Substance Abuse

More Than a Bad Habit - and More Treatable Than You Think

If You Need Support Right Now

If you or someone you love is in a substance-related crisis - an overdose, a suicidal moment, or acute withdrawal that needs medical attention - please call 911 immediately. Opioid overdose can be reversed with naloxone (Narcan), which is now available without a prescription at most pharmacies in Michigan.

The following resources are available 24 hours a day, free, and confidential:

  • SAMHSA National Helpline (free, confidential treatment referral and information, available in English and Spanish): 1-800-662-4357 (1-800-662-HELP)
  • 988 Suicide and Crisis Lifeline: Call or text 988
  • Oakland Community Health Network Crisis Line (Oakland County’s 24-hour behavioral health crisis line): 1-800-231-1127
  • Michigan 211 (statewide information and referral for treatment and recovery resources): dial 211 or visit mi211.org
  • Never Use Alone: 1-877-696-1996 (a free service that stays on the phone with people who use alone, in case of overdose)
  • Alcoholics Anonymous - Greater Detroit: 248-541-6565 | aa-semi.org
  • Narcotics Anonymous - Michigan: 1-800-230-4085 | michigan-na.org
  • SMART Recovery (secular, science-based recovery support meetings): smartrecovery.org

What This Page Is For

This page is for anyone whose life has been affected by substance use - people who suspect their use has become a problem, people who know it has, people in recovery who are working to stay there, people who have relapsed and are figuring out what comes next, parents and partners worried about someone they love, and adults whose lives have been shaped by growing up around addiction. All of you are welcome here.

At Behavioral Medical Center in Troy, MI, we treat substance use difficulties as what they are: serious but highly treatable clinical conditions that respond well to professional care. Our licensed clinicians work with individuals across the full spectrum of substance-related concerns, providing structured, evidence-based treatment for both the use itself and the underlying conditions that frequently sit beneath it.

We want to be honest about something important. Substance use exists on a wide spectrum, from concerning patterns of use through moderate use disorder to severe addiction requiring intensive intervention. BMC Troy is an outpatient mental health practice. We provide therapy, psychiatric care, and medication management for people whose substance use can be addressed in an outpatient setting. For individuals who need medical detox, residential treatment, intensive outpatient programs (IOP), or partial hospitalization (PHP), we coordinate with appropriate facilities and can help connect you with the right level of care. Knowing what level of care is needed is part of what assessment is for.

What Substance Use Disorder Actually Is

Substance use disorder is a clinical condition characterized by the continued use of a substance despite significant negative consequences, along with a set of identifiable patterns: difficulty controlling use, cravings, tolerance, withdrawal, time spent obtaining or recovering from the substance, and the gradual narrowing of life around the use itself. It is not a moral failing. It is not a lack of willpower. It is not something a person could simply stop doing if they wanted to badly enough.

Decades of research have established that addiction involves real changes in brain function - particularly in the systems that govern reward, motivation, decision-making, and stress response. These changes are why people continue using substances even when they sincerely want to stop, even when the costs have become enormous, and even when they have tried many times before. The brain that develops a substance use disorder is not the same brain that started using, and the gap between “wanting to stop” and “being able to stop” is real, measurable, and treatable.

Substance use disorder exists on a spectrum from mild to severe, and not everyone with a substance-related concern has full-blown addiction. Some people are using in concerning patterns that have not yet produced significant impairment but are heading in that direction. Some are using to cope with anxiety, depression, trauma, or chronic pain, and the substance has become the primary coping strategy. Some are physically dependent on a substance, including a prescribed one, and need clinical support to safely reduce or stop. All of these are legitimate reasons to seek care, and none of them require having “hit rock bottom” first.

Substances We Address

Our clinicians work with the full range of substance-related concerns, including:

  • Alcohol - the most common substance use disorder in the United States, ranging from concerning drinking patterns to severe alcohol use disorder requiring medical management
  • Opioids - including prescription pain medications, heroin, and fentanyl, with particular attention to the realities of the current overdose crisis
  • Stimulants - including cocaine, methamphetamine, and the misuse of prescription stimulants
  • Cannabis - including problematic use patterns that are increasingly recognized clinically, particularly with the higher potency of products available today
  • Benzodiazepines - including dependence on prescribed medications, where safe tapering and clinical support are essential
  • Nicotine - both traditional tobacco and vaping
  • Sedatives and other prescription medications - including dependence developed in the course of legitimate medical treatment
  • Polysubstance use - when more than one substance is involved, which is common and adds its own clinical considerations
  • Behavioral patterns that frequently overlap with substance use, including gambling, compulsive behaviors, and process addictions - families navigating these issues may also benefit from Detroit area support groups for families with addiction

How Substance Use Difficulty Shows Up

Substance use disorder doesn’t always look the way people expect. Some individuals fit the visible image - dramatic loss of functioning, obvious physical effects, life unraveling in ways the people around them can see. But for many others, the difficulty develops more quietly and is easier to miss or rationalize.

Common signs that substance use has become a clinical concern include:

  • Using more, or more often, than you intended
  • Difficulty cutting back or stopping, despite wanting to
  • Significant time spent obtaining, using, or recovering from the substance
  • Cravings or persistent urges to use
  • Continued use despite problems it is creating - in relationships, at work, with health, with finances, with the law
  • Giving up or reducing activities that used to matter to you
  • Use in situations where it is physically dangerous (driving, operating equipment)
  • Tolerance - needing more of the substance to get the same effect
  • Withdrawal symptoms when you stop or cut back
  • Failed attempts to stop or cut back, despite real intention
  • Using to manage emotions, sleep, stress, pain, anxiety, or other difficulties
  • Hiding or minimizing use from people close to you
  • A growing sense that you are not in control of the use, even when you tell yourself you are
  • Promises to yourself or others that have not been kept
  • Use that starts earlier in the day, lasts longer, or extends to settings where it did not used to be present
  • A narrowing of life around the substance and around protecting access to it
  • Family, friends, doctors, or others expressing concern about your use
  • Legal consequences, accidents, or near-misses related to use
  • Significant changes in mood, sleep, appetite, or daily functioning tied to use

Substance use disorder affects people differently, and no two presentations are identical. Some develop a problem quickly. Others use for years or decades before the line crosses. Some maintain external functioning - work, family, finances - for a long time even as the internal experience of being controlled by the substance grows. The clinical concern is not whether the situation looks bad from the outside. It is whether the use has become something other than what the person actually wants it to be.

What Often Sits Underneath

Substance use rarely exists in isolation. In a significant majority of cases, the use is connected to something else - and treatment that addresses only the substance without addressing what is underneath tends to produce limited or temporary results. This is one of the most consistent findings in the addiction treatment literature: integrated treatment of substance use and co-occurring conditions produces significantly better outcomes than treating either in isolation.

Common conditions and contributing factors that frequently accompany substance use difficulties include:

  • Anxiety disorders - one of the most common co-occurring conditions, with substances often serving as self-medication for chronic anxiety or panic
  • Depression - which both contributes to and is worsened by substance use, often in a cycle that requires addressing both layers
  • PTSD and trauma history - including childhood trauma, sexual abuse, combat exposure, and other experiences that the substance was numbing or holding at bay
  • ADHD - significantly elevated rates of substance use, often involving substances that produce focus or relief from chronic restlessness
  • Mood disorders - including bipolar spectrum conditions, where substances can both worsen episodes and complicate diagnosis
  • Chronic pain - particularly in opioid use disorders that developed from legitimate pain management
  • Chronic stress and burnout - including the use of alcohol or other substances as the primary mechanism for decompressing
  • Grief and loss - including unresolved losses that the substance has been helping to manage
  • Sleep disorders - which both contribute to and result from substance use
  • Eating disorders - which frequently co-occur with substance use, particularly in women
  • Personality disorders and difficulties with emotion regulation
  • Family history of addiction - including significant genetic and developmental factors
  • Adult children of alcoholics and addicts - where the family-of-origin experience shaped relational and coping patterns that may now be operating in the person’s own life
  • Untreated learning differences or neurodivergence - where years of compensation and exhaustion produced the conditions for problematic use

Understanding what is driving the use in a specific individual is one of the most important things assessment can do. A person whose substance use is rooted in untreated PTSD needs a different treatment plan than a person whose use is being driven by an undiagnosed mood disorder, and both differ from a person whose use developed in a primarily social or environmental context. Our clinicians take the time to look beneath the surface.

On Stigma and the Things That Get in the Way

We want to name something directly. Stigma is one of the most significant barriers to people getting help with substance use - more than cost, more than access, more than ambivalence about quitting. The shame attached to addiction in our culture causes real harm. It keeps people from disclosing to their doctors, from telling their partners, from acknowledging it to themselves, and from walking into a therapist’s office until things have gotten much worse than they had to.

Substance use disorder is a medical condition. People who develop it are not weak, broken, or morally deficient. They are people whose brains, biology, history, and life circumstances combined in ways that produced this particular difficulty. They deserve the same matter-of-fact, evidence-based care that any other medical condition warrants. Our clinicians treat substance use that way, without judgment and without the moralizing that makes this kind of work harder than it has to be.

On What “Recovery” Means

There is significant debate in the recovery world about what successful treatment looks like, and we want to be clear about how we approach it. For some substances and some individuals, complete abstinence is the appropriate and necessary goal - particularly for opioids, where the risks of continued use include overdose and death. For others, harm reduction approaches, controlled use, or significant reduction may be appropriate, depending on the substance, the severity, and the person’s own goals.

Our role is not to dictate what your recovery should look like. It is to provide accurate clinical information about what is realistic for your specific situation, help you think through what you actually want, and support you in pursuing the goals that fit your life. Some people thrive in 12-step programs. Some find SMART Recovery or other secular approaches more useful. Some do well with individual therapy alone. Many benefit from a combination. The right path is the one that works for you, and finding it is part of what good clinical work does.

How We Treat Substance Use at BMC Troy

Substance use treatment at BMC Troy is individualized, clinically informed, and integrated with care for whatever else is going on in the person’s life. There is no one-size-fits-all protocol.

Therapeutic and clinical approaches commonly used in this work include:

  • Cognitive-Behavioral Therapy (CBT) for substance use - identifying the triggers, thoughts, and patterns that maintain use, and building practical skills for managing cravings and high-risk situations
  • Motivational Interviewing - working with the ambivalence about change that nearly everyone with a substance use difficulty experiences, rather than fighting against it
  • Relapse Prevention - building the awareness, skills, and structures that protect recovery over time, including identifying warning signs and managing high-risk moments
  • Trauma-Informed Care - addressing the trauma history that frequently sits beneath substance use, paced carefully so it supports rather than destabilizes recovery
  • Treatment of Co-occurring Conditions - integrated work on the anxiety, depression, ADHD, PTSD, or other conditions that often drive use, because treating one without the other tends to produce limited results
  • Medication-Assisted Treatment coordination - for opioid use disorder, alcohol use disorder, and nicotine dependence, where medications like buprenorphine, naltrexone, and others can be valuable parts of treatment, coordinated with appropriate prescribers
  • Medication Management for co-occurring psychiatric conditions, where medication for depression, anxiety, ADHD, or other conditions is a helpful part of the overall plan
  • Family and Couples Work - because substance use affects whole systems, and recovery is often more sustainable when the people closest to the person are part of the work with family counseling
  • Coordination with 12-step, SMART Recovery, and other community-based support - which we view as a valuable complement to clinical care for many people, including free support groups in Metro Detroit
  • Referrals for higher levels of care when appropriate - including medical detox, IOP, PHP, and residential treatment - with continued support during and after the transition

Your clinician will recommend the approach - or combination of approaches - most likely to be effective based on your specific substance, severity, history, and goals. Treatment plans are not static. They evolve as you do, and your clinician will check in regularly to assess progress and adjust course when needed.

A Note on Relapse

Relapse is common in the course of recovery from substance use disorders. It is not evidence that treatment failed, that you are hopeless, or that you cannot recover. It is information - about what supports were missing, what triggers were not yet addressed, what underlying conditions need more attention, or what level of care is needed at this stage. Many people who eventually build long-term recovery have multiple relapses along the way. The work is not to demand perfection. It is to keep going, learn from what happened, and adjust the plan.

If you have relapsed and are reading this wondering whether it is worth trying again, the answer is yes. Each attempt builds something. Recovery is real, and it is possible, and people who have relapsed multiple times go on to build full and lasting recoveries every day. After-hours crisis care is available if you need support right now.

A Note for Families and Loved Ones

If you are reading this because someone you love is struggling with substance use, you are not alone, and there is support available for you specifically. Living with or loving someone with a substance use disorder is exhausting, frightening, and isolating. You may have tried everything you can think of. You may be carrying significant grief, anger, fear, and confusion.

Several things are worth knowing. You did not cause this. You cannot cure it. You also cannot control it - which is one of the hardest things to accept, and one of the most important. What you can do is take care of yourself, set the limits that protect your own functioning, learn what is realistic to expect, and access the support that exists for family members of people with addiction. Al-Anon, Nar-Anon, Adult Children of Alcoholics (ACA), and individual therapy for family members are all real options, and we work with family members of people with substance use disorders as part of our practice.

When to Seek Help

If you are wondering whether your substance use warrants professional support, consider these questions: Are you using more than you want to be, more often than you want to be, or in ways that are creating problems? Have you tried to cut back or stop and found you couldn’t? Is the substance becoming a bigger part of your life than you want it to be? Has anyone in your life expressed concern, even if you dismissed it at the time? Do you suspect the use is connected to something underneath - anxiety, depression, trauma, chronic pain, sleep problems - that has not been adequately addressed?

You don’t need to be in crisis to reach out. You don’t need to have “hit bottom.” Substance use is significantly easier to treat earlier in its course, before the consequences accumulate and before the use becomes more entrenched. Some of the most useful work in this area happens with people who recognized a concerning pattern early and got help before it became a crisis. If you’re unsure where to start, free mental health services in the Greater Detroit area may be a helpful first step.

A Note on Confidentiality

Everything discussed in substance use treatment sessions is confidential. Our clinicians adhere strictly to HIPAA privacy standards, and substance use treatment records carry additional federal confidentiality protections under 42 CFR Part 2. Nothing shared in session will be disclosed without your explicit written consent.

There are specific, limited exceptions we want you to know about up front. Under Michigan law, we are mandated reporters in cases of suspected child abuse or neglect, suspected abuse of a vulnerable adult, and imminent threats of serious harm to self or others. Your therapist will discuss this with you transparently if it ever becomes relevant.

Both in-person and telehealth sessions are available for substance use treatment.

Substance use disorder tries to convince you that you don’t have a problem, that you can handle it on your own, that nothing will really help, or that it is too late to do anything about it. None of those things are true. What you are dealing with is a treatable medical condition, recovery is real, and people build full and lasting lives after addiction every day.

If you are in crisis or have concerns about overdose or withdrawal, please call 911 or one of the resources listed at the top of this page. If you are ready to talk about clinical support for your use - or for someone you love - call us at (248) 528-9000, Monday through Friday, 9am-5pm, to schedule a confidential assessment. There is a path forward, and there are people ready to walk it with you.