Expert Telehealth Care for Substance Use Disorders in New York
Substance use disorders affect approximately 46.3 million Americans aged 12 and older — nearly 16.5% of the population — according to the 2021 National Survey on Drug Use and Health. In New York State, opioid-related overdose deaths and alcohol use disorders remain urgent public health concerns. Despite the scale of the crisis, fewer than 10% of those who need substance use treatment actually receive it — driven by stigma, systemic barriers, and the absence of integrated care that addresses both the addiction and the underlying mental health conditions so often driving it.
​
At Strong Enough Mental Health, Salvatore Marchica, PMHNP-BC, provides compassionate, non-judgmental telehealth psychiatric evaluation and integrated care for adults with substance use disorders across New York State — understanding that recovery is a process, and that psychiatric support is one of its most essential components.
What Are Substance Use Disorders?
Substance use disorder (SUD) is a medical condition in which a person's use of alcohol or another substance leads to significant impairment or distress. Addiction is not a moral failing or a lack of willpower — it is a complex, chronic brain condition with genetic, neurobiological, psychological, and social dimensions that requires compassionate, evidence-based care.
​
Substance use disorders exist on a spectrum from mild to severe and can involve:
-
Alcohol
-
Cannabis
-
Stimulants: cocaine, methamphetamine, prescription stimulants
-
Opioids: heroin, fentanyl, prescription opioid pain medications
-
Benzodiazepines and sedative-hypnotics
-
Hallucinogens and dissociatives
-
Other substances and polysubstance use
What Are The Signs And Symptoms of Substance Use Disorders?
The DSM-5 organizes substance use disorder criteria around four domains, with severity (mild, moderate, severe) determined by the number of criteria met:
Impaired Control
-
Using more of the substance than intended or for longer than planned
-
Persistent desire or unsuccessful attempts to cut down or stop use
-
Spending large amounts of time obtaining, using, or recovering from the substance
-
Craving — a strong urge or compulsion to use the substance
Social Impairment
-
Failure to fulfill major obligations at work, school, or home
-
Continued use despite persistent problems in relationships caused or worsened by the substance
-
Giving up or reducing important social, occupational, or recreational activities
Risky Use
-
Recurrent use in physically hazardous situations — driving, operating machinery
-
Continued use despite knowing it is causing or worsening a physical or psychological problem
-
Tolerance: Needing markedly more of the substance to achieve the same effect
-
Withdrawal: Experiencing characteristic withdrawal symptoms when stopping or significantly reducing use
Pharmacological Criteria
What Are The Risk Factors of Substance Use Disorders?
-
Genetics: Substance use disorders are strongly heritable — family history significantly increases risk
-
Co-occurring mental health conditions: Anxiety, depression, PTSD, ADHD, and bipolar disorder dramatically increase SUD risk and are frequently the underlying conditions being self-medicated
-
Trauma and adverse childhood experiences (ACEs): Among the most powerful predictors of substance use disorder
-
Social and environmental factors: Peer use, availability, social norms, and community context
-
Early initiation: Beginning substance use in adolescence significantly increases risk of disorder development
-
Chronic stress: Work, financial, and relational stressors
How Are Substance Use Disorders Diagnosed?
Substance use disorders are diagnosed through a comprehensive clinical evaluation assessing patterns of use, the DSM-5 criteria above, functional impact, physical health, and co-occurring psychiatric conditions. At Strong Enough Mental Health, Salvatore approaches every substance use evaluation with zero judgment — the goal is to understand your full story and develop a care plan that addresses your actual needs, including any underlying mental health conditions driving or complicating the substance use.
What Are Possible Treatments For Substance Use Disorders?
Medication for Substance Use Disorders
Medication-assisted treatment (MAT) is a highly evidence-based approach that uses medications to reduce cravings, manage withdrawal, and support sustained recovery. MAT dramatically reduces relapse risk and overdose mortality and is considered the standard of care for opioid and alcohol use disorders.
Medications for Alcohol Use Disorder (AUD)
-
Naltrexone (Vivitrol — monthly injection; Revia — oral) — Blocks opioid receptors to reduce the rewarding effects of alcohol and reduce cravings. FDA-approved for AUD. The injectable form (Vivitrol) eliminates daily adherence concerns.
-
Acamprosate (Campral) — Reduces withdrawal-related discomfort, anxiety, and dysphoria that can drive relapse. Most effective in patients who have already achieved abstinence.
-
Disulfiram (Antabuse) — Creates a highly unpleasant reaction when alcohol is consumed, serving as a deterrent. Requires strong motivation and consistent monitoring.
-
Gabapentin (Neurontin) — Used off-label for AUD; reduces cravings, withdrawal symptoms, and sleep disturbances
-
Topiramate (Topamax) — Used off-label; reduces alcohol consumption and cravings
MAT for OUD is the gold standard of care and dramatically reduces overdose risk, mortality, and criminal involvement. It is not 'trading one addiction for another' — it is evidence-based medical treatment.
​
-
Buprenorphine/Naloxone (Suboxone, Subutex) — A partial opioid agonist that significantly reduces cravings and withdrawal without producing the euphoric high of full agonists. One of the most effective MAT medications available for OUD. Can be prescribed via telehealth by qualified providers.
-
Naltrexone (Vivitrol — monthly injection) — An opioid antagonist that blocks all opioid effects entirely. Requires complete medically supervised detoxification before starting.
Medications for Opioid Use Disorder (OUD) — Medication-Assisted Treatment
Note: Methadone for OUD is dispensed only through federally certified opioid treatment programs (OTPs) and cannot be prescribed in standard outpatient telehealth practice. Buprenorphine is prescribable via telehealth by qualified PMHNP providers.
Treating co-occurring psychiatric conditions — depression, anxiety, ADHD, PTSD, bipolar disorder — is central to lasting recovery. Unaddressed mental health conditions are among the leading drivers of relapse. At Strong Enough Mental Health, identifying and treating co-occurring conditions is a core component of our substance use disorder approach.
Medications for Co-occurring Mental Health Conditions
-
Clonidine — Helps manage opioid and alcohol withdrawal symptoms — anxiety, sweating, elevated heart rate, and agitation
-
Hydroxyzine (Vistaril) — Non-habit-forming anxiolytic useful for acute anxiety during withdrawal
​
​Important safety note: Acute withdrawal from alcohol and benzodiazepines can be medically dangerous and may require inpatient medical supervision. At Strong Enough Mental Health, we carefully assess each patient's safety needs and refer to appropriate levels of care — including medical detox — when clinically indicated.