What is Addiction Psychiatry?

Addiction is often tied to a mental health condition. People self-medicate to reduce symptoms of a mental disorder and temporarily calm emotions. However, it often leads to a downward spiral, with deteriorating emotional regulation and worsening personal and professional problems.

In these instances, a dual diagnosis approach is necessary, addressing both addiction and its underlying cause- and that’s where addiction psychiatry comes in. It aims to diagnose both the substance use disorders and the underlying mental condition, leading to long-term recovery. Here’s what it involves:

• Professional Psychiatrists: Addiction treatment is typically provided by a professional with an addiction psychiatry fellowship or certification, such as a medical doctor with psychiatric training or a board-eligible psychiatrist.
• What is Treated: The therapy treats a wide range of substance use disorders and their underlying cause, which may include depression, anxiety, bipolar disorder, PTSD, ADHD, and psychosis.
• What’s Involved: Addiction psychiatry focuses on diagnosing and treating substance use and psychiatric disorders. The specialist will identify the underlying mental condition and recommend the best steps moving forward. They often prescribe medications and therapy, and plan a course for recovery.
• Where They Work: You can access addiction psychiatry care at a rehab facility, an outpatient treatment center, an academic medical center, a veterans’ hospital, a primary care and pain clinic, and a department of psychiatry at a hospital.

Addiction Psychiatry Process

The addiction psychiatry process is as follows:

Assessment

First, the care team will conduct a thorough assessment to evaluate your mental health needs. Here’s what’s involved:

• Severity of Addiction: They will ask you what type of drugs you use, how long you’ve been using them, and dosage amounts. Other questions will address attempts to stop and how drug use has impacted your life.
• Mental Health: You may be asked to discuss your mental health history, talking about symptoms and past diagnoses, if relevant. The specialist will also want to find out about any medications you are taking and if you experience suicidal ideation.
• Medical History: The therapist will want to know your medical history to understand how your physical health may affect your mental health and to identify potential harmful interactions. A physical exam may be necessary.
• Environmental Factors: You will be questioned about past and present environmental factors that may contribute to your emotional state.

Creating a Treatment Plan

The specialist will use their expertise in treating substance abuse to help you create a treatment plan. They will focus on goals such as abstinence, harm reduction, or stabilization and determine the necessary level of care. Physicians and other healthcare specialists may be included in the planning process.

Generally, you can choose from:

• Residential Care: Psychiatry residents typically have severe conditions that require 24/7 specialized care focused on therapeutic interventions.
• Partial Hospitalization Program (PHP): Similar to residential care, patients receive care during the day and return home at night.
• Intensive Outpatient Care: A good choice for people with stable home lives who need to manage responsibilities such as work and child care, this program involves seeing a therapist for approximately three hours a day, three days a week. It may be a follow-up to PHP or residential care.
• Outpatient Care: Often the final stage of treatment, this involves regular check-ins with general psychiatry visits to support emotional regulation.

Withdrawal Management

If you are currently using drugs and have a severe addiction, you may require detox. This is a difficult process as most clients experience withdrawal symptoms that increase relapse risk. However, they will work with other specialists to ensure optimal safety and comfort throughout the process.

Here’s what assisted detox will look like:

• Medication-Assisted Treatment: Medications are administered to control cravings and symptoms.
• Vital Sign Monitoring prevents severe complications.
• Oversight reduces relapse risk.

Medication Planning

Medications can be used as short- or long-term solutions. Here are some that are commonly integrated:

• Buprenorphine: Often used for opioid use disorder, this medication controls cravings and blocks opioid effects. It can calm withdrawal symptoms and may be used on a longer-term basis.
• Naltrexone: This opioid blocker can be integrated into treatment after detox.
• Methadone: Typically, a long-term solution, this medication provides stable opioid effects that support functionality.
• Disulfram: Treats alcohol addiction, making you sick if you drink.
• Anti-depressants and mood stabilizers are often used for long-term emotional regulation.

An addiction psychiatrist will use their advanced training to determine which is best for you based on your unique needs and physical and mental health.

Evidence-Based Treatments

Various evidence-based treatments may be introduced in therapy. While approaches may vary, they work to address the underlying cause of addiction and teach coping strategies so people can cope with their emotions without turning to drugs and alcohol. Common research-backed services include:

• Cognitive Behavioral Therapy (CBT): Addresses and identifies negative emotions and helps you develop healthy coping mechanisms.
• Dialectical Behavior Therapy (DBT): Focuses on emotional regulation.
• Motivational Enhancement: Motivates a person to improve.
• Contingency Management: Rewards people for positive behavior, such as maintaining sobriety.
• Family Therapy: Families are often included in sessions to learn how their behaviors may have contributed to drug use. They will work on building healthy relationships and providing a positive environment for their loved ones.

The therapist will use their subspecialty training and education to determine which approach is best suited to your needs. In many cases, a variety of therapies are utilized.

Monitoring and Follow-Up

Therapists realize that care doesn’t stop the moment clients complete the initial stages of treatment. They may continue to see clients on an outpatient basis, checking in monthly or bimonthly to monitor how they are managing cravings, symptoms, and medications. Adjustments may be made, if necessary.

When to Choose Addiction Psychiatry vs. Rehab

Addiction psychiatry is similar to rehab, and it can be difficult to determine which is best for you. Here are some things to consider when you make your decision.

• Issue: Severe mental health symptoms
• Best Choice: Addiction psychiatry
• Reason: Addiction psychiatry can address emotional disorders that may be overlooked in rehab

   

• Issue: Uncontrollable cravings, withdrawal symptoms, and emotions
• Best Choice: Addiction psychiatry
• Reason: Specialists can prescribe medications that keep symptoms under control

   

• Issue: Serious medical conditions
• Best Choice: Addiction psychiatry
• Reason: The therapist will determine which medications and approaches suit your individual needs and don’t produce interactions; a specialized approach may be used for pregnant women
• Issue: Ambivalence about recovery
• Best Choice: Addiction psychiatry
• Reason: Addiction specialists use methods like motivational interviewing to gradually push people towards recovery, eliminating an all-or-nothing approach

   

• Issue: You can’t stay sober
• Best Choice: Rehab
• Reason: Rehab offers a structured environment that makes it difficult to access substances

   

• Issue: You need immediate medically supervised detox
• Best Choice: Rehab
• Reason: Rehab centers often provide detox in an inpatient setting, reducing relapse risk
• Issue: Your home environment is fueling your addiction
• Best Choice: Rehab
• Reason: A rehab facility offers an environment that separates you from your home life

• Issue: Legal or job requirements
• Best Choice: Rehab
• Reason: Courts and workspaces often require you to go to rehab to meet the legal standards

Get the Care You Need at BNI Treatment Centers

BNI offers psychiatry sessions for adolescents and adults, ensuring a customized approach. We help our clients overcome addiction and its underlying cause to prepare them for success. Our team will support you every step of the way as you work toward a healthier quality of life.

Contact us to learn more about our comprehensive services.

Dr. Aram Keshishyan, PsyD.

Aram Keshishyan, PsyD. is a bilingual, Armenian-speaking, licensed clinical-forensic psychologist who has been practicing since 2013. Dr. Keshishyan emigrated to the United States at the age of 1 and grew up in the highly diverse Los Angeles County area. He obtained a Bachelor of Arts degree in Psychology from the University of California, Los Angeles, and Master of Arts and Doctorate of Psychology degrees in Clinical-Forensic Psychology from Alliant International University, Alhambra.

Arastou Aminzadeh, MD

Dr. Aminzadeh co-founded BNI to provide patients with exceptional and complete care that goes beyond the regular standards. Each individual is unique and based on each person's genetic makeup, some have a more painful response to challenges that arise on their journey and need assistance to get back on track.