Diagnostic Evaluation

A foundation of our approach in the Recovery Clinic is that addiction is a medical condition.  Research has demonstrated that addictive substances can lead to changes in the brain that alter the way a person thinks, feels, and behaves.  Because of this, our doctors start with a careful and thorough diagnostic evaluation.  We pay particularly close attention to factors that can contribute to the development and maintenance of addiction, including:

• Genetics: Vulnerability to addiction can be inherited or “run in the family”
• Environmental stressors: Both in childhood and in present time, including trauma
• Psychiatric disorders: Depression, anxiety, and other psychiatric disorders increase someone’s risk for developing a substance use disorder
• Exposure to drugs: Regular or frequent use of and/or using during adolescence put people at particular risk
• Present living situation: Being surrounded by poverty, crime, and/or other substance users
• Readiness to change

More generally, our assessments include the following:

• Substance use history:  Age of onset, pattern of use, level of physiological dependence, substance-related consequences and treatment history
• Social history: Childhood development, work/school history, present living situation, and social support
• Psychiatric history: Assessment for any mood, anxiety or other disorders; and treatment history including medication trials
• Medical history: All medical problems, treatment, and current medications

Treatment

After completing our diagnostic evaluation, we collaboratively develop a treatment plan with someone based on the results of our evaluation and their personal recovery goals.   At the center of our approach is an awareness of the importance that everyone’s history and situation is unique, and everyone has their strengths, problems, and goals.    Some of the options we may include in our treatment plan are:

• Medication management: We offer medication assisted therapy to treat substance use disorders.  This can normalize brain function, and help with withdrawal, cravings, and also block the addictive effects of substances.  Options include but are not limited to:
  • Opioid use disorders: Buprenorphine (Suboxone™) and injectable extended-release naltrexone (Vivitrol™)
  • Alcohol use disorders: Oral naltrexone, injectable extended-release naltrexone (Vivitrol™), acamprosate (Campral ™), and disulfiram (Antabuse ™)
• Individual therapy: We offer individual, weekly therapy sessions utilizing the best available techniques shown to treat addiction. Our therapy services are grounded in the cognitive-behavior-therapy (CBT) model but also include components of other well-supported strategies such as motivational interviewing, family behavior therapy, and couples counseling. Therapy can be a useful approach for learning more about addiction and developing skills to manage stress, cravings and other negative emotions. 
• Referral/coordination of care: We sometimes recommend that people obtain other treatment in addition to what we offer in the Recovery Clinic.  This can be for a number of reasons, including medical safety and the level of support someone needs to achieve their treatment goals. In these circumstances, we strive to work with people to help them arrange such treatments.  Moreover, we work in a collaborative manner with these programs, such that we can treat the patient in an integrated manner and do everything we can to assist them in their recovery.  Programs we may refer to include:
  • Inpatient detoxification
  • Residential addiction treatment
  • Intensive outpatient program (IOP)
  • Partial hospitalization program (PHP)
  • Methadone maintenance treatment program
• Co-occurring disorder treatment: Individuals often simultaneously suffer from substance use disorders as well as other psychiatric disorders.  Psychiatric symptoms and substance use interact in a very complex and bi-directional manner.   People do best when both types of conditions are treated in an integrated fashion.  We do this in the Recovery Clinic by carefully assessing and monitoring our patients, and by offering both psychiatric medication and psychotherapy as treatment options when appropriate.
• Aftercare/long-term treatment: As physicians and other healthcare professionals, we are experts at managing chronic diseases.  We apply this approach to our treatment of substance use disorders, including long-term follow-up.  In doing so we strive to help prevent or treat any issues that occur, such as stressors, return to use, or worsening of use if abstinence was not a goal.  We also recognize that people’s goals change over time, and we work to position ourselves in such a manner to both help people identify new goals and move towards achieving them.