Substance use problems are common, and they're medical conditions, not character flaws. They also travel with other psychiatric conditions: depression, anxiety, trauma, ADHD, and insomnia often come first, and alcohol, opioids, or other substances become a way to cope. Treating both at the same time, with the same doctor, tends to work better than treating either one alone.
I treat adults with opioid use disorder, alcohol use disorder, and other substance use problems, including office-based treatment with buprenorphine (Suboxone).
Opioid use disorder and Suboxone
Suboxone combines buprenorphine with naloxone. Buprenorphine is a partial opioid agonist: it occupies the same receptors as other opioids, which quiets withdrawal and cravings, but it has a ceiling effect that makes it much safer than full opioids. The naloxone is there to discourage misuse.
- It saves lives. Treatment with buprenorphine or methadone is linked to a large drop in the risk of overdose death, and to better odds of staying in treatment.
- It's treatment, not a substitute addiction. Taking a prescribed medication daily, under medical care, to manage a chronic condition is no different in principle from treating diabetes or high blood pressure.
- Longer is usually better. People who stay on treatment longer do better. Whether and when to taper is a decision we make together, slowly, and never on a fixed deadline.
How starting buprenorphine works
Buprenorphine has to be started at the right time. If you take the first dose while other opioids are still active, it can bring on sudden withdrawal. So we plan the start together: you wait until you're in mild to moderate withdrawal, then take the first dose and adjust over the next few days with close check-ins. Many people start at home, following a written plan.
Because fentanyl lingers in the body, starting can take a different approach for some people, and we'll talk through which one fits you.
Long-acting buprenorphine injections, given weekly or monthly, are another option for some people. They're given in person, so if they're a better fit, I'll help you arrange that.
Alcohol and other substances
- Alcohol. Naltrexone and acamprosate are FDA-approved, effective, and underused. Other medications can help depending on your goals and health.
- Nicotine. Varenicline and nicotine replacement substantially improve the odds of quitting compared with willpower alone.
- Cannabis and stimulants. There are no FDA-approved medications yet, but treating the sleep, anxiety, mood, or ADHD underneath often makes a real difference, alongside counseling.
One important safety point: stopping heavy daily drinking suddenly can cause dangerous withdrawal, including seizures. If you drink heavily every day, don't stop on your own. That kind of withdrawal needs medical supervision, and I'll help you get to the right setting.
Can this be done by telehealth in Florida?
Yes, in many cases. Since 2023, any clinician with a DEA registration can prescribe buprenorphine for opioid use disorder without a special waiver. Federal telehealth rules for controlled medications have changed several times in recent years, and I follow whatever rules are in effect at the time of your visit and explain any requirements, such as an in-person visit, up front.
Before prescribing, I check Florida's prescription drug monitoring program. Treatment also includes regular follow-up and periodic drug testing, which can be arranged through a local lab. These are standard parts of safe care, not a sign of distrust.
Staying safe
- Keep naloxone (Narcan) at home. It's sold over the counter, and the people around you should know where it is.
- Don't combine buprenorphine with alcohol, benzodiazepines, or other sedatives unless we've discussed it. The combination raises the risk of dangerous sedation.
- Store medication locked and out of reach of children. Even a small amount can be dangerous to a child.
What this practice is and isn't
This practice offers outpatient care: evaluation, medication, close follow-up, and coordination with counselors, recovery programs, and your other doctors. It isn't a detox program or a crisis service. If you need a higher level of care, such as medically supervised withdrawal or residential treatment, I'll help you find it.
Early treatment usually means more frequent visits, so we'll choose a plan that fits that stage. If you're unsure whether to start with a psychiatrist or a counselor, this guide explains the difference.
When to get help right away
If someone may be overdosing, with slow or stopped breathing, blue lips, or no response, call 911 and give naloxone if you have it. For free, confidential treatment referrals any time, call the SAMHSA National Helpline at 1-800-662-4357. If you're having thoughts of harming yourself, call or text 988.
This article is general information, not medical advice for your situation. If you're in crisis, call or text 988, or call 911.