Addiction is understood as a brain disease that is multidimensional, and, to this point, there are still very few effective treatments. What we also know is that addiction responds best to a combination of both medicine and psychotherapy for the addiction, as well as its underlying causes (only once the substance use stops). Unfortunately, though, there is still a great deal about addiction and its treatment that is misconstrued by both patients suffering with addiction and many psychiatrists and therapists treating them. Though there are many excellent therapists and skilled psychiatrists with variable levels of training, the following are some suggestions by our New York City addiction psychiatrist on how to find a psychiatrist who can best help you treat this very complex condition.
Evaluate the Training of an Addiction Psychiatrist
A psychiatrist is a physician who has completed medical school and has then spent four years as a psychiatry resident in training. The American Psychiatric Association (APA) and the American Board of Psychiatry and Neurology (ABPN) are the two organizations overseeing training and certification of Psychiatrists in the United States. The only certification that they endorse for treatment of substance use disorders is that of Addiction Psychiatrist. To become an Addiction Psychiatrist, a general psychiatrist must be accepted into, train in, and complete an ACGME accredited fellowship in Addiction Psychiatry. After successfully completing an Addiction Psychiatry Fellowship, the candidate must then pass a written exam to become Board Certified and must maintain a certain level of Continuing Medical Education credits, self-assessment and performance improvement in medical practice modules to maintain their status as a Board Certified Addiction Psychiatrist. It sounds like a lot, and it is. Essentially, to become an Addiction Psychiatrist, one needs to graduate college, then medical school, complete a 4-year General Psychiatry Residency program, and then successfully complete a Fellowship of 1-2 more years in Addiction Psychiatry.
Do No Harm: Look for Dangerous Signs
There are some psychiatrists (I know a few) who have great instincts, personal or family experience and understand addiction well, despite not having official ABPN certification in Addiction Psychiatry. Unfortunately, though, there are many who are truly ignorant (for lack of a better word). This can actually be dangerous. Things to look out for include any psychiatrist or psychotherapist who thinks they can medicate or give therapy for underlying depression or anxiety and the addiction will go away (this was actually the thinking decades ago and has since been proven wrong.)
Though self-medication of depression or anxiety is often the road that leads to a substance use disorder; once developed, addiction must be handled as an entity of its own. Once addiction is stabilized, the underlying condition can be treated. To only treat the underlying condition will only perpetuate the addictive behavior, sometimes amplify it, especially if habit-forming medications are prescribed.
Another potential pitfall is any treatment center or doctor who offers a “quick fix.” In my twenty-five years of practice, I have seen many new treatment approaches come and go. Some with good intentions, some truly just motivated by profit. But I would be careful of anything novel without years of trials in the general population. Whether it is a hallucinogen, hypnosis, or some other drug or approach, I have never seen anything that takes addiction away. The process of healing from addiction is just that, a process that takes effort, time, and skill. To be seduced by a rapid effortless solution can be harmful in that it perpetuates the addiction by appealing to the need for a quick fix, or, at worst, be toxic to the brain.
Does My Addiction Psychiatrist Treat with Psychotherapy and Medications?
Addiction can now be effectively treated with medications, and once stabilized, there are many helpful medications for underlying conditions such as anxiety disorders, depression, ADD, OCD and other mood disorders. A research-proven fact is that medication combined with psychotherapy is the gold standard of treatment and most effective. Many psychiatrists, these days (because of poor training and lack of reimbursement from insurance companies), only prescribe medication. However, because of the complexity of having an addiction and an underlying condition, to get split treatment (having a separate psychotherapist) can be confusing at best and potentially harmful. The best Addiction Psychiatrists I know mostly do both psychotherapy and medication management in the same setting.
What Support Network Does my Addiction Psychiatrist Have?
With addiction being such a complicated condition, it can be helpful if your Addiction Psychiatrist has a support network of his/her own. Many of the best psychiatrists I know that treat addiction are often part of a group practice. Teaching at a medical school, having a relationship with a hospital and being a member of professional organizations such as the American Academy of Addiction Psychiatrists (AAAP) and the American Psychiatric Association (APA) are indications that your Addiction Psychiatrist is plugged in, staying fresh, have appropriate people to refer to, are keeping up to date, and are supported by others in their profession.
The Most Important Person in the Office is the Patient
The essential concept I have learned from my patients, over the years, is that as an Addiction Psychiatrist, I am an expert enlisted in helping the patient meet THEIR goals. Not everyone wants to be completely sober, some want harm reduction and moderation, some want to use medication, and others only want therapy. Some patients are open to trying AA, but others would rather do anything but try AA. I believe the best psychiatrist for addiction treatment is one who has a broad-based understanding of addiction (see paragraph 1), but can be flexible, humble, and caring enough to form a strong alliance with the patient to achieve the goals that are important to them.
These are a few suggestions that can help you choose the right psychiatrist for addiction treatment. I hope that it helps!
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