Substance Dependence Treatment
Outpatient detox and medication-assisted treatment for substance use disorders
Understanding Substance Dependence
Substance dependence (now classified as Substance Use Disorder in DSM-5) is characterized by compulsive substance use despite harmful consequences, loss of control over use, craving, and physiological dependence (tolerance and withdrawal). It is a chronic brain disorder with genetic, environmental, and developmental components — not a moral failing or lack of willpower.
Dr. Agresti provides comprehensive outpatient substance dependence treatment including medically supervised detox, medication-assisted treatment (MAT), and integrated psychiatric care addressing co-occurring mental health conditions that often drive or worsen substance use.
Signs of Substance Use Disorder
- Using more than intended or for longer than intended
- Persistent desire to cut down or unsuccessful efforts to control use
- Significant time spent obtaining, using, or recovering from substance
- Craving or strong urge to use
- Failure to fulfill major obligations at work, school, or home
- Continued use despite persistent social or interpersonal problems
- Tolerance — needing more to achieve the same effect
- Withdrawal symptoms when stopping or reducing use
Treatment Approaches
Treatment must be matched to substance type, severity, and co-occurring conditions. Dr. Agresti provides outpatient medically supervised detox (safe withdrawal from home with prescription comfort medications and daily check-ins) and medication-assisted treatment (MAT) for opioid and alcohol use disorders using Suboxone, Sublocade, Vivitrol, or naltrexone.
Co-occurring psychiatric conditions — depression, anxiety, PTSD, ADHD, bipolar disorder — drive a significant proportion of substance use and must be treated concurrently. Self-medicating undiagnosed psychiatric illness is extremely common. Dr. Agresti's dual-diagnosis approach addresses both simultaneously.
Substance Dependence Services
Outpatient Detox
Medically supervised withdrawal from opioids, benzodiazepines, alcohol, stimulants, and cocaine — at home.
Medication-Assisted Treatment
Suboxone, Sublocade, and Vivitrol for opioid and alcohol use disorder.
Suboxone (Buprenorphine)
Gold-standard medication for opioid use disorder. Reduces cravings and blocks opioid effects.
Vivitrol (Naltrexone)
Monthly injection for opioid and alcohol use disorder. No opioid component.
Why Concierge Psychiatry for Recovery?
Recovery requires responsive, ongoing care — not an appointment 6 weeks away when a craving or withdrawal symptom hits. With Dr. Agresti's concierge model, you have his direct cell number throughout your treatment. This access is what makes outpatient detox and MAT safe and effective.
Learn About Concierge CareFrequently Asked Questions
Physical dependence involves tolerance (needing more for the same effect) and withdrawal symptoms when the substance is stopped. Psychological dependence involves compulsive craving and an inability to cope without the substance, even after physical withdrawal has resolved. Most patients with substance dependence experience both forms simultaneously, which is why treatment must address both the medical and psychological dimensions.
Opioid detox typically uses buprenorphine (Suboxone) to manage withdrawal and transition to maintenance. Alcohol detox uses benzodiazepine tapers and sometimes anticonvulsants. Benzodiazepine detox requires a gradual, physician-supervised taper, often converting to a longer-acting benzodiazepine. Dr. Agresti customizes each detox protocol based on substance type, dose, and duration of use.
MAT uses FDA-approved medications like Suboxone, Sublocade, or Vivitrol to reduce cravings, block the euphoric effects of substances, and normalize brain chemistry disrupted by prolonged substance use. Combined with psychiatric care for co-occurring conditions, MAT significantly improves long-term recovery outcomes and reduces overdose mortality by over 50%.
For appropriate candidates, outpatient detox is medically safe and effective. Dr. Agresti evaluates each patient's medical history, substance use severity, and withdrawal seizure risk before recommending outpatient versus inpatient detox. Patients with a history of withdrawal seizures or delirium tremens require inpatient monitoring. Outpatient detox includes daily physician check-ins and 24/7 direct cell access.
Undiagnosed depression, anxiety, PTSD, bipolar disorder, and ADHD drive a significant proportion of substance use. Patients often started using substances to self-medicate psychiatric symptoms they did not recognize as treatable conditions. Without addressing the underlying psychiatric illness, the motivation to use substances persists even after successful detox, leading to high relapse rates.