Can Physiatrists (Physical Medicine & Rehabilitation) Treat Addictions?

Question by : Can physiatrists (Physical Medicine & Rehabilitation) treat addictions?
Addiction is a disease, and it is debilitating. And the sufferers need rehabilitation. But as far as I know, physiatrists don’t treat addiction. I want to know for sure is they do or don’t, and if they don’t, how to attempt to increase awareness to the matter. And I know there are addiction medicene specialists, but shouldn’t physiatry also cover that?
I know its physical. But im talking about being dependent on the drug. How is being addicted to, say, cocaine or meth (also called ice), not physical? Some people who suffer from it, believe it or not, don’t want to be an addict. For example, being “dope sick”. Thats very physical.
Also, im not actualy addicted to anything. I want to be a physiatrist and am just trying to get rid of any confusion I have about it. Im 15.

Best answer:

Answer by The Big K
The first word of that specialty answers your question: PHYSICAL. They are the doctors concerned with treating patients that are undergoing some type of physical and occupational therapy after a surgery/stroke/major illness etc. These guys are concerned with getting a patient back up and walking/standing and able to do things for themselves.

That is a far cry from “rehabbing” someone addicted to a substance who needs more counseling to determine the underlying reasons for the addiction and treat those.

Answer by Mathieu
Physiatry deals with physical problems, addiction is a psychiatric condition and psychiatrists are the only type of physician that would typically treat an addiction. There is no doubt that substance abuse disorders are both debilitating and are legitimate medical conditions that a physician can treat.

Technically any doctor can treat any condition and, with a few exceptions, all doctors can prescribe any medication. However a physiatrist is not trained to treat a substance disorder and any good physiatrist would NOT provide medical treatment specifically for addiction. And since addiction is not related to the conditions physiatrists treat it does not make any sense for them to treat addiction.

Addiction, along with mood disorders, psychotic disorders, and anxiety disorders are the primary categories of psychiatric disorders (not including axis II conditions like personality disorders). Psychiatrists are trained in diagnosing substance abuse disorders, in pharmacological treatment of substance disorders, and psychiatrists are able to conduct therapy (however many choose not to do therapy) and are able to form a treatment plan for a person with an addiction.

In Canada, for example, a doctor has to get a waver to prescribe methadone for either opioid dependence and/or pain (each is a separate waver) and extra training must be done to be allowed to prescribe Suboxone (buprenorphine/naloxone), a drug also used in people addicted to opioids. It is unlikely a physiatrist would be allowed to get an exemption to prescribe methadone for substance abuse because of the lack of training (however a physiatrist could easily get an exemption to prescribe for pain since most physiatrists treat chronic pain. In The US physiatrists are one of only a small number of specialties able to become certified in pain management, psychiatrist can also become certified in pain management).

If you have a substance abuse problem I highly recommended you see a psychiatrist. It is also very important that people with a substance problem get evaluated, by a psychiatrist, for other psychiatric conditions since most addicts also have a comorbid psychiatrist disorder. If there is another psychiatric disorder it is important BOTH problems get treatment or it is unlikely that a person can maintain sobriety.


OK I see where you are coming from. The problem is that a physiatrist treats physical illness or injury. Drug withdrawal is completely different. Withdrawal is a result of the brain adapting to having the substance then, if it is rapidly discontinued, the brain can’t compensate and a withdrawal syndrome occurs. Withdrawal has to do with the neurobiology/neurochemistry of the brain- psychiatrists are trained in that.

And withdrawal can be easily relieved, if more drug is used the problem is gone (at least for a bit). The physical problems a physiatrist treats can’t be fixed, even temporary, that easily. And again all the physical problems with addiction are due to the brain and that is psychiatry not physiatry.

What is it you think a physiatrist could even do for people in withdrawal? I really can’t think of much except for things psychiatrists do and are better doing.

Oh also of course people addicted to drugs don’t want to be addicted. No one has ever used drugs with the intention to get addicted. Unfortunately some people have different responses to drugs and can end up addicted. And addiction is due to problems in the brain. It is also important to keep in mind that physical dependence is NOT addiction. People taking benzodiazepines, barbiturates, or opioids long term often become physically dependent, it is normal and not really a major problem. A person physically dependent, but not addicted, can slowly tapper off the medication without problems. An addict is psychologically dependent (and in many cases also physically dependent) and is unable to stop drug use even if there is no withdrawal.

M.D., C.M. psychiatry, internal medicine (Québec)
Hons. BSc pharmacology

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