Navigating Early Interventions in High-Functioning Patients With Substance Use Disorder

Rachel Rohaidy, MD, a double board-certified psychiatrist in adult and addiction psychiatry, serves as codirector of the transcranial magnetic stimulation program at Miami Neuroscience Institute with Baptist Health. As an interventional psychiatrist, she prioritizes early interventions before turning to medication, offering a tailored approach to patient care. In this interview, Rohaidy discusses her approach to treating substance use disorder (SUD) and the unique challenges faced by high-functioning individuals seeking treatment for SUD.

This transcript has been lightly edited; captions were auto-generated.

Transcript

As a psychiatrist at a neuroscience institute, what is your primary approach to treating patients with substance use disorder?

I see a lot more high-functioning patients who are just starting to see consequences of substance use, whether it be the difficulties in their family and their marriages, with their children, or difficulties at work because of their substance use. Treatment really has to look like what the patient needs at the moment; so, it's not really a blanket treatment for everyone.

A lot of the severe cases that I've seen here are patients who have had neurological issues. And that's the great thing about being part of the Neuroscience Institute, is that if they're seeing the neurologist—because of, let's say, a new seizure disorder or some kind of neurological movement disorder—and they can't figure it out, and it turns out to be because of substance use, then that's where I would come in, and vice versa. I see a lot of patients with substance use issues that all of a sudden are developing these neurological issues, and so I know who to send them to. I think that's the severity that I'm seeing on this end.

It's really meeting the patient where they're at and trying to do as much intervention as they will allow us to do, trying to get family involved as much as possible, because this patient population, fortunately, does have connections still—they haven't lost those support systems—and so really working within that realm. So, that's what addiction really looks like for me in this clinic.

Can you shed light on challenges faced when treating this specific patient population?

The trouble comes in getting them to be active participants in their recovery, that's the issue. A lot of times, these patients continue to maintain family connections, and they've not gotten separated from their wife, or they've not been kicked out of their house. They're working, even though they're not working well, but they're still working, they're not really getting in trouble. They don't necessarily have DUIs [Driving under the influence offenses] and jail time. So, it's really getting them to see that even if they haven't really had consequences, that they're moving towards that and they're in danger of having those consequences. "If I'm doing okay, why am I going to get help?" Right? So it's really managing that line right there.