Substance Use Disorder Treatment

Substance Use Disorder Treatment: Evidence-Based Care for Recovery

Substance use disorder is treatable. At KwikPsych, we provide comprehensive, evidence-based treatment combining medication-assisted therapy (MAT), psychiatric care, and behavioral support to help people with addiction recover and build lasting sobriety.

Dr. Monika Thangada specializes in addiction psychiatry and works with individuals and families to develop personalized treatment plans addressing not only substance use but also co-occurring mental health conditions.

What Is Substance Use Disorder Treatment?

Effective treatment for substance use disorder combines multiple evidence-based components:

1. Medical evaluation and detoxification: Safe management of withdrawal symptoms
2. Medication-assisted treatment (MAT): FDA-approved medications that reduce cravings and block intoxication
3. Behavioral therapies: Cognitive-behavioral therapy, motivational interviewing, and counseling
4. Psychiatric care: Evaluation and treatment of co-occurring mental health conditions
5. Psychosocial support: Peer support groups, family therapy, and lifestyle counseling

Treatment is individualized based on:

• Type of substance(s) used
• Severity of the disorder
• Duration of use
• Co-occurring mental health or medical conditions
• Social support and living situation
• Previous treatment history
• Personal goals and preferences

Medication-Assisted Treatment (MAT): The Gold Standard

Medication-assisted treatment is the most effective approach for opioid use disorder and increasingly recognized as valuable for alcohol use disorder. MAT combines FDA-approved medications with behavioral therapy and psychosocial support.

How MAT Works

The brain chemistry of addiction—particularly the dopamine reward system—is altered by chronic substance use. MAT medications restore neurochemical balance by:

• Reducing cravings: Decreasing the intense desire to use
• Blocking euphoria: Preventing the "high" that reinforces continued use
• Alleviating withdrawal: Managing the discomfort of discontinuing use
• Normalizing brain function: Allowing improved decision-making and impulse control

Contrary to misconceptions, MAT is not "replacing one addiction with another." The medications don't produce euphoria, don't require dose escalation, and allow normal functioning and brain development. Patients can work, drive, think clearly, and live normal lives on MAT.

Medications for Opioid Use Disorder

Buprenorphine (Suboxone, Subutex)

• Type: Partial opioid agonist
• Advantages: Lower overdose risk; less withdrawal if discontinued; convenient—available in office-based practices and telehealth
• Dosing: Typically 8-24 mg daily (sublingual tablet, film, or injection)
• Timeline: Can begin induction in the same day as initial evaluation; takes 5-7 days for full stabilization
• Best for: Moderate opioid use disorder, outpatient settings, pregnant women, people wanting to transition off medication after stabilization
• Cost: Usually covered by insurance; lower copays than some other MAT options

Methadone

• Type: Full opioid agonist
• Advantages: Highly effective; long-acting (24-hour dosing)
• Disadvantages: Requires daily clinic visits; slower induction; greater overdose risk if misused
• Dosing: Typically 60–120 mg/day or higher in some cases
• Timeline: Induction typically takes 1-2 weeks
• Best for: Severe opioid use disorder; people with multiple prior treatment failures; those needing structure and intensive monitoring
• Availability: Methadone clinics (regulated, more restrictive); not available in office-based practices

Naltrexone (Vivitrol—Injectable Extended-Release)

• Type: Opioid antagonist (opioid blocker)
• Advantages: No opioid effects; no overdose risk; good for those concerned about addiction potential of agonist medications
• Disadvantages: Requires abstinence before starting (to avoid precipitated withdrawal); injectable form requires monthly clinic visits
• Dosing: 380 mg IM injection monthly
• Timeline: Requires 7-10 days abstinence from opioids; works immediately upon injection
• Best for: Mild opioid use disorder; motivated patients; those with legal system involvement who need observable adherence
• Cost: More expensive; may require prior authorization from insurance

Medications for Alcohol Use Disorder

Naltrexone (Oral or Extended-Release Injectable)

• Mechanism: Blocks opioid receptors; reduces the rewarding effects of alcohol; reduces cravings
• Dosing: 50 mg daily (oral) or 380 mg IM monthly (Vivitrol)
• Evidence: Reduces heavy drinking days and relapses; better outcomes when combined with therapy
• Contraindication: Cannot use if person is opioid-dependent (opioid agonist MAT required instead)

Acamprosate (Campral)

• Mechanism: Restores glutamate neurotransmission; reduces protracted withdrawal symptoms and cravings
• Dosing: 666 mg three times daily
• Evidence: Effective for maintaining abstinence; particularly helpful for protracted withdrawal (anxiety, insomnia, anhedonia lasting weeks-months)
• Advantage: Can be used regardless of other medications; safe even in liver disease
• Timing: Can be started immediately

Disulfiram (Antabuse)

• Mechanism: Creates aversive reaction if alcohol is consumed (severe flushing, nausea, vomiting, chest pain, hypotension)
• Indication: Deterrent to drinking; requires high motivation and insight
• Dosing: 250 mg daily
• Important: Works only if the person remembers to take it and wants to avoid drinking
• Use: Better outcomes when combined with therapy and family monitoring

The Treatment Process

Phase 1: Comprehensive Evaluation and Assessment

Your first appointment includes:

• Psychiatric history: Including family history of addiction and mental health conditions
• Substance use assessment: What you've used, how much, how often, duration, consequences
• Withdrawal risk evaluation: Assessing need for medical supervision during detoxification
• Physical examination and labs: Baseline health status, screening for infectious diseases (HIV, hepatitis), liver function, pregnancy status
• Co-occurring condition screening: Depression, anxiety, PTSD, bipolar disorder, attention-deficit disorder, and other psychiatric illnesses
• Psychosocial assessment: Living situation, employment, legal issues, relationships, support system
• Medical history: Other conditions, current medications, allergies
• Motivational interviewing: Understanding your goals, ambivalence about change, and readiness for treatment

This comprehensive assessment determines:

• Type and severity of substance use disorder
• Appropriate level of care (outpatient, intensive outpatient, inpatient)
• Whether medications are indicated and which ones
• Concurrent treatment needs (depression, anxiety, trauma)
• Timeline and plan

Phase 2: Detoxification and Withdrawal Management

For substances with manageable withdrawal (opioids, cannabis, stimulants):

• Outpatient detoxification with medication support
• Weekly appointments to monitor symptoms and adjust medications
• Symptom management: anti-anxiety medications for opioid withdrawal, antidepressants for mood support
• No missed work or school required

For substances with potentially dangerous withdrawal (alcohol, benzodiazepines):

• Medical evaluation to assess seizure risk
• Inpatient hospitalization if high-risk withdrawal
• Outpatient medically-supervised withdrawal for mild-moderate cases
• Benzodiazepines (typically chlordiazepoxide or lorazepam) on a tapering schedule
• Close monitoring for seizures, delirium, and other complications
• Typically 3-7 days for acute withdrawal

Timeline: Acute withdrawal varies by substance:

• Alcohol: onset within 6–24 hours; peak symptoms typically at 24–72 hours; severe symptoms subside by day 3–5; protracted symptoms persist weeks
• Opioids: onset within 8–24 hours for short-acting opioids; peak symptoms days 2–3; acute withdrawal resolved by day 10–14
• Benzodiazepines: Slow, carefully managed taper over weeks-months
• Stimulants: No significant physical withdrawal, but severe dysphoria and cravings

Phase 3: Medication-Assisted Treatment Initiation

If MAT is recommended:

Buprenorphine induction (outpatient):

• Day 1: 2-4 mg initial dose at clinic; can give second dose at home later in day if inadequate withdrawal relief
• Days 2-3: Titrate up by 2-4 mg daily to reach target dose
• Day 4: Stabilized; can begin telehealth follow-ups
• Full effects: Stabilization takes 5-7 days; brain function improvement continues over weeks

Methadone induction (clinic-based):

• Day 1: 10-30 mg initial dose; witnessed consumption at clinic
• Days 2-5: Increase by 5-10 mg daily, up to 60 mg by end of first week
• Week 2-4: Slower increases to reach target dose (usually 60-100 mg)
• Daily clinic visits required during induction and stabilization
• Cannot leave clinic until stable; typically several weeks minimum

Naltrexone initiation:

• Requires 7-10 days abstinence from opioids (high withdrawal risk if started too soon)
• First dose: 25-50 mg oral
• Can switch to extended-release injectable (Vivitrol) after 1-2 weeks of oral

Phase 4: Stabilization and Ongoing Treatment

Once stabilized on medication:

Frequency of visits:

• Weeks 1-4: Weekly appointments (in-person or telehealth)
• Weeks 5-12: Bi-weekly appointments
• Months 3+: Monthly appointments (typically)

What happens at appointments:

• Assessment of cravings and substance use urges
• Review of any substance use or relapse
• Psychiatric assessment: mood, anxiety, sleep, functioning
• Medication side effects and response
• Psychosocial issues: relationships, work, housing, legal
• Discussion of behavioral therapy and support group engagement
• Drug screening if indicated (urine drug screens, random testing)
• Lab monitoring: liver function, HIV/hepatitis status (as indicated)

Behavioral therapy (concurrent with medication):

• Individual counseling: 1-2 sessions weekly
• Group therapy or peer support: AA, NA, SMART Recovery, or other support groups
• Family therapy: If relationships are affected
• Cognitive-behavioral therapy: Learning triggers and coping strategies
• Motivational interviewing: Strengthening commitment to recovery

Lifestyle modifications:

• Avoiding triggers (people, places, situations associated with use)
• Building new routines and activities
• Rebuilding relationships damaged by substance use
• Employment and educational goals
• Physical health: exercise, nutrition, sleep
• Stress management and coping skills

Phase 5: Long-Term Recovery and Maintenance

Duration of medication treatment: Typically 1-2 years minimum. Many people benefit from extended maintenance (years or indefinitely). There's no set timeline; treatment duration is individualized based on:

• Stability and recovery quality
• Risk of relapse if medication discontinued
• Personal goals
• Ability to maintain recovery through behavior alone

Sustained engagement in support:

• Continuing therapy and counseling
• Regular participation in peer support groups
• Ongoing psychiatric monitoring
• Medication refills and follow-up
• Management of co-occurring mental health conditions

Behavioral and Psychological Therapies

While medication treats the brain chemistry of addiction, behavioral therapy teaches skills and changes habits that support recovery.

Cognitive-Behavioral Therapy (CBT) for Addiction

CBT focuses on identifying the thoughts, feelings, and situations that trigger substance cravings and teaching alternative coping strategies.

Components:

• Identifying high-risk situations: People, places, emotions, times of day that trigger cravings
• Understanding the addiction cycle: How triggers lead to cravings, how cravings lead to use
• Developing coping strategies: Healthy alternatives to substance use for managing triggers and emotions
• Building skills: Stress management, emotion regulation, problem-solving, communication
• Cognitive restructuring: Challenging thoughts that drive substance use ("I can't handle this without drugs")
• Relapse prevention: Planning for high-risk situations and developing action plans

Evidence: Moderate to strong evidence for reducing substance use and maintaining abstinence; works well combined with medication

Motivational Interviewing (MI)

MI addresses the ambivalence many people feel about changing substance use. It's not confrontational but rather collaborative, exploring the person's own reasons for change.

Key techniques:

• Asking open-ended questions: What are the downsides of your use? What would get better if you quit?
• Reflective listening: Demonstrating understanding without judgment
• Developing discrepancy: Helping the person recognize the gap between their substance use and their values/goals
• Supporting self-efficacy: "You've succeeded at hard things before; you can do this"

Evidence: Increases motivation and engagement in treatment; particularly effective early in treatment

Contingency Management (Motivational Incentives)

Contingency management uses positive reinforcement to motivate behavior change.

Approaches:

• Vouchers: Tangible rewards (gift cards, vouchers) for meeting goals (abstinence, attending therapy, taking medication)
• Prize drawings: Random draws for reward-eligible behaviors (maintaining abstinence, negative drug screens)
• Escalating reinforcement: Rewards increase for continued success

Evidence: Strong evidence for reducing substance use during active reinforcement; supports initial behavior change while longer-term strategies develop

12-Step Facilitation

For people who find peer support and spiritual approaches valuable:

• AA (Alcoholics Anonymous): 12-step program for alcohol use disorder
• NA (Narcotics Anonymous): 12-step program for opioid and other drug use
• SMART Recovery: Self-empowerment program based on cognitive-behavioral principles
• Refuge Recovery: Secular, meditation-based recovery program
• Secular Organizations for Sobriety (SOS): Non-religious mutual support

12-step components:

• Peer support from others in recovery
• Sponsorship (mentoring by someone stable in recovery)
• Working through the 12 steps with a sponsor
• Regular meetings and community involvement
• Spiritual dimension (higher power, making amends)

Evidence: Strong evidence for peer support and community involvement in recovery; most effective combined with professional treatment

Family Therapy

Substance use affects the whole family. Family therapy:

• Educates family members about addiction as a disease
• Addresses family dynamics: Communication patterns, enabling behaviors, boundaries
• Improves support: Family members learn how to support recovery while protecting themselves
• Repairs relationships: Addressing betrayals, broken trust, hurt
• Involves family in treatment: Family becomes part of the solution

Support groups for families:

• Al-Anon: For families of people with alcohol use disorder
• Nar-Anon: For families of people with opioid/drug use disorders
• Families Anonymous: For families of people with substance use disorders

Co-Occurring Mental Health Conditions

Between 35-60% of people with substance use disorders also have depression, anxiety, PTSD, or bipolar disorder. Integrated treatment of both conditions is essential.

Depression and Substance Use

Depression is either primary (predating substance use) or secondary (caused by substance-induced changes).

Treatment:

• Antidepressant medications (SSRIs like sertraline, paroxetine)
• Therapy addressing both depression and substance use
• Behavioral activation: engaging in activities that naturally improve mood
• Often improves within weeks of achieving abstinence

Anxiety Disorders and Substance Use

Alcohol, benzodiazepines, and cannabis are commonly used to self-medicate anxiety.

Treatment:

• SSRIs or SNRIs (serotonin-norepinephrine reuptake inhibitors)
• Buspiron or beta-blockers for specific anxiety disorders
• CBT for anxiety (exposure therapy, breathing techniques)
• Mindfulness and meditation
• Critical: Avoid benzodiazepines if possible (high addiction risk); if necessary, use cautiously with close monitoring and clear taper plan

PTSD and Substance Use

Trauma often precedes substance use; substance use is used to numb trauma memories and hyperarousal.

Treatment:

• Trauma-focused cognitive-behavioral therapy or prolonged exposure therapy
• EMDR (eye-movement desensitization and reprocessing)
• Medications: SSRIs, prazosin (for nightmares)
• Sequencing: Early phase focuses on stabilization and safety; trauma processing comes later

Bipolar Disorder and Substance Use

Stimulants and alcohol can trigger dangerous manic episodes.

Treatment:

• Mood stabilizers: Lithium, valproate, lamotrigine, carbamazepine
• Antipsychotics: Quetiapine, olanzapine, risperidone
• Strict abstinence from mood-destabilizing substances (stimulants, alcohol)
• Regular monitoring and medication adjustments
• Psychoeducation about triggers and early warning signs of mania

Levels of Care

Treatment intensity is matched to severity and circumstances:

Outpatient Treatment

• Frequency: 1-3 sessions per week
• Setting: Office-based or telehealth
• Best for: Mild-moderate substance use disorder; good social support; employed or in school; no acute psychiatric crisis
• What's included: Psychiatric appointments, medication management, individual counseling
• Referrals to: Separate behavioral therapists, support groups, peer counseling

Intensive Outpatient Program (IOP)

• Frequency: 9+ hours per week (usually 3-5 hours/day, 3+ days/week)
• Duration: Usually 4-12 weeks
• Best for: Moderate-severe substance use disorder; failed outpatient treatment; co-occurring psychiatric conditions; limited support system
• What's included: Group therapy, individual counseling, skills training, psychiatric evaluation
• Advantage: Intensive support while maintaining work/school and home
• Availability: Evening and weekend options in some programs

Partial Hospitalization Program (PHP)

• Schedule: Daytime program (6-8 hours/day); patients go home evenings
• Duration: 2-6 weeks typically
• Best for: Severe substance use disorder; psychiatric crisis (suicidality, severe depression); severe withdrawal requiring medical monitoring
• What's included: Medical monitoring, psychiatry, group and individual therapy, medication management, meals/structure

Inpatient/Residential Treatment

• Duration: 7-30 days or longer
• Best for: Severe intoxication/withdrawal; imminent danger (suicidal, homicidal); severe psychiatric conditions; no safe living environment; multiple failed treatment attempts
• What's included: 24-hour medical and psychiatric monitoring; structured environment; group and individual therapy; medication management
• Types:
• Medical detoxification units (hospitals)
• Psychiatric inpatient units
• Residential rehabilitation programs

At KwikPsych, we can provide outpatient psychiatric care and can refer to appropriate higher levels of care when needed.

Insurance and Cost

Insurance Coverage

We accept 10+ major insurance carriers:

• Aetna
• Blue Cross Blue Shield (BCBS)
• Cigna
• UnitedHealthcare
• Superior HealthPlan/Ambetter
• Baylor Scott & White
• Oscar
• First Health Network
• Optum
• Medicare

Substance use treatment is typically covered because it's recognized as a medical condition. Most plans cover:

• Psychiatric evaluation and management
• Medication-assisted treatment medications
• Individual therapy/counseling

Prior authorization: Some insurance plans require prior authorization (approval before treatment begins). We handle this for you.

Self-Pay Pricing

For uninsured patients or those with high deductibles:

• Initial comprehensive evaluation: $299
• Follow-up appointments (15-30 minutes): $179
• Medication management appointments (30-45 minutes): $199-249

Medications: MAT medications (buprenorphine, methadone, naltrexone, acamprosate, disulfiram) have their own costs. Generic options are typically less expensive; we discuss options during evaluation.

Telehealth Availability

We provide telehealth appointments for substance use disorder treatment across Texas, allowing:

• Convenience of home appointments
• Access for rural areas
• Continuity of care if you relocate
• Regular follow-ups without travel

Medication initiation typically requires an in-person appointment; ongoing management can be via telehealth.

What to Expect: Your Treatment Journey

Week 1: Initial evaluation, assessment, discussion of treatment options

Weeks 2-4: Detoxification (if needed) and medication initiation, weekly appointments

Weeks 5-12: Stabilization, bi-weekly appointments, beginning behavioral therapy

Months 3+: Monthly maintenance appointments, ongoing therapy, support group participation

Most people see significant improvement within the first 1-2 months. Stabilization and rebuilding life typically takes longer—usually 6-12 months for meaningful recovery.

Getting Started

If you or a loved one is struggling with substance use, contact us today:

Phone: 737-367-1230

Address: 12335 Hymeadow Dr, Ste 450, Austin, TX 78750

Telehealth: Available across Texas

We'll schedule a comprehensive evaluation and discuss treatment options with you.

Crisis Resources:

• Suicide & Crisis Lifeline: 988
• SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7)
• Emergency: 911

Important Note: If you or someone you know is in crisis, please contact emergency services or the Suicide & Crisis Lifeline. This content is educational and not a substitute for professional medical care.