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Treatment Providers

The Problems with the U.S. Addiction Treatment System

by John M. Grohol, Psy.D. 6/30/2024

The Problems with the U.S. Addiction Treatment System Did you know that most addiction treatment specialists have little formal education or training in addiction? Fourteen states require only a high school diploma or a GED to become an addiction counselor; 10 require only an associate’s degree.

But it gets worse — fully 20 states in the U.S. don’t require any degree, or don’t even require addictions counselors to be certified or licensed in any way.

Is it any wonder then that many addiction or rehab programs still rely on an outdated model that’s directly dependent upon how long companies are typically reimbursed for treatment — 30 days? Or that many programs still use treatment methods largely unchanged from the 1950s — not research-backed, modern approaches to treatment?

A groundbreaking report published last year from Columbia University lays out the sad facts of addiction treatment in the U.S. As the report notes, “Some [treatment programs] promise “one time” fixes; others offer posh residential treatment at astronomical prices with little evidence justifying the cost. Even for those who do have insurance coverage or can pay out-of-pocket, there are no outcome data reflecting the quality of treatment providers so that patients can make informed decisions.”

6/30/2024 12 comments

Does Interpersonal Psychotherapy Work for Depression?

by John M. Grohol, Psy.D. 10/14/2023

By John M. Grohol, Psy.D.

Does Interpersonal Psychotherapy Work for Depression? Psychotherapy. You know, I spend a lot of time talking about it here, and it’s no wonder — it’s an effective treatment modality that too many people simply aren’t even considering. Much less using.

Psychotherapy research is less likely to be biased than other types of treatment research, too, because researchers tend not to be treatment providers nor have any direct (or even indirect) financial incentives in the outcomes of their research. Sure, there remains the “publication bias” that affects all research, but generally speaking, I tend to trust psychotherapy research data more than I do most psychiatric medication research.

So I was interested to read a recent meta-analysis on a specific form of psychotherapy called interpersonal psychotherapy for the treatment of depression. Its treatment focus is on the relationships of the person who is coming into treatment — whether they be family, romantic, friends, or others.

Interpersonal psychotherapy doesn’t get as much press or attention as other popular forms of psychotherapy (such as cognitive behavior therapy), so fewer practitioners use it and fewer consumers know of it.

But is it effective? Here’s what the researchers found out.

10/14/2023 5 comments

Why Doctors Avoid Mental Health Treatment

by John M. Grohol, Psy.D. 12/26/2022

By John M. Grohol, Psy.D.

Physicians Avoid Mental Health Care It’s no wonder mental health stigma still exists surrounding issues like depression, bipolar disorder and schizophrenia.

Physicians who are the front-line treatment providers for mental health issues don’t always recognize the value of mental health professionals for their own mental health needs. Or they recognize the value, but don’t use them because of concerns about privacy and confidentiality. In a just-published survey of 3,500 doctors in the UK, researchers found:

Nearly three quarters of respondents said they would rather discuss mental health problems with family or friends than seek formal or informal advice, citing reasons such as career implications, professional integrity, and perceived stigma of mental health problems.

Let’s go through some of those reasons. Career implications? If an organization is going to deny you career advancement because you’re being honest about a mental health condition, perhaps that’s a sign you need to find another organization to work for. Or work to change such mid-century, backwards thinking from within the organization. Would an organization rather a doctor work while depressed, potentially harming his or her patients because they aren’t as interested in the patients’ complaints and rigorous diagnosis?

Professional integrity? What kind of doctor has any integrity if they are not being honest with themselves about their own lack of treatment for treatable mental disorders? Could you imagine a doctor walking around with a broken arm, because getting it treated would somehow impact their integrity? Really?

And stigma. This is what it all really boils down to. I guess doctors don’t realize they are only perpetuating the cycle of stigma, by avoiding such treatment themselves. And whether they admit it or not, such thinking can’t help but influence the way they portray behavioral health treatments to their patients.

The researchers suggest that one of the big concerns amongst these UK physicians is the doctors’ privacy and confidentiality. In the UK, doctors are members of the National Health Service, and so they may be afraid that by seeking treatment within the same system, it will be used against them in the future. That’s a legitimate concern, and one that could be easily corrected by adding additional privacy protections for such professionals.

I know this is the same reason many in the military do not seek out treatment — because it can affect their career advancement, security clearance, and their perceived reliability or stability by others in their unit. In a system where such information is too readily available to others, and the group of people is dependent upon the system for their own career, well, you can see how the two will inevitably clash.

But none of this is of much concern when it comes to most (but not all) physical diseases. Which suggests that this is, at the end of the day, primarily about our old friend stigma. Career advancement would not be an issue of others did not stigmatize those with mental health issues. Science now recognizes that mental health concerns don’t come from people’s personal weakness, but rather from a complex interaction of biology, brain, genes, psychology, and social connections.

It’s high time for organizations like the UK’s NHS and others to work toward ridding our world of such stigma and ignorance, and stop the discrimination against professionals who have a mental health concern. If you lead, others will follow.

Physicians Avoid Mental Health Care

12/26/2022 20 comments