Substance Use Disorders and Medication Assisted Treatment (MAT) at Rittenhouse Psychiatric Associates.
We do not accept insurance and a credit card is required to schedule.
In-office and Virtual Care. Some treatments may not be available in your state by our practice.
Injectables (Vivitrol, Sublocade) typically require patients to come to Pennsylvania pharmacies monthly. We do not administer injectables at our locations, and have partnered with some PA pharmacies for this service.
Alcohol Use Disorder
Outpatient care is not safe for all patients, and if a patient is drinking more than 5 standard drinks per day, OR is concurrently taking benzodiazepines (xanax [alprazolam], valium [diazepam], klonopin [clonazepam] or ativan [lorazepam]) even if prescribed by a medical provider, OR has a history of seizures, delerium tremens (“DT’s”), unstable vital signs, withdrawal tremors, withdrawal psychosis or withdrawal requiring hospitalization in the past (this is not a complete list), we will not be able to schedule for outpatient care until the patient is stabilized at an inpatient hospital or rehab facility. Alcohol and benzodiazepine withdrawal can be deadly, and we recommend close monitoring by on-site medical staff for patients at risk of significant withdrawal. Once a patient is stabilized (for example, abstinent from any alcohol or benzodiazepines for 2-4 weeks), then our providers are typically able to take over long-term outpatient care. Our providers are happy to collaborate with your treatment team at local inpatient recovery centers and hospitals in Philadelphia, Pittsburgh, New York, Wilmington, and throughout the areas that we serve to make the transition to outpatient care as streamlined as possible.
Our providers will perform a thorough initial psychiatric evaluation for all patients, which includes a complete medical and psychiatric history. We may recommend bloodwork as well. It is incredibly important for patients to be evaluated for mood, anxiety and other medical and psychiatric disorders, that could be making them more vulnerable to their addiction. We need to treat the whole person, not just a singular diagnosis.
We recommend that all patients be engaged in psychotherapy AND a 12-step program. While this is not a requirement, evidence suggests that patients are more likely to be successful in their recovery, by doing so. We will also discuss diet, exercise, yoga/meditation, sleep hygiene, work-life balance, relationships and other aspects about a patient’s life and self-care, that may be an important part of their treatment plan.
Examples of Medication Assisted Treatment for Alcohol Use Disorder include oral naltrexone and long-acting injection naltrexone (Vivitrol), Disulfiram (Antabuse), Acamprosate and others. Specific recommendations for a patient, would be made at their visit, AFTER a full evaluation.
- Vivitrol (a long acting naltrexone injection) can be started and continued by our providers, when used for alcohol dependence. We do not administer this medication directly, but we partner with local pharmacies (throughout the state of Pennsylvania) who can administer injections when we submit prescriptions. This medication can be very effective for decreasing alcohol cravings (even in some cases where oral naltrexone did not achieve the desired effect). Of note, patients should confirm with a participating pharmacy (we can provide lists) that their insurance will pay for the medication and that the pharmacy can accommodate their injections. If a patient is unable to receive their injection (if there is a problem with their insurance or w/ finding a pharmacy) then patients are typically transitioned to oral naltrexone, or we may utilize other treatments for their alcohol use disorder. We can only prescribe Vivitrol to patients living in Pennsylvania, or patients who are able to come into Pennsylvania for the injections, on a monthly basis.
- Oral Naltrexone can be started and continued by our providers. This is used for alcohol dependence to decrease cravings.
- Disulfiram (Antabuse) is an oral medication that can be prescribed by our providers. This medication blocks an enzyme that the body uses to break down a metabolite of alcohol (so individuals can become extremely ill if they drink while taking it). This can be a very effective medication to prevent alcohol use in those with an alcohol use disorder, and can quickly create an aversion to alcohol in these individuals.
- Acamprosate (Campral) is a medication that can be prescribed by our providers. This medication likely works through GABA and glutamate pathways to decrease cravings.
Opiate Use Disorder
Some of the providers at Rittenhouse Psychiatric Associates are able to treat Opiate Use Disorder (opiate dependence) with Medication Assisted Treatment (MAT). This type of treatment is not appropriate for all patients, and scheduling an appointment does not guarantee that a medication will be prescribed. Patients are liable for any visit fees, regardless.
Our providers are happy to collaborate with your treatment team at local IOPs, PHPs, inpatient recovery centers, detox centers and hospitals in Philadelphia, Pittsburgh, New York, Wilmington and throughout the areas that we serve, to make the transition to outpatient care as streamlined as possible. We can also see patients for evaluations who are not currently engaged in a higher level of care. Recommendations for additional services may be part of your evaluation.
Our providers will perform a thorough initial psychiatric evaluation for all patients, which includes a complete medical and psychiatric history. We may recommend bloodwork as well. It is incredibly important for patients to be evaluated for mood, anxiety and other medical and psychiatric disorders, that could be making them more vulnerable to their addiction. We need to treat the whole person, not just a singular diagnosis.
We recommend that all patients be engaged in psychotherapy AND a 12-step program. While this is not a requirement, evidence suggests that patients are more likely to be successful in their recovery, by doing so. Our prescribers will be happy to collaborate with psychotherapists and addiction counselors outside of our practice. We will also discuss diet, exercise, yoga/meditation, sleep hygiene, work-life balance, relationships and other aspects about a patient’s life and self-care, that may be an important consideration/ part of their treatment plan.
- Virtual MAT treatment for opiate dependence is available for patients living in several of the states that we are licensed in. Injections (Vivitrol, Sublocade) are only available to patients who can come to PA for administration.
- Urine drug screens will be required for care. You will need to identify a local lab, that accepts your insurance, so that these can occur at regular intervals. Our prescribers will provide necessary lab scripts at appointments. Failure to have these tests completed within a provider’s requested time-frame, is grounds for termination of care.
- Routine blood work may also be part of your care.
- Patients are required to sign a controlled medication contract. Breaching that contract is grounds for termination of care.
- No medication is kept on-site.
- Examples of medications that may be appropriate for your care.
- Vivitrol (long acting naltrexone injections). Vivitrol is typically started while a patient is inpatient at a hospital or rehabilitation facility, outside of our practice. Patients need to typically wait between 10 and 14 days after last use of any opiate to start this medication (and starting prematurely, can cause severe “precipitated” withdrawal). Once a patient has safely started this medication, our providers are typically able to continue it for patients, with them having an injection every 4 weeks at Pennsylvania pharmacies that we partner with. We recommend that patients request a list of participating pharmacies from our staff, before making an appointment, and confirm that a pharmacy convenient for them, will have availability for their injections. Patients may also want to confirm with their insurance, that they will pay for their vivitrol injections. If a patient cannot find a local pharmacy to administer this medication (as our providers do not administer it directly) or if their insurance will not pay for it, then we often transition patients to oral naltrexone or a buprenorphine medication. We are not responsible for the actions or policies of pharmacies or insurance companies. We can only prescribe Vivitrol for opiate dependence to patients living in Pennsylvania, or coming in-office for appointments.
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- Suboxone (buprenorphine) is a medication that can be utilized for opiate dependence. It is not appropriate for all patients, and it does have abuse potential, for some individuals. Patients must take it as directed, and there is no guarantee that we will prescribe this medication (patients are responsible for their visit fee regardless). We also recommend that patients call their insurance directly, to confirm that their insurance will cover them filling it. We do not keep this medication on-site. Appointments are required. Patients are seen at a minimum of monthly, but we will likely recommend more frequent appointments, particularly early in a patient’s recovery.
- Sublocade (injectable buprenorphine): Our providers partner with Pennsylvania pharmacies that are able to administer injectable medications. Patients with opiate dependence can be transitioned to sublingual (tablet or film) buprenorphine (like Suboxone) by our providers for 7+ days, and then can be transitioned to Sublocade. It is important that patients are taking a sublingual product for 7-10 days, because this injection can cause severe “precipitated” withdrawal, if started too soon from last opiate use. Sublocade is an injection given monthly of buprenorphine. This can be a very effective medication for patients who have difficulty with compliance with daily buprenorphine. We can only prescribe Sublocade to individuals living in Pennsylvania (or those coming into PA for their appointments). We additionally recommend that patients identify a pharmacy from our lists that can accommodate their injections, and that they confirm with their insurance that it will be paid for, before making an appointment. If a patient can not identify a pharmacy, or their insurance will not pay for this medication, our providers typically start a patient on sublingual buprenorphine (such as Suboxone).
- Brixadi (injectable buprenorphine): We are hoping to be able to prescribe this medication for patients in the near future. We will update this site with any changes.
- We will Never Treat a Patient without An Appointment.
- Pre-payment of Initial Visit Fee is Required for Patients scheduling for MAT for Opiate Dependence, and we have a strict 48 business hour cancellation policy, for the full amount. We have found that holding patients to a strict cancellation policy for this service, increases their sense of accountability to make their appointments, and increases the chance that they will indeed start one of these potentially life saving medications.
Call to Set up an Appointment, or to Discuss Services in Your Area.
Scheduling@RittenhousePA.com
267-358-6155
