There was a time not so long ago when the prospect of using psychiatry to treat addiction would have been seen as baffling. Rather than seen as a brain disease [1],
Substance Use Disorders were viewed as moral weaknesses needing spiritual treatment rather than psychiatric care.
Thankfully, increased medical knowledge has updated the principles of addiction medicine and made ample room for psychiatric treatments [2].
After decades, if not centuries of ineffective care, medical authorities realised that treating alcohol or drug addiction was about rewiring the brain.
The facilitators of this treatment are, of course, known as addiction psychiatrists. Essentially, they are medical doctors who specialise in substance abuse treatment and how addictive behaviours manifest.
A Board-certified psychiatrist will specialise in both substance use disorders and the mental illnesses that can accompany them.
As such, they’ll be trained in how to diagnose and treat SUD, but also how to help patients recover from co-occurring disorders [3]: a crucial term in the addiction treatment realm.
Co-occurring Psychiatric Disorders can include Depression, Generalized Anxiety Disorder, Antisocial Personality Disorder, and many more.
To ensure they are equipped to treat such an array of psychological issues, as well as the direct symptoms of substance abuse, psychiatrists undergo extensive training.
After undertaking medical school for general psychiatry, newly qualified doctors go on to complete a one-year addiction psychiatry residency. In a clinical setting, they’ll learn how to diagnose and treat SUD as well as co-existing disorders.
Upon completing one of these programmes, addiction psychiatrists are free to seek work in either private rehabilitation settings or publicly-funded NHS hospitals. Here, they’ll help patients achieve enduring recoveries through a menu of bespoke treatments.
The Role They Play in Addiction Treatment
An addiction psychiatrist plays a vital role in each part of the recovery process; from when someone presents for treatment, till long after they’ve left clinical services.
They’ll understand more than most the complex nature of addiction and will personalise treatment plans to suit the individual’s needs.
1. Forming a Diagnosis
However, personalising addiction treatment [4] is impossible without first obtaining a formal diagnosis. To gauge the kinds of ongoing care their patient needs, addiction psychiatrists will start by evaluating their mental and physical symptoms.
This thorough evaluation involves assessing the person’s medical history, substance use history, and any symptoms they’re experiencing.
Oftentimes, this procedure is combined with blood, urine, or other laboratory tests to provide an overall picture of someone’s health before entering treatment.
During their assessment, psychiatrists will also try to get a clear idea of how well the person can function in day-to-day life. If someone cannot eat, dress, go to work, or take care of themselves adequately, they’ll need to be referred for immediate inpatient care.
Another integral part of the evaluation is ascertaining someone’s psychological well-being, and whether dual diagnosis treatment is needed.
For this, psychiatrists may refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5): a useful SUD criteria published by the American Psychiatric Association [5].
2. Creating Treatment Plans
From here, the role of addiction psychiatrists is to design and implement a comprehensive treatment plan. Their approach to treatment will vary depending on how severe their patient’s addiction is, and whether they’re suffering from a co-occurring condition.
For example, the action plan for someone with alcohol addiction and obsessive-compulsive disorder will look vastly different from someone with opioid addiction and no comorbidity.
When curating a personalised care plan, psychiatrists take into account the type of substance addiction, symptom severity, and whether inpatient or outpatient treatment is needed.
The former involves staying overnight at a rehab clinic for a typical duration of 28 days [6], while the latter involves living at home and travelling to pre-arranged therapy appointments.
This provision of bespoke care means having contact with an addiction psychiatrist is perhaps the best way to ensure treatment longevity.
After their comprehensive evaluation, your addiction psychiatrist will know the ins and outs of your condition: allowing them to curate a successful relapse prevention plan.
3. Liaising With Other Care Providers
Addiction psychiatrists rarely work alone, and each patient often requires a care team made up of doctors, nurses, social workers and neurologists. With such an integrated system, each member of the team must communicate with one another, especially when a patient has unique or challenging needs.
As such, it’s the job of every psychiatrist to consult with members of a patient’s care team. Once they’ve reached a diagnosis [7] and designed a treatment programme, they’ll communicate with members of staff to ensure everyone is on the same page.
Having a team of several healthcare professionals caring for SUD victims allows patients to receive well-rounded care. As each professional may have different specialities, various medical opinions can enter the mix and work together to create a cohesive treatment plan.
If appropriate, mental health professionals will also keep the patient’s friends and family updated on their loved one’s treatment. This ensures that everyone touched by a case of addiction can begin coming to terms with the situation and start the healing process.
What Kinds of Treatment Do They Use?
During their training, addiction psychiatrists learn how to implement a plethora of treatment strategies [8].
Because there’s no set way of recovering from SUD, psychiatrists must tackle this complex condition on a case-by-case basis, allowing strategies to change depending on the needs of each person.
Saying this, many addiction psychiatrists follow a basic template for treating their patients, as certain methods are integral to recovering from SUD. These strategies are implemented by professionals across the world for their combination of medical and psychotherapeutic techniques.
1. Medicated Detox
Helping their patient to safely wean off of drugs or alcohol [9] is the initial goal of most addiction psychiatrists. This is because most addictive substances cause debilitating physical dependencies in victims, and this will lead to dangerous withdrawal if not treated properly.
Addiction psychiatrists will design a bespoke detox protocol to begin as soon as possible to limit further substance-induced harm.
They’ll take several factors into close consideration when creating a detox plan, such as the type of substance, duration of use, and comorbidities.
Other facets such as weight, age, and blood work results help the psychiatrist determine their patient’s risk of withdrawal, and how much supervision they’ll need.
In cases of inpatient detox, psychiatrists will inform the on-site healthcare team of each person’s tapering schedule, medication plan, and unique risk of withdrawal.
Tapering is the controlled process of lowering someone’s substance levels by a little each time until their system is clear and the threat of adverse symptoms is low.
Psychiatrists may also prescribe short-term medications during detox to help battle cravings and other side effects. For those battling heroin use disorder, partial activators of the opioid receptor are often implemented to keep dangerous symptoms at bay.
In other cases of severe addiction, craving inhibitors can play a major role in the first crucial weeks of detox. Psychiatrists might recommend a course of Naltrexone or Vivitrol, an opioid-blocking agent that can make relapse less viable.
2. Medication Management
While prescription medications don’t have the power to cure addiction, they can make symptoms more manageable: whether these are physical or mental, short-term or long-term. Part of an addiction psychiatrist’s training focuses on being able to prescribe medical support and deem when it’s necessary to do this.
As we’ve mentioned, various medications are prescribed during detox to help people cope with adverse symptoms, and these are usually temporary.
However, some individuals need extra pharmacological support after they’ve finished detoxing. It’s the role of the psychiatrist to decide whether someone needs prolonged medical care and to choose a sustainable form of medication.
One example is if the patient is suffering from Post Acute Withdrawal Syndrome (PAWS) [10]. This describes a worrying situation wherein withdrawal symptoms continue for weeks or months following detox.
Not only can PAWS threaten relapse, but it can make daily life intolerable: with common symptoms including anxiety, depression, and insomnia.
To help patients deal with the symptoms of PAWS, psychiatrists will base their prescriptions on the individual’s substance use and medical history. For example, benzodiazepines are often prescribed to those suffering from prolonged alcohol withdrawal syndromes.
At a low dose, they can help ease anxiety, restlessness, mood disorders, and sleeping problems to ensure the patient feels ready to undertake their other treatments.
Other cases that may require psychiatric medications are co-occurring disorders.
Sadly, many addiction sufferers have been battling mental illness for many years before seeking treatment. In situations where symptoms of anxiety or depression are debilitating, psychiatrists often prescribe SSRIs to relieve discomfort.
3. Psychotherapy
Therapeutic methods are the cornerstone treatments used by psychiatrists and have gained traction in SUD recovery over the years. Also known as talk therapy, psychotherapy is grounded in the dialogue between the patient and their psychiatrist, typically spanning a few weeks or months.
During sessions, those in recovery will sit down and talk with their psychiatrist for a duration of 1-1.5 hours depending on the style of therapy. This gives them the chance to work through issues that are at the root of their alcohol or drug addiction.
Typically, an addiction psychiatrist will plan therapy to start following their patient’s detox [11] to ensure they’re in a good place physically.
The types of psychotherapy they choose to integrate will depend on the person’s addiction severity and any other mental health conditions that are present.
What Types of Therapy Might An Addiction Psychiatrist Use?
A good psychiatrist understands that there’s no single form of therapy that works for everyone in recovery, instead referring to a toolkit of different strategies.
Tailoring an individual’s treatment plan is crucial to achieving long-term sobriety, and each patient is carefully evaluated to find out which therapy style would suit them best.
1. Cognitive Behavioural Therapy (CBT)
This type of behavioural therapy is one that you’ve probably come across before, either through personal experience or your own research, and it’s well-known for good reason.
In addiction treatment, psychiatrists use CBT to help individuals identify their relapse triggers and rewire negative thought patterns.
Sessions encourage participants to explore their innermost thoughts and feelings, aided by psychiatric techniques such as cognitive reframing. This describes the process of challenging, modifying, and replacing the irrational thoughts that are holding someone back.
Another major part played by psychiatrists during CBT is showing their patients how to cope with relapse triggers. No matter how much effort is poured into rewiring thought pathways, triggering situations or emotions can crop up throughout recovery.
Psychiatrists can suggest strategies for getting through difficult scenarios with less stress, tension, and anxiety. Depending on the individual and their comorbidity, common examples to help deal with uncomfortable thoughts include journalling, thought records, and mindfulness.
Alongside classic CBT tactics [12], addiction psychiatrists might also choose to implement Exposure Therapy. Used to confront fears, this CBT side step involves gradually exposing a patient to sources of anxiety, while explaining how to cope with them as they occur.
2. Dialectical Behavioural Therapy (DBT)
Similarly to classic behavioural therapies, DBT helps those in recovery deal with negative thoughts but has a larger focus on emotional welfare.
Oftentimes, psychiatrists will encourage patients who are victims of trauma to undertake DBT, as its techniques will help them heal emotionally and process their addiction.
During DBT sessions, psychiatrists help patients learn how to cultivate healthy, more positive behaviours. This can mean fostering healthy relationships, learning to let go of past troubles, and acknowledging unwanted thoughts sans judgement.
Addiction psychiatrists who implement the DBT approach understand the importance of emotional regulation and distress tolerance in recovery.
Learning to sit with discomfort and let life’s troubles wash over you is a powerful way to avoid slipping back into substance use. In the long term, skills learned during DBT will help cultivate a more positive outlook for those in addiction treatment.
3. Acceptance and Commitment Therapy (ACT)
Along a similar vein, ACT for addiction [13] helps patients overcome destructive thoughts and emotions.
As a combination of both CBT and DBT principles, this third-wave behavioural therapy has become an increasingly popular psychiatric treatment. Many addiction psychiatrists utilise this treatment because it’s so easy to personalise and mould to tackle an array of comorbidities.
Across ACT sessions, psychiatrists help participants work on their psychological flexibility: which is the ability to overcome tough situations by responding healthily.
This is achieved through 6 key skills: acceptance, self-as-context, thoughts vs reality, mindfulness, core values, and committed action. When combined, these create an essential toolkit for emotional recovery post-substance abuse.
4. Group Therapy
Oftentimes, addiction psychiatrists are able to facilitate both individual and group therapy in their programmes, with each style having its own set of benefits.
Group support therapies see groups of between 6-12 come together and discuss their recovery experience or how they cope with a mental health disorder, with sessions mediated by an experienced therapist.
In many cases, psychiatrists hold group therapy sessions in their place of work, such as a private practice, rehab centre, or out in the community if they’re working for a 12-Step group.
Sessions encourage participants to share their experiences with addiction recovery: promoting altruism, boosting self-esteem, and creating new friendships.
5. Family Therapy
While the individual patient is at the heart of every treatment plan, an experienced psychiatrist will involve family members in the recovery process wherever possible.
Not only is it crucial to have the support of loved ones to help prevent relapse, but it’s also essential that friends and family begin healing from the addicted person’s actions.
After evaluating their patient’s living situations, family dynamics, and addiction severity, psychiatrists will decide which type of therapy would suit them best.
For example, Multidimensional Family Therapy is designed for addicted adolescents and adults who care for them, while Behavioural Contracting helps patients cultivate a substance-free home.
During therapy sessions, addiction psychiatrists can help the family unit face a variety of issues, from long-standing resentments to mental illness within the group.
In addition, sessions may involve a level of education, with therapists helping loved ones understand addiction as a chronic disease. This can help family members understand their addicted loved one and empathise with the recovery process [14].
How Can I Enlist the Help of a Psychiatrist?
When faced with an addiction, whether it’s happening to you or someone you love, enlisting the help of a psychiatrist can be a tremendous help. However, if you’re researching a potential psychiatrist independently, there are certain factors to consider and things to look out for.
First and foremost, it’s crucial to check that a psychiatrist is licensed to deliver addiction treatment [15]. Whether they have their website, work in a clinic, or appear in a directory of psychiatrists, they should have the correct and up-to-date certification displayed.
If they are a general psychiatrist, it’s also important to ensure they have experience dealing with Substance Use Disorder and mental illness.
Because SUD treatment is such a specialised field, good psychiatrists will be open to having a sub-speciality of addiction psychiatry. This means they’ll have all the experience and tools needed to diagnose and treat SUD, alongside co-occurring disorders such as depression or anxiety.
Alternatively, you can call the OK Rehab team and ask a member of staff about how best to find an addiction psychiatrist. They’ll take the time and care needed to go through each option and can refer you to someone in your local area.
By setting you up with a consultation, we can ease the burden that comes with independently researching treatment, especially if you’re feeling emotionally vulnerable.
To start your journey towards a healthier future [16], simply call 0800 326 5559 to make an enquiry, or visit our website to request a callback.
References
[1] The Brain Disease Model of Addiction The Brain Disease Model of Addiction | Hazelden Betty Ford
[2] Addiction Psychiatric Medicine, A Comprehensive Board Review Addiction Psychiatric Medicine – Google Books
[3] Dual Disorders, Essentials for Assessment and Treatment Dual Disorders – Google Books
[4] The Addiction Solution: Unravelling the Mysteries of Addiction Through Cutting-Edge Brain Science https://books.google.co.th/books?id=_HlQfxWyJogC&printsec=frontcover&dq=valium+addiction&hl=en&sa=X&redir_esc=y#v=onepage&q=valium%20addiction&f=false
[5] DSM-5 Criteria for Addiction Simplified https://www.addictionpolicy.org/post/dsm-5-facts-and-figures
[6] Ok Rehab: Drug Rehab Drug Rehab Treatment | Private Clinics | OK Rehab
[7] The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Screening, Brief Intervention, and Referral to Treatment (SBIRT) | SAMHSA
[8] Innovations in the Treatment of Substance Addiction https://www.google.co.th/books/editionHuman_connection_as_a_treatment_for_addi/B1CqEAAAQBAJ?hl=en&gbpv=0
[9] Ok Rehab: Medically-Assisted Therapy (MAT) For Addiction Medically-Assisted Therapy (MAT) for Addiction | OK Rehab
[10] Coping With PAWS: Acute Withdrawal Syndrome, SMART Recovery “Am I Going Crazy?!” – SMART Recovery
[11] Alcohol Detox: The Guide to Safely Clean Up Your Lifestyle, Detoxify & Maintain Healthy Body Without Drugs https://www.google.co.uk/books/edition/Alcohol_Detox/JrLpzgEACAAJ?hl=en
[12] Ok Rehab: Cognitive Behavioural Therapy (CBT) Cognitive Behavioural Therapy (CBT) for Addiction | OK Rehab
[13] Ok Rehab: Acceptance and Commitment Therapy (ACT) Acceptance & Commitment Therapy | OK Rehab
[14] Understanding and Loving a Person with Alcohol Or Drug Addiction Understanding and Loving a Person with Alcohol Or Drug Addiction – Google Books
[15] Group Cognitive Therapy For Addictions Group Cognitive Therapy for Addictions – Google Books
[16] Ok Rehab: About Us About Us | Learn More | OK Rehab
