What can concierge medicine offer a person with a substance use problem?
In November 2021, I spoke with Abe Malkin, MD, MBA, a family medicine physician who also practices addiction medicine. He built a concierge practice that delivers medical care in people’s homes, and he came to medicine after several years in finance.
This is an archive episode, recorded when the show covered addiction and recovery broadly. He also described several IV and anti-aging services his company offered, and I have left those details to the recording itself.
How does a career in finance lead to medicine?
At 1:24, Abe described how he nearly skipped medicine altogether. As a pre-med student, he made a last-minute decision to take a job on Wall Street and spent almost four years in finance before applying to medical school. At the time, he thought the delay was crazy. Looking back, it helped.
Still, his interest in business never faded. He chose a combined MD and MBA program, then a family medicine residency in Los Angeles, and soon afterward opened a concierge practice. He told me that in 2016 many of his patients were struggling with substance use, and because concierge patients tend to open up more, his work moved naturally toward addiction medicine.
How can one practice reach patients across the country?
At 3:55, I said I could relate to building a concierge practice. What struck me was the scale, since his model reached people all over the country.
From 5:07, he explained how it works. A network of physicians, nurse practitioners, physician assistants, and registered nurses delivers care at home, and many local providers run their own business under his brand with tools his company supplies. In his view, his real skill was helping others succeed in business while still giving good care to his own patients.
How is this different from the telemedicine startups?
At 8:01, I described something I had noticed. After the pandemic changed the rules on telemedicine, a wave of startups began offering care for substance use across entire states. Most of them, I thought, were aiming at the accessible end of the market, with minimal medical care and quick access to medication.
Abe agreed that his patients wanted something different. At 8:49, he said many of them had already tried other options and were looking for an immersive approach. For a detox, his team stays with the patient for about a week, with nurses present around the clock and daily check-ins with a provider.
Is concierge care fair to people who cannot afford it?
At 18:42, I raised a criticism some physicians make, that concierge medicine serves only the people who can pay. I agreed that everyone should have access to care. Yet some people would never stand in line at a methadone clinic or sit in a crowded waiting room, and they may suffer quietly at home.
Abe answered at 20:02 that concierge care may cost less than it seems. In his view, catching problems early prevents expensive hospital stays, which saves money for the patient and for the system as a whole.
At 21:26, I offered a comparison. Some people hear a monthly fee and think of a car payment. Of course, many of those same people spend freely on cars, cable, and sporting events, because those are their priorities. Abe added at 22:17 that concierge care spreads the cost of medical care across a whole life, rather than leaving it all for the end.
What happens after the detox is over?
At 24:28, I asked whether his approach to alcohol was based on abstinence. Abe said the detox itself is, with medications to ease withdrawal symptoms. From 24:42, he described an aftercare model that combines medical and psychiatric care, therapy, case management, and sober companionship.
At 25:25, I said a professional sober companion made sense to me, because friends and peers cannot always be there. Interestingly, Abe said his team liked sober coaches even more. In his view, a coach builds accountability and better decisions because the patient trusts that person and feels close to them.
Can work become a substitute for a substance?
At 27:49, I mentioned that I had once interviewed an expert on work addiction, an idea I had never taken seriously before. Some people who stop drinking or using, I suggested, pour the same energy into their jobs. Abe said at 28:25 that this was very common among his patients.
Unfortunately, the long hours bring their own harm. He listed lack of sleep, poor diet, and no exercise, and those secondary effects are what his team tries to fix.
Is care at home an alternative to a residential program?
At 29:50, I asked how he saw his service next to a residential program. Abe said that for detox, his team was as effective as any treatment center. For aftercare, however, some people need a structured setting with peers around them.
In his view, at 30:15, the hard part of a long residential stay is coming back to real life and applying what was learned there. Care delivered at home fits into everyday life. Still, he said there is room for both, and the choice depends on the person.
How should families be involved?
At 31:35, I asked about people who are not ready for help while their families fear for their safety, and I mentioned Florida’s Baker Act and Marchman Act. Abe said at 32:20 that in severe cases his team brings in an intervention team. Much of the work, though, is staying in touch and building trust until the person is ready.
At 33:12, I said family support matters, although sometimes the family is the problem. Abe agreed. In his view, family members do not help much during the detox itself, yet they can be important in aftercare once the team has identified any who may be triggers.
Who is Abe Malkin?
Abe Malkin, MD, MBA, is a family medicine physician who also practices addiction medicine. He founded a concierge practice that brings medical care into the home, and he serves as medical director for several treatment centers in Los Angeles. He has appeared as a medical expert on CNBC, Fox News, and Yahoo News.
What can listeners take away from this conversation?
Where care happens shapes how well it fits into a person’s life. Abe’s view was that care brought into the home, and continued well past the first week, can help people stay well in the place where they actually live. Whether the right setting is a home, a clinic, or a residential program, the choice should depend on the person.
How do I approach this today?
My thinking has kept developing since this conversation was recorded. Today my practice is built on one idea that runs through all of it: when the body has adapted to a substance, the safest way off is usually gradual, with the smallest steps the person’s nervous system can tolerate. Physical dependence is not addiction.
For alcohol dependence I use the Sinclair Method. The person takes naltrexone about an hour before drinking, and over time the drinking itself becomes less rewarding, so the urge fades gradually instead of being fought every day. It does not require stopping on day one, and it does not rely on willpower or meetings.
Like a slow taper, it lets the brain change at its own pace. For many people that makes it a more humane path than a sudden stop, which can also be medically dangerous for someone whose body depends on alcohol.
Call 911 or go to an emergency department if there is a seizure, confusion or hallucinations, or thoughts of self-harm. For thoughts of suicide or any mental health crisis, you can also call or text the 988 Suicide and Crisis Lifeline.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (42 minutes)
Dr. Mark Leeds [00:00] Abe Malkin, Dr. Abe Malkin, welcome to the podcast. So how are you doing today?
Abe Malkin, MD, MBA [00:09] Great. It’s good to chat with you.
Dr. Mark Leeds [00:11] Good to talk to you. So it’s pretty early there. It’s 1030 here in Fort Lauderdale, Florida. Must be what, like 730, 5 a.m.?
Abe Malkin, MD, MBA [00:20] Yeah. I’m an early riser usually, so this time is good.
Dr. Mark Leeds [00:26] Yeah I’ve noticed that recently I’ve been waking up early and when I get up at five o’clock it gives me like a couple hours to do stuff before everybody else gets up
Abe Malkin, MD, MBA [00:33] Yeah I find that morning is the most productive couple hours of my day before I start getting calls and emails so it’s a good time to get things done
Dr. Mark Leeds [00:42] Yeah definitely yeah I was looking at you know your linkedin page of all the you know things you’re doing and things you’ve done and it’s really incredible. I was just thinking to myself, you know, when I was in college or medical school, if someone had come to me and said, you know, you need to accomplish all these things, you know, any time in your life, I can’t even imagine, like, I can’t imagine, I can’t imagine where I would even get started. I mean, it’s just, it’s overwhelming. I mean, it’s incredible. So, I mean, how did you, how did this all come about? Like, how did you get into addiction medicine and, you know, of concierge medicine and all these businesses that you founded and that you’re running right now.
Abe Malkin, MD, MBA [01:24] Sure. Well, thank you for that intro. Part of it is intentional and part of it was just being at the right place at the right time. I was a pre-med student in college, in undergrad, where I was at Yeshiva University. And I was sort of ambivalent about whether I wanted to finish pre-med and become a doctor or go into business where a lot of my friends were getting jobs in Wall Street. And, you know, right before I graduated undergrad and applied for medical school, I just had a last minute decision to throw my hat in the ring for a job at Goldman Sachs, which I ended up getting. So I delayed starting medical school to spend a few years working in finance, which, you know, at the time I thought was crazy because it was going to set me back. But actually I think ultimately really proved to be beneficial. It gave me some real world experience that helped me later down the line. So after working in finance for almost four years, I then decided to apply to medical school, but I realized that I really did have a passion for business and I wanted to combine the two. So I applied for an MD MBA program at Tufts, which I got into and really set the framework for what I was going to do afterwards. I met some really interesting people who were doing a unique blend of business and medicine, both in my cohort in Tufts, as well as people who had graduated and were all into doing different things. And when I finished medical school, I still was unsure if I wanted to practice medicine, but I decided to do a family medicine residency here at Kaiser Permanente in Los Angeles. And then shortly after completing that I started a concierge medical practice just knowing that I had the ability to build a business and attract patients I felt like that would be a successful business and while I was doing concierge medicine this was back in 2016 you know a lot of my patients did suffer from addiction issues so at the time I wasn’t intentionally planning on getting into addiction medicine but being in the field of concierge medicine where you know patients tend to open up more to you have a closer relationship with them I naturally naturally went in that direction and ultimately became board certified in addiction medicine as well so that’s sort of how I ended up in addiction medicine but you know a large part of my practice is really aside from that is also just delivering high quality care to patients at home across the country
Dr. Mark Leeds [03:55] Okay yeah and I can relate to up to that point of you know, opening up a practice and, you know, developing a concierge practice and knowing how to attract patients like that part, I fully relate to. And, you know, and then also the fact that you find that addiction is a major problem. I think everybody experiences addiction to some degree, you know, it’s just a part of being a person part of being human. But, you know, of course, some people experience it worse than others, depending on what path they take. But yeah I can’t you know then then you went from having your own practice and you know […] but you took a whole different path I mean you have places all over the country I mean so you’ve somehow connected with doctors, I guess, or I don’t know if you employ all the doctors or if they work with you, but somehow you have probably doctors in every community in the country that a person can reach out to you and then be connected to get concierge medical service.
Abe Malkin, MD, MBA [05:07] Yeah, we have a really great network of providers, both physicians, mid-level providers like nurse practitioners and PAs, as well as registered nurses. And the goal is that pretty much across the country and you know the top 50 cities in the u.s people can leverage our platform through the different brands that we’ve created to get at-home medical care both convenient care as well as sort of cutting-edge anti-aging treatments and addiction medicine and it’s really been great to empower local providers to essentially almost run their own business under our umbrella which a lot of healthcare practitioners are hesitant to do we give them the tools to set up their own their own business locally and then and then run their practice under our brand so a lot of the locations that you see are actually licensed out using our brand and we give them the tools to be successful we are also operating in multiple states ourself but it’s really a blend of the two, which, you know, I feel like my skill set really is helping others achieve their business success, as well as delivering good patient care to our own patients.
Dr. Mark Leeds [06:28] Yeah. And when I think of concierge medicine, you know, the first thing, because I actually have patients that they see me for addiction treatment, and then they also have a provider with a company called MDVIP. And I guess they’re a concierge company and somehow a lot of their doctors don’t want to be involved with addiction treatment. But is that like a competitor for you or how do you compare it to something like MDVIP?
Abe Malkin, MD, MBA [06:53] My understanding of MDVIP, and I might be wrong, is that they’re more clinic-based and they have locations around the country, whereas we’re all at-home medical care. The other area that we focus on, like you mentioned, is addiction medicine. So people that are looking for that tend to tend to join our practice. And then lastly, we don’t just deliver efficient and quick medical care at home, we actually really push the envelope in terms of cutting edge anti aging medicine. Because what I’ve found is that especially with patients who have addiction issues, when you remove the substance that they’re to, they need something to make them feel vibrant. And part of that is finding out, is their testosterone low? Do they need supplements like NAD or stem cells or peptides or other things that make them feel young again and vibrant? And that’s really what we try to do is to try to really not just cure the disease, but really make them live a full life with other tools that are available. So that sort of differentiates us from some other concierge practice.
Dr. Mark Leeds [08:01] Yeah, that makes sense. And I can see how it would also differentiate you from, you know, there’s a lot of addiction startups popping up all over. I mean, I think I counted like two of them a couple years ago. Now it seems like there’s at least 10 or more of these kind of taking advantage of the change in the laws of the pandemic and providing telemedicine addiction treatment to like entire states and multiple states. I mean, some of them are like in every single state or nearly every state. But I think most of them are going towards the other end of the market, you know, just trying to be very accessible, but maybe provide just a minimal amount of medical treatment and make sure that patients have access to medication. But I can see also that’s not something that your patients would be looking for, most likely that they’re looking for a lot more service.
Abe Malkin, MD, MBA [08:49] Yeah, we tend to find that patients that come to us have really tried a lot of different other avenues and they’re looking for someone to be a really an immersive treatment for them to help them break the cycle of you know addiction relapse sobriety and what we do is we come in you know for a detox for example we’ll spend five to seven days with the patient 24 hours a day with our nursing coverage daily check-ins with a provider to detox them and then beyond that really immersive concierge medical care to ensure that they’re staying so sober and not just staying sober but also really becoming healthy on a much different level so whether that means identifying lab deficiencies tool giving them the tools to build up their different biomarkers that help them give have more energy and more vitality that’s ultimately what leads them to live a happier healthier life and stay sober
Dr. Mark Leeds [09:52] Yeah yeah that makes sense that’s important you know to basically take care of the whole person you know make sure that everything’s taken care of now when I see in the list of things that you provide and you had mentioned it I think you know iv services you know home iv a person can get an iv you know the first thing to say you know I know that there’s chelation therapy and where you know some kind of a treatment where they remove dangerous metals from the body and also the first thing I think of combined with addiction treatment is ketamine, which is currently the only legal psychedelic type treatment that doctors can administer off-label. And are those services that you provide?
Abe Malkin, MD, MBA [10:30] So we do provide a variety of IV services. The most common one is just vitamin IV therapy. So things like Myers cocktails, B12 vitamin C, other drips with essential vitamins. That really helps people replete themselves, especially after detox when they just feel depleted. You know, in medicine, there’s not many things you can do that immediately make you feel better and that are good for you. Most of the time, you may not feel very different taking a vitamin orally and you end up stop, you stop taking it because you don’t feel that positive feedback. But when you get a vitamin IV drip, you feel better right away and it reinforces in you the need to maintain those healthy habits. The other big, really impactful IV that we offer is NAD. NAD is an enzyme that helps your body in multiple different ways, one of which is helping repair your mental focus, cognition, memory, a lot of your brain functions, as well as your energy levels and other benefits. This IV, in particular for patients with addiction problem, really helps rewire their circuitry in their brain and allow them to kind of get back to the way that they used to be before they were dependent on substances. We are starting to offer ketamine treatments. However, just being very careful and cautious that although ketamine is extremely beneficial for some patients, it does have some addiction potential. So we really use it in a very targeted way. But I do think psychedelics in general offer a huge opportunity to treat patients with mental health disorders that has yet to really achieve its full potential.
Dr. Mark Leeds [12:17] Yeah. Now, what NAD, does that stand for something? What is it in NAD?
Abe Malkin, MD, MBA [12:21] I’m going to butcher the name, but it’s something along the lines of nicotinamide, adenosine dinucleotide. It’s essentially an enzyme that catalyzes production of mitochondrial energy. So it powers the Krebs cycle, if you remember back from biology, to produce ATP, which then your body uses to produce energy for a bunch of different functions. As you age, your body produces less and less NAD, which is why you can’t recover as well when you have trauma to your body or toxins or other issues that just come up with the natural course of aging. So by repleting your body with NAD, it’s essentially giving your body a blank check to then fix whatever is wrong with the body. It tends to help a lot with mental health issues because it does cross the blood-brain barrier and can help repair a lot of the functions in the brain, which is why I noticed when patients take it, they really experience better focus, better mood, better memory, better cognition, and that really leads to a positive feedback that I was mentioning.
Dr. Mark Leeds [13:30] Okay yeah and now that actually when you spelled out what it stands for it kind of sparked a memory of like something I should probably know and remember from biochemistry or something yeah exactly but yeah so what about what about like obesity and you know food addiction binge eating do you treat those conditions
Abe Malkin, MD, MBA [13:50] We do work with a number of other practitioners nutritionists fitness trainers obviously from the medical standpoint we optimize our patients lab values in terms of their blood sugar their cholesterol but we go beyond that and really try to get patients on a good lifestyle regimen to help reduce the obesity and blood sugar issues that they may be experiencing because ultimately you know dealing with the medical side of a patient’s health in addition to their addiction side is important in achieving a healthy lifestyle which ultimately lead to a higher chance of staying sober so we really try to treat the entire patient on both sides
Dr. Mark Leeds [14:34] Okay yeah that makes sense let’s see what was I going to ask you about so obesity and yeah okay give me a second sorry I just lost my train of thought don’t worry I edit these things so
Abe Malkin, MD, MBA [14:51] No worries
Dr. Mark Leeds [14:53] I’ll edit that part out but
Abe Malkin, MD, MBA [14:54] We can talk a little bit about some other IV treatments if you want
Dr. Mark Leeds [14:58] Oh yeah yeah definitely yeah yeah tell me about the other IV treatments you provide
Abe Malkin, MD, MBA [15:02] Sure so another IV treatment that’s really popular is stem cell IV treatments and exosome IV treatments you know a lot of patients that come to us with you know opiate addiction and underlying pain have tried various pain control methods but they haven’t yet really dealt with the underlying issue that’s causing their pain. So if someone comes with degenerative disc disease or osteoarthritis or tendon issues, we often treat them with stem cell IV treatments, which help regenerate tissue in the areas of degeneration. So what that entails is they get an IV infusion of embryonic stem cells, which travel throughout the body to the areas that need to be regenerated. They then seed their regrow tissue and help alleviate the pain by curing the underlying issue. Exosomes are sort of a byproduct of stem cells, which also help reduce inflammation and work very quickly to reduce pain. So these are some of the more cutting edge, novel treatments that really get to the underlying issues that drive patients’ discomfort and ultimately their addiction behavior.
Dr. Mark Leeds [16:18] Stem cells, I think a lot of people, when they hear stem cells, they probably think, well, that’s not legal in the US. That’s something you have to go to South America or some out-of-the-country clinic to get stem cell therapy. Is it now legal, or is there just a certain form of stem cell therapy that’s available in the US?
Abe Malkin, MD, MBA [16:36] Yeah, it’s a common misperception. What we do here in the U.S., by contrast to what they do internationally, is here we take stem cells from donated umbilical tissue. We then harvest the stem cells and then infuse those into the person via IV. What they do outside the U.S. Is they take the stem cells from the umbilical tissue. They then put them in a petri dish and grow more stem cells and then infuse those. So that’s called expanding stem cells. That’s what’s not legal here in the U.S. Because it violates ethical issues around creating new life. But taking an existing stem cell and infusing that is perfectly legal here in the U.S. The other issue here is that the FDA has not approved the use of stem cells for any specific condition. So it’s not legal to market stem cells for a particular condition. However, just like vitamin C is not FDA approved to treat a condition, but you can use vitamin C at your discretion as a physician, you can use stem cells at your discretion to treat diseases. So I think the confusion really stems from the lack of FDA approval of some of these therapeutics.
Dr. Mark Leeds [17:49] Okay. And what about medical cannabis? Are you involved with that at all, medical marijuana?
Abe Malkin, MD, MBA [17:55] I’m not involved in medical cannabis, but I do think it, you know, I am very involved with ketamine therapy. And I think it’s sort of an extension of psychedelics. You know, typically when you go to a doctor and you have anxiety or depression or pain, you know, you’re treated with benzodiazepines, SSRIs, opiates. And I think the use of psychedelic medicine, or even in this case, cannabis, is a departure from the standard treatments, which I think opens up a whole new world of opportunities to get people off some of those other substances. So I’m very supportive in general of alternative therapies like that.
Dr. Mark Leeds [18:42] Okay. And now, as far as the, just the idea of concierge medicine, I know there’s some people in the medical community who are against that, who think, you know, it’s not right to focus on elite medicine for only the people who can afford it. And, you know, doctors should be focusing on making their care available to everyone. And, but I kind of agree with you in the sense that when you start treating people who come in for concierge medicine, you realize that you’re helping people that have the potential to help a lot more people, you know, once you get them back on track and recovering and doing better. And although it’s very, it is very important that everyone have access to care, regardless of their financial ability to pay for care, it’s also very important to, you know, there’s people that would never go to the local methadone clinic or lineup at a clinic waiting for their dose of medication or sit in a crowded waiting room, and those people may suffer quietly at home. And if you can provide care to those people that would really welcome concierge treatment, once they’re back healthy again, they can really do a lot to, maybe through their finances or business ability or whatever they’re involved in, they’re the people that can really make a difference in many other people’s lives. So I totally agree with that. So I think that’s a good thing. What do you think about that issue of concierge versus care available for everyone?
Abe Malkin, MD, MBA [20:02] So, you know, I would say two things. First of all, concierge medicine ultimately may not be that much more costly than traditional medicine. If you think if you take into account the fact that we’re intervening in patients lives often before they’ve had significant medical issues that put them in the hospital or other significant outcomes. These patients have chosen to make the decision to prioritize their health over other spending in their lives. The cost of concierge medicine, although compared to traditional medicine that’s covered by insurance, is more expensive. It’s far less costly than other expenses people incur in their lives. It’s just a matter that these patients have chosen to prioritize their health over other spending. And ultimately, dealing with issues in a more proactive way before they become severe health problems is both a cost saving to them personally and to society. Because when someone goes to the emergency room and has a significant issue that requires a long hospital stay, both them and the medical system incur the brunt of that. So in the concierge model, we take a more proactive approach to help prevent those episodes of costly care. So I think when you look at it from that lens, it actually can be a cost saving to the system.
Dr. Mark Leeds [21:26] Yeah, that makes sense. I think people, when they hear about a monthly cost for care, and there’s another thing, what is it called, where they provide low cost care for a whole family. It’s similar to concierge, but it’s, you know, like, you know, […]. I forgot what they call that. But, you know, but then the thing is that when a patient hears like, you know, the cost of concierge medicine might be as much as a few hundred dollars per month. And, you know, they think, wow, that’s like a car payment. But you know you’re right maybe people have more cars than they need out front or maybe they’re paying too much for cable and you know sporting events that they pay extra for and you know people spend a lot of money on things that they prioritize just like you’re saying
Abe Malkin, MD, MBA [22:17] And the way that I look at it is you know it’s you really what you’re doing when you sign up for concierge medical practices you’re just staggering your the cost of your medical care across your entire life as opposed to backloading it at the end of your life what a lot of people do is they neglect their medical care until they’re older, and then they have developed more severe medical issues, which tend to be costlier. In a concierge model, most of my patients are, you know, in the younger years of their life, 30s, 40s, 50s, they’ve chosen to address issues now so that they can live a longer, healthier lifestyle and not have to deal with issues only later on in life. So think about it from that perspective. It’s really just staggering the cost across your entire life and leading a healthier life throughout.
Dr. Mark Leeds [23:03] Yeah. And now suppose a patient, do you still see patients yourself personally, or are you currently not involved in active patient care?
Abe Malkin, MD, MBA [23:13] I do on a small set. I’m the medical director for several treatment centers here in Los Angeles. So those patients I do see myself. But much of what I do is really overseeing the care from other providers across the country.
Dr. Mark Leeds [23:28] Okay. Now, if a person with, say, alcoholism walked into any one of your centers all around the country, would they get the same care? Like, is it by like a certain protocol or would it depend on the doctor that they see that they get one type of treatment or another type of treatment?
Abe Malkin, MD, MBA [23:44] So in our at-home detox model, the care is really standardized across the country because the actual decision-making about care is really centralized. So we have a really strong team of providers that do either telemedicine or in some cases will fly out to see patients across the country. And we have very consistent protocols when it comes to medical care. Same with the nurses who stay with the patient. So during our detoxes, nurses will stay with patients 24 hours a day for, like I said, five to seven days. And these are nurses that are traveling throughout the country. So our team is mobile and the care that you’d get across the country is consistent.
Dr. Mark Leeds [24:28] Okay. So for alcoholism, it would mostly be like an abstinence-based type thing where you detox a person off of alcohol and then provide ongoing long-term support to get them healthy and deal with cravings and psychological issues going forward?
Abe Malkin, MD, MBA [24:42] Yeah. So, you know, the medical detox portion is purely based on abstinence, of course, and medications to support to mitigate withdrawal symptoms. Post-detox, we approach it with an aftercare model that includes a medical, psychiatric, therapy, case management, and sober companionship, which I think it really addresses a lot of the aftercare problems that people might encounter. We obviously pull in additional support when needed, including, like I mentioned, the IV therapy and other modalities to help individualize the treatment for patients, but we really take a full spectrum approach to helping patients maintain sobriety in their aftercare.
Dr. Mark Leeds [25:25] Yeah, the idea of a sober companion, that is interesting. You know, I had worked with someone that provided sober companions to patients, and it seems to really help. I mean, to, you know, make sense, you know, it’s almost like, you know, how if you go to Alcoholics Anonymous, you have a sponsor and you have friends that you call on the phone, but those aren’t professional people. You can’t count on them 100% to always be there for you. But a professional sober companion is someone who’s there looking out for you all the time. So that have you have you found that’s really helpful in keeping a person sober?
Abe Malkin, MD, MBA [25:54] Yeah, we really like sober companions and even even more so sober coaches. Just having that level of accountability for patients and someone that they look up to and trust can really help, you know, engender better decision making in the patient. Companionship is helpful just from the physical act of someone being with you. But we really like the coaching because that takes it a step further and helps develop better decision-making habits and patients from someone that they develop a closeness to and feel accountable to.
Dr. Mark Leeds [26:26] Okay, and do you involve the 12-step philosophy or 12-step programs at all? Is that integrated also?
Abe Malkin, MD, MBA [26:34] We are very supportive of 12-step and recommend that to our patients to join groups and be a part of the active community as part of their journey. It’s not the only modality that works, but it definitely can be a good adjunct to other treatment options.
Dr. Mark Leeds [26:56] Okay. And as far as when you said sober coach, do you provide any other kind of coaching services to people? Say like, you know, success coach, business coach, life coach?
Abe Malkin, MD, MBA [27:05] We do refer patients out for things like that. One thing we often do is set up patients with, like I mentioned before, nutritionists and therapists who help identify underlying mental health issues. The therapists do and work on those. And the nutritionists obviously develop lifestyle habits that patients can change to help feel better and ultimately be more motivated to staying sober. A lot of our patients do have, are very successful in business, and they do like the idea of having someone to give them a more holistic support, so we do pull in other providers when necessary.
Dr. Mark Leeds [27:49] Yeah, and that brings up another interesting thing, work addiction, which I, you know, up to a point would never have thought that was a thing, and I actually interviewed someone on the podcast who was the world’s foremost expert on work addiction, and it was interesting to think that’s a real thing. And like, once you become aware of that, you may even see with a lot of the concierge patients who are very experienced in business, you know, that they just work way too much. And maybe they even use work as an alternate addiction to drug addiction. You know, they may have had years clean and, you know, sobriety, but they replaced their substance addiction with a work addiction.
Abe Malkin, MD, MBA [28:25] Yeah, I think that’s very common amongst our patient base. And part of addressing that is just addressing the poor lifestyle behavior choices that people make because of their addiction to work, whether it be lack of sleep, poor diet, lack of exercise. It’s really those secondary effects which we try to address and fix. So I think you hit the nail on the head that a lot of our patients pour themselves into their work because they have an addictive personality and it can ultimately lead to poor healthcare choices, which need to be addressed.
Dr. Mark Leeds [29:04] Yeah. And are you also able to help people with things like cocaine addiction, meth addiction? I would imagine cocaine is a big problem in the patient population that you work with.
Abe Malkin, MD, MBA [29:15] Certainly. Yeah, I mean, patients with those addictive issues, really, it becomes more of a behavioral health approach for them. Some of the other addictive behaviors, like alcohol, for example, have more of a medical need to detox safely. But with cocaine, for example, certainly there’s some withdrawal symptoms that occur, but most of the work is really on the behavioral health side to identify the triggers and the behavior choices that people are making. But we can really handle any type of addictive behavior.
Dr. Mark Leeds [29:50] Yeah. Now, suppose someone came to you with an addiction issue and they were considering going to rehab or the family wanted them to go to rehab. Would you see your program as a rehab alternative? Or would you, in some cases, or many cases, say, you really need to be in rehab and away from things for a period of time before we can work with you? How do you feel about rehab in general?
Abe Malkin, MD, MBA [30:15] Sure. We certainly on the detox side, we certainly are equally as effective as any treatment center at detoxing patients. When it comes to rehab and aftercare, some patients do need a structured environment with support of other patients and peers in that kind of setting versus an at home model like we focus on. A lot of our patients have gone to rehab centers and have failed that model and are choosing us for an alternative as an at-home the reason being I think is that when you go to a treatment center you spend 30 60 90 days there it’s an amazing immersive experience and then you come back to real life and it can be challenging to take some of those lessons and apply them in that setting. Whereas in our model, we’re providing care to you seamlessly throughout your everyday life. So it does integrate in a better way sometimes. However, certainly there is a place for people who need to just remove themselves completely from their day-to-day, go to a treatment center for a month, two months, three months, as opposed to trying to fix things on the fly while they’re living their everyday life. So I think there’s definitely room for both. And it’s really individualized based on the patient.
Dr. Mark Leeds [31:35] Okay. And do you also sometimes deal with patients where the patient needs help and they don’t want to get help yet? They’re not ready for it. And the family is concerned about the level of how they’re a danger to themselves and to people around them. And I know there’s legal issues. I’ve also interviewed a local lawyer who specializes in the Baker Act and then what we have in Florida, the Marchman Act. And, you know, so, you know, which is to put people in compulsively, put them in treatment, even if they don’t want to go in treatment for, I think, up to six months at a time. Do you help families with that? Like if a person just refuses to get help or they just keep relapsing over and over again to kind of help them get treatment when they don’t want to get treatment?
Abe Malkin, MD, MBA [32:20] Yeah, we do work with some really effective interventionist companies who help us with really difficult patients who have not yet accepted addiction problems or the need for treatment. So in severe cases, we will bring in an intervention team to assist. However, part of what we do also is we just keep a contact with patients and try to just be ready for them when they’re ready to make that decision. So again, it’s really individualized based on the patient. If we feel patients in, you know, danger to themselves or others, certainly we’ll bring in an acute intervention team to assist. But a lot of times it’s just maintaining that closeness with the patient, developing trust, building trust with them, and that when they’re ready, you can step in quickly and assist. So we do offer both services.
Dr. Mark Leeds [33:12] Yeah, family support. I mean, when it’s practical, I mean, sometimes family is not the best thing because sometimes family is the problem. But, you know, in a lot of cases, family support is important. And, you know, sometimes people want to be treated for addiction in private. You know, they don’t want anyone to know about it. But yeah, I can imagine that, you know, you may want to at times have the family involved. And I mean, is that do you provide like any kind of family services also to keep the family involved? Like suppose that you start with a patient would you encourage the patient to authorize the doctor to be able to communicate with the family also or is that not a good idea
Abe Malkin, MD, MBA [33:48] Yeah I think because our model tends to be a more integrated model into the patient’s life because we’re detoxing them at home you know during the detox itself it’s really it’s not not really helpful to have family members involved but post detox and the aftercare portion I think family support is really important. Like you mentioned, in some cases, the family members are really the triggers and often detrimental to the patient’s sobriety. We try to identify that early and only involve family members when we think they can be helpful. But we certainly do feel like there is a place for this in ongoing support and sobriety. And we want people to feel like their sobriety is not a departure from their from their life but it can be a seamless transition integrated into their daily living involving their family members and other aspects of their life which give them fulfillment but part of what we do when we when we do detoxification is to try to identify any detrimental family members or triggers in the family and counsel patients to you know to be aware of that
Dr. Mark Leeds [35:03] Okay and I just I wanted to ask that as far as I get back to iv therapy I think you mentioned the meyer solution is that the thing that does chelation therapy that somehow gets dangerous metals that have accumulated in the body out of the body
Abe Malkin, MD, MBA [35:17] So it’s no but Myers’ cocktail is just infusing a cocktail of vitamins into the body chelation therapy uses a chelating agent, like you mentioned, to remove metals from the body. We don’t do that at home just because it is a little bit more higher risk. It’s extremely beneficial and effective for certain types of patients, for example, with Lyme disease or other bloodborne pathogens, but not specifically for addiction. We haven’t used that, but it is something interesting to look into.
Dr. Mark Leeds [35:50] Okay. And what about like oxygen therapy or even hyperbaric oxygen treatment? Do you provide those treatments? I can imagine bringing a hyperbaric chamber to a person’s house would probably not be practical. But, you know, but like say like just a person that doesn’t necessarily need oxygen, they don’t have a, you know, low oxygen problem. But, you know, sometimes, you know, putting that nasal cannula with a little bit of oxygen, people find that can be helpful for different reasons. You know, they go to these oxygen bars.
Abe Malkin, MD, MBA [36:19] Well yeah I think I think ozone therapy and I don’t know if this is what you were getting at but ozone therapy can be really helpful ozone similar to chelation helps cleanse the blood by removing the blood from essentially you do phlebotomy remove blood run it through an oxygen ozone machine and then infuse it back into the body when it’s cleansed to some degree that actually is also very helpful for patients with bloodborne issues but it does carry a higher liability. So it’s something we don’t really do in home, but I do encourage patients to look into that because it is something that clinics do and it can be very helpful as well. You know, any, any of these modalities that can help a patient feel more refreshed and revitalized, you know, at post detox, I think are really helpful for helping them get the right tools to live a happier, healthier life.
Dr. Mark Leeds [37:11] Okay. And just to give you like a hypothetical case, like suppose there was someone who might be interested in the concierge model of what you’re providing. And there are main issues that say that a person has had just for example kidney failure and they’re on home dialysis and they’re trying to prepare themselves for a transplant. But they have issues like they need to lose weight, they need to get themselves in optimal health, and they want to make sure that they’re at the top of that list or on that list even. Would you be able to provide at-home services to do everything possible to help them lose weight and get at their healthiest to be prepared for that?
Abe Malkin, MD, MBA [37:50] Yeah, I think part of what we do is really doing a full assessment of patients to identify all their medical issues, whether it be lab abnormalities, sources of pain, other triggers for poor healthcare decision-making, and then bring in providers to address all those issues. So a lot of our patients have multi-system disease, and we either treat that ourselves or work with specialists to treat them, to get them really optimized in terms of their health. So I would see no difference in someone who has addiction problems trying to optimize their health versus someone who just leads a poor healthy lifestyle. We certainly can help identify and optimize health in a lot of different ways.
Dr. Mark Leeds [38:36] Okay do you maintain like a database of like quality providers around the country not not just the ones that work with you but say that you do need to refer out and you want to make sure that someone in whatever community they’re in whatever major city they’re in that you refer them to the best place possible I’ve tried to do that in my local community it’s not not easy to do keeping up with you know I used to like in the beginning when I graduated you know came out of residency you know because I was able to see local surgeons actually do surgery I only wanted to refer my patients to surgeons that I could vouch for that I actually watched them do surgery and I knew they were good and you know 20 years out it’s not as easy because a lot of them have retired now but and I can imagine across the country like how do you know how can you really trust who you’re referring to that’s the right person for your patient in whatever city they’re in
Abe Malkin, MD, MBA [39:22] Sure you know certainly in some markets specifically within California we have a really higher penetration rate and knowledge of the top providers in each market. But we do try and, as the needs arise, source strong providers. And I think a lot of that is through referrals from other providers that we trust. And I think in general, when a need arises, we can identify a good provider. And we stay involved with the patient to ensure that they’re having a good experience. And I think that’s really important. So getting that positive or negative feedback to help tailor our recommendations going forward helps quite a bit. But certainly within California and New York, Florida, some of our bigger markets, we have a really strong provider base that we can pull from.
Dr. Mark Leeds [40:17] Okay. And how are you doing with COVID vaccines? Are you making sure all your patients are up to date with their vaccines?
Abe Malkin, MD, MBA [40:25] Yeah, we don’t provide the vaccine ourselves, but we do strongly recommend it. And it’s really regional. In some markets, patients are very receptive of getting the vaccine, whereas in other markets, they’re a little bit more hesitant. But I counsel patients often that getting a vaccine is important, not just personally, but for the public health. And I strongly recommend it.
Dr. Mark Leeds [40:51] Yeah, definitely. Definitely. Yeah, I see that you’ve also that you’ve worked as a medical expert on some of the major networks, you know, news shows and, you know, discussing, you know, some of the major topics in healthcare, you know, especially the opioid crisis. And that’s really incredible. Like, what are some of the programs that you’ve been on?
Abe Malkin, MD, MBA [41:13] I’ve been on quite a few. I’ve been on CNBC, Fox News, Yahoo News. I’ve been on other podcasts, you know, different publications, both locally and internationally. You know, I think being in the addiction medicine space and in, you know, concierge anti-aging medicine, we have a different take on a slightly different take on medicine than a typical provider and it you know there’s a there’s a there’s a thirst for knowledge about around this field so I love sharing kind of my story my approach and in hopes that other people can can learn from it
Dr. Mark Leeds [41:58] Yeah definitely definitely it’s important to get the message out of you know that these things are available. So, okay. Yeah. Dr. Abe Malkin, thank you for joining me on the podcast today.
Abe Malkin, MD, MBA [42:13] Oh, it’s been my pleasure.
