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Chronic Pain & Opioid Use Disorder (OUD)
Breaking the Cycle of Pain and Dependency
Managing chronic pain while treating Opioid Use Disorder requires frequent follow up and an expert team. We focus on functional restoration, symptom control and safety.
Our Clinical Strategy
We utilize an integrated framework to address pain without putting recovery at risk. For example:
- Moving toward Buprenorphine: For many, transitioning from full-agonist opioids (like oxycodone) to buprenorphine (a partial agonist) provides superior pain relief with a much higher safety profile and lower risk of respiratory depression. This change helps people “get their lives back”
- Medication Management: The fewest medications with the most benefits. We strive to choose medications that treat both the physical pain and the psychiatric symptoms. There are many medications that serve a dual purpose- we lean into that to maximize benefit and reduce exposure to polypharmacy.
What to Expect
- Comprehensive Pain Audit: We review your entire medical history, imaging (MRIs/X-rays) when available, previous surgical outcomes, your pain medication history.
- Stabilization Phase: We focus on stopping the cycle of withdrawal, stabilizing then when appropriate, reducing doses very, very slowly.
- Functional Goal Setting: Success is measured by life improvements for example a return to work, riding your motorcycle again, or engaging with your kids.
ADHD & Stimulant Use Disorder
Treating ADHD in the context of a history of stimulant misuse (cocaine, methamphetamine, or diverted prescription stimulants) is one of the most underserved and hot button areas of psychiatry. We provide a path to cognitive clarity that prioritizes brain health and long-term stability.
The Challenge of the “Dopamine Gap”
Patients with ADHD often have a baseline dopamine deficit. When stimulant use disorder is present, the brain’s reward system becomes further dysregulated, leading to a cycle of “self-medicating” to feel normal. We see this and hear this and we can help.
High-Dose Stimulant Replacement Therapy (SRT)
An Agonist Approach to Stimulant Recovery
For many patients struggling with chronic cocaine or methamphetamine use, the standard “abstinence-only” or “non-stimulant-only” approach just does not work..
At Bridge Psychiatry, we utilize an evidence-based Agonist Replacement Therapy model—similar to using Methadone or Buprenorphine for Opioid Use Disorder—using high doses of prescription stimulants to stabilize brain chemistry and support long-term recovery.
The Evidence for High-Dose Treatment
- Abstinence & Reduction: High-dose prescription stimulants have been shown to significantly increase rates of sustained abstinence and reduce the frequency of use in patients with Cocaine and Amphetamine Use Disorders.
- Craving Management: Research indicates that “robust” doses (often at or above the FDA-maximum for ADHD) are required to successfully compete with illicit stimulants at the dopamine transporter site, effectively “quieting” the intense cravings that drive the cycle of use.
- Safety & Tolerance: Clinical data shows that when supervised by addiction specialists, high-dose protocols are generally well-tolerated with minimal impact on blood pressure and heart rate in stabilized patients.
Our Protocol for Stimulant Replacement
Because we are an Integrated Practice, we are uniquely equipped to manage the high-level monitoring required for this protocol which we develop by referencing the 2024/2025 ASAM/AAAP Clinical Practice Guidelines for Stimulant Use Disorder.:
- Cardiac Clearance: Before beginning high-dose SRT, we perform an in-house EKG and cardiovascular screening to ensure your safety.
- Long-Acting Formulations: We prioritize extended-release (ER) medications (like Concerta or Vyvanse) which provide a steady, therapeutic level of dopamine without the “spike” associated with illicit use or immediate-release pills.
- Functional Outcomes: We measure success not just by negative drug screens, but by improvements in your “quality of life” markers—stability in employment, improved mood, and re-engagement with family.
- Rigorous Monitoring: This protocol can involve frequent check-ins, mandatory pill counts, and regular toxicology screenings
- Clinical Note: Treatment is highly individualized. We “dose to effect,” meaning we adjust the medication until cravings are suppressed and you are able to function, while staying within safe clinical parameters. High dose stimulants is not appropriate for every person in recovery from Stimulant use disorder
Our goal is to help you achieve “quiet focus”:
- If you come into the office and are experiencing “overamping” we will attempt to cool you, give you a space to rest that is quiet with low stimulation, we will promote hydration and physical safety.
Once you have been stabilized on medications we will attempt to work with:
- Cognitive Behavioral Therapy (CBT) specifically for ADHD.
- Sleep hygiene management (as sleep deprivation often mimics ADHD).
- Safe, monitored medical intervention.
Benzodiazepine Use Disorder Care
Our clinic specializes in compassionate, evidence-based treatment for individuals struggling with benzodiazepine use disorder, including dependence on both pharmaceutical-grade medications and illicit/black-market benzodiazepines.
We recognize that many individuals using non-prescribed benzodiazepines are doing so to manage anxiety, trauma, insomnia, or other unmet health needs. Our approach prioritizes safety, dignity, and stabilization.
Our Clinical Approach Includes:
- Expertise in treating dependence on pharmaceutical benzodiazepines (e.g., alprazolam, clonazepam, lorazepam)
- Experience working with individuals using non-pharmaceutical or black-market benzodiazepines
- Careful clinical transitions from unknown-potency substances to regulated, pharmaceutical-grade medications when clinically appropriate
- Very gradual, individualized tapering protocols designed to minimize withdrawal symptoms and preserve functioning
- Focus on improving quality of life, emotional stability, cognitive functioning, and day-to-day capacity—not simply medication reduction
Our goal is not rapid discontinuation, but safe stabilization and long-term recovery, using practices supported by clinical evidence and harm-reduction principles.
Alcohol Use Disorder & Outpatient (Home-Based) Detox
We offer evidence-based outpatient treatment for alcohol use disorder, including medically supported home detox for appropriate patients.
For individuals who meet clinical criteria for outpatient withdrawal management, we provide structured monitoring, medication-supported protocols, and ongoing psychiatric care to support safety and success.
Services Include:
- Comprehensive assessment to determine appropriateness for outpatient vs. higher level of care
- Evidence-based medications for alcohol withdrawal management and relapse prevention (when appropriate)
- Close clinical follow-up during detox process
- Ongoing psychiatric care for co-occurring anxiety, depression, trauma, or sleep disorders
- Long-term support focused on stabilization, relapse prevention, and functional recovery
We understand that recovery looks different for different people. Our care is individualized, realistic, and grounded in both medical science and respect for each person’s goals.
Nicotine Use Disorder Treatment
Nicotine dependence is one of the most common and difficult-to-treat substance use disorders—but effective, evidence-based treatments are available.
We provide comprehensive treatment for nicotine use disorder, including dependence on:
- Cigarettes
- Vaping products
- Nicotine pouches and other nicotine delivery systems
Evidence-Based Interventions We Offer:
- FDA-approved medications (e.g., varenicline, bupropion, nicotine replacement therapies)
- Behavioral strategies shown to improve quit success
- Motivational interviewing to support readiness and reduce shame
- Treatment of underlying anxiety, ADHD, trauma, or mood disorders that often drive nicotine use
Our goal is to support long-term success while minimizing distress, withdrawal, and relapse cycles
Recovery-Oriented Care: Motivational Interviewing & Supportive Collaboration
We believe sustainable change happens through collaboration—not coercion.
Our clinicians use motivational interviewing, a well-established, evidence-based counseling approach that helps individuals explore their own values, goals, and readiness for change without judgment or pressure.
We also actively collaborate with:
- Recovery coaches
- Community supports
- Therapists and care teams (with consent)
Our philosophy supports individuals in building a life that feels meaningful and stable. For some, that includes abstinence. For others, it may involve safer use, gradual change, or stabilization first. We respect that recovery is personal—and we meet people where they are.