What is a Substance Use Disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5), a substance use disorder is a cluster of symptoms indicating that a person is engaged in the continued use of an addictive substance for non-medical purposes to obtain an "artificial" state of mind (euphoria) despite severe negative consequences.

Today, the field of psychiatry now has treatments and medications to treat certain types of addictions that were not even available ten years ago. TelePsychiatry Associates can now deliver these treatments remotely, even alcohol and drug detoxification, in the location of your choosing.

Co-morbid disorders, such as anxiety disorders and mood disorders, commonly occur either in conjunction with, or as a result of, an addiction. Our providers have the expertise and experience to address these co-morbid conditions as well as your addiction.

Whether your patients reside in a detoxification center, home-care facility, or hospital, TelePsychiatry Associates can meet your treatment needs. Let us help your patients get on a road to recovery using our advanced technology to deliver treatment confidentially and safely.

Alcohol Use Disorder
 It is common. In any given year, nearly 5% of teens and 8.5% of American adults struggle with alcohol use disorder.
 Risk factors include family history, genetics, cultural attitudes, and age of first alcohol use.
  The earlier the intervention, the better the outcome. Many comorbid ailments such as liver disease and cognitive impairments can be prevented with early intervention.
 Treating all the conditions. Well over 50% of individuals with an addiction have a co-morbid psychiatric disorder such as depression or anxiety. TelePsychiatry Associates has the expertise to treat the full spectrum of psychiatric disorders.
 Best treated with a combination of behavioral, psychological, and medication interventions.
 Symptoms of untreated withdrawal make stopping much more difficult and potentially dangerous including risk of seizures, psychosis, and delirium tremens.
 Detoxification using medical intervention with close, 24/7observation can substantially reduce the risks associated with withdrawal and place you on a path to recovery. TelePsychiatry Associates physicians provide the technology, medications, and supervision needed for safe and successful outcomes.
 Acute and chronic phases of alcohol detoxification need to be approached using different types of medications and therapy techniques.

What is an Addictive Substance?
The hallmark of an addictive substance is one that directly activates the brain reward system producing a “high” or euphoria that then leads to the creation of strong memories and the reinforcement of maladaptive behaviors.

All substances of abuse work by “hijacking” the brain's reward system, though each substance may do it via different chemical and physiological mechanisms. It is also now recognized that those who become addicted to a substance have genetic and possibly non-genetic risk factors that predispose them to addiction before ever having exposure to the problematic drug.

 Over 3 million Americans struggle with opioid use disorder in any given year with over 5 million using heroin at some point in their life.
 Approximately 50,000 Americans die each year from opioid overdose.
 Impulsivity and novelty seeking are highly associated risk factors.
 Fear of withdrawal, and not just the desire for euphoria, leads to a cycle of continual use.
 Opioid withdrawal treatment needs to be tailored to the unique medical needs of the patient as well as the type of opioid being used.
 Substitution opioid detoxification with buprenorphine/naloxone can typically be completed in 1 to 3 days.
 Treatment of co-morbid disorders, such as anxiety and depression, require additional expertise such as that provided by TelePsychiatry Associates in order to treat the addiction successfully.

What to expect?
Alcohol withdrawal can be a frightening experience, especially if untreated. As a person with alcohol withdrawal gets older, the risk of having significant withdrawal symptoms increases. It is unusual for a person to have medically significant withdrawal symptoms if they are in their teens or early 20's, irrespective of the amounts used. However, as a person ages, alcohol withdrawal becomes more likely with approximately 50% of people developing withdrawal symptoms with cessation of use. Twenty percent of people, without medication-assisted treatment, will develop severe withdrawal including hallucinations, seizures, and delirium tremens.

Clinical Manifestations
As outlined in the graph below, alcohol withdrawal often follows a “typical” course from mild symptoms to more severe symptoms. Without treatment, withdrawal symptoms usually begin within 6 to 24 hours after cessation of alcohol or after an abrupt decline in amounts consumed. Timely and appropriate treatment with the correct medications can minimize and prevent nearly all of these symptoms.
 Minor withdrawal: Symptoms of minor or early withdrawal usually include anxiety, mild agitation, restlessness, nausea, vomiting, sweats, tremor, palpitations, loss of appetite, insomnia, and hypertension. Those with minor withdrawal will have resolution usually within one to two days.
 Moderate withdrawal: This stage involves progression of all the symptoms that occur in the minor stage of withdrawal with a greater degree of incapacitation with possible dehydration, weakness, and severe agitation. Alcohol hallucinosisinvolves the acute onset of visual hallucinations, often of insects or small animals, though auditory and tactile hallucinations can also occur. It is distinguished from the psychosis of delirium tremens by a clear sensorium (no delirium) and relatively normal vital signs. usually beings within 12 to 24 hours from cessation and resolve within another 1 to 3 days.
 Severe withdrawal: When symptoms progress to the severe stage, all the symptoms in the moderate stage become more severe and the person can have associated seizures and delirium tremens. Seizures occur in 20% to 30% of those with significant withdrawal. They are often of short duration, but can occur in multiples. Delirium tremens involves a severe, acute alteration in one's sensorium with gross disorientation, change in cognition, hallucinations, confusion, poor attention, severe agitation, severe sweats with dehydration, oscillations in vital signs including hyperthermia. Without treatment, mortality from the DT's can be as high as 20%. With treatment, that rate is reduced to 1% to 4%. Predictors of having the DT's include genetic constitution and having a history of the DT's.

Appropriate medical treatment with close monitoringcan significantly decrease the likelihood of having remarkable or dangerous withdrawal symptoms.

Call us today for a consultation regarding our treatment plans and how we can help you have an uneventful detoxification with appropriate medical over-sight.
Below is a graph that depicts the typical sequence of alcohol withdrawal symptoms that occur over time without treatment.

What is a Mood Disorder? Mood Disorders include those disorders where the predominant symptom manifestation involves extreme mood states that interfere with a person's social and/or occupational functioning.

Major Depressive Disorder.One common mood disorder is major depressive disorder. Individuals with major depression experience:
 Persistently depressed mood and/or loss of interest or pleasure in previously enjoyed activities.
 Symptoms persist most days for at least 2 or more weeks.
 Weight change (either an increase or decrease)
 A change in sleep pattern, usually terminal insomnia
 Feelings of worthlessness or excessive guilt
 Thoughts of death or suicide
 Loss of energy or being easily fatigued

Bipolar Disorder.Bipolar disorder may also include episodes of major depression, but the disorder is defined by periods of mania or hypomania. Manic episodes commonly include:
 An elevated, euphoric, or irritable mood state lasting at least one week for mania and four days for hypomania
 An increase in talkativeness or increased rate of speech
 A decreased need for sleep (usually due to a lack of feeling tired, not insomnia)
 A sense of grandiosity or elevated self-importance, sometimes with a delusional quality
 High levels of energy and/or activity (cleaning for hours)
These symptoms generally persist everyday and are often followed by episodes of depression or euthymia before another episode occurs. Mood disorders can now be well controlled and resolved with medications and psychotherapy, often allowing people to resume their prior level of functioning at home, school, and work. If you struggle with a mood disorder, contact us to help you through this difficult time.

What is an Anxiety Disorder?
Anxiety is defined as the emotional and physiological response to a real or imagined imminent threat. Though the experience of anxiety is normal, and even useful, anxiety for many people is maladaptive and can take on a wide array of presentations from simple phobias to panic disorder to selective mutism. They all share, to varying degrees, symptoms of:
 Anxiety and fear
 Tension
 Feeling on edge
 Change in sleep (usually initial insomnia)
 Poor concentration
 Worries
 Being easily fatigued.
 Frequently, avoidant behaviors as an attempt to control the symptoms of anxiety and fear.

The providers of TelePsychiatry Associates utilize the most advanced techniques and medications delivered remotely to a location of your choice for maximum convenience and privacy. If you or a loved one suffers from an anxiety disorder, register today so we can help you take back control.