Dr Jonathan Avery Explains How Substance Use Affects the Care of Patients With Mental Illness

Jonathan Avery, MD, director of addiction psychiatry, New York-Presbyterian Hospital, Weill Cornell Medical Center, discussed how some psychiatrists will back away when treating a patient with co-occurring substance use and mental illness, when instead they should be leaning in to deliver evidence-based treatment.

How do concurrent substance use disorders affect how psychiatrists treat patients with mental illnesses?
Our hope is that co-occurring disorders cause a psychiatrist to lean in and offer all the evidence-based treatments. I think in practice what happens is that we tend to back out of the room when it looks like a complicated patient has multiple diagnoses, especially substance use disorders, and I think we tend to undertreat or refer out and not treat ourselves. And part of that is stigma-related, I think it’s been shown repeatedly that doctors have worse attitudes towards patients with co-occurring disorders than towards more simple cases. We really want them to not do non–evidence-based things, to not sort of back away but really to offer all the evidence-based treatments for the different diagnoses that they have.
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