Shirah Vollmer MD

The Musings of Dr. Vollmer

Addiction Therapy: Let’s Think About This

Posted by Dr. Vollmer on November 18, 2013

How do we treat addiction? Psychotherapy? Psychopharmacology? Rehabilitation Facilities? Yoga? Meditation? Twelve Step Programs? All of the above? None of the above? There are no answers to these questions, yet with the Affordable Care Act, every plan must include addiction treatment. We, taxpayers, will support treatment for which there are very few outcome measures of success. Am I saying that people with addiction should not get treatment? No, addiction is a symptom of an underlying disorder in one’s mental state, in which one sabotages oneself, and one’s family, and as such, treatment is indicated. At the same time, we need to be honest that although treatment is indicated, the field is in its infancy, and as such, the appropriate intervention is not known. Scientific studies are in progress, but we need to deal with the state of the art, at the moment. My solution is that every patient with self-sabotaging behavior, including addictions, should be evaluated by a psychiatrist and then the psychiatrist can determine the best plan of action. I do not think patients should self-refer to a rehabilitation facility, as this is an intervention that makes sense for some, but not all addicts. I return to the  building blocks of good medical care. A good history, an experienced and well-trained clinician, yields our best bet, given the limited science. The term “addiction treatment” should be re-framed to go under general psychiatric care, where patients are evaluated for mental distress and then referred on to a treatment program. “Addiction treatment” should not be separated from psychiatric care, in general. This division takes away from patient’s understanding of themselves, which is critical to their recovery. The psychiatrist needs to explain to patients, after the evaluation, his/her best guess as to the nature of his illness and the most appropriate intervention. Calling it “addiction coverage” is like saying all insurance plans should have “chemotherapy coverage”. Addiction coverage should be implied in mental health care. I state the obvious, but apparently, it needs to be said.

http://www.whitehouse.gov/ondcp/healthcare

2 Responses to “Addiction Therapy: Let’s Think About This”

  1. Shelly said

    Maybe I’m naive, but isn’t addiction coverage something found in most insurance programs? Wouldn’t it be cheaper for a medical plan to have a residential stay for 2 months (or however long these things take) than a year of therapy? I realize you say that not all addiction programs fit all and such coverage needs to be tailored to the needs of the patient but in addiction (please correct me if I’m wrong), isn’t the problem two-fold? There is the medical issue–the body’s reaction to the substance, and the psychological one–the stressers that caused the patient to become addicted?

    • It was not on all insurance companies, but the Affordable Care Act mandates “addiction coverage.” As you say, there is no known duration of treatment which is optimal. Typically, the psychological aspects of addiction are the harder issues to treat, as with withdrawal can be handled with monitoring, and sometimes medication, in a relatively short period of time. Thanks.

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