As Associate Medical Director, Dr. Anish John oversees care for patients in the partial hospitalization and intensive outpatient programs.
The son of physicians, he knew early on he wanted to be either a physician – or a rock star. Though he loved singing and playing the guitar and vocals, eventually medicine won out.
While in medical school in India, John volunteered in poor, rural villages where residents had little to no access to healthcare. A fascination with the neurobiology of the brain and the intricate mind-body connection drew him to psychiatry. He returned to the United States for a series of externships, first working with indigent patients with psychiatric and substance abuse issues in Chicago, and later in the inpatient psychiatric and chemical dependency units at two New York City hospitals.
During his medical education, which included an internship and residency in psychiatry, Dr. John was struck by how often psychiatric conditions and addiction were linked – and how the presence of one complicated treatment of the other.
Too often, addiction disorders and psychiatric conditions left those suffering from them, and their loved ones, feeling hopeless. Wanting to better understand the interplay of addiction and mental health issues, and learn techniques to better help patients, he completed a clinical fellowship in addiction psychiatry at Mount Sinai Beth Israel in New York City.
Individualized treatment plans are crucial
Patients with both substance abuse disorders and co-occurring psychiatric disorders need highly individualized treatment plans, he says. A key part of that is conducting patient evaluations and developing treatment plans based on bio-psycho-social clinical formulations.
“We do detailed, thorough histories, to figure out when things started going wrong and when substance came into the picture. More often than not, whether the mental health issue or the substance abuse came first is muddled,” he says. “So you need to treat and monitor patients over time to get the clear picture, addressing symptoms and monitoring for improvement that can be achieved by the brain recalibrating without substances on board.”
Every aspect of a patient, from genetics to past traumas to personality profiles, has to be taken into account. “There is no cookie cutter approach. Treatment has to be tailored to the person, and you have to consider all aspects of the person,” he says.
Overcoming patient resistance to care
Also complicating care for patients with substance abuse disorders is that many don’t want to be in treatment, or they haven’t fully accepted the seriousness of their disease. “Sometimes you’re the last person they want to see. They have been forced to be there, or everything has crashed around them,” he says. “To do this work, you need to love what you’re doing. And I’m thankful that I do. There’s a huge satisfaction when you do see the response, and you see them getting better.”
As patients progress in their recovery, it’s important for them to become partners in their treatment, and treatment decisions. “We can offer our medical experience, but patients know themselves. They have to be OK with the plan, and you need to periodically check with them to see if this is still the goal.”
He also practices elements from the field of positive psychiatry, which promotes well-being by reminding patients of their unique strengths instead of focusing only on what’s gone wrong. Building up people’s self-esteem, and helping to see their self-worth or their purpose in life, helps to restore their well-being, which is a powerful force in resisting relapse.
But the entire recovery process takes time, he adds, and commitment from the patient, their family and the psychiatrist to keep working at it. “It’s not always instant gratification with psychiatry,” he says. “There are layers upon layers. It takes time and work by the physician, by the patient, and by the family, because psychiatric issues and substance abuse impacts them significantly too.”
“There are rarely overnight returns. But if you invest yourself with the patient, you can see dramatic results.”