Substance and Alcohol Abuse

Addiction as Defined by the American Society of Addiction Medicine.


Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristics biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behavior and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.


Opiate Use Disorder


Causes of Addiction


Addiction is a brain disease. The reward circuit is hijacked. Opiate addicts get "hooked" on the medication because of the way it acts on the user's brain. The brain stops producing natural pain killers called endorphins. As a result, the person who is addicted to opiates experiences a physical "need" for the drug. Addicts become physically sick if they stop taking or using the drug, which in turn means they can't just stop. Psychological Trauma and genetics also play an important role.


Why Choose Medication Assisted Therapy?


Now there are FDA approved medication to treat certain Addictions. Buprenorphine/Suboxone can maintain patients in treatment and eliminate opioid use by decreasing withdrawal symptoms and cravings. Suboxone offers an opportunity to treat opioid addiction in the privacy and confidentiality of a doctor's office. Patients treated with Suboxone generally do not have to be hospitalized or make daily visits to a clinic. As a result, treatment with Suboxone and counseling may allow more time for work, family and other activities.


How Counseling and Medicine Work Together


Medication works by normalizing the Limbic system, the central part of the brain, while counseling helps with the cortex of the brain. When you combine medication-assisted treatment with counseling, you have a greater opportunity for success. With Dr. Vijapura, the patient will have built-in support with counseling, in the form of group therapy.


Better Outcomes of Treatment


Opioid cravings can occur months and even years after your last use. Their suddenness and intensity can put even the most committed person at risk for relapse. While Suboxone helps the patient with the physical cravings associated with the disease, counseling can help the patient begin to make better decisions by avoiding the trap of Stinking Thinking.


Patients with Substance Abuse Disorder benefit from group therapy, such as 12 Step program participation like NA, AA or Church based fellowships. Medication Assisted Therapy is frequently misunderstood in settings other than a medical model, such as our office. We use a multi prong approach in treatment which gives the best outcome. We specifically developed a group therapy program geared towards the needs of our patients on Medication Assisted Therapy. Some of our group topics include:

  • Tools for recovery

  • Definition of Addiction

  • Am I an Addict?

  • Relapse Prevention

  • Assertive Communication

  • Neurobiology of Addiction

  • Co-Occurring mental illness

  • How Buprenorphine works

  • Distinction between Recovery and Abstinence

  • Difference between Dependence and Addiction


Group Participation is limited to our patients, it is highly encouraged and free for those patients.


Alcohol Use Disorder


Alcohol use disorder (Alcoholism) is a pattern of alcohol use that involves problems controlling your drinking, being preoccupied with alcohol, continuing to use alcohol even when it causes problems, having to drink more to get the same effect, or having withdrawal symptoms when you rapidly decrease or stop drinking.

Unhealthy alcohol use includes any alcohol use that puts your health or safety at risk or causes other alcohol-related problems. It also includes binge drinking —a pattern of drinking where a male consumes five or more drinks within two hours or a female drinks at least four drinks within two hours. Binge drinking causes significant health and safety risks. 

If your pattern of drinking results in repeated significant distress and problems functioning in your daily life, you likely have alcohol use disorder. It can range from mild to severe. However, even a mild disorder can escalate and lead to serious problems, so early treatment is important.




Alcohol use disorder can be mild, moderate or severe, based on the number of symptoms you experience. Signs and symptoms may include:

  •       •Being unable to limit the amount of alcohol you drink

  •       •Wanting to cut down on how much you drink or making unsuccessful attempts to do so

  •       •Spending a lot of time drinking, getting alcohol or recovering from alcohol use

  •       •Feeling a strong craving or urge to drink alcohol

  •       •Failing to fulfill major obligations at work, school or home due to repeated alcohol use

  •       •Continuing to drink alcohol even though you know it's causing physical, social or interpersonal problems

  •       •Giving up or reducing social and work activities and hobbies

  •       •Using alcohol in situations where it's not safe, such as when driving or swimming

  •       •Developing a tolerance to alcohol so you need more to feel its effect or you have a reduced effect from the same amount

  •       •Experiencing withdrawal symptomssuch as nausea, sweating and shakingwhen you don't drink, or drinking to avoid these symptoms


Alcohol use disorder can include periods of alcohol intoxication and symptoms of withdrawal.


What Addiction Specialist can Offer in Treatment of Alcohol Use Disorder?


Alcohol Use Disorder (Alcoholism) is a chronic progressive benign disease. Now there are FDA approved medications to help reduce cravings and compulsion. The best treatment includes combined approach of medication and psychological help together (i.e. professional counseling and/or self-help groups like Alcoholics Anonymous).


Medications for Treating Alcohol Use Disorder:


Almost one third of Americans consume enough alcohol to be considered at risk for alcohol dependence and are associated with more than 100,000 deaths from alcohol-related diseases and injuries each year.

Counseling and 12-step structured treatment programs have been the mainstays of alcohol dependence treatment, whereas pharmacologic treatments traditionally have played an adjunctive role.

Medications such as Naltrexone, Vivitrol, Acamprosate, Disuliram and other medications are indicated to treat Alcohol Use Disorder.

  • Naltrexone - an anticraving agent, reduces relapse rates and cravings and increases abstinence rates. Naltrexone is an opioid receptor antagonist approved in the treatment of alcohol dependence in conjunction with psychosocial interventions. It is believed that Naltrexone works through its blockage of opioid receptors, which reduces the reinforcing effects of alcohol leading to decreased feelings of intoxication and fewer cravings. 

    The recommended dosage of Naltrexone is 50mg per day in a single dose. Long-term opioid therapy for chronic pain or heroin dependence is a contraindication for Naltrexone because the drug could precipitate severe withdrawal syndrome. This drug also is contraindicated in patients with hepatitis or liver failure. Naltrexone is generally well tolerated; nausea is the most common adverse effect.


    Vivitrol is a once a month injectionformulationthat is used to treat alcoholism by reducing your urge to drink alcohol. This may help you drink less or stop drinking altogether. Naltrexone will not decrease the effects of alcohol you recently consumed. You should not be drinking at the time you receive your first Vivitrol injection.


    Acamprosate (Camprel) is believed to block glutaminergicN-methyl-Daspartate receptors and activate 3-aminobutyric acid type A receptors and was recently approved by the FDA for the treatment of alcohol dependence.

    Acamprosate is available in 333-mg enteric. It is well tolerated with limited side effects, most commonly transient diarrhea. Patients with renal insufficiency should not take acamprosate, but it may be taken safely by patients with liver dysfunction.


    Disulfiram-(Antabuse) Disulfiram inhibits acetaldehyde dehydrogenase. Although it has been used to treat alcohol dependence for more than 40 years, the evidence for its effectiveness is weak.

    Disulfiram usually is given in a dosage of 250 mg per day with a maximum dosage of 500 mg per day. Consuming alcohol after taking disulfiram results in symptoms such as palpitations, flushing, nausea, vomiting, and headache. More severe reactions could include myocardial infarction, congestive heart failure, respiratory depression, and death. Because of these significant restrictions and problems with compliance, disulfiram is not recommended for treating alcohol dependence.


Serotonergic Agents

The use of selective serotonin antagonists, like Prozacfor early-onset alcohol dependence also has been investigated, with positive results. Zofran was also shown to significantly reduce self-reported drinking. Patients who received Zofran 4 mcg per kg twice per day had fewer drinks per day.



Topiramate (Topamax) inhibits mesocorticolimbic dopamine release, which is believed to be associated with craving for alcohol. Gabapentin (Neurontin)and Valproate (Depacon)have shown some promise in case studies and small trials.



These medications, such as Ativan and Valium, are frequently used for a few days only for detoxification purposes.


The best choices for prevention of relapse are naltrexone and acamprosate with concurrent counseling through professional or self-help programs.

Frequently there are co-occurring disorders like depression, anxiety, PTSD, Bipolar Disorder and ADHD needs to be addressed and treated as well.