Choosing a therapist is a very personal matter. Your therapist will become a person who will guide you through your recovery and with whom you will develop a therapeutic relationship based on trust and mutual respect. You will find different types of professionals who offer their help in the treatment of addictions.
We will explain to you what these different types of professionals are, what academic training they have, and what they can offer you. Let’s see what professionals are required to visit and what can be a complement to treatment. Let’s define the concepts of therapist and psychotherapist.
The development that we are going to do next will only refer to the professionals who offer the outpatient treatment modality.
Types Of Addiction Specialists
In the field of addictions, we find different professionals, depending on their academic training and specialization. As in any profession, excellence is achieved with a balance between academic training and experience. You will see the official designation that each professional receives corresponds to his/her academic years and not so much to his/her professional years.
First, we differentiate between graduates and persons without university degrees. Graduates are usually doctors and psychologists, who may, in turn, have done a specialty (e.g. psychiatric doctors and clinical psychologists). Psychiatrists, therefore, have studied medicine and then have done the specialty of psychiatry via internal medicine physicians (like the other medical specialties: cardiology, general surgery, ophthalmology, etc.).
Psychologists are, in principle, made a career in psychology and are not considered health personnel unless they have done their specialty in clinical psychology via specialized health training or have done a master’s degree in general health psychologist. Nurses are healthcare graduates, while social workers are non-healthcare graduates.
Among the professionals without university degrees, we have facilitators or counsels, professionals dedicated to alternative therapies, and spiritual leaders.
Of the different professionals working in addictions, the most qualified would be psychiatrists, with a minimum of 10 years of supervised training.
In summary, you can see the following list of the various professionals and their years of training:
- General practitioner: degree in medicine (6 years) and surgery without specialty
- Family Doctor: Bachelor of Medicine (6 years) with a specialization in family medicine (4 years)
- Psychiatrist: degree in medicine (6 years) with a specialty in psychiatry (4 years)
- Clinical psychologist: degree in Psychology (5 years) with a specialization in clinical psychology (3-4 years)
- General Health Psychologist: degree in Psychology (5 years old) with a master’s degree that accredits as such
- Nurse: Diploma in Nursing (3 years) with or without the mental health specialty (1 year)
Non-health professionals with a degree, diploma, or degree:
- Psychologist: degree in psychology with or without postgraduate training in addictions and psychotherapy
- Social worker: Diploma in social work
Non-health professionals without a bachelor’s degree, diploma, or degree:
- Counselor, facilitator
Professionals engaged in alternative therapies.
As we see in this list of professionals, the most qualified would be psychiatrists, with a minimum of 10 years of training, the last four years being a very specialized training (like internal medicine physician) in mental health, eminently practical, and supervised.
Something similar happens with psychologists who have done the Clinical Psychology specialty, which a total of 8-9 years of training, the last three or four years being also practical and supervised training. Thirdly, there would be psychologists who have a master’s degree in health psychology or a more specific master’s degree in addiction.
All professionals have a university degree, bachelor, graduate, or diploma in health sciences or social intervention that can make postgraduate training more specialized in addictions.
The professionals who are most interested in this type of doctoral studies and who have the most previous training are psychiatrists and psychologists. In spite of this, not all psychiatrists and psychologists have specific training in addictions, and it will depend on their curriculum and where they have chosen to lead their professional careers, although they all have more than basic notions.
In the USA, the professional associations of doctors and psychologists offer a service of information to citizenships, through which it is possible to consult if a specific person is enrolled in that school and, in the case of doctors, what specialty is recognized.
As Claude Lévi-Strauss said,” the richness of humanity lies in diversity.” When it comes to professional choice, you will also find yourself fortunately with a great variety to choose from. Each professional is going to have some different characteristics, about which you will have to decide what interests you the most. Here are the main features you can take into account:
- Age of the therapist.
- Gender of the therapist.
- The therapist’s character and way of being.
- Years of experience.
- Whether he/she is a psychologist or a psychiatrist, the fundamental difference is that the psychiatrist is a doctor and can make medical assessments and prescribe medication. The psychologist will have more training in psychology a priori, although the psychiatrist can do postgraduate training to equalize knowledge.
- Specialized academic training in addictions, usually postgraduate courses.
- Update level by attending congresses and specialized meetings, national and international.
- Collaboration as a teacher in a post-graduate degree related to addictions.
- Publications in specialized scientific journals.
- Specific guidance in psychotherapy.
- Training in Group, family, or couple therapy, if that’s what you’re looking for.
- Specialization in some other field that might be interesting to you, such as dual pathology, grief, or psychological trauma.
In general, professionals with the best résumé are usually the best qualified, although we should consider whether the bulk of their résumé is related to addictions or other fields. Similarly, the best trained and most experienced professionals are often older and have the highest fees, while those with the lowest experience are the youngest and with the lowest prices.
As you can see, there are many factors to consider, and it is possible that so many parameters overwhelm you. You often decide to go to a professional who has recommended you to a family member or friend. This is fine because you’re going to go with Good Will, as long as you don’t go out of a commitment to that person or to your relatives who have forced you to go.
We usually do not recommend that you go to the same therapist as your partner or a first-or second-degree relative to avoid a conflict of interest.
If you have confidence in that profession because of the good results seen in your loved one, ask him or her to recommend a partner who can help you in your case. We are sure that he/she advises you to someone as competent as himself/herself.
Which Professional Do You Have To Consult?
We have seen a long list of professionals and university degrees; now, from a practical point of view, we are going to advise you soon what the professionals will be about to pivot your treatment :
- A psychiatrist with experience in addiction and dual pathology.
- A psychotherapist (psychologist or psychiatrist) with experience in addiction.
- A general practitioner or family medicine specialist with experience in addictions.
Although you may find many professionals, this is the result of professional specialization and a multidisciplinary approach. Each professional has specific knowledge and training, so they have something different to offer you.
We have drawn up a chart that describes the most common scenario in which an addict begins his/her treatment. Although, on some occasions, the reality is a little different, we insist on the importance of each of the three professionals: doctor, psychiatrist, and psychologist.
As we see in the chart, we recommend that the method of treatment be through a doctor, either a general practitioner or a psychiatrist.
The usual practice in public health care is that the patient’s first contact is with the family doctor (due to its accessibility) or with the general doctor of the medical centers for the treatment of addictions.
Both doctors will make an assessment of the patient’s physical condition and decide how urgent and convenient a psychiatric evaluation is. Although some public addiction treatment centers do not have a psychiatrist, our recommendation is that a psychiatrist evaluates all patients at some point in their treatment.
This recommendation is due to the high frequency in which psychiatric disorders are present among people who consult for an addiction. The results in the treatment of addictions are much better when coexisting psychiatric disorders are treated. What is available to all public addiction treatment centers are psychologists, who are referred to almost all patients for psychotherapeutic treatment, either individual or group.
Although some public addiction treatment centers do not have a psychiatrist, our recommendation is that a psychiatrist evaluates all patients at some point in their treatment.
Ideally, the first evaluation should be done by a doctor (general or psychiatrist) to make a basic assessment of the physical condition, although it is often a psychologist who performs the first consultation because it is less stigmatizing for the patient.
In these cases, the psychologist usually refers the patient to a psychiatrist, who, after a basic medical assessment, decides whether to have the patient evaluated by another specialist physician. In any case, we recommend that all patients be evaluated by a psychiatrist so that, as we said before, they can complete a psychiatric evaluation and initiate treatment if they have any concomitant mental disorder.
Also, the psychiatrist may also prescribe medications approved for the treatment of addictions or symptoms associated with the withdrawal of the substance.
Obviously, in the isolation period, it is also recommended that the patient perform a psychotherapeutic treatment, which can be with the same psychiatrist who carries the medication. Also, this can be with another specialist in psychotherapy or a psychologist specialized in addictions.
It is essential to understand that alternative treatments do not replace conventional medicine, since not enough research has been carried out to support their effectiveness and superiority over traditional therapies.
There may be patients who benefit from the performance of other professionals, such as nurses, social workers, or counselors. For example, a patient who requires specific attention to some area of self-care or who requires an intramuscular medication or periodic analytics will be in contact with the nursing staff.
Social workers will act to produce social Reports, report on unemployment benefits, report on disabilities and disabilities, report on homelessness, etc. Counsels can be very interesting, especially for patients who require close supervision and a lot of support in their day-to-day.
Also, there may be patients who want to do some unconventional treatment in what we call alternative therapies. In this case, it is essential to understand that these alternative treatments do not replace conventional treatment, since not enough research has been carried out to support their efficacy and superiority over traditional therapies.
If you think they can help you, don’t hesitate to try it, but consult your doctor or psychiatrist, mainly if it includes taking a product that could interact with other treatments you take or may produce undesirable effects.
Physician Training In Addiction
In the USA, doctors, after completing their university degree in medicine, have the possibility to specialize in different areas after taking an examination of access to internal medicine physician training. Training as an internal medicine physician lasts between four and six years, depending on the specialty.
This specialty needs a psychiatrist for four reasons:
- Part of the practice during psychiatric training is in addictions and dual pathology.
- Many people with addictions also have a mental disorder (the coexistence of the two diseases is known as dual pathology), and it is the psychiatrist who has to treat it.
- Most of the treatments used in addictions are drugs that were initially marketed to treat psychiatric disorders, so psychiatrists handle them very comfortably.
- Psychiatrists have psychotherapeutic training, interview, and patient management skills that are difficult to achieve and promote a unique therapeutic alliance and adherence to consultations.
Unfortunately, on many occasions, addiction training during residence is minimal. Therefore, psychiatrists may choose to train themselves through personal study or through one of the few postgraduate courses that exist. In general, it can be said that not all psychiatrists are sufficiently trained or have sufficient experience in addictions; however, they are the specialists who will best treat you.
It should not be forgotten that people who suffer from addictive disorders also suffer the medical consequences of addiction. It is not uncommon to get sexually transmitted infections or diseases, to develop chronic heart, liver and lung diseases, to have heart attacks, etc. All of these medical conditions should be treated by another specialist, who may be a family doctor or general practitioner.
It should not be forgotten that people suffering from addictive disorders also suffer the medical consequences of addiction.
Therapist Training As A Psychotherapist
The term “therapist ” is used generically to define a professional who has knowledge and skills to treat an illness. This does not mean that they have university education for it. A person without a university degree in medicine or psychology can designate himself or herself as a therapist without being considered intrusive, although ethically, he or she should clarify what his or her academic background is.
However, a person cannot announce himself or herself as a doctor, psychologist, or psychiatrist without having fulfilled the requirements for such a qualification because, in such a case, it could be considered an example of professional intrusion.
The term “therapist ” is used generically to define a professional who has knowledge and skills to treat an illness.
Instead of the term therapist, which we consider to be too generic – we prefer to use the term psychotherapist, which we believe to be more academic and professional. The professional career of the psychotherapist is also regulated in USA, and we can also find people who announce themselves as psychotherapists and do not have a university degree in medicine or psychology. For this reason, some societies and scientific associations offer to associate with them in exchange for ensuring that this professional has a degree or university degree in psychology and medicine, that they have received postgraduate training in psychotherapy and that they have accumulated a definite number of hours of practice and supervision.
Most of these associations are national in nature, and some depend on international agencies. Of course, some associations are much less demanding than others in giving their stamp to professionals. Most associations generally understand as more appropriate the applications of psychologists and doctors with the specialty of psychiatry.
Therefore, there are professionals that are defined as therapists who do not have academic training in psychology or in medicine with the specialty of psychiatry, but who get their knowledge through experience, college graduate training, personal study, and attendance at courses and meetings of experts.
The counselor does not usually have a bachelor’s degree or a degree in psychology, but they complete formal theoretical and practical training to acquire an accredited degree.
It is common for the counselor to gain their experiential knowledge of having the first-person experience of an addiction they treated with treatment similar to the one they now promote.
What Kind Of Psychotherapy Is Best Suited For The Treatment Of Addictions?
Returning to psychotherapists and psychotherapies, we must know that there are more than 500 schools of psychotherapy in the world. Although a priori, it seems crazy, most of them have several characteristics in common that hardly make them differ from each other. Jerome Frank (Frank, 1971) identified four features common to all psychotherapies, and that these were effective:
- Establishing a special relationship between the patient and the therapist, based on the patient’s trust in the therapist’s competence to help himself/herself.
- Society designates psychotherapy as an element of healing, so this social consideration itself increases the patient’s expectation.
- Psychotherapies are based on a myth about health and illness, which must be shared by the patient and his/her therapist in their respective cultural constructions.
- The therapist demonstrates his/her competence by exhibiting specific skills and procedures that facilitate patient change.
If there are so many psychotherapies, how can we know which ones are effective in the treatment of addictions? The fact is that we have a few studies in this area. What we are sure of is the following statements:
- Receiving any therapy increases the likelihood of abstinence and maintaining it over time compared to no treatment (Timko et al., 2000).
- Non-professional treatments, such as regular attendance at self-help and mutual support meetings of addiction associations, can have similar efficacy to professional treatments.
- The complementarity of professional treatments with non-professional treatments, such as regular attendance at self-help meetings and mutual support of addiction associations, has superior results to receiving either of the two treatments individually (Timko et al., 2000).
- Some patients may benefit from family or partner psychotherapy in addition to individual psychotherapy.
- Group psychotherapy has an essential guarantee of effectiveness in the treatment of addictions and, being of lower cost, should be offered to patients seeking treatment.
Most psychotherapists, psychologists, or psychiatrists in the USA are trained in the various psychotherapies listed above and usually undertake an integrative approach in which they use their knowledge of motivational interview, cognitive behavioral therapy, contingency management.
For immigrants or those who have been raised in a cultural environment other than the dominant one in the national territory, it is essential for the therapist to take cultural differences into account during treatment. Even membership in social movements or urban movements must also be taken into account. In this way, they are respecting the ideology of the person within their cultural environment.
Many professionals can offer their services to treat addictions. You must take into account the professional’s academic background, their professional experience in the field of addictions, and the relationship you can establish with them. In principle, you need to carry out a complete medical assessment, psychological treatment, and psychiatric evaluation (which assesses the coexistence of a mental disorder and the need for pharmacological treatment). Other professionals with lower academic qualifications, but with a high level of experience in the field of addiction, can be an excellent complement to health professionals and psychologists.