A Conversation With an Addictions Psychiatrist

,

CLINICAL CONVERSATIONS

As COVID-19 put a spotlight on issues in mental health and wellness, the opioid epidemic shined a light on issues in addiction psychiatry. Even the White House has taken an interest in addressing addiction problems, with President Joe Biden sharing his Administration’s inaugural National Drug Control Strategy in April 2022.

To help address the clinical challenges and issues and provide insight into the solutions and care that might best help your patients, Psychiatric TimesTM welcomes Roueen Rafeyan, MD, DFAPA, FASAM, as Addictions Section Editor. Dr Rafeyan is chief medical officer of Gateway Foundation in Chicago and clinical assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. Psychiatric TimesTM asked Dr Rafeyan a few questions by means of an introduction.

Psychiatric TimesTM: When did you first discover you wanted to be a psychiatrist?

Roueen Rafeyan, MD: My interest in behavioral health and psychology started early in my high school years. I enjoyed my entire medical school experience, and I enjoyed every rotation. This made a decision for residency training very hard, as every specialty remained an option.

During my psychiatry rotation, the complexity of the disease states as well as the impact on the person and family along with limited treatment options intrigued me and further sparked my interest.

I followed my heart, even though, at the time, psychiatry training was considered waste of medical education. Although I encountered stigma, I chose to pursue my passion. Thirty years later, I have absolutely no regrets; on the contrary, I am proud and happy about my choice.


Pursue your dreams. The only limitations are the ones that are self-imposed. Bank on your strengths, and enjoy the ride.


PT: What do you enjoy most about being a psychiatrist?

Rafeyan: I enjoy being a physician and a healer. Psychiatry is the only field that requires us to consider the whole person. It is not about an organ that is malfunctioning. In fact, we not only treat the person as a whole, but must also consider their close relationships, social functioning, and family dynamics. The impact of our treatment expands beyond the person, and we can have generational impact.

PT: What most interests you in the field of addictions?

Rafeyan: What interests me the most in field of addiction are the challenges and ever-evolving landscape.

Although the “disease” remains the same, the drugs of abuse are constantly changing with newer synthetic and semisynthetic compounds introduced into market. It requires us as addiction specialists to remain up to date and continue to improve our knowledge in order to provide appropriate care.

PT: What has changed the most since you entered the field?

Rafeyan: So much has changed since I started addiction medicine:

- Recognition has increased significantly. Both the medical community and general public are more aware of its impact.

- Treatment options are evolving.

- Increasingly more residents are showing interest in pursuing further training in addiction medicine.

- Addiction medicine now has its own board certification process and is recognized by the American Board of Medical Specialties.

PT: What are the biggest challenges facing (general) psychiatry today? In addiction psychiatry?

Rafeyan: We are in a much better place now in both psychiatry and addiction medicine, however, there are still many challenges in psychiatry:

- We are facing a serious shortage of psychiatrists, and our approach to inpatient care has changed so much over the years that many times inpatient care has become more of crisis stabilization.

- Coordination of inpatient and outpatient care remains broken, resulting in excessive utilization of services and poorer outcomes.

- Access to psychiatric treatment still remains restricted.

Addiction medicine faces all those challenges and more:

- There is an even greater shortage of addiction specialists, Not many general psychiatrists are interested in supporting these needs.

- Delivery of addiction treatment is fragmented. Historically, treatment has been provided in various settings, by various providers and standards of treatment can be different in each setting.

- The general public are usually not aware of the evidenced base treatment modalities.

- We need more standardized evidence based treatments for addiction across all treatment centers.

PT: If you could impart wisdom on your younger self/earlier in your career in psychiatry, what would it be?

Rafeyan: My career has been very fulfilling, and I have enjoyed the path that has brought me here. I want to share with our early career colleagues an important point:

Pursue your dreams. The only limitations are the ones that are self-imposed. Bank on your strengths, and enjoy the ride.

PT: What do you hope to share with readers as the Psychiatric TimesTM Addictions Section Editor?

Rafeyan: I would like to share with our readers that addiction psychiatry is a needed and integral part of all fields of medicine, and more so in the field of psychiatry.

I am looking forward to bringing articles and knowledge relevant to readers’ practices and being avaluable resource for common approaches and latest treatment options in addiction medicine.

Do you have questions or suggestions for Dr Rafeyan? Email him via PTEditor@mmhgroup.com.