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By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Clinical Approach Solutions to Manage Opioid Use Disorder


Unveil the clinical approach to opioid use disorder and learn about evidence-based methods for effective treatment.

Overcoming Barriers in Managing Opioid Use Disorder: Strategies for Effective Care

A lot of people today have opioid use disorder (OUD), which is a serious health problem. It falls under the larger group of substance use disorders (SUD). Treating OUD can be difficult because everyone has their own set of problems, like pain or other health issues. Doctors and other healthcare professionals must make plans that are specific to each patient. They also need to stay up to date on laws, ethics, and ways to protect patient information. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 covers all patients, but those getting treatment for drug or alcohol abuse have to follow more rules.

In this tutorial, we talk about how to get around problems with OUD administration. We look at stigma, team-based approaches, ways to talk to patients, treatment that puts the patient first, and legal issues. Health care workers can help patients get better by using these methods. Keywords like “opioid use disorder management,” “overcoming stigma in OUD,” and “patient-centered care for SUD” highlight important ideas to help people understand better and find what they’re looking for.

Learning Objectives

  • Explain treatment planning methods that use patient-focused choices and proven ways to talk.
  • Name the three kinds of stigma and how they affect people with mental health issues, SUD, and especially OUD.
  • Talk about legal, ethical, and privacy concerns in caring for people with OUD.

Effective Treatment Planning with Patient-Centered Decisions

People with complex issues, like mental health problems, SUD, and pain, need special care. Each person shows up differently, so health systems are now focusing on care that puts the patient first.

Patient-centered care means building teams with doctors, patients, and families. They work together to plan, give, and check health care. This way ensures the patient’s needs are met, and their wishes, likes, and family situations are respected. It focuses on shared choices about treatments while seeing the patient as a whole person in their daily life (Dwamena et al., 2012; Bokhour et al., 2018).

Studies show key steps for a good patient-centered plan:

  • Take a full patient history and a check-up, reviewing old and new treatments.
  • Find all available drug and non-drug options.
  • Check the patient’s current health, recent changes, and patterns.
  • Look at risks for misusing or abusing opioids.

If starting opioids or if the patient is already on them, think about opioid stewardship. This means checking harms, benefits, risks, side effects, pain control, daily function, drug tests, stop plans, and ways to spot OUD. These programs, sometimes called analgesia stewardship, help manage opioids safely (Harle et al., 2019; Coffin et al., 2022). Guides exist to set them up (American Hospital Association, n.d.; Shrestha et al., 2023).

Integrative chiropractic care can play a big role here. It uses spinal adjustments and targeted exercises to get proper spinal alignment. This helps reduce pain without relying only on drugs, making it a good fit for OUD patients with pain. For example, adjustments fix spine issues that cause pain, and exercises strengthen muscles to keep alignment right.

A Nurse Practitioner (NP) adds full management and ergonomic advice. They look at work setups to prevent pain, such as how to sit or lift. NPs coordinate care by reviewing options such as therapy, meds, and lifestyle changes, ensuring everything works together.

Dr. Alexander Jimenez, DC, APRN, FNP-BC, with over 30 years in chiropractic and as a family nurse practitioner, observes that blending these methods cuts opioid use. At his El Paso clinic, he uses functional medicine to address root causes through nutrition and non-invasive treatments. He notes that poor posture from modern life worsens pain, leading to OUD risks. His teams help patients with self-massage and VR for recovery, reducing drug needs (Jimenez, n.d.a; Jimenez, n.d.b).

Evidence-Based Ways to Communicate

Good talking skills are key to building a patient-centered plan (Schaefer & Block, 2009). There are proven methods for starting conversations and getting patients involved.

One method is BATHE:

  • Background: Ask, “How have things been since your last visit?”
  • Affect: Ask, “How does this make you feel?”
  • Trouble: Ask, “What bothers you most?”
  • Handling: Ask, “How are you coping?”
  • Empathy: Say, “That sounds hard.”

This uses open questions to let patients lead and feel supported (Stuart & Lieberman, 2018; Thomas et al., 2019).

Another is GREAT:

  • Greetings/Goals: Start with hello and set aims.
  • Rapport: Build trust.
  • Evaluation/Expectation/Examination/Explanation: Check and explain.
  • Ask/Answer/Acknowledge: Listen and respond.
  • Tacit agreement/Thanks: Agree and thank.

This guide talks well (Brindley et al., 2014).

Motivational interviewing is also useful. It’s a team-style talk to boost a patient’s desire to change. Build a bond, focus on the issue, spark a desire for change, and plan steps (Frost et al., 2018).

These methods emphasize listening, clear communication, and a structured approach to planning. For OUD patients with pain or mental issues, mix techniques for the best results.

Dr. Jimenez shares that in his practice, these talks help patients see non-drug options, such as chiropractic adjustments. He finds that empathy reduces stigma and fear, encouraging openness about OUD (Jimenez, n.d.a).

Understanding Stigma in Mental Health and Substance Use Disorders

Stigma blocks good talk for many with mental health or SUD. It’s attitudes, beliefs, actions, and systems that lead to unfair views and bad treatment (Cheetham et al., 2022).

Studies show stigmas like linking mental illness to violence (Perry, 2011). Media on shootings with mentally ill people strengthens this (McGinty et al., 2014; McGinty et al., 2016; Schomerus et al., 2022). For SUD, people think they’re more dangerous than those with schizophrenia or depression (Schomerus et al., 2011). Society blames people with SUDs more and avoids them (McGinty et al., 2015; Corrigan et al., 2012).

Views come from knowledge, contact with affected people, and the media. Public ideas are tied to norms on causes, blame, and danger. Race, ethnicity, and culture shape attitudes too (Giacco et al., 2014).

Health workers have biases. A survey of VA mental health providers showed awareness of race issues but avoidance of talks, using codes like “urban,” and thinking training stops racism (McMaster et al., 2021).

There are three stigma types:

  • Structural Stigma: The ways Society and institutions keep prejudice. In health, it’s worse care, less access to behavioral health. Less funding for mental vs. physical issues (National Academies of Sciences, Engineering, and Medicine, 2016).
  • Public Stigma: General or group attitudes, like police or church norms. Laws reinforce it, like broad mental illness rules implying all are unfit (Corrigan & Shapiro, 2010).
  • Self-Stigma: When people internalize stigmas, it leads to low self-worth and shame. “Why try” affects independent living (Corrigan et al., 2009; Clement et al., 2015).

Dr. Jimenez observes that stigma makes OUD patients hide symptoms, delaying care. In his integrative work, he addresses this through education on holistic options, showing that recovery is possible without judgment (Jimenez, n.d.b).

Overcoming Stigma and Addressing Social Factors

To fight stigma, use education, behavior changes, and better care. Laws like the ADA and MHPAEA help ensure equal coverage and prevent discrimination (U.S. Congress, 2009; U.S. Congress, 2008; U.S. Department of Health and Human Services, n.d.; Busch & Barry, 2008; Haffajee et al., 2019).

These address social determinants of health (SDOH), such as coverage, access, quality, education, and stability (Centers for Disease Control and Prevention, n.d.).

Community programs help too:

  • West Virginia’s Jobs and Hope: Training, jobs, education, transport, skills, record clearing for SUD people (Jobs and Hope, n.d.).
  • Belden’s Pathway: Rehab for failed drug tests, leading to jobs (Belden, n.d.).

Education boosts provider confidence in OUD meds, reducing barriers (Adzrago et al., 2022; Hooker et al., 2023; Campbell et al., 2021).

Overcoming stigma is key to success in mental health and SUD.

Interprofessional Team Work

Teams improve outcomes for patients with chronic pain and mental health or SUD (Joypaul et al., 2019; Gauthier et al., 2019).

Teams include doctors, nurses, NPs, pharmacists, PAs, social workers, PTs, therapists, SUD experts, and case managers.

Each helps uniquely:

  • Pharmacists watch meds, spot interactions.
  • Case managers link specialists, find resources, and support families (Sortedahl et al., 2018).
  • Teams set goals, max non-opioid treatments (Liossi et al., 2019).

Integrative chiropractic care includes adjustments and exercises for alignment, easing pain naturally.

NPs give full care, ergonomic tips to avoid pain triggers, and coordinate options.

Dr. Jimenez’s clinic shows this. As a DC and FNP-BC, he leads teams with therapists, nutritionists, and coaches. He observes interprofessional work cuts opioid use by addressing the roots with functional medicine, VR, and nutrition. For OUD, he blends chiropractic care for pain, NP coordination for plans, and stigma-fighting through team support (Jimenez, n.d.a; Jimenez, n.d.b).

The Power of Chiropractic Care in Injury Rehabilitation-Video

Legal and Ethical Issues in SUD Care

Providers must know laws and ethics for mental/SUD patients, like discrimination, aid, and privacy (Center for Substance Abuse Treatment, 2000).

Key Federal laws:

  • Americans with Disabilities Act (ADA) of 1990.
  • Rehabilitation Act of 1973.
  • Workforce Investment Act of 1998.
  • Drug-Free Workplace Act of 1988.

ADA and Rehabilitation ban discrimination in government and in business services like hotels, shops, and hospitals. Protect those with impairments limiting life activities (U.S. Department of Health and Human Services, n.d.).

Provisions:

  • Protect “qualified” people who meet the requirements.
  • Reasonable accommodations for jobs.
  • No hire/retain if there is a direct threat.
  • No denial of benefits, access, or jobs in funded places.

For SUD: Alcohol users are protected if qualified, no threat. Ex-drug users in rehab are the same. Current illegal drug users are protected for health/rehab, not others. Programs can deny if used during.

Workforce Act centralizes job programs; no refusal to SUD people (U.S. Congress, 1998).

Drug-Free Act requires drug-free policies for federal funds/contracts: statements, awareness, actions on violations (U.S. Code, n.d.).

States have their own laws; check the local laws.

Public Aid laws:

  • Contract with America Act (1996): No SSI/DI if SUD key factor (U.S. Congress, 1996).
  • Adoption Act (1997): 15-month foster reunification limit (U.S. Congress, 1997).
  • Personal Responsibility Act (1996): Work after 2 years of aid, drug screens (U.S. Department of Health and Human Services, 1996).

These push work, sobriety.

Dr. Jimenez notes that legal awareness helps his practice by ensuring holistic plans comply and by reducing OUD risks through a non-drug focus (Jimenez, n.d.a).

Keeping Patient Info Private

Privacy is vital. Laws include:

  • HIPAA (1996): Protects PHI, sets use/disclosure rules (U.S. Department of Health and Human Services, n.d.).
  • 42 CFR Part 2: Extra for SUD records. No disclosure of name or status without consent. Fines for breaks. Applies to federal-aided programs (Substance Abuse and Mental Health Services Administration, n.d.).

Consent needs: program name, receiver, patient name, purpose, info type, revoke note, expire date, signature, and date.

This fights discrimination fears, encouraging treatment (Center for Substance Abuse Treatment, 2000).

Wrapping Up

As we deal with the ongoing problems of opioid use disorder (OUD), it’s clear that the best way to handle them is through a multi-faceted approach that puts the health of the patient first instead of quick fixes. Healthcare providers are essential to changing lives. They do this by supporting patient-centered decision-making and evidence-based communication, and by breaking down the three types of stigma—structural, public, and self—that make it harder for people to get better. Legal and ethical frameworks, such as HIPAA and 42 CFR Part 2 privacy protections, make sure that people who need help can get it without worrying about being treated unfairly. Interprofessional teams also help make sure that everyone receives the care they need.

Chiropractic care, which focuses on spinal adjustments and specific exercises to help with proper alignment, is a non-invasive way to ease pain and cut down on the need for opioids. Nurse Practitioners (NPs) improve this by offering comprehensive care, ergonomic advice to avoid injury, and the coordination of various treatment options, including therapy and lifestyle changes. Dr. Alexander Jimenez, DC, APRN, FNP-BC, stresses in his clinical practice that these integrative methods not only help with physical symptoms but also give patients the tools they need to make educated decisions and follow personalized plans. This leads to long-term recovery and less use of opioids (Jimenez, n.d.a; Jimenez, n.d.b).

Recent developments in OUD treatment as of 2025 indicate a transition towards more individualized and accessible alternatives. For example:

  • FDA-approved drugs like methadone, buprenorphine, and naltrexone are still the mainstays of treatment for OUD. They help reduce cravings and withdrawal symptoms while also assisting people to stay stable over the long term.
  • Precision medicine goes beyond one-size-fits-all approaches by tailoring treatments to each person’s genetic, psychological, and social factors. This should lead to better results.
  • New Guideline: The World Health Organization’s 2025 updates emphasize the importance of psychosocial support alongside drug treatments. They also focus on preventing overdoses in the community and making care more widely available.
  • Declining Trends: The number of deaths involving opioids dropped for the first time in 2023 since 2018, which is a good sign that ongoing efforts in policy, education, and treatment are having an effect.

We can create a future where OUD is not a life sentence but a condition that can be managed by combining these new ideas with reducing stigma and working together to care for people. Healthcare professionals, communities, and policymakers must continue to push for fair access to care so that everyone gets the compassionate, evidence-based help they need. In the end, overcoming the obstacles to managing OUD isn’t just about treatment; it’s also about restoring hope, respect, and a better quality of life.

References

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Pain Management Explained for Opioid Therapy in a Clinical Approach


Understand the role of opioid therapy in a clinical approach to pain management and its impact on treatment strategies.

Key Points on Safe Pain Management with Opioids

  • Pain Affects Many People: Research suggests that about 100 million adults in the U.S. deal with pain, and this number might grow due to aging, more health issues like diabetes, and better survival from injuries. It’s important to address pain early to prevent it from becoming long-term (Institute of Medicine, 2011).
  • Non-Opioid Options First: Evidence leans toward starting with treatments like exercise, therapy, or over-the-counter meds before opioids, as they can be just as effective for common pains like backaches or headaches, with fewer risks (National Academies of Sciences, Engineering, and Medicine, 2019).
  • Team-Based Care Works Best: Studies show teams of doctors, nurses, and therapists can improve pain relief and daily life, though results vary. This approach seems likely to help more than solo care, especially for ongoing pain (Gauthier et al., 2019).
  • Opioids When Needed, But Carefully: Guidelines recommend low doses, short times, and regular check-ins to balance relief with risks like addiction. It’s complex, so talk openly with your doctor (Centers for Disease Control and Prevention, 2022).
  • Alternatives Like Chiropractic and NP Support: Integrative methods, such as chiropractic adjustments for spine alignment and ergonomic tips from nurse practitioners, can reduce reliance on meds. Clinical observations from experts like Dr. Alexander Jimenez highlight non-invasive approaches to managing pain effectively.

Understanding Pain Types

Pain can be short-term (acute), medium-term (subacute), or long-lasting (chronic). Acute pain often lasts less than three months and comes from injuries. If not treated well, it might turn chronic, affecting daily activities. Always respect someone’s pain experience—it’s personal and influenced by life factors (Raja et al., 2020).

Assessing Pain Simply

Doctors use tools like questions about when pain started, what makes it worse, and how it feels. Scales help rate it, from numbers (0-10) to faces showing discomfort. For kids or elders, special tools watch for signs like faster heartbeats (Wong-Baker FACES Foundation, 2022).

Treatment Basics

Start with non-drug options like rest, ice, or physical therapy. For chronic pain, meds like acetaminophen or therapies like yoga help. Opioids are for severe cases but come with risks—use them wisely (Agency for Healthcare Research and Quality, n.d.).

Role of Experts

According to clinical observations by Dr. Alexander Jimenez, DC, APRN, FNP-BC, who runs a multidisciplinary practice in El Paso, Texas (https://dralexjimenez.com/), combining chiropractic care with exercises targets root causes, such as misaligned spines, reducing opioid needs. As a nurse practitioner, he coordinates care and offers ergonomic advice to prevent pain from daily habits (LinkedIn Profile).

Comprehensive Guide to Safe and Effective Pain Management Using Opioid Therapy

Pain is a common problem that affects millions of people and can affect everything from work to hobbies. It’s important to find safe ways to deal with pain, whether it’s coming from an injury that happened suddenly or one that keeps coming back. This detailed guide goes over how to assess pain, the different treatment options available, and how to use opioids safely. We’ll talk about alternatives to opioids, team-based care, and advice from experts like Dr. Alexander Jimenez, who stresses the importance of a whole-person approach. There are words like “pain management strategies,” “opioid therapy guidelines,” and “non-opioid pain relief” that are mixed in to help you find good information online.

Introduction to Pain in America

The Institute of Medicine estimates that around 100 million American adults face acute or chronic pain daily. This number is expected to climb due to an aging population, rising rates of conditions like diabetes, heart disease, arthritis, and cancer, plus better survival from serious injuries and more surgeries that can lead to post-op pain (Institute of Medicine, 2011).

As people learn more about pain relief options and gain better access through laws like the Affordable Care Act (ACA), more folks—especially older ones—seek help. Passed in 2010, the ACA requires insurers to cover essential pain management benefits, including prescription drugs, chronic disease care, mental health support, and emergency services (111th Congress, 2009-2010). To use these effectively, healthcare providers need a solid grasp of pain assessment, classification, and treatment.

What Is Pain?

The International Association for the Study of Pain defines it as an unpleasant feeling associated with real or potential tissue damage. It’s subjective, shaped by biology, emotions, and social life. People learn about pain through experiences—some seek help right away, others try home remedies first. Respect their stories (Raja et al., 2020).

Pain falls into three main types, though definitions overlap:

  • Acute Pain: Lasts less than 3 months, or 1 day to 12 weeks; often limits daily activities for a month or less.
  • Subacute Pain: Sometimes seen as part of acute, or separate; lasts 1-3 months, or 6-12 weeks.
  • Chronic Pain: Persists over 3 months, or limits activities for more than 12 weeks (Banerjee & Argáez, 2019).

Poorly managed short-term pain can become chronic, so early action is important (Marin et al., 2017).

Assessing Pain Thoroughly

Pain is complex, influenced by body, mind, and environment. A full check includes history, physical exam, pain details, other health issues, and mental states like anxiety.

Basic pain evaluation covers:

  • When it started (date/time).
  • What caused it (injury?).
  • How does it feel (sharp, dull?)?
  • How bad it is.
  • Where is it?
  • How long does it last?
  • What worsens it (moving?).
  • What helps it?
  • Related signs (swelling?).
  • Impact on daily life.

Mnemonics help remember these. Here’s a table comparing common ones:

MnemonicBreakdown
COLDERRACharacteristics, Onset, Location, Duration, Exacerbation, Radiation, Relief, Associated signs
OLDCARTOnset, Location, Duration, Characterization, Aggravating factors, Radiation, Treatment
PQRSTProvoked, Quality, Region/Radiation, Severity, Timing

Pain scales provide information but aren’t diagnoses because they’re subjective. Single-dimensional ones focus on intensity:

  • Verbal: Mild, moderate, severe.
  • Numeric: 0 (none) to 10 (worst).
  • Visual: Like Wong-Baker FACES®, using faces for kids, adults, or those with barriers (Wong-Baker FACES Foundation, 2022). An emoji version works for surgery patients (Li et al., 2023).

Multi-dimensional scales check intensity plus life impact. The McGill Pain Questionnaire uses words like “dull” to rate sensory, emotional, and overall effects; shorter versions exist (Melzack, 1975; Main, 2016). For nerve pain, PainDETECT helps (König et al., 2021). Brief Pain Inventory scores severity and interference with mood/life (Poquet & Lin, 2016).

For babies, watch heart rate, oxygen, and breathing. Tools like CRIES rate crying, oxygen need, vitals, expression, sleep (Castagno et al., 2022). FLACC for ages 2 months-7 years checks face, legs, activity, cry, consolability (Crellin et al., 2015). Older kids use Varni-Thompson or draw pain maps (Sawyer et al., 2004; Jacob et al., 2014).

Elders face barriers like hearing loss or dementia. PAINAD assesses breathing, sounds, face, body, and consolability on a 0-10 scale (Malara et al., 2016).

The Joint Commission sets standards across various settings, which affect tool choice (The Joint Commission, n.d.).

Building Treatment Plans

Plans depend on pain type, cause, severity, and patient traits. For acute: meds, distraction, psych therapies, rest, heat/ice, massage, activity, meditation, stimulation, blocks, injections (National Academies of Sciences, Engineering, and Medicine, 2019).

Re-check ongoing acute pain to avoid chronic shift. Goals: control pain, prevent long-term opioids. Barriers: access to docs/pharmacies, costs, follow-ups.

For chronic: meds, anesthesia, surgery, psych, rehab, CAM. Non-opioids include:

  • Oral Meds:
    • Acetaminophen.
    • NSAIDs (celecoxib, etc.).
    • Antidepressants (SNRIs like duloxetine; TCAs like amitriptyline).
    • Anticonvulsants (gabapentin, etc.).
    • Muscle relaxers (cyclobenzaprine).
    • Memantine.
  • Topical: Diclofenac, capsaicin, lidocaine.
  • Cannabis: Medical (inhaled/oral/topical); phytocannabinoids (THC/CBD); synthetics (dronabinol) (Agency for Healthcare Research and Quality, n.d.).

Opioid use has risen, raising concerns (National Academies of Sciences, Engineering, and Medicine, 2019).

Key plan elements:

  • Quick recognition/treatment.
  • Address barriers.
  • Involve patients/families.
  • Reassess/adjust.
  • Coordinate transitions.
  • Monitor processes/outcomes.
  • Assess outpatient failure risk.
  • Check opioid misuse (Wells et al., 2008; Society of Hospital Medicine, n.d.).

Team Approach to Pain

Studies support the use of interprofessional teams for better results (Gauthier et al., 2019). Teams include docs, nurses, NPs, pharmacists, PAs, social workers, PTs, behavioral therapists, and abuse experts.

A 2017 report showed that teams improved pain/function from baseline, though not always compared with controls (Banerjee & Argáez, 2017). A meta-analysis found that teams were better at reducing pain after 1 month and sustained benefits at 12 months (Liossi et al., 2019).

Integrative chiropractic care fits here. It involves spinal adjustments—gentle manipulations to correct misalignments—and targeted exercises, such as core strengthening, to maintain alignment and reduce pressure on nerves/muscles. Dr. Alexander Jimenez observes that this helps sciatica/back pain without opioids, using tools like decompression (dralexjimenez.com).

Nurse Practitioners (NPs) provide comprehensive management, including ergonomic advice (e.g., better sitting postures) to prevent strain. They coordinate by reviewing options, referring to specialists, and overseeing plans, as seen in Dr. Jimenez’s practice, where his FNP-BC role includes telemedicine for holistic care (LinkedIn, n.d.).

Beyond Adjustments: Chiropractic and Integrative Healthcare- Video

Managing Opioids Safely

CDC’s 2022 guidelines cover starting opioids, dosing, duration, and risks (Centers for Disease Control and Prevention, 2022).

1. Starting Opioids:

Maximize non-opioids first—they match opioids for many acute pains (back, neck, etc.). Discuss benefits/risks (Recommendation 1, Category B, Type 3).

Evaluate/confirm diagnosis. Non-drug examples:

  • Back: Exercise, PT.
  • Low back: Psych, manipulation, laser, massage, yoga, acupuncture.
  • Knee OA: Exercise, weight loss.
  • Hip OA: Exercise, manuals.
  • Neck: Yoga, massage, acupuncture.
  • Fibromyalgia: Exercise, CBT, massage, tai chi.
  • Tension headache: Manipulation.

Review labels, use the lowest dose/shortest time. Set goals, exit strategy. For ongoing, optimize non-opioids (Recommendation 2, A, 2).

2. Choosing/Dosing Opioids:

Immediate-release (hydromorphone, etc.) over ER/LA (methadone, etc.). Studies show no edge for ER/LA; avoid for acute/intermittent (Recommendation 3, A, 4).

No rigid thresholds—guideposts. Risks rise with dose; avoid high if benefits dim (Recommendation 4, A, 3).

Taper slowly to avoid withdrawal (anxiety, etc.). Collaborate on plans; use Teams. If there is disagreement, empathize and avoid abandonment (Recommendation 5, B, 4).

3. Duration/Follow-Up:

For acute, prescribe just enough—often 3 days or less. Evaluate every 2 weeks. Taper if used for days. Avoid unintended long-term (Recommendation 6, A, 4).

Follow-up 1-4 weeks after start/escalation; closer for high-risk (Recommendation 7, A, 4).

4. Risks/Harms:

Screen for SUD/OUD. Offer naloxone for overdose risk (Recommendation 8, A, 4).

Check PDMPs for scripts/combos (Recommendation 9, B, 4).

Toxicology tests are performed annually to assess interactions (Recommendation 10, B, 4).

Caution with benzodiazepines (Recommendation 11, B, 3).

For OUD, use DSM-5 (2+ criteria/year); offer meds like buprenorphine (Recommendation 12, A, 1) (Hasin et al., 2013; American Psychiatric Association, 2013).

OUD signs: Larger amounts, failed cuts, time spent, cravings, role failures, social issues, activity loss, hazardous use, continued despite problems, tolerance, withdrawal.

Treatment: Meds, counseling, groups. Coordinate with specialists.

Conclusion

In conclusion, you don’t have to rely only on opioids to manage pain well. We can help millions of people live better lives by putting non-opioid options first, like acetaminophen, physical therapy, or mindfulness, and only using opioids when necessary and with close monitoring. Doctors, nurses, pharmacists, and specialists like chiropractors work together in teams to make plans that are right for each person. This lowers the risk of things like addiction. Integrative chiropractic care, which focuses on spinal adjustments and specific exercises, is a big part of getting your body back in line and relieving pain naturally, which often means you don’t need to take medicine. Nurse practitioners are valuable because they provide comprehensive management, ergonomic advice to prevent problems, and coordination of treatments for better overall results.

Experts like Dr. Alexander Jimenez explain how these methods promote long-term health by treating the root causes with functional medicine and non-invasive procedures. The future looks better for safer pain relief as new technologies and drugs that don’t contain opioids are approved by the FDA. In the end, getting patients involved in decisions and keeping them up to date gives everyone the tools they need to manage pain directly, which improves daily tasks and overall health. Talk to your doctor to find out what works best for you. Early assessment and balanced care are important.

References

By Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP, IFMCP 0 Comments Advanced Practice Registered Nurses (APRN), Chiropractic Care , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

A Clinical Approach for Treatment for Patients with Substance Use Disorder

Delve into the clinical approach for a comprehensive understanding of effective management and care for substance use disorder for patients.

Integrative Management of Substance Use Disorder (SUD) and Musculoskeletal Health: A Collaborative Model for Chiropractors and Nurse Practitioners

The musculoskeletal system, behavior, brain, and overall body are all impacted by substance use disorder (SUD), a chronic illness that may be treated. For many individuals, SUD coexists with functional restrictions, mental discomfort, chronic pain, and injury. According to the American Medical Association [AMA], n.d., the National Institute on Drug Abuse [NIDA], n.d., and the National Institute of Mental Health [NIMH], 2025, an integrative care model can lower risk, enhance function, and promote long-term recovery by combining evidence-based SUD screening and treatment with chiropractic care and nurse practitioner (NP)-led primary care.

This article describes SUD, how it may be recognized and classified, how physicians can treat it with useful processes, and how integrated chiropractic and NP treatment can address physical repercussions and overlapping risk profiles.

What Is Substance Use Disorder (SUD)?

SUD is a medical condition in which the use of alcohol, medications, or other substances leads to significant impairment or distress in daily life. It is not a moral failing or a lack of willpower; it is a chronic, brain‑ and body‑based disease that is treatable (NIDA, n.d.; NIMH, 2025).

SUD exists on a spectrum from mild to severe. People with SUD may:

  • Use more of the substance than they planned
  • Try and fail to cut down or stop
  • Spend a lot of time obtaining, using, or recovering from the substance
  • Continue to use even though it harms health, work, relationships, or safety (American Psychiatric Association, 2022; NIMH, 2025)

Person‑first, non‑stigmatizing language

Stigma can keep people from seeking care. Using respectful, person‑first language reduces shame and supports engagement. NIDA and the AMA recommend (NIDA, n.d.; AMA, n.d.):

  • Say “person with a substance use disorder,” not “addict” or “drug abuser.”
  • Say “substance use” or “misuse,” not “abuse.”
  • Focus on SUD as a chronic, treatable condition.

Categories and Diagnostic Features of SUD

DSM‑5‑TR framework: Mild, moderate, severe

Diagnostic criteria for SUD come from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM‑5‑TR) (American Psychiatric Association, 2022; NIAAA, 2025). A diagnosis is based on the number of symptoms present over 12 months.

Typical criteria include (paraphrased):

  • Using more or for longer than intended
  • Unsuccessful efforts to cut down
  • Spending a lot of time obtaining, using, or recovering
  • Cravings or strong urges
  • Role failures at work, school, or home
  • Social or interpersonal problems caused or worsened by use
  • Giving up important activities
  • Using in physically hazardous situations
  • Continued use despite physical or psychological problems
  • Tolerance
  • Withdrawal

Severity is determined by symptom count (American Psychiatric Association, 2022; NIAAA, 2025):

  • Mild: 2–3 symptoms
  • Moderate: 4–5 symptoms
  • Severe: 6 or more symptoms

Substance‑specific categories

Clinically, SUD is further categorized by substance type (NIDA, n.d.; NIMH, 2025):

  • Alcohol use disorder (AUD)
  • Opioid use disorder (e.g., heroin, oxycodone, hydrocodone)
  • Stimulant use disorder (e.g., cocaine, methamphetamine)
  • Sedative, hypnotic, or anxiolytic use disorder (e.g., benzodiazepines)
  • Cannabis, tobacco, hallucinogen, or inhalant use disorders

Each category has similar behavioral criteria but unique medical risks, withdrawal profiles, and treatment options (NIDA, n.d.; NIAAA, 2025).

Risk and severity categories for clinical workflows

For practical care, validated screening tools classify risk that guide next steps (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

  • Low/no risk: Negative screen or very low scores
  • Moderate risk: At‑risk use with potential consequences (e.g., falls, crashes, future disease)
  • Substantial/severe risk: High scores suggest likely SUD and active harm

For example, adult risk zones using tools like AUDIT and DAST (AMA, n.d.):

  • Low risk/abstain: AUDIT 0–7; DAST 0–2
  • Moderate risk: AUDIT 8–15; DAST 3–5
  • Substantial/severe risk: AUDIT ≥16; DAST ≥6

These categories help teams decide when to give brief interventions, when to intensify care, and when to refer to specialty treatment.

Epidemiology and Public Health Impact

National surveys show that millions of people in the United States live with SUD, yet only a fraction receive treatment (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023). The 2022 National Survey on Drug Use and Health reported high rates of both substance use and serious mental illness, often co‑occurring (SAMHSA, 2023).

Key points from recent federal data (SAMHSA, 2023; NIMH, 2025):

  • SUD commonly co‑occurs with depression, anxiety, and other mental disorders.
  • Co‑occurring conditions worsen medical outcomes and increase healthcare use.
  • Early identification and integrated treatment can improve function, reduce complications, and lower long‑term costs.

Identifying Patients With SUD: Screening and Assessment

Early, routine identification is critical. Primary care teams, NPs, and chiropractic clinics that integrate behavioral health can all play a role (AMA, n.d.; NIDA, n.d.; NIAAA, 2025).

Building a safe, trauma‑informed environment

Before asking about substance use, the team should (AMA, n.d.; NIDA, n.d.):

  • Explain that “we screen everyone” as part of whole‑person care.
  • Emphasize confidentiality within legal limits.
  • Use a calm, nonjudgmental tone and body language.
  • Offer patients the option not to answer any question.
  • Acknowledge that stress, trauma, pain, and life pressures often contribute to substance use.

This aligns with trauma‑informed care principles promoted by SAMHSA and helps patients feel safe enough to share (AMA, n.d.).

Validated screening tools

Evidence‑based tools are preferred over informal questioning. Common options include (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

For adults:

  • AUDIT or AUDIT‑C (Alcohol Use Disorders Identification Test) – screens for unhealthy alcohol use and risk of AUD.
  • DAST‑10 (Drug Abuse Screening Test) – screens for non‑alcohol drug use problems.
  • TAPS Tool (Tobacco, Alcohol, Prescription medication, and other Substances) – combined screen and brief assessment.

For adolescents:

  • CRAFFT 2.1+N – widely used for youth; captures risk behaviors and problems.
  • S2BI (Screening to Brief Intervention) and BSTAD – brief tools validated for ages 12–17 (NIDA, n.d.; AMA, n.d.).

For alcohol‑specific quick screens:

  • AUDIT‑C (3 questions) or full AUDIT
  • NIAAA Single Alcohol Screening Question (SASQ):
    “How many times in the past year have you had 4 (for women) or 5 (for men) or more drinks in a day?” (NIAAA, 2025)

Results guide risk categorization and next steps.

Role of the care team

In integrated practices, roles can be divided (AMA, n.d.):

  • Medical assistants or nurses
    • Administer pre‑screens and full questionnaires.
    • Flag positive or concerning responses.
  • Nurse practitioners / primary care clinicians
    • Review screening results.
    • Deliver brief interventions using motivational interviewing.
    • Conduct or oversee further assessment.
    • Prescribe and manage pharmacotherapy for SUD when indicated.
    • Coordinate referrals and follow‑up.
  • Behavioral health clinicians (on‑site or virtual)
    • Perform biopsychosocial in-depth evaluations.
    • Provide psychotherapy and relapse‑prevention skills.
    • Support motivational enhancement and family engagement.
  • Chiropractors and physical‑medicine providers
    • Screen for substance misuse related to pain, function, and injury patterns.
    • Observe red flags (frequent lost prescriptions, inconsistent pain reports, sedation, falls).
    • Communicate concerns to the NP or primary medical provider.

Dr. Alexander Jimenez, DC, APRN, FNP‑BC, exemplifies this dual role. As both a chiropractor and a family practice NP, he combines neuromusculoskeletal assessment with medical screening and functional medicine evaluation to identify root causes of chronic pain and unhealthy substance use patterns (Jimenez, n.d.).

Clinical clues that may suggest SUD

Beyond formal tools, clinicians should stay alert for patterns such as (AMA, n.d.; NIMH, 2025):

  • Frequent injuries, falls, or motor vehicle accidents
  • Repeated missed appointments or poor adherence to treatment
  • Drowsiness, agitation, slurred speech, or odor of alcohol
  • Unexplained weight loss, infections, or liver abnormalities
  • Social and financial instability, job loss, or legal problems

In chiropractic and musculoskeletal settings, repeated injuries, delayed healing, inconsistent exam findings, or “pain behaviors” that do not match imaging or biomechanics may prompt gentle, supportive screening and medical referral.

Comprehensive Assessment and Risk Stratification

Once a screen is positive, the next level is a more detailed assessment. This should examine substance type, frequency, amount, impact, withdrawal, mental health, physical comorbidities, and function (AMA, n.d.; NIMH, 2025).

Structured assessment tools

Clinicians may use (AMA, n.d.; NIDA, n.d.; NIAAA, 2025):

  • Full AUDIT for alcohol
  • DAST‑10 for general drugs
  • CRAFFT or GAIN for adolescents
  • Checklists based directly on DSM‑5‑TR criteria to rate symptom count and severity (NIAAA, 2025).

These tools allow classification into mild, moderate, or severe SUD and support shared decision‑making regarding level of care.

Co‑occurring mental health conditions

SUD frequently co‑occurs with (NIMH, 2025):

  • Major depressive disorder
  • Anxiety disorders
  • Posttraumatic stress disorder (PTSD)
  • Bipolar disorder
  • Attention‑deficit/hyperactivity disorder

Co‑occurring disorders can:

  • Increased risk for self‑medication with substances
  • Worsen treatment outcomes if not recognized
  • Require integrated treatment plans (NIMH, 2025)

NPs, behavioral health clinicians, and chiropractors with integrative training should maintain a low threshold for mental health screening and referral.

Managing Patients With SUD: A Practical Clinical Process

Effective SUD care is chronic‑disease care: ongoing, team‑based, and tailored to readiness to change (AMA, n.d.; SAMHSA, 2023).

Core elements of management

Key components include (AMA, n.d.; NIDA, n.d.; NIMH, 2025):

  • Routine screening and re‑screening
  • Brief interventions and motivational interviewing
  • Harm‑reduction strategies
  • Medications for certain SUDs (when appropriate)
  • Evidence‑based behavioral therapies
  • Peer and family support
  • Long‑term follow‑up and relapse‑prevention planning

Brief intervention and motivational interviewing

For patients with low to moderate risk, brief intervention can be delivered in 5–15 minutes and often by NPs or primary care clinicians (AMA, n.d.; NIAAA, 2025). Using motivational interviewing, clinicians:

  • Ask open‑ended questions (“What do you enjoy about drinking? What concerns you about it?”)
  • Reflect and summarize the patient’s own statements
  • Ask permission before giving advice
  • Help patients set realistic, patient‑chosen goals (cutting down, abstaining, or seeking treatment)

This approach respects autonomy and builds internal motivation for change.

Determining level of care

The American Society of Addiction Medicine (ASAM) describes a continuum of care (AMA, n.d.; SAMHSA, 2023):

  • Prevention/early intervention
    • Brief interventions in primary care
    • Self‑management support and education
  • Outpatient services
    • Office‑based counseling and medications for AUD or opioid use disorder (OUD)
    • Integrated behavioral health visits
  • Intensive outpatient / partial hospitalization
    • Several therapy sessions per week, day or evening programs
  • Residential/inpatient services
    • 24‑hour structured care for severe or complex cases
  • Medically managed intensive inpatient services
    • Medically supervised detoxification and stabilization

NPs and primary care teams decide the appropriate level based on risk severity, co‑occurring medical and psychiatric conditions, social supports, and patient preference (AMA, n.d.; NIMH, 2025).

Medications for SUD

For some patients, medications support recovery by reducing cravings, blocking rewarding effects, or stabilizing brain function (SAMHSA, 2020; AMA, n.d.; NIAAA, 2025). Examples include:

  • Alcohol use disorder
    • Acamprosate – supports abstinence after detox
    • Disulfiram – creates an unpleasant reaction to alcohol, discouraging use
    • Naltrexone blocks the rewarding effects of alcohol
  • Opioid use disorder
    • Buprenorphine – a partial opioid agonist that reduces cravings and overdose risk; often prescribed in primary care with appropriate DEA registration
    • Methadone – full agonist, dispensed in specialized opioid treatment programs
    • Naltrexone (extended‑release) – opioid antagonist that prevents relapse after detox
  • Overdose prevention
    • Naloxone – rapid opioid‑overdose reversal, recommended for anyone at risk (AMA, n.d.).

NPs managing patients with SUD work within state scope‑of‑practice rules and in collaboration with addiction specialists where needed.

Behavioral therapies and peer support

Evidence‑based therapies include (AMA, n.d.; NIDA, n.d.):

  • Cognitive behavioral therapy (CBT)
  • Dialectical behavior therapy (DBT)
  • Motivational enhancement therapy
  • The Matrix Model (especially for stimulants)
  • Family‑based therapy for adolescents

Peer support groups (Alcoholics Anonymous, Narcotics Anonymous, SMART Recovery) can reinforce coping skills, hope, and accountability.

Long‑term follow‑up

SUD is chronic; relapse risk can persist for years. Best practice includes (AMA, n.d.; NIMH, 2025):

  • Follow‑up within 2 weeks after treatment initiation
  • Monthly to quarterly visits as patients stabilize
  • Peer support and care management between visits
  • Rapid re‑engagement after any relapse or lapse

NASW, NIDA, and NIMH stress that relapse should be treated as a signal to adjust care—not as failure (NIDA, n.d.; NIMH, 2025).

How SUD Affects the Body and the Musculoskeletal System

SUD impacts nearly every organ system. Many effects directly or indirectly worsen neuromusculoskeletal health and pain.

General systemic effects

Common systemic consequences include (NIDA, n.d.; NIMH, 2025; SAMHSA, 2023):

  • Cardiovascular disease and hypertension
  • Liver disease and pancreatitis (especially with alcohol)
  • Respiratory disease (especially with tobacco and some drugs)
  • Endocrine and hormonal disruption
  • Immune dysfunction and higher infection risk
  • Sleep disturbances and fatigue
  • Worsening of mood, anxiety, and cognitive function

These changes affect healing capacity, resilience, and the way patients perceive pain.

Musculoskeletal and pain‑related effects

Substance use and SUD can influence the musculoskeletal system through several pathways:

  • Increased injury risk
    • Impaired judgment, coordination, and reaction time increase the risk of falls, motor vehicle accidents, and sports injuries.
    • Heavy alcohol use is associated with fractures, soft tissue injuries, and delayed healing (AMA, n.d.; SAMHSA, 2023).
  • Bone, joint, and muscle changes
    • Alcohol and some drugs can impair bone density and quality, increasing osteoporosis and fracture risk.
    • Nutritional deficiencies associated with SUDs weaken connective tissue and muscle function.
    • Sedentary behavior and deconditioning are common in people with long‑standing SUD.
  • Chronic pain and central sensitization
    • Chronic alcohol or opioid use can alter pain pathways in the central nervous system, raising pain sensitivity.
    • Opioid‑induced hyperalgesia can make pain seem worse even at stable or increasing doses.
  • Functional and ergonomic stress
    • Disrupted sleep, poor posture, and prolonged sitting or immobility (for example, in recovery environments or during unemployment) can lead to spinal stress, neck and low back pain, and muscle imbalance.

Clinically, Dr. Jimenez and similar integrative providers often see patients with combined profiles: chronic low back or neck pain, sedentary work, ergonomic strain, poor sleep, high stress, and escalating reliance on medications, including opioids or sedatives. Addressing both the mechanical and behavioral contributors can change the trajectory of pain and SUD risk (Jimenez, n.d.).

Integrative Chiropractic Care in the Context of SUD

Philosophy of integrative chiropractic care

Integrative chiropractic care focuses on restoring alignment, mobility, and neuromuscular control while considering lifestyle, nutrition, sleep, and emotional stress. In the model used by Dr. Jimenez, chiropractic adjustments are combined with functional medicine strategies, targeted exercise, and collaborative medical care (Jimenez, n.d.).

For patients with or at risk of SUD, this approach offers:

  • Non‑pharmacologic pain management
  • Improved movement, posture, and ergonomics
  • Education that empowers patients to self‑manage pain
  • Reduced reliance on habit‑forming medications

Spinal adjustments and targeted exercises

Spinal and extremity adjustments aim to:

  • Restore joint mobility
  • Reduce mechanical irritation of nerves and soft tissues
  • Improve segmental alignment and overall posture

Targeted exercises are prescribed to:

  • Strengthen deep stabilizing muscles (core, gluteal, cervical stabilizers)
  • Correct muscle imbalances and faulty patterns
  • Increase flexibility and joint range of motion
  • Enhance proprioception, balance, and movement control

Examples of targeted exercise strategies often used in integrative chiropractic and rehab clinics include (Jimenez, n.d.):

  • Lumbar stabilization and core‑strengthening sequences
  • Hip mobility and glute activation drills for low back and sciatica‑like pain
  • Cervical and scapular stabilization for neck and shoulder pain
  • Postural retraining, including ergonomic break routines for prolonged sitting

By reducing biomechanical stress and enhancing functional capacity, these interventions may decrease pain intensity, frequency, and flare‑ups, which in turn can lower the drive to self‑medicate with substances.

Reducing overlapping risk profiles

Many risk factors for SUD and for chronic musculoskeletal pain overlap, including (NIMH, 2025; NIDA, n.d.; Jimenez, n.d.):

  • Chronic stress and trauma
  • Poor sleep and circadian disruption
  • Sedentary lifestyle and obesity
  • Repetitive strain and poor ergonomics
  • Social isolation and low self‑efficacy

Integrative chiropractic care can help shift these shared risk profiles by:

  • Encouraging regular physical activity and graded movement
  • Coaching ergonomic and postural strategies at work and home
  • Teaching breathing, stretching, and relaxation routines that reduce muscle tension and sympathetic overdrive
  • Collaborating with NPs and behavioral health clinicians to align interventions with mental health and SUD treatment plans

In Dr. Jimenez’s practice, this often includes structured flexibility, mobility, and agility programs that are adapted to age and functional status, with close monitoring to avoid over‑reliance on medications, including opioids and sedatives (Jimenez, n.d.).

The Nurse Practitioner’s Role in Comprehensive SUD and Musculoskeletal Care

NPs are well-positioned to coordinate SUD care and integrate it with musculoskeletal and chiropractic treatment.

Comprehensive medical management

NP responsibilities typically include (AMA, n.d.; NIMH, 2025; NIAAA, 2025):

  • Conducting and interpreting SUD screening and risk stratification
  • Performing physical exams and ordering labs or imaging
  • Diagnosing SUD and co‑occurring conditions
  • Prescribing non‑addictive pain strategies and medications where indicated
  • Managing or co‑managing medications for AUD or OUD (per training and regulations)
  • Monitoring for drug–drug and drug–disease interactions
  • Coordinating with behavioral health and community resources

In integrative settings like Dr. Jimenez’s clinic, the NP role is blended with functional medicine principles, looking at nutrition, metabolic health, hormonal balance, and inflammation that influence both pain and SUD risk (Jimenez, n.d.).

Ergonomic and lifestyle counseling

NPs also provide individualized counseling on:

  • Workplace ergonomics (desk height, chair support, screen position)
  • Safe lifting strategies and body mechanics
  • Activity pacing and graded return to work or sport
  • Sleep hygiene and circadian rhythm support
  • Nutrition strategies that support musculoskeletal healing and brain health

These interventions lower the mechanical load on the spine and joints, reduce fatigue, and increase a patient’s sense of control—all of which help reduce triggers for substance use and relapse.

Care coordination and team communication

NPs often serve as the central coordinator who (AMA, n.d.; NIMH, 2025):

  • Ensures all team members (chiropractor, physical therapist, behavioral health, addiction medicine, primary care, or specialty providers) share a coherent plan
  • Tracks progress on pain, function, substance use, mood, and quality of life
  • Adjusts the plan as conditions change
  • Supports families and caregivers in understanding both SUD and musculoskeletal needs

In a model like Dr. Jimenez’s, this may involve regular case conferences, shared EHR notes, and integrated treatment plans that align spinal rehabilitation with SUD recovery goals (Jimenez, n.d.).

Understanding Long Lasting Injuries- Video

Practical Clinical Pathway: From First Contact to Long‑Term Recovery

For clinics that combine chiropractic and NP services, a practical, stepwise pathway for patients with possible SUD and musculoskeletal complaints can look like this (AMA, n.d.; NIDA, n.d.; NIAAA, 2025; NIMH, 2025; Jimenez, n.d.):

Step 1: Initial visit and global screening

  • Intake includes questions on pain, function, injuries, sleep, mood, and substance use.
  • Staff administer brief tools (for example, AUDIT‑C and DAST‑10 for adults, CRAFFT for adolescents).
  • The chiropractor documents neuromusculoskeletal findings; the NP reviews medical and behavioral health risks.

Step 2: Identification of SUD risk

  • Negative or low‑risk screens → brief positive health message and reinforcement of low‑risk behavior.
  • Moderate risk → NP provides brief intervention, motivational interviewing, and a follow‑up plan.
  • Substantial or severe risk → NP initiates comprehensive assessment, safety planning, and possible referral to specialized services.

Step 3: Integrated treatment planning

The team crafts a unified plan that may include:

  • Spinal adjustments and targeted exercises to correct alignment and biomechanics
  • Gradual increase in physical activity with pain‑sensitive pacing
  • Non‑pharmacologic pain strategies (manual therapy, exercise therapy, education)
  • Behavioral health referral for CBT, trauma‑informed treatment, or other modalities
  • Consideration of medications for AUD or OUD, if indicated
  • Harm‑reduction measures (for example, naloxone prescription for those at overdose risk)

Step 4: Ergonomics and lifestyle

  • NP and chiropractor jointly review workplace and home ergonomics, posture, and activity patterns.
  • Patients learn micro‑break routines, stretching, and strengthening sequences for high‑risk tasks (for example, lifting or prolonged sitting).
  • Nutrition, stress‑management, and sleep interventions are introduced or refined.

Step 5: Monitoring and long‑term follow‑up

  • Regular follow‑up visits evaluate:
    • Pain levels and functional capacity
    • Substance use patterns and cravings
    • Mood, sleep, and quality of life
    • Adherence to exercise and ergonomic plans
  • The team updates the treatment plan to respond to progress, setbacks, or new diagnoses.
  • Patients are coached to view flare-ups or lapses as opportunities to learn and adjust, not as failures.

This kind of coordinated, integrative approach can reduce repeated injuries, unnecessary imaging or surgeries, and long‑term dependence on medications, including opioids.

Clinical Insights from an Integrative Practice Model

Although each practice is unique, Dr. Alexander Jimenez’s clinic illustrates several principles that can guide others (Jimenez, n.d.):

  • Whole‑person assessment: History taking includes injuries, lifestyle, trauma, nutrition, environment, and psychosocial stressors.
  • Functional movement focus: Care plans emphasize flexibility, mobility, agility, and strength to restore capacity rather than just relieve symptoms.
  • Non‑invasive first: Chiropractic adjustments, functional exercise, and lifestyle interventions are prioritized before invasive procedures or long‑term controlled substances.
  • Integrated roles: As both DC and FNP‑BC, Dr. Jimenez unifies neuromusculoskeletal, primary care, and functional medicine perspectives in a single, coordinated plan.
  • Patient empowerment: Education, coaching, and accessible care options help patients take a proactive role in maintaining spinal health and reducing SUD risk.

This model aligns with national guidance on behavioral health integration and SUD management in medical settings while adding the musculoskeletal and ergonomic expertise of chiropractic care (AMA, n.d.; NIDA, n.d.; NIMH, 2025).

Key Takeaways

  • SUD is a chronic, treatable medical condition that often co‑occurs with mental disorders and chronic pain.
  • Validated screening tools and non‑stigmatizing, trauma‑informed communication are core to early identification.
  • Risk and severity categories (mild, moderate, severe) guide brief intervention, level of care, and referral decisions.
  • SUD significantly affects the body, including bone health, soft tissue integrity, injury risk, and chronic pain pathways.
  • Integrative chiropractic care—with spinal adjustments, targeted exercises, and ergonomic guidance—can reduce pain, improve function, and lower overlapping risk factors for SUD.
  • Nurse practitioners provide comprehensive SUD management, coordinate care, and deliver ergonomic and lifestyle counseling that complements chiropractic treatment.
  • A collaborative, long‑term, patient‑centered model—such as the one exemplified by Dr. Alexander Jimenez—offers a promising pathway to healthier spines, healthier brains, and healthier lives.

Conclusion

Compassion, evidence-based screening, and multidisciplinary care coordination are necessary for substance use disorder, a complicated medical illness. Understanding what SUD is, how to recognize it, and how to respond with respect and evidence-based interventions are the first steps towards enabling healthcare professionals—whether they are primary care physicians, chiropractors, nurse practitioners, or behavioral health specialists—to identify and support patients with SUD.

For patients dealing with both chronic pain and drug abuse, the combination of chiropractic therapy with nurse practitioner-led primary care provides a unique benefit. Patients may not disclose that they are also struggling with alcoholism, prescription opioid abuse, or amphetamine use when they arrive with a job injury, car accident, or years of bad ergonomics. However, these difficulties often coexist. The burden of poor healing, muscular atrophy, elevated pain sensitivity, and increased fracture risk falls on the musculoskeletal system. Both the intellect and the nerve system are impacted, and the cycle of pain and drug abuse is exacerbated by sleep disturbance, mood swings, and a diminished ability to handle stress.

This loop may be broken by clinics and practices that include screening, short intervention, and coordinated therapy. Mechanical function is restored via spinal modifications. Strength and proprioception are restored via targeted activities. Re-injury may be avoided with ergonomic coaching. Nurse practitioners help with medication coordination, drug interaction monitoring, and lifestyle counseling to promote healthy spines and SUD recovery. Counselors in behavioral health provide peer support, treatment, and relapse prevention. This team works together to address the underlying issues rather than simply the symptoms.

A single physician with dual expertise—chiropractic and family practice nurse practitioner credentials—can skillfully weave these threads into a cohesive, patient-centered strategy, as shown by the clinical paradigm typified by Dr. Alexander Jimenez. Continuity, goal alignment, and a clinician who is knowledgeable about the neurology of addiction as well as the biomechanics of a herniated disc are all advantageous to patients. With intentional team communication, collaborative decision-making, and a dedication to non-stigmatizing, trauma-informed treatment, larger practices may get comparable outcomes.

There is no doubt that early detection improves results and saves lives. Tools for validated screening are accurate and fast. Brief interventions and motivational interviews are effective. When used carefully, medications for alcohol and opioid use disorders are both safe and effective. Exercise, physical therapy, stress management, and social support are all effective but underused non-pharmacologic methods. Additionally, patients recover more quickly, resume their normal activities sooner, and are far less likely to relapse into drug abuse when musculoskeletal and behavioral health treatment are integrated.

Patients who regain their health, relationships, and sense of purpose are the ultimate reward for healthcare teams that are prepared to go beyond isolated complaints—beyond “just” back pain or “just” worry. This is what integrative, team-based, evidence-based treatment for musculoskeletal disorders and drug use disorders promises.

References