Conquer your substance use disorder.
Addiction Medication for Alcohol and Opiate Use Disorder in Troy, Michigan and online.
Back at Square One with Sobriety?
You're not alone in having to start your journey of sobriety again, but the secret slips sure can make you feel that way.
Do you feel like you don’t fit in anywhere anymore? You aren’t with those who are using and not even trying to break free. That isn’t you anymore — even if you do join them from time to time. But you don’t fit with the sober people either when you keep slipping. There can be such feelings of failure in struggles with substances. The stigma and shame penetrates deeply and spills over into your relationships and every aspect of life. Trust has been destroyed and replaced by memories that fill you with regret. You're tired of letting others down and disappointing yourself. It's an exhausting battle and the struggle seems to always end up with another slip — a day, a week, or a month from now. Even when you’re sober, it feels like only a matter of time until you’re not. You wonder…will you ever really break free and get your life back?
Or maybe you’re holding things together and functioning. Your friends would never guess your substance use has gotten out of hand. You can still pay your bills and do your job, but this secret part of your life is growing bigger and bigger and getting harder to disguise – especially from those close to you. You’re worried that it’s only a matter of time before your secret is out–and then what will you do? The impact on your life, your job, and your family would be catastrophic. You keep making promises on how to keep things from getting worse, but you find yourself breaking them more and more. Maybe you can’t kick this on your own… but how can you get discreet help to get you sober before your life collapses?
Do you need a safe, confidential place where sobriety becomes a journey that lasts?
Treatment with — No judgment. No stigma. No shame.
Sobriety is just plain hard. The substances play a role in your life. They help you cope. They numb your pain and they give you a quick escape when challenges overwhelm you. Without them, life is infinitely difficult. When you are sober, there is no quick escape from the struggle, and there is nothing to quickly deaden the pain. When you begin sobriety you’re piecing your life back together one step at a time: your relationships, your job, your finances. Everything is different when you get sober. Everything needs to be healed. It’s not as easy as just stopping the use. Often you do it alone. You might be trying to cut ties with your using friends and your sober friends and family are hanging back…waiting to see if this will last before they trust you again. Or maybe they don’t even know the secret battle you’re waging. It’s a brutal and lonely process. Little wonder people have to start over and over again in recovery.
So, if you’re starting again, there is no shame in that. It’s typical, really. Most people have to start again. And starting again is a courageous step.
Don’t just take my word for it… What do the experts and researchers say?
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“Consumers with co-occurring disorders have a better chance of recovering from both disorders when they receive mental health and substance abuse treatment in an integrated fashion from the same practitioner.” Substance Abuse and Mental Health Services Administration. Integrated Treatment for Co-Occurring Disorders: Building Your Program. DHHS Pub. No. SMA-08-4366, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009. Click here to read the article.
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“Medication for opioid use disorder (MOUD) is effective and improves mortality, treatment retention, and remission, but most people with OUD remain untreated.” Journal of American Medical Association. Click here to read article.
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“Prescribing naltrexone for alcohol misuse continues to be one of the most underutilized interventions in medicine…daily naltrexone and long-acting injectable naltrexone have perhaps the strongest evidence for their use. They have been shown to improve numerous drinking outcomes, including a return to any drinking and a return to heavy drinking” (American Journal of Psychiatry 12/1/2022). https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.20220821 Click here to read article.
A wise person once said that the opposite of addiction is connection. I believe healing starts with a safe relationship and this is where I begin. With this type of support, your sobriety can become a journey that lasts and a place where you can be real and transparent. It is safe because I see recovery as an imperfect process with no judgment, stigma, or shame. You have enough of that on the inside already, don’t you? We meet and work exactly where you are. The process isn’t perfect. There are ups and downs. But a slip is not a relapse, it’s a moment. And then the journey continues. A compassionate, prescribing mental health professional can make all the difference in your recovery.
Here’s how:
Often those with substance use disorders have a co-occurring mental health disorder. I treat both at the same time. Suffering and symptoms are reduced. So many programs will treat one or the other but not both. That just doesn’t make sense.
Some substance use disorders are greatly helped with medication–especially alcohol use disorder and opioid use disorder.
Not every substance use disorder has a medication that treats it, but symptoms like anxiety, depression, and difficulty sleeping can still be addressed with medication and make the recovery process easier.
Better Tools + Better Support= Better Recovery.
Questions?
FAQs about Addiction Services
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Substance use disorders are not like some other illnesses that can be diagnosed with a simple test. Instead, it is important to look at the impact the substance is having on your life. The more symptoms of impact, the more severe the disorder. The DSM-5 is the book that defines how psychiatric and substance use disorders are diagnosed. Whatever the substance, the criteria are very similar. Here is a list with alcohol as an example, but you can substitute other substances to consider if you might have a substance use disorder. If you have 2-3 symptoms it is a Mild Substance Use Disorder, 4-5 symptoms is a Moderate Substance Use Disorder, 6 or more symptoms is a Severe Substance Use Disorder. If you have a mild disorder, don’t wait until it worsens to get help.
1. Drinking more alcohol than planned or for a longer time.
2. Being unsuccessful in your attempts to cut down on alcohol.
3. Spending a lot of time getting, using, or recovering from alcohol.
4. Strongly wanting or craving alcohol.
5. Drinking leading to problems at work, school, or home.
6. Using alcohol despite having social or relationship issues because of it.
7. Giving up important activities due to alcohol use.
8. Drinking in risky situations.
9. Using alcohol even with knowledge of health problems it causes.
10. Needing more alcohol to feel its effects or experiencing reduced effects.
11. Going through withdrawal symptoms when not drinking, or using alcohol to avoid these symptoms.
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This type of medication can be taken several ways. In the case of Suboxone, it is in a film that is placed under your tongue and allowed to dissolve. This medication does not taste good, but you should never rinse your mouth, brush your teeth, or drink something to get rid of the taste because this will also eliminate some of the medicine. It is also important not to smoke 30 minutes prior to taking the medication. This will constrict your blood vessels and make it harder for your body to absorb the medication. You also shouldn’t eat, drink, or smoke for 30 minutes after taking it. There is a tablet form of the medication that is also dissolved under the tongue. Lastly, there are monthly injections.
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This is a personal decision with no “right” answer. The American Society of Addiction Medicine does not have a treatment length recommendation. Treatment decisions should be made considering risks and benefits. I have had many patients who have wanted to stay on Suboxone indefinitely. They have worked hard to recover their lives one step at a time. Now that they are sober, stable, working, in restored relationships, with housing and possessions. They don’t want to risk losing everything again. I have also had patients that wanted to get off the medication at some point. They did a slow taper despite knowing that they were at an increased risk for relapse because it was important to them to stop the medication. I support my patients and whatever decision they feel is right for their recovery. I do not try to get patients to taper off the medication, but after explaining the risks, if they want to taper, I support their decision and work with them to achieve their treatment goals.
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When patients begin Suboxone, they must be in a moderate state of withdrawal. If they are not, they will go into a precipitated withdrawal and get “dope sick” quickly. It is an experience few want to repeat! Here’s why this happens: When you take an opiate –whether it is heroin, percocet, fentanyl (or any other opiate) – the drug is attached to mu receptors in your brain. The drugs hang onto the receptors like a magnet on your refrigerator. When you take Suboxone (a partial opiate) the “magnet” in Suboxone is much stronger. Because of that, it will knock all the remaining opiates off the mu receptors so the Suboxone can cling to the receptor. This causes a severe withdrawal. When I prescribe Suboxone to a new patient there is alot of teaching on when they are ready to start the medication to make sure they don’t go into a precipitated withdrawal.
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Vivitrol will block the euphoric effects of alcohol. There is no reason you cannot drink on Vivitrol. It is not like Antabuse where you become violently ill if you drink while taking it. But, because the euphoric effects are blocked, people are more able to stop drinking if they are on Vivitrol. They are also more likely to entirely quit drinking. Vivitrol does not block all effects of alcohol. You may still be less coordinated or have decreased mental function. It also will not make your tolerance to alcohol higher.
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The answer to this is pretty simple. With the injection you make a decision once a month to get the injection. With the pill form, you make the decision daily. It is harder to make a daily decision to stay sober, and if you decide to drink that day, you can just skip your pill and get drunk if you want to. This makes the oral medication less effective.
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The Sinclair Method is an approach to help people drink more moderately. With this method, you would take naltrexone (in pill form) an hour before you drink. Because it blocks the euphoria, patients are more able to stop drinking and drink more like a social drinker. I have seen this be a successful approach where drinking became more controlled and it stopped the problems alcohol use was creating if the person’s life. I have also seen others who just skip the pill when they want to become drunk, so it is not an effective approach. I meet my patients where they are and am open to prescribing naltrexone this way if it will help patients achieve their treatment goals. If it fails to help them, they often become more open to pursuing an abstinence approach toward alcohol.