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What is an Addiction Psychiatrist?

By Manjari Bansal, Michael Howard
Psychiatrists are a common feature of modern-day addiction treatment programs.

Successfully treating drug addiction requires a flexible and multifaceted approach. Many treatment programs involve a combination of medication, counseling, and various behavioral therapies. Psychiatrists often play an essential role in the process, and the American Psychiatric Association recognizes Addiction Psychiatry as a distinct field. Read on to learn how an addiction psychiatrist could help you achieve long-term recovery.

1. Is Addiction a Mental Health Issue?

Addiction is the term used when you are not able to control yourself while taking, doing, or using something to an extent that it could cause harm to you, states the National Health Service. 

“While addiction is not necessarily considered a mental health issue, it is a medical disorder that often coexists with mental illness,” Rahul Gupta, MD, Double Board-Certified Medical Director at Buckhead Behavioral Health and Tampa Recovery, tells WebMD Connect to Care. 

“Substance use disorder and mental health conditions can be caused by trauma, stress, and genetics. There are certain mental health conditions that can make you more likely to abuse substances. In addition, due to the way substance use disorder changes the brain, it can lead to mental health conditions and complications,” Gupta explains.

“Addiction is a multifactorial issue that can affect someone’s life in various domains, including physical, mental, emotional, psychological, spiritual, social, vocational, educational, etc,” Elijah Wilder, DO, Addiction Psychiatrist and Regional Medical Director for Landmark Recovery, tells WebMD Connect to Care. 

“Accordingly, mental health is an aspect that both contribute to and can be impacted by addiction. Research is ongoing into presumptive causes and/or risk factors for addiction, and the most common themes appear to be related to genetic inheritance, environmental factors, early childhood experiences, various socio-economic factors, and history of trauma (especially sexual and physical),” says Wilder.

“Most addiction experts agree with the brain disease model of addiction, that addiction is a relapsing and chronic disease of the brain,” Aaron Sternlicht, LMHC, CASAC, a Therapist and Co-Founder of Family Addiction Specialist in New York, tells WebMD Connect to Care. “As such, it is treated as a mental health disorder and as a disease with biological, neurological, genetic, and environmental components.”

2. What is an Addiction Psychiatrist?

“An addiction psychiatrist is a medical provider/specialist who, after completion of medical school, has received residency training in Psychiatry, and then received extra, additional fellowship sub-specialty training, specifically in Addiction,” Wilder says. “As such, the addition psychiatrist is a dually-trained expert trained to be able to diagnose and treat both mental health issues and addiction issues.”

“Addiction psychiatrists are able to prescribe medication when deemed to be necessary, appropriate, and beneficial,” Sternlicht says. “Oftentimes in addiction recovery psychiatrists will serve the function of prescribing medication and ongoing medication management while another therapist will help the individual develop the cognitive, emotional, and behavioral skills to maintain abstinence. Therefore it is common practice that individuals undergoing addiction treatment will work in conjunction with both a psychiatrist and therapist.”

Addiction psychiatrists view addiction as a mental health disorder that people can cure using psychiatric treatment methods, with a particular focus on co-occurring mental health conditions.

“In addiction medicine, we are focused on the prevention, evaluation, diagnosis, treatment, and recovery of those with substance use disorders,”  Lori Nation Legrand, MD, Medical Director of Daviess Treatment Services and Georgetown Medical, tells WebMD Connect to Care. “The goal is to assist those living with substance use disorders to improve health and social functioning while decreasing symptoms of the disease.”

Psychiatrists are usually part of a team of specialists working together to help patients overcome addiction. Legrand notes, however, that “while therapy plays a vital role in recovery programs, the difference between psychiatrists’ and therapists’ roles in recovery programs is often misunderstood.”

The scope of a psychiatrist in the context of addiction treatment tends to be narrower and more specific than that of a therapist. This is because, in addition to having more specialized training, addiction psychiatrists are in relatively short supply.

“It is rare to find a program where the psychiatrist acts as the therapist because of the widespread shortage of psychiatrists in this field,” says Legrand. “While psychiatrists are trained in therapy, they generally assist with medication management in recovery programs and work with a team of therapists to provide comprehensive care.”

3. What is Dual Diagnosis in Mental Health?

“Dual diagnosis implies that in addition to being diagnosed with a substance use disorder, the patient also has been diagnosed with a mental health issue,” Wilder says. “An example of this could be someone diagnosed with alcohol use disorder and diagnosed with depression. Both diagnoses are pertinent and cause difficulties in the patient’s life.”

“Dual diagnosis is quite common, and research has shown that almost 50% of those with substance use disorder also have a co-occurring mental health disorder. In fact, one set of diagnoses can often worsen and/or perpetuate the other set of diagnoses, and treatment of both sets of diagnoses is often vital and necessary for someone to optimally improve their quality of life and overall functioning,” Wilder adds. 

“Such disorders can be diagnosed by a variety of licensed mental health professionals including but not limited to psychiatrists, psychologists, nurse practitioners, licensed mental health counselors, and licensed clinical social workers,” Sternlicht says. “All such professionals are able to diagnose and treat dual-diagnosis disorders, but one of the primary differences is that only psychiatrists, nurse practitioners or other medical doctors are able to prescribe medication if and when it is needed.”

4.What is the Difference Between Addiction Medicine and Addiction Psychiatry?

Addiction Medicine and Addiction Psychiatry are two subspecialties for physicians, which are both recognized by the American Board of Medical Specialities (ABMS). Both specialties focus on the treatment of patients with substance use disorders, according to a 2020 study published by the American Journal on Addictions. Addiction medicine can be practiced by any ABMS primary specialty, however, addiction psychiatry can only be practiced by Board-certified psychiatrists.  

There is a lot of overlap between the two as they both focus on the prevention, diagnosis, and treatment of people with addiction,” Kate Daly, MD, MPHIL, Medical Director at All Points North, tells WebMD Connect to Care. 

“The clearest differentiation is usually in provider background and function. Addiction medicine specialists typically have internal medicine or family medicine training, and as the name suggests, they focus on medical interventions. They are usually the treatment providers for medical and ICU detoxification,” Daly says. 

On the other hand, “Addiction Psychiatrists are providers who completed medical school, a psychiatry residency, and further training in addiction psychiatry. They focus more on psychological causes of addiction and overlap with mental health issues such as depression, anxiety, and trauma. They are usually the treatment providers for psychotherapeutic interventions and psychiatric medication,” Daly explains.

5. What is Addiction Therapy?

Addiction therapy usually entails behavioral counseling and, if necessary, the treatment of co-occurring psychological disorders like anxiety and depression.

According to the National Institute on Drug Abuse (NIDA), the main objectives of addiction therapy are to:

  • Correct negative patterns of thought and behavior
  • Improve treatment retention
  • Promote healthy life skills

There are a variety of modalities that can be used in addiction therapy. American Addiction Centers notes that some common forms of addiction therapy include:

  • Individual, Group, and Family Therapy. This entails individual and/or group meetings with a therapist and important people in their life in order to address addiction and improving relationships to support recovery. 
  • Cognitive Behavioral Therapy (CBT). In this form of therapy, patients learn techniques to recognize and change maladaptive behaviors and thought patterns, while also developing coping skills, trigger recognition, and other skills that help prevent relapse. 
  • Contingency Management (CM). This form of treatment offers incentives for recovery-related behaviors, such as sobriety. It may be effective for treating addiction to alcohol, opioids, cannabis, and stimulants. 
  • Motivational Interviewing (MI). The goal of this type of treatment is to fortify each patient's individual motivation for and commitment to change, n accordance with their specific values. 

6. What’s the Role of an Addiction Psychiatrist Within a Recovery Plan?

“The addiction psychiatrist will make sure that all mental illness is diagnosed and treated in a safe manner,” Mark Jaffe, MD, Psychiatrist at Westwind Recovery Los Angeles, tells WebMD Connect to Care. “They will treat addiction with proven, evidence-based methods that are known to be effective. They will utilize medication-assisted treatment to treat addiction when indicated, which makes it less likely that someone will die from a fatal heroin overdose.”

The Addiction Psychiatrist assesses the individual to determine appropriate medications and appropriate course of care and treatment,” Stephanie Robilio, LCSW, Clinical Director at Agape Behavioral Health Center, tells WebMD Connect to Care. “The Addiction Psychiatrist also is the point person overseeing the individual's response to medication and interventions (ongoing symptom assessment and adjustments taking place if and as needed).”

“They will have an initial meeting with a patient to assess and evaluate patient history, applicable diagnoses, pertinent treatment options, and most appropriate level of care,” Wilder says. “From there, the patient may proceed with inpatient or outpatient-based treatment, depending upon a range of factors (including the degree of substance abuse, safety factors, social supports, psychiatric stability, overall functioning, overall commitment to therapy, level of risk of detox, etc.).”

“Addiction psychiatrists work in both inpatient and outpatient settings, and aid with evaluation and assessment, diagnosis, treatment, and ongoing follow-up care in association with the continuum of levels of addiction care. They often cooperate with other treatment providers on a comprehensive care team, including psychologists, therapists, social workers, peer recovery coaches, etc., and will also refer to the other providers if/as necessary to best meet individual patient care needs.” Wilder explains.

7. What Psychiatric Techniques are Used to Treat Addiction?

“Psychiatric techniques used to treat addiction range from therapy to medication to interventional psychiatry (an emerging subspecialty),” Daly says.“Providers may recommend psychotherapies such as cognitive behavioral therapy (CBT), eye-movement desensitization and reprocessing (EMDR), dialectic behavioral therapy (DBT), interpersonal and psychodynamic therapy, and group therapy models.”

“Medications that treat cravings and support ongoing sobriety are also psychiatric options. Often, the psychiatric approach to treatment includes both medications and psychotherapy for underlying or co-occurring mental health diagnoses,” Daly adds.

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