As the opioid crisis continues to claim lives, more people than ever before are wondering what separates a great addictionologist, or addiction specialist, from an average one. In this post, we’ll examine this question in detail, providing you with the tools you’ll need to identify a stellar specialist and treatment facility.
Along the way, we’ll delve into the importance of evidence-based treatment, and we’ll explore how substance use disorder is diagnosed in the first place. Knowing the facts about this important topic can help you wade through the attention-hungry headlines you might see from blogs and videos on the topic. We stick to the science.
Let’s get started.
The Addiction Crisis in 2020
As a society, addiction has been with us for centuries, though the role of the addictionologist or addiction specialist has certainly morphed over time. The most recent addiction crisis, which started gaining widespread news coverage in 2014, is centered on opioids. This latest epidemic is different from previous drug-related public health emergencies in that it affects a broader swatch of society. While drugs like crack disproportionately affect minorities and low-income individuals, people of all economic backgrounds use opioids.
Indeed, opioids are effective painkillers. Many of these opioids are locked away behind prescriptions, but these prescriptions are not particularly difficult to obtain. Combine that with the fact that opioids are addictive, and we have the potential for a public health crisis.
The fact that these drugs are available by prescription lulls patients into a false sense of security. The thinking goes something like this: My doctor gave me these meds, so they can’t be dangerous. This isn’t meant to imply, however, that doctors are to blame. Some individuals suffer from chronic pain that doesn’t respond to weaker painkillers. Asking these individuals to live with their pain is not in the cards. But the opioid horse has escaped the barn, so to speak, and society must now decide how best to deal with the opioid crisis without curtailing legitimate patients’ rights to treatment and pain relief.
However, the situation cannot be ignored. Every day, more than 130 people in the U.S. alone die from opioid overdose. What’s more, prescription opioid abuse costs the U.S. over $70-billion per year in emergency treatment, addiction treatment and lost productivity. See the paper, The Economic Burden of Prescription Opioid Overdose, Abuse Dependence in the United States, by Curtis Florence PhD, for more on this.
How did this become such a huge issue?
According to the paper, Pain as the Fifth Vital Sign: Exposing the Vital Need for Pain Education, pharmaceutical companies may have gotten ahead of themselves by assuring doctors and other health practitioners that prescription opioids would not prove addictive. As a result, doctors began prescribing them in large numbers. In the year 2017, over 45,000 Americans died from opioid overdose.
In that same year, around 1.5-million Americans identified as suffering from substance abuse disorder.
Clearly, there is a need for qualified addiction specialists who practice evidence-based treatments. But what does that mean, exactly? Let’s find out.
Where Is the Evidence-Based Care?
Over the last fifty years or so, medical practice has moved away from the view that addiction is a moral failing. Indeed, addiction is a chronic condition that begins with very real changes in brain function. It isn’t the result of immorality or laziness as some once believed. Today, there are over 5,000 medical doctors who are board-certified to provide evidence-based addiction treatment. These individuals have the training to evaluate and treat addiction at any stage. When evaluating any particular specialist, look for certification from these groups:
- The American Board of Preventative Medicine
- The American Board of Addiction Medicine
- The American Board of Psychiatry and Neurology
But what is ‘evidence-based’ treatment, and why is it important?
Over the last few years, this term has become much more common. Pop-sci blogs and magazine articles love to use this term to differentiate between various levels of care. Indeed, the term ‘evidence-based’ is often misconstrued, sometimes by folks who have an agenda to push. Many of these blog posts, news stories and videos claim that rehab centers need more ‘evidence-based medication assisted treatment options.’ But the truth is, any highly regarded rehab center will employ specialists who practice evidence-based treatment.
Indeed, most rehab facilities already use cutting edge, evidence-based MAT treatments. The adoption of a particular treatment may seem slow because addictionologists are understandably cautious. Studies, clinical trials and other forms of evidence of efficacy are slow to come to fruition. Even then, other experts must evaluate these studies in a process known as peer review. This takes time.
The Substance Abuse and Mental Health Services Administration maintains a list of over 175 evidence-based treatments. Any quality rehab facility will retain addictionologists who are well versed in a number of these.
What Is an Addictionologist?
So far, we’ve discussed the current addiction crisis and have challenged the idea that evidence-based treatment isn’t a priority for rehab facilities. Now let’s turn our attention to the addictionologist herself. An addictionologist, or addiction treatment specialist, is a medical professional who holds a specialty in addiction medicine. Alternatively, an addiction specialist may hold a board certification in addiction psychiatry.
As mentioned, the American Board of Preventive Medicine and the American Board of Psychiatry and Neurology are two organizations that issue these certifications in the U.S.
However, you may see other qualifications. For instance, the American Board of Addiction Medicine offers board certification in addiction medicine. The American Osteopathic Association, meanwhile, offers a Certificate of Added Qualification in addiction medicine.
Broadly speaking, there are two types of addiction specialists, and you find both in a rehabilitation facility.
- Addiction medicine physicians. These experts can help you understand and cope with the physical symptoms of drug addiction and withdrawal. They can work with you to create a complete treatment plan. These folks tend to be primary care doctors. As such, they can conduct a complete medical exam to identify existing health issues, such as micro-nutrient deficiencies, which may make recovery more difficult.
- Addiction psychiatrists. These folks work with physicians to help patients manage and understand the symptoms of addiction and withdrawal. In addition, they can recognize psychiatric complications of addiction. For instance, an addiction psychiatrist may spot a co-current, but undiagnosed, mental illness that may be contributing to addiction.
How Does Therapy Fit In?
The above specialists can play an immense role in confirming the existence of addiction and can help identify and treat underlying issues. For some, this is enough. Many folks, however, benefit from ongoing addiction therapy, or counseling. An addiction counselor offers one-on-one or group sessions to help individuals come to terms with the fact that they have an addiction. Moreover, ongoing therapy can teach patients how to manage impulsive—and often self-destructive—thoughts that my trigger relapse.
Therapists utilize a wide range of proven techniques, such as cognitive behavioral therapy, contingency management, Rational Emotive Behavior Therapy, motivational interviewing and Eye Movement Desentisization and Reprocessing Therapy. These therapies become essential once the patient gets through the initial detox phase.
Without learning powerful coping mechanisms such as these, those struggling with addiction are likely to use again after leaving rehab.
For instance, cognitive behavioral therapy can help an individual identify thought distortions that lead them to use. Often, these thought distortions, such as all or nothing thinking or catastrophizing, become more frequent during periods of high stress. Knowing this ahead of time gives the person struggling with addiction an advantage.
Psychology Today provides a handy directory that includes thousands of therapists. Being ‘verified’ by Psychology Today means that the therapist has at least a Master’s degree and a valid license to practice in their state of residence.
What to Look for in an Addictionologist
Apart from the aforementioned certifications, there are a few characteristics of a stellar addiction specialist to look out for. In no particular order, these are:
- A desire to stay up to date on the latest research, and a commitment to continuing education
- A treatment-focused mindset that avoids casting blame
- An understanding that addiction is a chronic disease that starts in the brain
Finding a specialist with these characteristics will give you the best chance of achieving lasting recovery. The focus should be on treating the addiction as a condition of the brain and not as a function of behavior, impulse control or willpower.
Naturally, addictionologists are often retained by rehabilitation centers. Any reputable rehab center will put the qualifications of their specialists on display, often on their website. But you should take care to evaluate the center itself. Quality rehab centers will seek accreditation from the Commission on Accreditation of Rehabilitation Facilities—CARF—or the The Joint Commission. The Joint Commission and CARF are both nonprofit organizations, and they’re both independent. This means that they’re not reliant on any rehab facility or other organization for funding.
What’s more, LegitScript, an Internet payments compliance company, issues certifications to qualifying rehab facilities. This special certification enables rehabilitation facilities to advertise on Google, Facebook and other large platforms in confidence. LegitScritp’s vetting process is quite rigorous, so if you see this certification on an ad, you can be sure that the rehab facility is legit.
Finally, while all rehab facilities post testimonials on their own websites, you should look for reviews from other people, posted to sites that the rehab facility does not control.
A quality rehab center will employ a number of addictionologists who collectively provide a broad spectrum of specializations. This is known as a multidisciplinary treatment team. You’ll likely find:
- Several nurses
- A nutritionist or dietitian
- A medical doctor
- A psychologist
- A psychiatrist
- A chemical dependency counselor
- A wellness specialist
- A spiritual care counselor
Addiction is a complex disorder, and what works for one person may not work for another. For this reason, a multidisciplinary treatment team is essential.
Researchers now understand that addiction is a chronic condition. By the time you’ve developed a chemical dependency, changes have occurred in the brain that may never reverse. The good news is that addiction can be managed, and you can play an active role in that. Recently, the Diagnosis and Statistical Manual for Mental Disorders combined substance abuse and dependence into a single category, substance abuse disorder.
When someone thinks they may have a problem with substance abuse, the first step often involves a trip to a family doctor. This doctor should then refer the individual to a substance abuse disorder specialist. This specialist will ask the patient questions designed to help them determine frequency of use and the drug’s impact on daily functioning. Specifically, the specialist will want to determine how the drug use is affecting the individual’s social, emotional and occupational functioning.
At the same time, the specialist will ask the patient whether they’ve tried to cut back, how many attempts were made and whether they experienced withdrawal symptoms. Establishing a pattern of having tried—and failed—to quit is important.
The DSM-5 breaks substance abuse disorder down into nine subtypes, because each type can have different withdrawal symptoms. These subtypes are:
- Opioid-related disorders
- Caffeine-related disorders
- Alcohol-related disorders
- Cannabis-related disorders
- Inhalant-related disorders
- Sedative-related disorders
- Tobacco-related disorders
- Non Substance-related disorders, such as gambling
- Unknown substance-related disorders
Each of these subtypes have their own specific criteria for diagnosis. But they also have important commonalities between them, such as:
- The patient regularly consumes large amounts of the substance, more than was intended or for longer periods than planned
- The patient has a history of voicing a desire to cut back or moderate their use of the substance
- The patient spends a great deal of time trying to obtain the substance, using it or recovering from using it
- The patient experiences intense cravings for the substance or frequently expresses a desire to use it
- The patient fails to fulfill professional, educational, personal or family obligations because of substance use
- The patient regularly uses the substance despite emotional, social, or personal consequences
- The patient has given up pastimes, hobbies or social activities to use the substance more often
- The patient consumes the substance even in situations that could cause physical harm
- The patient continues to use the substance even though they are aware it is causing physical or psychological harm
- The patient exhibits increased tolerance; they must use more of the drug to get the same high
- The patient experiences withdrawal if they stop using
Exhibiting only two of these symptoms at the same time can be enough for a specialist to diagnose substance use disorder.
If you see yourself in the above, don’t wait. Seek help now. The earlier you seek treatment, the sooner you can get control over your addiction. You can reclaim your life. Though the journey may not always be easy or pleasant, the satisfaction you gain from knowing you have your addiction under control, and that you’re firmly in the driver’s seat of your own life makes it all worth it.
If you’re trying to get addiction treatment for yourself or for someone you love, reach out to The Hills for comprehensive and caring treatment with addictionologists who will help patients detox and learn the skills to cope with their triggers and their addiction.