• A client experiencing increased alcohol cravings and/or medical concerns as well as a wish to decrease or stop alcohol consumption before it has become a physical dependency and their presentation does not reach the level of IOP/ OP? inpatient treatment.

• Situations where it appears that clients are using higher than usual amounts of stimulants, also feel anxious or are having sleep issues and then are using benzodiazepines in an accelerating fashion.

• Clients that have been on benzodiazepines for MANY years and the dose of the benzodiazepine has gone up to a concerning level and someone is having some concerns about this dose/medication either in combination with other medications or as to concerns with falls, cognition, ability to drive, as examples. Clients may be very worried that they cannot go without this medication for many reasons which need to be heard. All potential Strategies to safely and mitigate the issue should be considered based on a review of the literature.

• Clients that are on mostly controlled medications and not “core psychiatric medications”. Some clients I have had could be considered for antidepressants if for example Xanax is all that is being taken for anxiety, or THC plus Xanax for depression, or PTSD. I am only mentioning this because if the benzo dose reaches a certain level of dosing with tolerance and the anxiety or depression is still present because the issue of not having a base of treating meds is still there.

• Clients that have been through a lot of issues, doctors, or struggles with relapses and still “don’t know what their diagnosis really is”…

• Clients that seem to be using” something”, but nothing shows up in your UDS… hmm.

• Clients may want help with things that have become a “problem for them“ such are KRATOM, derivatives of GHB, Huffing, DARK WEB benzo synthetics. In some of these cases depending how long someone has been on them and the other issues in the medical picture there may be ways to address these situations. Often clients seem to be struggling with something and just feel like they are “not making progress”.

• Clients that want help with things that they may have bought over the counter or of the internet that they want some information about or that they want to see how to “get off of”. Or clients want to understand if some supplements can replace their existing medication treatments. For example: Could Samee OTC supplement replace lithium? [Answer is no by the way…]

The screening and evaluation of these types of requests will be carefully thought out and likely require some form of counseling/therapy to be done in tandem with the treatment that Dr Deerfield provides in addition to a Primary Care provider. Some of these services which would fall into the category of Ambulatory type Two, needs frequent extended monitoring could not be provided via DRS will not be available until the actual office building space is available and more staff is hired, trained, and “ready to get started”.
All of these more complex services will be screened and evaluated using ASAM, SAMSHA, and NIH criteria so that if a client presents needing a higher level of care that will be recommended. LAB testing and past records from clients’ records will be required and transparency in providing information about substance use will be especially important as this will be crucial to providing correct treatment protocols. Because I have the liberty of having more time to allocate for clients in my private practice, I can dedicate the time to providing services and integrating care with other providers (that are also seeing my client) yet still treating the Psychiatric concerns as well. It is my goal to offer appropriate clients these services in a very private confidential setting along with psychoeducation in an empathic nonjudgmental way. Hopefully they can ask for help with these substance issues becoming more compelling and higher levels of become emergent. These emergent levels of care often are addressed in Emergency centers, Crisis settings and Hospitals that will not have the full client background and can be very expensive care settings.

The availability of these services will be updated regularly soon after the website opens as this practice grows and expands to office space. It is also possible to work with other providers in providing these services as a consultant. I will also be writing BLOGS that will focus specifically on some of these topics especially the use of “online” medications and substances and how this is affecting co-occurring disorders and can make treatment more complex.

In attempting to treat outpatient Substance Use Disorders, if they meet criteria for safe treatment on that basis (after ASAM and SAMHSA, and NIH criteria), the protocol production and changes thereafter will be based on many different many dimensions. See ASAM criteria dimensions for illustration of what I am going to mention such things as social support, medical issues, willingness to change, etc. From a pharmacological standpoint increasing risk factors are then applied for alcohol use, sedatives and hypnotics, barbiturates, etc.., also age, health and certain medical conditions, number of times in relapse… If there is a slow taper of a benzo, I usually apply the Ashton method. I have done methadone to buprenorphine bridges in emergency setting in the past and there are many ways to accomplish this now a days, but it is best done within a short stay facility. At this point these more advanced services will be discussed by consultation or by individuals in a screening phone call. Please remember that this is NOT the place to call for help with an acute withdrawal state as we are not equipped for that. We are here to try to get you help before that, but if you relapse under our care, we are still here. Its “progress not perfection”. We do support reasonable “harm reduction” along with solid psychopharmacology and a holistic focus that attempts to promote consistent gradual growth that is sustainable and self-reinforcing.