Addictions Corner
by Daniel Neff, M.D., FAPA
Medical Director, Mirmont Treatment Center, Main Line Health
Daniel Neff, M.D., is a board-certified psychiatrist and addiction psychiatrist specializing in evidence-based treatment for substance use disorders. He trained at Thomas Jefferson University Hospital and the University of Pennsylvania and now serves as Medical Director of the Mirmont Treatment Center while remaining active in teaching and professional leadership.
Sobriety is a state; recovery is a lifestyle.
Patients with addictions represent a distinct population with unique needs, strengths, and clinical considerations. Although psychiatrists receive limited formal training in addiction—typically one month as required by the ACGME—many enter practice feeling underprepared to manage active substance use or to support patients in sustained remission. Most training focuses on the acute phase of addictive illness, leaving generalists less equipped to address the nuances of long-term recovery.
Patients in durable recovery often face challenges around the use of controlled or potentially addictive medications, especially in acute care settings. While clinicians are trained to identify drug-seeking behaviors, patients in recovery are equally likely to avoid or refuse necessary medications due to fear of relapse or reactivation of past trauma. When such treatments are clinically required, it is essential to explore the patient’s concerns and offer trauma-informed support.
Recovery is more than abstinence—it is an ongoing, holistic commitment to physical, emotional, spiritual, and moral well-being. Many patients engage in robust recovery communities that provide accountability, social connection, and meaning. As with any cultural group, effective care requires sensitivity to the beliefs, values, and structures that shape a patient’s recovery journey. Key considerations include:
- Understanding the Sponsor–Sponsee relationship
- Recognizing that recovery programs vary widely between individuals
- Exploring beliefs about medications and medical providers
- Integrating recovery tools into broader therapeutic work
- Highlighting resilience as a foundation for self-esteem and growth
Patients in recovery often demonstrate exceptional strength and determination. One of my patients illustrates this well: On the morning of a planned Grand Rounds panel discussion, this patient arrived and told me of new acute abdominal pain and hematuria. Nevertheless he insisted on honoring his commitment to present before seeking care. Without showing any indication of the severe pain he was experiencing he completed the panel expertly. Afterward, he promptly went to the ED, where imaging revealed a 7 mm renal stone. His quiet perseverance and commitment to his recovery mission reflects the resilience I see daily in patients living active recovery.
When meeting a patient in recovery, take time to appreciate this vital part of their lived experience. A simple, powerful opening question is: “What does your recovery mean to you?”
Daniel Neff, M.D., FAPA, is Medical Director at Mirmont Treatment Center, Main Line Health System in Media, PA, providing comprehensive addiction treatment across all levels of care.