Medication-Assisted Treatment, Part IV – Medical Professionals & Substance Use Treatment

Man considering treatment

Addiction Hope Medication-Assisted Treatment Interview of Dr. Mark Gold & Dr. Brian Fuehrlein – 8-17-20

In Part 4 of this 4-part series, you will read the continuation of an important and informative interview about medication-assisted treatment between Jacquelyn Ekern of Addiction Hope and Dr. Mark Gold and Dr. Brian Fuerhlein, two leading doctors in the addiction field. They discuss medication-assisted treatment of addiction, particularly concerning medical professionals.

Medication-Assisted Treatment, Part IV – Medical Professionals & Substance Use Treatment

JE: Medical professionals struggling with substance use disorder often struggle in reaching out for treatment and help. For those reading, how can they confidentially get treatment and not hinder their career long-term?

MG: I would recommend they call a professional that is Board Certified in addiction medicine or addiction psychiatry and get a consult with them. It is also very important that they don’t diagnose themselves.

We find often that a person’s description of themselves is very different than the people who are working with them, which is very different than how their spouse would describe them, etc. Often, you need a two or three day evaluation just to peel away the layers of the onion.

It is very important to get history and information from a variety of people as well as testing. Doctors can be difficult to evaluate, but testing helps, as, over time, they become very deceptive and tangential and less forthcoming.

BF: Absolutely true. I will add just a few things. Dr. Gold is very educated in this area, as well as one of my old mentors, Dr. Teitlelbaum. His livelihood was treating impaired professionals.

Speaking for physicians generally, we have a remarkable ability to hold work together despite the world crumbling around us. As such, if work is starting to become affected by the addiction, the addiction is likely fairly advanced at that point.

The rates of addiction among licensed professionals as a whole is considered to be a bit higher than among the average population, so if you walk around a hospital, you’re very likely to encounter someone who at some point is having substance use disorder.

The good news is that licensed professionals have added incentive to stay sober due to licensing agencies’ power to take away a license. Licensing agencies spend a lot of time, effort, and money on licensing their expel and do not want to throw away those licenses and fire people.

Licensing agencies encourage their licensees to get help and get treatment. Licensed professionals also often have better access to treatment because the agency that oversees us cares about our ability to maintain sobriety and licensing.

So, my advice to professionals struggling with a substance use disorder is don’t put people’s lives at risk. Recognize that there is a problem, reach out to your state licensing board, get an evaluation, and ask for help.

Then, follow the recommendations. If you do this, you are more likely to be able to maintain your livelihood, maintain your license, and get sober.

Medical professionals in medication-assisted treatment can be susceptible to substance abuse as wellJE: Thank you. It is important to mention that anyone can contact us at Addiction Hope, and we will confidentially try to put you in contact with the right folks to protect your privacy and help you find the care that you need.

My final question for you doctors – what can we do to bring greater attention to veteran’s needs and care?

BF: I think I’ll answer that with a quick story. Someone that I know lost a teenager of an overdose and invited me to speak at high schools about opiates and opiate use disorder.

This person had many contacts in town, so they created a social media campaign to attract families. The presentation was geared to the parents and was intended to be a big information session about what to look for with your children in regard to opiates.

This was a major high school with a lot of kids, and we only had five parents show up. All five of these parents already had experiences with their child having a problem with drugs or alcohol.

All of the other parents that didn’t attend either ignored the problem or were unaware of the problem. One of the organizers said, “you know, if this was the exact same thing but with the topic of ‘How to Get Your Kid Into the Best College,’ the auditorium would have been packed.

Instead, because we were talking about drugs, nobody wanted to attend or believe that this would ever happen to them or to their child.

It is incredible that something so pervasive and so important still has such a stigma attached to it. Nobody wants to acknowledge that this could happen to them or to their family, and that is unfortunate because this is a treatable illness.

Now, to get to your question about veterans, everybody loves the veterans and says they support them, and that is why breaking through this stigma is so important.

If a veteran has an opiate use disorder or a mental health condition, they’re often seen as veterans first, and they want to help because they are a veteran, but if this person was not a veteran, their identity only becomes being a “drug addict.”

Same two people, same disorder, but one becomes stigmatized and doesn’t get the same love, attention, and care. With that said, there are obviously still things that we need to do to help veterans.

Even so, you shouldn’t have to feel the same way about loving people and wanting to support them and help them get better.

JE: Absolutely, that is an important perspective. Dr. Gold, did you have any final comments to add?

Man struggling with substance abuse and in need of medication-assisted treatmentMG: I appreciate Addiction Hope focusing on this and getting the word out. When it comes to medication-assisted treatment, we have to remember to save the person’s life but then also to work on helping them rebuild their life.

From a prevention point-of-view, it is important to remember that they didn’t start with opioids. The Gateway Hypothesis data says that, typically, people train their brain to respond to drugs by smoking cigarettes, drinking alcohol, or smoking cannabis when children or teenagers.

That brain training makes the brain respond to drugs in a way that’s somewhat different than if they would have never done those behaviors. This is why the prevention message needs to be that if someone is going to start “experimenting,” doing so at 30 instead of 13 would make a difference because the brain is developed rather than developing.

My last prevention method to keep in mind is that smoking is injection without a needle, so any smoking event is, in essence, an injection event as far as the brain is concerned.

Imagining this, each puff of a cigarette can be considered an injection; therefore, it is almost as if they were injecting themselves hundreds of times a day.

If smoking is injection and smoking is brain training, the brain training of smoking is what causes the progressive aspect of drug switching as you become tolerant. These are things that are important to consider as one looks at prevention and considers gateway behaviors.

Please See Part 1 of the Interview
Please See Part 2 of the Interview
Please See Part 3 of the Interview


Virtual interview with Dr. Mark Gold & Dr. Brian Fuehrlein conducted by Jacquelyn Ekern, MS, LPC, – Founder & President of Eating Disorder Hope and Addiction Hope on August 17, 2020.

About the Interviewee:

Mark GoldMark S. Gold, M.D., Professor, Washington University School of Medicine – Department of Psychiatry, served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. He was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.

Dr. Gold is also a Distinguished Fellow, American Society of Addiction Medicine; Distinguished Life Fellow, the American Psychiatric Association; Distinguished Fellow, American College of Clinical Pharmacology; Clinical Professor of Psychiatry, Tulane University School of Medicine; Professor( Adjunct), Washington University in St Louis, School of Medicine, Department of Psychiatry; National Council, Washington University in St Louis, Institute for Public Health

Learn more about Mark S. Gold, MD

About the Transcriber:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental, and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Published on December 3, 2020
Reviewed & Approved by Jacquelyn Ekern, MS, LPC on December 3, 2020
Published on

About Baxter Ekern

Baxter Ekern is the Vice President of Ekern Enterprises, Inc. He contributed and helped write a major portion of Addiction Hope and is responsible for the operations of the website.