MD Infusions Provider Spotlight: Dr. Jonathan Adelstein, Front Door Health
May 12, 2021
Jonathan Adelstein, MD, is a board-certified general and addiction psychiatrist. He trained at NYU and the University of Washington and has worked in a variety of treatment settings. This experience has left him frustrated because the majority of substance use treatment just doesn’t work. Largely as a result of this, 90% of those who are struggling with substance use disorders don’t seek any treatment at all. To address this need, Dr. Adelstein founded Front Door Health, an innovative home-based substance use treatment program.
Can you give us a brief history of addiction treatment in the US?
Dr. Adelstein: Formal addiction treatment in the US began with the creation of Alcoholics Anonymous (AA) in the 1930s. Despite no central organization, formal marketing, or political affiliations, AA and similar “12-step” traditions continue to dominate the addiction treatment landscape. Many folks welcome the community and other resources they offer, however, there is actually no evidence that 12-step programs are effective in treating substance use disorders, and the vast majority of people find them to be overly restrictive, dogmatic, unscientific, and outdated.
In the 1970s and 80s, growth in “harm reduction” mindsets led to a more flexible approach to substance use treatment, and soon afterward, medications were studied and developed with demonstrable success in the treatment of substance use disorders. Coupled with enhanced public awareness during the current “opioid epidemic,” substance use disorders are finally starting to shed their stigma and be recognized as the biological vulnerabilities that they are, with associated treatment approaches and lifesaving medications that work.
What do you see as the strengths and weaknesses of the current treatment options?
Dr. Adelstein: When most people think of current substance use disorder treatment options, they think of “rehab,” a residential treatment facility where people stay generally for 28 days in early recovery. At best, rehab is effective because it offers a controlled environment, where one is unable to use, however after rehab is over, those same individuals are dropped back into the same environments with the same stressors that precipitated the substance use, to begin with, often with only a patchwork of outpatient providers at their disposal. Many rehabs and “IOPs,” or intensive outpatient programs–a sort of rehab-lite, are still heavily 12-step based and rely on groups to conduct therapy. These groups are often unproductive and sometimes downright traumatizing. And despite our knowledge that medications can be lifesaving in the treatment of substance use disorders, individuals in rehab often see a psychiatrist for maybe 10 minutes, if at all.
Tell us about your model at Front Door Health.
Dr. Adelstein: Front Door Health offers an alternative to treatment as usual. We recognize substance use disorders as the chronic, relapsing, biologically-based conditions that they are, and we treat them as such. We come to you, privately, confidentially, for a year of treatment, when you need us. We treat you individually—based on your unique needs—and we work with you in your real-life environment to help restructure and rebuild your life in a sustainable way that works for you. And because we’re individualized and flexible, we can adjust the intensity of services we offer in real-time as your needs change.
What is your view on ketamine treatment for addiction and psychological conditions in general?
Dr. Adelstein: You may have heard the term “paradigm shift” with respect to ketamine—ketamine is like nothing the field of psychiatry has ever seen. Study after study after study demonstrates not only that ketamine works but that it works well. Ketamine is effective in the management of depression and anxiety, trauma, chronic pain, and has already demonstrated efficacy in the management of various substance use disorders and is only beginning to be studied in this regard. It has been used for decades in medicine (even as an anesthetic in children), and thus has extensive safety and tolerability data. And it lowers our internal barriers to accessing some of our more uncomfortable memories and experiences, thus facilitating the process of psychotherapy and healing.
Are there any other novel treatment options on the horizon that you are excited about?
Dr. Adelstein: Similar to ketamine, psilocybin- and MDMA-facilitated psychotherapy offers incredible promise in the treatment of substance use disorders (as well as many other behavioral health conditions, including some that were once thought to be “untreatable,” like trauma and personality disorders). As we work to reduce stigma around compounds that were once considered “illicit” and we study their incredible therapeutic potential, a whole world of possibilities opens up for recovery. We no longer need to be held back by our past, and instead, we can look forward with hope and renewed optimism.