Medical Definition of Addiction?

Addiction is a treatable, chronic medical disease involving complex
interactions among brain circuits, genetics, the environment, and an
individual’s life experiences. People with addiction use substances or engage
in behaviors that become compulsive and often continue despite harmful
consequences. Prevention efforts and treatment approaches for addiction are
generally as successful as those for other chronic diseases. Adopted by the
ASAM Board of Directors September 15, 2019

How Severe is my disease?

Respond YES for those statements that describe your drinking or substance
use.
1. In the past 12 months, I often used alcohol or drugs in large amounts over
longer periods of time than I intended.
2 In the past 12 months, I often wanted or tried to cut down or control my
alcohol or drug use.
3. In the past 12 months, I spend a lot of time either (a) using alcohol or drugs,
(b) in activities trying to obtain alcohol or drugs, or (c) recovering from the
effects of my drinking or drug use.
4. In the past 12 months, I gave up or reduced my involvement in important
social, occupational, or recreational activities because of my alcohol or drug
use.
5. In the past 12 months, I continued to use alcohol or drugs despite knowing
that it likely caused or made worse psychological or physical problems I had
(for example, continued drinking or drug use knowing it was making my
ulcer or depression worse).
6. In the past 12 months, I found I needed greater amounts of alcohol or drugs
than I use to in order to feel intoxicated or to get a desired effect, OR I got
much less of an effect by using the same amount of alcohol or drugs as in the
past.

7. In the past 12 months, I experienced withdrawal symptoms when I tried to
cut down or stop my drinking or drug use OR I drank alcohol or used drugs to
relieve or avoid withdrawal symptoms.
8. In the past 12 months, my continued alcohol or drug use resulted in my not
fulfilling major obligations at work, school, or home (for example, repeated
absences or poor performances at work or school; neglecting my children or
home).
9. In the past 12 months, I repeatedly used/acquired alcohol or drugs in
situations that were physically hazardous (for example, driving a car or
operating machinery, obtaining drugs from non-medical sources)
10. In the past 12 months, I have experienced strong desires, urges, or cravings
to use alcohol or drugs.
11. In the past 12 months, I continued to use alcohol or drugs despite having
persistent or recurrent social or interpersonal problems caused or made
worse by the effects of my drinking or drug use (e.g., arguments with friends
or family about my drinking or drug use or physical fights).

Tally up your YES’s:
2-3 = Mild Substance Use Disorder
4-5 = Moderate Substance Use Disorder
6 or greater = Severe Substance Use Disorder

How much will my treatment cost?

Every patient is different, at a minimum your first month will cost $575. Monthly follow-up visits will be required initially until you are stable and will be charged according to the time needed / fee schedule. Most patients who
are doing well on their medication can expect their follow-up appointments to take less than 15 minutes. Depending on your treatment and as you progress in Recovery, you will need to follow up less frequently. The cost of your medication will vary according to your insurance plan. If your plan does not cover these medications, it is strongly recommended to use GoodRx to find the best cash-pay price.​

What can I expect during my visit?

During your first visit, a thorough history will be obtained, you will also have a physical exam and if you had lab work prior to your visit, we’ll also go over the results. You’ll have a urine drug test, so we get a full assessment and can formulate the best treatment plan which we’ll discuss thoroughly and address any questions or concerns. We will also review important office policies. This visit may take up to 120 minutes.

How long will I need to stay on Medication

Every patient is different. It is recommended that you stay on medication for at least one year, if you stop prior to one year, your chance of relapse is about 90%. A duration of two years is generally recommended. Some patients may choose to remain on MAT indefinitely- this is also completely acceptable. Once you are stable, if you wish your primary care provider to manage your refills, I would be
happy to transition your treatment back to your regular physician. However, be aware that many physicians are uncomfortable treating addiction. If your primary care provider is not willing- I will do my best to advocate on your behalf.

Here are a couple objective sources regarding optimal duration of MAT:

5 myths about using suboxone to treat opiate addiction

Discontinuing Buprenorphine Treatment of Opioid Use Disorder: What Do We (Not) Know?

If you are being managed by your primary care provider and then decide to wean off Buprenorphine, I recommend that you return to RTR to begin that process.

Regarding MAT, unfortunately, as with many things, you will encounter more misinformation than truth on the internet.

Why such a strict cancellation policy?

* You’ve taken an important step to change your life and begin your recovery, it is a difficult step and your apprehension may cause you to not meet your commitment toward embarking on your recovery. Having a financial stake will hopefully motivate you to meet your commitment.

*A business which generates revenue by filling available appointments cannot continue to operate if appointments go unfilled due to no-shows and late cancellations.

* An unutilized reserved time slot not only deprives you of the care you require, it also makes that time unavailable to others who also desire care.

Why don’t you participate in /accept insurance?

Insurance companies exist to make money, by underpaying for care they are able to do this. The only way providers can meet their bottom line is by seeing high volumes of patients, resulting in suboptimal care, poor patient experience and provider burnout.​

Why can’t you see Medicare enrollees?

Until this practice is self-sustaining I will be working for other entities part-time, which will require their ability to bill Medicare for those services.

Medicare has strict policies about billing. Until I am able to completely “Opt-out” I am unable to provide services to Medicare enrollees at this practice.