In this commentary, the authors argue that historical approaches to inpatient addiction treatment favoring more confrontational, expert-centric, or paternalistic undercurrents continue to permeate the hidden curriculum in medical training. These older approaches unfortunately continue to inform how many trainees learn to approach inpatient addiction treatment. The authors go on to provide several examples of how clinical challenges specific to inpatient addiction treatment can be addressed by employing principles of motivational interviewing, harm reduction, and psychodynamic thought. Key skills are described including accurate reflection, recognition of countertransference, and assisting patients to sit with important dialectics. The authors call for greater training of attending physicians, precepting advanced practice providers, and trainees across these disciplines, as well as further study of whether systematic improvements in such provider communication may alter patient outcomes.
Keywords: Motivational Interviewing; communication; inpatient treatment; psychotherapy.