Addiction treatment has become safer, better, and more thoroughly regulated than it was even five or ten years ago, and that’s great news. But as with all facets of our healthcare system, there’s still progress to be made.
One area of concern in the addiction treatment field: Many centers operate with no medical doctors (including psychiatrists) on staff—or even in affiliated roles.
I do not mean to disparage people in my field who did not go to medical school—be they nurses, psychologists, therapists, or anyone else who is leading a treatment team. As a rule, these professionals do an excellent job. They have their important roles, and fulfill their duties as far as their training and expertise allow. But their training and expertise are different from that of an M.D.
Here’s why the expertise of a doctor is so important in the addiction treatment setting:
1. Physicians have knowledge of COVID and other viruses.
All doctors get virus and contagious illness training in medical school and beyond. The result is that doctors have been better able to safeguard their rehabs by way of various protocols during COVID. The importance of this knowledge will continue as long as COVID-type viruses and other infectious diseases exist. Which will be always.
2. Doctors have training and knowledge of physical illnesses.
Many times, when patients seek addiction treatment, they’re also dealing with serious physical issues such as diabetes, obesity, heart disease, and cancer. These health issues don’t take a break when a person goes into rehab. They must be dealt with alongside the addiction. An M.D. is the best person to oversee that.
Older people living with addiction may have the most reasons of all to look for M.D.-led treatment centers. Older people tend to have higher disease rates than younger people, and often take longer to get through detox. Proper medical oversight is vital during those times.
3. Physicians have training and knowledge of mental illnesses.
Addiction itself is a mental illness, of course, but many others are common in the addicted population. When another mental illness is present along with addiction, it’s known as a co-occurring disorder (also known as a dual diagnosis).
Illnesses such as anxiety, depression, trauma, bipolar disorders, and so on, are very difficult to treat, especially when addiction is also present. That requires a huge amount of training and knowledge to get right. If you just treat the addiction, the depression remains. If you just treat the depression, the addiction remains. These conditions must be tackled in a fully integrated manner and, you guessed it, an M.D. is the best-equipped provider to do that.
4. Doctors are critical during the dangerous detox period of recovery.
You may have heard the phrase, “medically assisted detox.” That’s a very comforting protocol for patients and their loved ones when a patient is facing that awful seven- to ten-day period when he or she is getting off drugs or alcohol.
Lots of bad things can and do happen during detox. These include anxiety attacks, sleeplessness, extreme nightmares, tremors, even seizures and heart attacks. An M.D. is vital for administering needed medications and other treatments to help alleviate or prevent those potentially deadly reactions.
5. Physicians can oversee safe, effective medication-assisted treatment (MAT).
As complete-abstinence treatment recedes and MAT evolves as the standard in addiction care, doctors who prescribe medications and who understand the body’s biochemistry are in higher demand than ever. Making medication decisions is dangerous if you don’t have the training, or don’t know the big picture of how the body works.
MAT medications, like suboxone or naltrexone, are proven to be effective, but they are powerful drugs. They come with risks, and there are a lot of potential adverse interactions to manage. An M.D. is in the best position to handle those contingencies.
6. Doctors have more clout when it comes to getting health insurance companies to pay for necessary addiction treatment.
Length of stays in rehab and the treatment protocols on offer are not always set in stone. Both are dictated by individual patient needs, of course, but treatment center providers can also influence them. One way that happens is if a provider signs off on the need for a patient to stay an extra week, for example. This official signoff makes it more likely (though not a sure bet) that the patient’s insurance company will extend coverage for the added week.
But here's the caveat on that: I know from experience that if there’s a therapist’s note in the patient’s file versus a doctor’s note, a health insurance company will pay more attention to the doctor’s note every time. I’m not sure this is how the system should work, but it’s how the system usually does work.
7. An M.D. can help patients and their loved ones feel more confident about their stay in rehab.
This “confidence effect” can’t be underestimated. A patient is naturally going to feel more reassured knowing there’s an onsite M.D. helping her get through the hell of detox. That patient is also going to feel more reassured when meeting with a doctor to discuss medications, a co-occurring disorder, or a physical condition.
A patient’s confidence and positive attitude is a huge asset on the journey to recovery. And clearly, the patient’s loved ones will be bolstered in the same way.
Final thoughts: I want to emphasize again that this post is not meant to disparage non-physicians. I’m simply explaining why it’s important for people to seek an addiction treatment center that has the in-house medical and psychiatric expertise they deserve and can feel confident about.
The only thing better than having an M.D. on staff? Having two on staff. Especially if they have distinct expertise areas that complement and amplify each other.