENT: THE BIRTH OF ADDICTION MEDICINE
In recent years, Addiction Medicine has become its own officially recognized specialty with board certification provided by the American Board of Preventative Medicine.
Addiction medicine is open as a subspecialty to psychiatrists as well as to medical doctors from other specialties including internal medicine, family medicine, emergency medicine, and even transfusion medicine (my former specialty) among others.
WHY SHOULD I LOOK FOR A BOARD CERTIFIED DOCTOR?
Physicians aren’t actually required to be board certified to practice, but board certification is an important signifier that your doctor has completed a rigorous process of training, clinical experience and examination in their field of certification. To maintain certification, physicians must demonstrate that they are staying up to date within their specialty and many must take additional exams throughout their career.
To be eligible to take the board exam for Addiction Medicine physicians must:
- complete an addiction medicine fellowship
- have extensive clinical experience in the assessment and treatment of substance use disorders
A small number of individuals, including me, qualified by clinical experience AND also pursued advanced training through an addiction medicine fellowship.
WHAT ARE THE DIFFERENCES BETWEEN ADDICTION MEDICINE AND ADDICTION PSYCHIATRY?
While the scopes of addiction psychiatry and addiction medicine overlap considerably there are some general differences between the two fields.
- Explicitly includes the assessment and treatment of chronic pain conditions
- There is more comfort with the medical complications and disorders in people struggling with addiction such as chronic heart, lung or liver disease or infection.
- Psychiatrists have more skill in the diagnosis and treatment of conditions such as schizophrenia, dementia, severe personality disorders, autism and other developmental disorders
BOTH ADDICTION MEDICINE AND ADDICTION PSYCHIATRY
- Includes training to recognize and treat the psychiatric disorders that commonly occur in patients with addiction such as mood disorders, anxiety, trauma-related disorders, and sleep disturbances.
- Emphasize the understanding of the biological, psychological, social and environmental factors that contribute to the development of addiction, its clinical course, and response to treatment
- Must know how to manage and treat intoxication, withdrawal and long term effects of substances of abuse and be able diagnosis and treat behavioral addictions in addition to drug and alcohol use disorders.
- Physicians of both specialties must be familiar with the various individual and group therapies effective in recovery treatment as well as the clinical levels of care and treatment settings for substance use disorders.
HOW TO CHOSE A DOCTOR
The choice of who to see for your addiction treatment, chronic pain or mental health conditions should be based on a number of factors.
Certification is a marker of clinical knowledge, but consider also using these questions to help you chose:
- Does your doctor make you feel safe and respected or do they increase your feelings of fear and shame?
- Does your doctor listen to you and ask questions in a non-judgmental way?
- Does your doctor take the time to educate you about your conditions and treatment options?
- Do you feel like a partner in making treatment decisions or do you feel that decisions are made without you?
There are more questions to consider, but these are the most important.