Substance Use Disorders
The treatment of a substance use disorder involves first a comprehensive assessment and treatment often in a multidisciplinary setting. There are many types of care available in the community. Inpatient detoxification may be necessary in order for an individual to become substance free before ongoing treatment can begin. Part of the initial assessment involves screening for and treating co-occurring psychiatric conditions such as anxiety and panic disorders, depression and other mood disorders, such as Bipolar Disorder. A plan of treatment should be established.
In assessing alcohol dependence (alcoholism), many levels of treatments are possible, i.e., outpatient office treatment, intensive outpatient treatment, residential treatment, and inpatient detoxification and inpatient psychiatric treatment. Generally speaking, we would hope to find the least intensive form of treatment while still being effective. As well, the decision should be made as to whether medication treatments can play a useful role in helping a person on the journey to recovery. There are now several medications for the treatment of alcohol dependence such as Acamprosate (Campral), Topiramate (Topamax), Disulfiram, and Naltrexone.
My role is to help a person towards effective intensive treatment when indicated, and to also assist the recovery process psychiatrically, in particularly to assist with the management of co-occurring psychiatric conditions. I work collaboratively with several local treatment resources. I will work along with other treatment professionals to put together a recovery program that can be successful.
Buprenorphine (Suboxone) is a new treatment option for those struggling with dependence on opiod substances (heroin, oxycodone, hydrocodone, and other narcotic pain medications). For many opiod dependent patients, outpatient treatment with Suboxone can make the difference between success and failure.
Some struggle with dependence on tranquilizers and sedatives (e.g., Xanax, Ativan, Valium). Devising a plan for addressing these conditions requires a personalized assessment. It would be important to determine whether a safe detox could be accomplished on an outpatient basis, or whether more intensive inpatient treatment is necessary. My approach is to look to devise a plan of recovery treatment that is as intensive as is necessary, but that will also provide the least amount of disruption to a person’s lifestyle.
Dependence on marijuana (cannabis) can be an unrecognized problem. Now that Medical Marijuana cards are so easily obtainable in California (and other states), access to ongoing doses of potent cannabis is easier than ever. Unfortunately, this ease of access makes it much easier for a person to develop a dependence pattern of use. Similar to alcohol and many other substances, not everyone that uses marijuana will become addicted, but just as with alcohol and other psychoactive substances dependence can and does develop in some.
Abuse/dependence on other substances, including amphetamine, Cocaine, MDMA, hallucinogens, and others may be a problem. When office based treatment is appropriate, an individual may benefit from a mix of individual psychotherapy and pharmacotherapy (medications). Other times, referral to more intensive treatments is called for. In such cases, I can usually help connect a person to local resources and provide ongoing support for the management of accompanying psychiatric problems.