Brian Akrami, DO

The Heart and Family Health Institute is a multi-specialty medical practice on the Treasure Coast.

About Us Addiction Alternatives is a comprehensive outpatient program primarily intended to transition patients from dependence on opiate medications to a therapeutic alternative such a buprenorphine (Suboxone, *Sebutex). Patients are medical evaluated then placed on a detoxification schedule for buprenorphine. Adjunctive medications are prescribed to assist in the transition process. This phase is a called induction and may last 2-7 days. The next step is called stabilization as the cravings and withdrawal symptoms subside and the patient reaches a comfortable maintenance dosage of buprenorphine. Subsequently, the patient is given a taper schedule for buprenorphine, intended to allow reduction and eventual discontinuation of the medication without a relapse into opiate use or dependence. While the duration of the entire process varies from individual to individual, it usually requires about six months in the well-motivated patient. While the above process is evolving, the patient is directed to attend 12 Step models of outpatient rehabilitation meetings at AA and NA meetings. These are imperative as patients require psychologic adjustment to a drug-free and abstinent existence when the buprenorphine is eventually discontinued. Serial urine monitoring will occur at visits in the office, and randomly as well, to ensure compliance with the therapeutic contract which is signed upon entry to the practice. Patients utilizing illicit or unprescribed medications will be excluded from future participation. All patients are given reading materials to foster education regarding opioid dependence and abuse. There is an extensive support system available and questions are addressed seven days a week telephonically or in person. While the primary purpose of the practice is opioid detoxification and rehabilitation, there is also treatment of alcohol dependence with naltrexone HCL (Vivitrol) with intramuscular injections of the medication, AA meetings, education, and urine monitoring. Naltrexone was also approved for maintenance treatment of opioid dependence in 2010. Another maintenance agent utilized for alcohol dependence is acamprosate sodium (* Campral). Patients who are substance dependent often times have underlying co-occurring psychiatric symptoms which interfere with rehabilitation and exacerbate symptoms of anxiety, depression, and mood dysregulation. This psychiatric component is evaluated and treated contemporaneously with the rehabilitation process, utilizing psychotropic medication and psychotherapy.

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