How We Treat Substance Use Disorders
The Arroyos approaches the treatment of substance use disorders (drug and alcohol abuse) from an interdisciplinary team approach. We start with a thorough evaluation of your drug and alcohol abuse patterns to make sure we understand your symptoms to make an accurate diagnosis. We also carefully assess for any co-occurring psychological and medical disorders. The vast majority of patients at The Arroyos have one or more mental health disorders in addition to their substance use diagnoses (sometimes called “co-occurring” or “dual diagnosis” patients).
At the time of initial assessment, the Arroyos team determines if the degree of substance use is so severe as to require detox in a hospital setting. This is especially an issue for severe abuse of alcohol and benzodiazepine drugs. In this case, we will hospitalize you for a drug detox and then continue your outpatient treatment at The Arroyos when it is safe to do so.
We approach the outpatient treatment of dual diagnosis patients with an understanding of the relationship between the use of substances and the underlying mental health diagnoses. We treat all conditions simultaneously and provide psychoeducation about the interactions between drugs and alcohol and psychiatric disorders such as depression, anxiety, bipolar disorder, and other mental health conditions. We strongly advocate abstinence from all substances and encourage our patients to connect with adjunctive community support programs such as SMART Recovery, 12-Step, LifeRing, SOS, and Women for Sobriety. Some patients are unable or unwilling to set sobriety at a goal, in which case we may consider a harm reduction model and encourage participation in community programs such as Moderation Management. We also offer Medication Assisted Treatment (MAT) to assist patients with cravings or tapering off of Suboxone.
Diagnosing Substance Use Disorders
When we diagnose as substance use (drug and alcohol) disorder at The Arroyos, we use several different techniques. We ask you to fill out questionnaires and psychological tests that document your present use of drugs and alcohol as well as your past use of substances and any problems that you may have experienced. We also ask you to describe any prior treatments for substance use problems including detoxes, hospitalizations, or other treatments, legal problems, and whether drugs or alcohol have interfered with your social, occupational, or education functioning or family relationships.
We also explore the effects that drugs and alcohol may have on any co-occurring psychological and psychiatric disorders that you have such as anxiety, depression, bipolar disorder, and/or OCD. Sometimes a person is not aware that they have a drug or alcohol problem until it becomes apparent that their use of substances is negatively affecting their underlying psychiatric condition.
We also offer drug and alcohol testing on-site at The Arroyos. We are a CLIA-waived, licensed laboratory and are able to perform urine drug screens and alcohol breathalyzer tests in our office. We can send off positive urine drug samples to an off-site lab for confirmation using GC/MS spectrometry.
With your permission, we often like to include family members in our diagnostic assessment procedures as they may have a very helpful perspective on possible patterns of substance use that you are not fully aware of.
Types of Substance Use Disorders
Substance use disorders are defined as the continued use of a substance despite the presence of cognitive, behavioral, and physiological symptoms that cause significant problems in the individual’s functioning. Substance use disorders are classified by the type of substance that is abused, and are briefly described here:
Alcohol-Related Disorders: Intoxication, withdrawal, and maladaptive patterns of abuse of alcohol
Caffeine-Related Disorders: Intoxication and withdrawal of caffeine
Cannabis-Related Disorders: Intoxication, withdrawal, and maladaptive patterns of abuse of cannabis
Hallucinogen-Related Disorders: Intoxication and maladaptive patterns of abuse of hallucinogens
Inhalant-Use Disorders: Intoxication and maladaptive patterns of abuse of inhalants
Opioid-Related Disorders: Intoxication, withdrawal, and maladaptive patterns of abuse of opioids
Sedative, Hypnotic, or Anxiolytic-Related Disorders: Intoxication, withdrawal, and maladaptive patterns of abuse of sedatives, hypnotics, or anxiolytics
Stimulant-Related Disorders: Intoxication, withdrawal, and maladaptive patterns of abuse of stimulants
Tobacco-Related Disorders: Withdrawal and maladaptive patterns of abuse of tobacco
Psychotherapy for Substance Use Disorders
Individual psychotherapy for substance use disorders involves developing awareness and understanding of the negative effects of the pattern of maladaptive use on the patient as well as those around him or her. This may involve cognitive behavioral therapy, interpersonal and social rhythm therapy (IPSRT), and supportive psychodynamic therapy. Psychotherapy also focuses on the interaction between the person’s substance abuse and their other co-occurring psychological conditions using a self-medication model. Helping the patient understand that they may have been using drugs or alcohol as an attempt to “treat underlying anxiety, depression, mania, obsessions, or psychosis may help increase motivation to abstain from substances and comply with psychotherapy and medications.
Family psychotherapy focuses on the effects of substance abuse on the broader family system. Family members are provided psychoeducation about substance abuse and co-occurring (dual diagnosis) disorders. Patterns of enabling and codependency are identified, and family members are helped to support the patient in ways that do not encourage continued maladaptive use of substances. Family members also learn about co-occurring psychiatric disorders and how they may be supportive of the patient’s treatment of these underlying mental health conditions.
Medications for Substance Use Disorders
There are a variety of medications that may be helpful in the treatment of substance use disorders. Some of these medications are given “off-label,” meaning that they are not FDA approved for the purpose stated. However, there has been research supportive of the intended use when prescribed and supervised by a qualified physician. Arroyos psychiatrists prescribe to our patients on an individualized basis, and we cannot guarantee that an Arroyos psychiatrist will prescribe any specific medication listed here to you.
Alcohol
- Acamprosate (Campral) may help maintain abstinence
- Disulfiram (Antabuse) may help maintain abstinence
- Naltrexone (Revia, Vivitrol) may help reduce cravings
Cannabis
- Bupropion (Wellbutrin) may help treat withdrawal
- Gabapentin (Neurontin) may help treat withdrawal
- Naltrexone (Revia, Vivitrol) may help reduce cravings for alcohol
Opioids
- Naltrexone (Revia, Vivitrol) may help reduce cravings for opioids
- Buprenorphine (Suboxone) may help taper off of opioids
How to Help a Loved One
If you have a loved one who is suffering from drug or alcohol abuse, it is important to talk with them right away about your concerns. They may be embarrassed about their condition, have difficulty putting their feelings into words, feel hopeless or worthless, or be preoccupied with their substance use behavior or even with suicidal thoughts. Let them know that you care and that you are confident that they can feel better if they speak to a trained professional. Some people with drug and alcohol abuse are highly unpredictable and can be a danger to themselves or others, while other individuals with substance use disorders may be very lethargic, uncommunicative, and disengaged from the world. Please call us if your loved one is willing to schedule an intake appointment. If they are unwilling or unable to get help, they may need to be hospitalized as substance use disorders can be fatal if not treated with expert care. If your loved one is expressing thoughts of hurting themselves or someone else, this is an emergency. Call 911 or take them to the nearest emergency room.