22 Jul Why Modern Psychiatry Can’t Ignore Addiction Anymore
Addiction doesn’t wait for a clean calendar or a quiet life. It digs in when people are at their worst and robs them of the small things that made them feel like themselves. Modern psychiatry can’t sidestep it anymore, not if we’re serious about treating the whole patient, not just the symptoms that fit neatly on a billing code. The old split between mental health and addiction care keeps falling apart because it doesn’t reflect how people actually live—or how they actually suffer.
The Two-Way Street Between Trauma And Substances
It’s rare to meet someone in treatment whose addiction story doesn’t include a chapter on trauma. Whether it’s childhood neglect, violence, or a string of smaller injuries that piled up, trauma sets up the brain to reach for relief wherever it can find it. Substance use offers that relief fast, even if it’s temporary, and the brain learns to chase that escape. But then the substances fuel anxiety, depression, and shame, reinforcing the trauma’s grip.
Psychiatrists often see patients who’ve cycled through medication changes for depression or anxiety, only to realize the alcohol or pills they use at night are keeping them sick. The dopamine system doesn’t distinguish between what’s prescribed and what’s poured into a glass; it just wants more of what makes the pain go quiet. Treating trauma and substance use separately ignores how tightly they’re tied together, and patients know it, even if they can’t always articulate it in a clinical interview.
Meeting Patients Where They Actually Are
It’s easy to talk about “meeting patients where they are” until it’s time to actually do it. Patients don’t always come in clean, stable, and ready for cognitive-behavioral therapy. They come in high, exhausted, embarrassed, or angry. They cancel appointments or ghost altogether, and many have already heard they’re “noncompliant.”
The real work in modern psychiatry is dropping the judgment and holding the line on honesty without moralizing. A patient may need residential care, a 12-step in Charlottesville, a Houston rehab or a medical detox in Miami, but what they also need is a provider who doesn’t treat them like a collection of bad decisions. They need someone to acknowledge that the drug use made sense when they started, even if it’s destroying them now. They need practical pathways to stability, not vague encouragement to “get help.”
Medication-Assisted Treatment Is Not Selling Out
There’s still a stubborn resistance in some corners of psychiatry about medication-assisted treatment (MAT), like it’s cheating or like real recovery can’t involve a pill. It’s outdated and it hurts patients. If we know buprenorphine keeps people alive, keeps them in jobs, and keeps them out of jail, we shouldn’t hold back because of a misplaced sense of moral purity about abstinence.
MAT doesn’t fix everything, but it creates breathing room for patients to address what’s driving their addiction. It also brings them into regular contact with a clinician, which opens doors for treating the depression or PTSD that’s often tangled up with their substance use. There’s still work to do in psychiatry to integrate MAT fully, to ensure patients don’t have to beg for it, and to stop treating it like a second-tier solution for people who “can’t do” traditional recovery. The data doesn’t lie: MAT saves lives, and it keeps people engaged long enough to make deeper changes.
Moving Beyond Abstinence-Only Mentality
We’ve got to be honest about how outdated the abstinence-only mindset is for many patients. It’s not that abstinence doesn’t work for some people; it’s that demanding immediate, permanent abstinence as a precondition for care shuts out the people who need help the most. Harm reduction has been a buzzword for years, but in real practice, it looks like accepting that a patient who cuts down from daily use to weekends is making progress. It looks like keeping the door open for patients who relapse rather than shaming them away from treatment.
Long-term recovery often isn’t a straight line, and modern psychiatry needs to stop pretending it is. The goal should be to help people build lives that feel worth staying sober for, not just demanding they stop using without addressing why they needed substances in the first place. We should be measuring progress by health, stability, and relationships, not just negative urine screens. This is how we build long-term addiction solutions that stick.
Training The Next Generation Of Psychiatrists
If psychiatry wants to stay relevant, residency programs need to step up. Too many new psychiatrists graduate with minimal exposure to addiction medicine, and it shows when they hit practice. We don’t need specialists who can only diagnose and treat depression without recognizing when alcohol is fueling it. We need psychiatrists who can comfortably handle buprenorphine inductions, understand motivational interviewing, and know how to spot the warning signs of stimulant misuse before it spirals.
It also means teaching young psychiatrists to examine their biases. Addiction isn’t a moral failing, and patients struggling with it aren’t “difficult” by default. They’re sick, and they need doctors who will treat them with the same urgency and respect they’d give a patient in hypertensive crisis or a diabetic patient with a foot ulcer. The training culture needs to reinforce that addiction treatment is part of psychiatry, not a side hustle for someone else to handle.
The Road Ahead
Psychiatry can’t afford to stay in its comfort zone if it wants to make a meaningful dent in the addiction crisis. We need to embrace treatments that work, acknowledge that trauma and addiction are deeply connected, and stay flexible enough to meet patients where they are without judgment. We need to train psychiatrists who see addiction care as central, not peripheral, to their work.
Addiction has never been a tidy condition to treat, but that’s not a reason to shy away from it. The opportunity is here to change the story, to give patients more than a prescription or a quick lecture about lifestyle. We can offer a path toward stability that’s rooted in science, honesty, and compassion. If modern psychiatry can’t rise to meet that, it risks becoming irrelevant to the people who need it most.
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- If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat at org. To learn how to get support for mental health, drug or alcohol conditions, visit FindSupport.gov. If you are ready to locate a treatment facility or provider, you can go directly to FindTreatment.govor call 800-662-HELP (4357).
- U.S. veterans or service members who are in crisis can call 988 and then press “1” for the Veterans Crisis Line. Or text 838255. Or chat online.
- The Suicide & Crisis Lifeline in the U.S. has a Spanish language phone line at 1-888-628-9454 (toll-free).
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Last Updated on July 22, 2025 by Marie Benz MD FAAD
