Alcohol 

Many people wonder when drinking crosses the line into a problem. Dr. Felgus uses a plain-language continuum (from “no problem” through “use, abuse, dependence”) to help patients see where they are today and what next step fits.

Common signs that deserve a closer look

• Drinking more or more often than planned; needing alcohol to relax/sleep
• Blackouts, injuries, DUIs, or relationship/job strain
• “Rules” around drinking that are getting harder to keep
• Loved ones expressing concern

Treatment approach

• Education & monitoring: Understand patterns; set small, realistic experiments (e.g., alcohol-free days, tracking).
• Address the drivers: Anxiety, low mood, trauma, insomnia, social stressors.
  Medication when wanted/indicated: Options to reduce cravings or the “pull” to drink, always within a larger plan.
• Support that fits the person: 12-Step, non-12-Step, therapy, skills training, or a mix.

What to expect

• A respectful conversation (no lectures) and a plan matched to goals – cutting back or stopping – without one-size-fits-all rules.

Cannabis

Yes, dependence on cannabis can occur. Daily or near-daily use, difficulty cutting down, or using to cope with anxiety, sleep, motivation, or focus may signal a problem.

What we evaluate

• Frequency, potency, delivery (flower, vape, edibles), and withdrawal symptoms (irritability, sleep issues)
• Impact on concentration, motivation, and energy; in teens/young adults, effects on learning and development
• Whether cannabis has become the only way to manage anxiety, sleep, or mood

Treatment approach

• Respectful evaluation: No shaming; align recommendations with what the patient wants (reduce, pause, or stop).
• Skill-building & supports: Alternatives for sleep/anxiety; routines that make change easier.
• Mental-health care: Treat co-occurring anxiety, depression, OCD, or insomnia so cannabis isn’t carrying the whole load.
• Medication when appropriate: Short-term aids (for sleep/anxiety) only if they genuinely help progress.

What to expect

Clear steps that make experimenting with change doable, plus follow-up to adjust.

Opioids (pain pills, heroin, fentanyl)

No one plans to develop an opioid problem. Genetics, life stress, and early exposure can all play a role. Short-term daily use can cause withdrawal when stopping; some people then keep using simply to feel “normal.”

What we evaluate

• Type and amount of opioids, prior attempts to stop, withdrawal history
• Co-occurring pain, anxiety, depression, trauma, or insomnia
• Safety risks (overdose, mixing with benzodiazepines/alcohol)
• Readiness for Medication-Assisted Treatment (MAT) and supports at home/work

Treatment approach

• Stabilize first: If indicated, start MAT (often buprenorphine/Suboxone®) to stop withdrawal/cravings and reduce overdose risk.
• Right-sized dosing: Lowest effective dose that supports stability and life function.
• Whole-person plan: Sleep, anxiety/depression treatment, pain strategies, skills training.
• Tapering when appropriate: For some, a gradual, supported taper becomes possible, timed to readiness and stability.

What to expect

• A non-judgmental, safety-first plan; regular check-ins; education for loved ones if desired.

Suboxone & tapering

Suboxone (buprenorphine) can be life-saving and reduces overdose risk. Starting typically requires being off other opioids long enough to avoid precipitated withdrawal. Experts differ on how long to remain on Suboxone; the right timeline depends on the person.

Dr. Felgus’s approach

• Stabilize on the lowest effective dose to support safety and daily function
• Strengthen the foundations of wellness (sleep, mood, anxiety, supports)
• Consider tapering when timing, readiness, and stability align
• Never rushed, never one-size-fits-all

Other drugs (stimulants, benzodiazepines, hallucinogens, kratom)

From stimulants (Adderall, cocaine, meth) to sedatives (Xanax, Valium, Ambien) and hallucinogens/MDMA, patterns can shift from occasional to problematic.

What we evaluate

• Frequency, intensity, and context of use (work/school impact, sleep, mood)
• Underlying drivers (attention issues, anxiety, trauma, insomnia)
• Medication interactions and safety risks (e.g., mixing sedatives and alcohol)

Treatment approach

• Open, honest assessment without shame; clear risks and options
• Skill-first strategies for focus, anxiety, and sleep; therapy supports as needed
• Medication decisions anchored in safety (e.g., stimulant prescribing only with appropriate psychological testing)
• Harm-reduction education where helpful, with a pathway toward stability

What to expect

• Straight talk, realistic steps, and a plan that respects individual differences.

Medications for Mental Health (dual diagnosis)

Most of Dr. Felgus’ patients are dual diagnosis; substance use with mental-health concerns. Treating both together improves outcomes.

Conditions treated

• Anxiety (generalized, social, panic) · Depression/mood disorders · Obsessive-Compulsive Disorder · Insomnia
• Mild psychosis (select cases with careful coordination)

Approach

• Careful prescribing: The least-pill philosophy: use medication when it helps, not as the only tool.
• Skills & therapy supports: Cognitive/behavioral tools, sleep routines, stress reduction.
• ADHD policy: Stimulant prescribing is considered only with appropriate neuropsychological testing and documentation; alternatives discussed when stimulants are not indicated.
• Educational evaluations without medication are available for patients who want clarity without starting meds.

What to expect

• Clear explanations, collaborative decisions, and follow-up geared to how life is actually going, not just symptom scores.