# Substance Use & Dependence > Dependence is when the substance stops being a choice you make and becomes a schedule you keep. Care at that stage is medical, structured and unashamed, and it works best when the depression or anxiety underneath is treated in the same room. **Source:** https://www.uniquembhs.com/treatment-for-substance-abuse-and-dependence **Practice:** Unique Minds Behavioral Health Services, LLC. Baltimore, MD: 6810 Park Heights Ave, Suite C6, Baltimore, MD 21215 · Washington, DC: 1402 North Capitol St NW, #1, Washington, DC 20002 · Delaware, OH: 1 W Winter St, Suite 211, Delaware, OH 43015 **Phone:** (443) 538-8400 **Clinically reviewed by:** Dr. Victorine (Vicky) Ngang, DNP, APRN, PMHNP-BC, MSN, RN **Last reviewed:** 2026-08-11 ## Quick answer When substance use has become dependence (withdrawal, failed attempts to stop, a life organised around using) treatment needs more than willpower. Unique Minds provides outpatient psychiatric care for substance dependence and co-occurring mental health conditions across Maryland, Washington, D.C. and Ohio, with therapy, medication support, and referral for medical detox where safety requires it. ## When use becomes dependence Dependence has a clinical shape: tolerance rising, withdrawal when stopping, attempts to quit that do not hold, and a day increasingly organised around the substance. By this stage willpower is the wrong tool for the job, not because character failed, but because the brain's reward and stress systems have been recruited. [MedlinePlus](https://medlineplus.gov/dualdiagnosis.html) notes how often this arrives paired with another mental health condition; roughly half of people with a substance use disorder will experience one, and each untreated half sabotages the other's treatment. That pairing (dependence plus depression, anxiety, PTSD or bipolar disorder) is the specific territory of this page, and of our care. ## The signs, in three groups A substance use disorder is assessed against criteria that fall into three families. You do not need all of them, and severity is graded by how many apply. **Loss of control** - Using more, or for longer, than you intended. - Wanting to cut down or stop, and repeatedly not managing it. - A great deal of time spent obtaining, using, or recovering. - Craving. An urge strong enough to crowd out other thinking. **Consequences you can name and use anyway** - Obligations at work, school or home going unmet. - Continuing despite arguments, damaged relationships or lost trust. - Interests, activities and people dropped to make room. - Using in situations where it is physically hazardous, driving being the obvious one. - Continuing despite a physical or mental health problem that it is clearly making worse. **Physical adaptation** - **Tolerance**: needing noticeably more for the same effect. - **Withdrawal**: feeling physically unwell when the substance leaves, and using to relieve it. Two things to note. Tolerance and withdrawal alone are not the disorder; they occur with correctly taken prescribed medication too. And the disorder is graded (mild, moderate, severe) which matters practically, because it points at how much structure the treatment needs rather than at how bad a person you are. ## How it is diagnosed, and what the evaluation covers The [psychiatric evaluation](/psychiatry-practices/psychiatric-evaluation) works through four things: - **The substance history**, asked plainly: what, how much, how often, by what route, since when, and what happens when you stop. Honesty here is not confession, it is the input the plan is built from, and an under-reported amount produces an unsafe plan. - **The safety question.** Which withdrawals are dangerous, whether medically supervised withdrawal is needed before anything else, and whether overdose risk is present. - **The mental health picture underneath.** Depression, anxiety, PTSD, bipolar disorder and ADHD are all common here, and it is often impossible to tell at first whether a symptom is causing the use, caused by it, or both, which is why integrated treatment beats sequencing. - **What has been tried**, including what worked for a while. Previous attempts are not failures on a record; they are the most useful data anybody brings to a first appointment. ## Why willpower is the wrong tool Repeated use changes the systems that handle reward, motivation and stress. Reward tips toward the substance and away from everything that used to supply it; stress-response systems become more reactive, so ordinary difficulty hits harder; and the parts of the brain that weigh consequences work least well exactly when craving is loudest. The practical consequences are worth stating because they contradict what most people are told. Relapse is a feature of the condition's course rather than proof of insincerity. Craving passing in waves is expected rather than a sign the treatment is failing. And treating the depression, trauma or anxiety underneath is not a distraction from the substance work. It is frequently the part that makes it hold. ## How treatment works here The [psychiatric evaluation](/psychiatry-practices/psychiatric-evaluation) maps three things honestly: the substance picture (what, how much, what happens when you stop), the mental health picture underneath, and the safety question, because for some dependencies, medically supervised withdrawal comes first, and we will say so and help arrange it rather than improvise around it. From there, integrated outpatient care: [medication management](/psychiatry-practices/medication-management) for both sides of a dual diagnosis where evidence supports it, [therapy](/therapy-services/individual-therapy) for the patterns and the pain the using was managing, and structure matched to the season. Weekly appointments when steady, more frequent ones and [group therapy](/therapy-services/group-therapy) when the week needs scaffolding, and a straight referral onward when it needs a frame we cannot build. Stepping up is not failure and stepping down is not graduation; both are just fit. ## When to reach out If stopping keeps not holding, or you have never dared find out whether it would, come as you are, including still using. That is not a disqualification; it is the normal starting state of everyone who ever started. The evaluation is confidential, unshocked and concrete about next steps. ## What it can look like - Needing more for the same effect, and feeling it when you stop. - Stops and cutbacks that keep not holding. - The day quietly organised around obtaining, using and recovering. - Continuing despite consequences you can name out loud. - Using alone, earlier, or in amounts you hide. - A mood problem underneath: drinking the anxiety quiet, using the dark away. - Interests, people and plans quietly dropped to make room. - Shame doing the talking whenever help comes up. ## How we treat it - [Psychiatric Evaluation](https://www.uniquembhs.com/psychiatry-practices/psychiatric-evaluation) - [Medication Management](https://www.uniquembhs.com/psychiatry-practices/medication-management) - [Group Therapy](https://www.uniquembhs.com/therapy-services/group-therapy) ## Frequently asked questions ### What is dual diagnosis, and why does it change treatment? Dual diagnosis means a substance use disorder occurring alongside another mental health condition: depression, anxiety, PTSD, bipolar disorder. It changes treatment because the two feed each other: the untreated condition drives relapse, and the substance blocks the condition's treatment. The evidence-based answer is integrated care, both treated by one team with one plan, which is what we do. ### Do I need detox before starting with you? It depends on the substance and the level of physical dependence. Stopping alcohol or benzodiazepines abruptly can be genuinely dangerous, and that safety call is part of your evaluation, not a guess you have to make alone. Where medically supervised withdrawal is needed first, we say so plainly, help you arrange it, and are the care you land in afterwards. ### Is medication used in treating dependence? Where the evidence supports it, yes. Medication has an established role in treating some dependencies and in steadying the mood and anxiety conditions underneath. What we prescribe, and what we refer out for, is decided at evaluation and explained plainly. No single tool is the plan; the plan is the plan. ### I've relapsed before. Why would this time be different? Because relapse is part of this illness's course, not proof against you. Most people who reach stable recovery have prior attempts in the rearview. What changes outcomes is treating the co-occurring conditions, matching the structure to the season (more frequent sessions, or a referral onward when that is what safety needs), and a team that treats a slip as information rather than failure. ### How is a substance use disorder diagnosed? By clinical assessment against a recognised set of criteria covering loss of control, continued use despite harm, and physical adaptation. In practice your provider asks what you use, how much, how often, what happens when you stop, what you have already tried, and what it has cost you. Severity is graded from mild to severe by how many of those criteria fit, which is useful, because it points at the level of care rather than at a verdict. ### Which withdrawals are actually dangerous? Alcohol and benzodiazepines are the two where stopping abruptly can be medically dangerous (seizures and, rarely, life-threatening complications), and they should never be quit cold without medical advice. Opioid withdrawal is intensely unpleasant but not usually dangerous in itself, though the loss of tolerance afterwards makes overdose more likely if someone returns to a previous dose. Your evaluation makes this safety call; it is not one to make alone. ## Sources - Substance Use and Co-Occurring Mental Disorders. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health - Dual Diagnosis. MedlinePlus, U.S. National Library of Medicine. https://medlineplus.gov/dualdiagnosis.html ## Related pages - [Substance Use, Adults & Children](https://www.uniquembhs.com/substance-abuse-treatment-adults-children) - [Depression](https://www.uniquembhs.com/depression-treatment) - [Trauma & PTSD](https://www.uniquembhs.com/trauma-ptsd-treatment) --- This page is general health information, not medical advice. In a crisis, call or text 988 (988 Suicide & Crisis Lifeline) any hour, or call 911 in an emergency.