Imagine being told that you have a progressively debilitating and potentially fatal medical disorder. It’s widely recognized in the research community as a brain disease. Then you learn that physicians or other medical personnel will NOT be involved in the assessment, diagnosis, acute treatment, or continued monitoring of your condition. Even worse, imagine that many of the organizations who treat your disease have no affiliation with a hospital or other primary healthcare facility. If you’re lucky, you might hear of FDA-approved medications that specifically your condition, but that you won’t have access to these medications as part of your prescribed treatment.
These are precisely the circumstances encountered today by the majority of people entering addiction treatment in the U.S. There are more than 18,000 facilities in the United States that specialize in the assessment and treatment of substance use disorders. Surveys of these facilities reveal a low complement of physicians on staff. Nearly have of them have no physician availability. Many of the U.S.’s publicly funded addiction treatment programs lack physician services and access to pharmacotherapy.
Physicians Are The Missing Link In Addiction Treatment
Physicians are critically needed as part of the multidisciplinary teams involved in addiction treatment. Some of the more important functions they perform include:
- Diagnosing the presence, severity, and complexity of substance use disorders, particularly in distinguishing these disorders from other medical and psychiatric conditions which may manifest as, be masked by, or be self-medicated by excessive alcohol and other drug use.
- Diagnosing and treating acute medical and psychiatric conditions that result from or co-occur with substance use disorders—conditions that if left untreated pose a significant burden within the recovery process.
- Assessing and addressing the physical and emotional toll addiction has exacted on family members.
- Participating in, if not leading, development of a personalized plan for acute stabilization and a more comprehensive plan of sustained recovery management for the patient and family.
- Evaluating the role medications could potentially play in detoxification, acute stabilization, and long-term recovery management.
- Providing guidance on the management of chronic primary health care problems and promoting recovery-enhancing wellness activities, e.g., smoking cessation, diet, and exercise.
- Educating patients and families on the addiction and recovery processes.
- Supervising other members of the treatment team.
- Providing regularly scheduled post-treatment recovery check-ups as part of the long-term recovery management plan.
Two Ways To Get Your Physician Involved
If you or a family member must enter treatment for a substance use disorder in a program that does not have physician services, I recommend the following two steps:
- Involve your primary care physician (PCP) in the treatment process. Inform your PCP of the following: you are entering addiction treatment, you would like your PCP to be available for consultation regarding that treatment, you will provide your PCP copies of all records related to your treatment, and you would like your recovery status regularly evaluated through all future check-ups. If you do not have a primary care physician, make obtaining a PCP a priority as part of your treatment /recovery plan.
- Consider engaging a physician trained in addiction medicine to consult in your overall treatment and to provide ongoing guidance following treatment discharge. It is recommended that such a physician be affiliated with the American Society of Addiction Medicine or the American Academy of Addiction Psychiatry. Addiction medicine specialists in your area can be identified by contacting these organizations.
Beyond these two suggestions, it’s critical that anyone seeking addiction treatment become an informed consumer. This requires seeking both experiential knowledge and empirical knowledge about addiction and recovery. The former can be obtained by talking to individuals and families who have successfully resolved alcohol and other drug problems. The latter can be obtained by reading the latest research findings about the critical ingredients of addiction treatment and recovery—research findings that have recently been translated for public consumption by the Recovery Research Institute, a nonprofit arm of Massachusetts General Hospital and Harvard Medical School.
Each Person In Recovery Must Own His Or Her Recovery
A wide variety of professional and peer support services may be helpful along this journey, but the person in recovery must direct this process. He or she must assembling diverse consultants who can inform and assist this effort. Physicians and psychiatrists knowledgeable about addiction recovery and experienced in offering guidance through the recovery process can be important and even crucial resources within the recovery process. The challenge for America is to expand the number of physicians and psychiatrists who possess such knowledge and expertise. The challenge for organizations that make up the addiction treatment industry is to assure their staffing patterns match their rhetoric of addiction as a treatable medical disorder.