Managing Mental, Emotional, and Addiction Symptoms with Medication-Assisted Treatment

As codirector of the transcranial magnetic stimulation (TMS) program at Miami Neuroscience Institute with Baptist Health, Rachel Rohaidy, MD, takes a personalized approach to mental health care, prioritizing early interventions that address substance use disorder (SUD) and coexisting mental, emotional, and neurological symptoms. In this interview, Rohaidy discusses the role of medication-assisted treatment in managing SUDs, the complex relationship between addiction and mental health conditions like attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD), and the evolving potential of TMS therapy. She emphasizes the importance of stabilizing patients in the present while providing individualized treatment to support long-term recovery.

This transcript has been lightly edited; captions were auto-generated.

Transcript

What treatment options are available for patients with substance use disorder and what do you find most effective?

MAT treatment, so medication-assisted treatment, has been very successful in this patient population. We can manage symptoms and cravings, whether it be withdrawal or, directly, some of those neurological issues that are happening with them. We can manage them directly with medication-assisted treatment. A lot of [patients] are on some kind of medication to help with cravings or to help with withdrawal or anything like that. And then also managing their mood symptoms. So, if it's a patient with severe PTSD or—prior to the substance use, or let's say, because of all the substance use—their ADHD has gotten worse, or panic attacks have gotten worse, and we manage the mood issues along with the substance use issues.

You offer transcranial magnetic stimulation at the neuroscience institute; is this therapy an option for substance use disorder?

Not yet. They are still in that testing phase to see where and with who, and how it would help with substance use. The TMS that we're doing here in this clinic is really for major depressive disorder, severe, for those patients who have not responded well to medications.

Evidence shows mental health comorbidities like depression often coincide with substance use disorder; how do you approach these cases?

A lot of times it goes hand in hand, we don't really know which came first. It's kind of like the chicken and the egg; which came first, the depression or the substance use? And many times we can distinguish, and we can delineate—if we take a really good history—what happened when and where, and if there was a disconnect at some point in their life, but many times we don't. And to tell you the truth, a lot of my patients don't even want to revisit their past. They're functioning, they're okay. "I've gotten past it. I've already dealt with it. I've already had the therapy. I don't want to talk about it." And it really is just getting them stable in the now, and hopefully getting them stable, and then if they seek to go back to those issues, then we do. But really, it's getting them stable now and functioning, and getting them back to work or back into school, things like that.