KEY ASPECTS OF ADDICTION TREATMENT

WHAT ARE THEY AND WHY?

Jim Dhrymes MD

Private Practice

Unit Chief, Dual-Diagnosis Unit, VA Medical Center - Manhattan

Attending Physician, Bellevue CPEP

Clinical Asst. Professor of Psychiatry, NYU

Starting off with a frank, judgment-free discussion about what a patient themselves is interested in, as opposed to what others, including the clinician, might assume

Perhaps this is important for clinicians primarily, and may be obvious to those seeking treatment. Some people may be having trouble with a particular addiction, others with many addictions; some people may looking to "take a break," others may have reached the conclusion that abstinence is the most appropriate route. Many may be unsure, particularly at the outset of treatment. But having this discussion is key in terms of proceeding accordingly.

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Creating an environment to encourage honesty in all information provided

Discussing some aspects of addiction can be uncomfortable and there may be motivation to conceal certain things. Clearly there are some areas that one may not want to discuss, and there are certainly areas that are not crucial to discuss at the beginning of treatment, but there are some area that must be. Being in a situation where one can feel open to discuss and disclose without judgment is a crucial element. On a related note, as a clinician, bringing up inconsistencies or concerns about information that may not be wholly accurate is also key in establishing not only trust, but accountability.

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Reviewing the importance of allowing collateral parties to offer information, particularly at the acute stages of treatment

A third party's perspective can shed light on issues that may not be apparent to the person themselves. Sometimes, some situations may be so painful to recall that we may not even be able to do so. Thus, obtaining information from others is also a useful tenet of treatment. However, the next point is key as well-

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Reminding ourselves that the clinician is the patient's advocate, not the collateral parties' advocate

Ultimately, we advocate for our patients, not their spouses, friends, family or others. If there is a sense of "teams" we try to address this and work together. But ultimately we are on our patient's "team."

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Meeting regularly for appointments

A seemingly simple concept, this is actually key on a few different levels. Establishing a regular structure of treatment is in itself a therapeutic element. Discussing situations on a regular basis, even if things are going well, allows us to better know our clients, to provide valuable feedback when times may be tough, and to respond more accurately and efficiently if crises do arise.  

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Avoiding certain highly habit forming medications particularly in the early stages of recovery.

In spite of best intentions, the use of medications that immediately attenuate affect, i.e. reduce unpleasant emotions, is a decision that one must evaluate carefully, particularly in early recovery. Among these, there are some that can be so insidiously habit-forming that even if used under appropriate circumstances, they can put someone at risk.

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Keeping an open mind, and utilizing a flexible approach

Addiction treatment is not an algorithmic, flow-chart style treatment. There are situations where that type of treatment is not only totally appropriate, but most effective. This is not one of them. Owing to the large variety of manners in which addiction can manifest, the large amount of potentially co-occuring disorders, complexities of personalities and behavior, and particular goals of the patient, we must do our best to implement a plan that is in keeping with the patient's preferences, to work with someone's strengths and to be flexible depending on changes in situations.

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In over 10 years of working with all varieties of addictive illness, though I've encountered many challenging situations, I consider myself fortunate to have the opportunity to work with people and help them with their goals; I find this area to be highly rewarding and continue to encourage psychiatrists starting off in their careers to pursue this path.

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