Substance use disorders are complex — and they rarely travel alone. Most of my patients dealing with addiction are also managing depression, anxiety, trauma, or another psychiatric condition that’s been driving the substance use for years. That’s the connection I focus on.
Substance Use Disorders I Treat
Alcohol use disorder is the most common I see, but opioids are right behind it — prescription painkillers, heroin, fentanyl. I also treat people dealing with cannabis, cocaine and other stimulants, benzodiazepines, sedatives, and combinations. A lot of my patients don’t fit neatly into one category. They’ve used different things at different times, depending on what was available, what was prescribed, or what worked when nothing else did.
One pattern I see fairly often: substance use that started with a legitimate prescription. Opioids after surgery. Benzodiazepines for anxiety or sleep. It worked, and then it worked a little too well, and eventually became something they couldn’t manage on their own. That history matters, and it shapes how we approach things.
Why Addiction and Psychiatric Health Are Deeply Connected
Substance use disorders rarely travel alone. After 25 years doing this, it’s probably the single most consistent thing I see. Depression, anxiety, PTSD, ADHD, and bipolar disorder are extremely common among people who develop problematic substance use — and the relationship runs in both directions. Sometimes substance use comes first and psychiatric symptoms develop over time. More often, people are self-medicating a condition that was never properly identified or treated.
The current clinical term for what most people call “substance abuse” is substance use disorder (SUD) — a DSM-5 diagnosis that spans a spectrum from mild to severe. What matters more than the label, though, is understanding why someone started using, what it’s doing for them psychologically, and what’s making it difficult to stop even when they want to. That’s why a thorough psychiatric evaluation — not just a substance use screening — is where I always start.
How I Approach Substance Use Disorder Treatment
Treatment starts with a thorough psychiatric evaluation — mood, anxiety, sleep, trauma history, relationships, and how things are going at work and at home. From there, medication is sometimes part of the picture. For alcohol and opioid use disorder, naltrexone is one of the most useful tools I have; for opioid dependence specifically, buprenorphine (Suboxone) is worth serious consideration for many patients. These medications don’t do the whole job, but they can make the rest of treatment possible in a way that willpower alone often can’t.
Therapy is almost always part of it too. CBT and motivational interviewing have the best evidence for substance use disorders, and I coordinate with therapists who provide them. When depression, anxiety, PTSD, or ADHD is driving the substance use — which it often is — addressing that directly is usually where the real progress happens. I also work alongside addiction specialists and primary care physicians when the clinical picture calls for it.
This isn’t a short-term program. Some patients need more intensive support early on; others come to me already in recovery and need help with the psychiatric piece. I meet patients where they are.
I’m Dr. David Brendel, MD, PhD — a Harvard-trained, board-certified private psychiatrist in Belmont, MA, with over 25 years in practice.
Why Patients Choose Dr. Brendel for Substance Use Disorder Treatment
- 25+ years treating substance use disorders and co-occurring conditions in private practice in Belmont, MA
- Harvard-trained, MD and PhD — board-certified by the American Board of Psychiatry and Neurology
- Dual diagnosis experience: addiction treated alongside depression, anxiety, PTSD, ADHD, and bipolar disorder
- Medication options including naltrexone and buprenorphine discussed openly, without pressure
- No judgment — many patients have felt stigmatized elsewhere; this is a different kind of practice
- Long-term ongoing care, not a short-term program
- Belmont, MA — serving Boston, Cambridge, and surrounding communities
- Book via ZocDoc or call (617) 932-1548 — accepting new patients now
One thing I hear often from new patients is that they’ve put off asking for help because of shame — or because a previous provider made them feel that their addiction was a personal failure rather than a medical condition. I don’t approach it that way.
Substance use disorders develop for reasons. They’re shaped by biology, early experience, stress, and circumstances that are rarely anyone’s fault. My job isn’t to judge any of that — it’s to understand it with you, and to build a treatment approach that actually accounts for what’s driving the pattern.
The patients who tend to do best are the ones who feel safe being genuinely honest — about what they’re using, how much, and why. That kind of honesty only happens when someone feels they won’t be shamed or lectured. Creating that environment is something I take seriously, and it’s often where the real work of recovery begins.
If Now Feels Like the Right Time
Many people wait months — sometimes years — before asking for help with substance use. If you’re wondering whether it’s time, that usually means it is. I’m currently accepting new patients in Belmont, MA.