This article is part of Medication-Assisted Treatment & Harm Reduction Psychiatry, a series examining how PMHNPs use evidence-based medications and harm reduction principles to support long-term recovery.
A PMHNP’s Role in Treating Addiction: What Comprehensive Care Actually Looks Like
This article is part of The PMHNP Guide to Addiction Psychiatry, a clinical education series exploring how Psychiatric Mental Health Nurse Practitioners assess, diagnose, and treat substance use disorders using evidence-based, trauma-informed care.
When people picture addiction treatment, they often imagine rehab, detox centers, or therapy. What many don’t realize is that Psychiatric Mental Health Nurse Practitioners (PMHNPs) play one of the most crucial roles in the entire process.
PMHNPs sit at the intersection of:
- medicine
- psychotherapy
- neuroscience
- trauma-informed care
- harm reduction
- patient advocacy
In addiction care, PMHNPs are uniquely trained to treat both substance use disorders (SUD) and co-occurring mental health conditions — which appear together in over 60–75% of cases.
Here’s what addiction treatment looks like through a PMHNP’s lens.
Understanding Addiction as a Chronic Brain Disease
As PMHNPs, we don’t view addiction as “bad behavior” or a lack of willpower.
NIDA – Addiction as a Brain Disease
We understand it as:
- a chronic, progressive illness
- driven by brain changes
- influenced by trauma
- reinforced by emotional pain
- worsened by unmanaged psychiatric symptoms
A PMHNP assesses every patient through three major lenses:
- Neurobiology
- Psychiatric comorbidity
- Environmental and relational factors
This creates a 360° clinical understanding — not just of the addiction, but of the human being behind it.
What Patients Often Tell PMHNPs
- “I feel like my brain doesn’t work anymore.”
- “I’m exhausted of wanting to quit but not being able to.”
- “My anxiety is ruining my sobriety.”
- “My trauma triggers are too strong.”
- “I don’t have coping skills.”
- “I don’t want to disappoint everyone.”
PMHNPs address the root causes — not just the symptoms.
Why PMHNPs Are Uniquely Positioned in Addiction Recovery
Because PMHNPs:
- diagnose psychiatric disorders
- prescribe medication
- provide therapy
- understand trauma
- understand the brain
- treat the whole person
This combination is rare and incredibly powerful in SUD treatment.
The PMHNP Initial Addiction Psychiatric Assessment
A PMHNP’s evaluation is far deeper than a standard intake.
✓ Substance use history
- onset
- progression
- tolerance
- withdrawal
- attempts to quit
- triggers
- patterns
- route of administration
✓ Mental health conditions
We screen for:
- PTSD
- ADHD
- bipolar disorder
- depression
- anxiety
- personality disorders
These conditions dramatically change treatment plans.
✓ Trauma history
We assess nervous system responses, dissociation patterns, and trauma-related coping.
✓ Medical status
Addiction often causes:
- liver disease
- heart complications
- sleep disorders
- GI issues
- hormonal changes
✓ Safety and risk
We evaluate:
- overdose risk
- self-harm
- psychosis
- withdrawal severity
- environmental safety
✓ Motivation and readiness for change
No two patients start in the same place.
We tailor treatment to the stage they’re actually in.
APA – Integrated Treatment Models
Reach out today for more information
Treatment from a PMHNP Perspective: Beyond Prescribing
PMHNPs provide a mix of:
including:
- Suboxone / buprenorphine
- Naltrexone (oral or Vivitrol)
- Disulfiram (cautious, selective use)
- Gabapentin (for anxiety/withdrawal support)
- Benzodiazepines for acute withdrawal only
- SSRIs/SNRIs
- Mood stabilizers
- Sleep medications
- ADHD treatment (carefully diagnosed and monitored)
2. Psychotherapy
PMHNPs are trained therapists who can provide:
- CBT for addiction
- DBT skills for distress tolerance
- Motivational interviewing
- Trauma-informed therapy
- Psychoeducation
3. Harm reduction
We don’t wait for perfection.
We meet patients where they are:
- safer use plans
- overdose prevention (Narcan)
- cutting down vs. immediate cessation
- stabilizing sleep and nutrition
- reducing risky triggers
CDC – Overdose & Harm Reduction
4. Medical monitoring
Lab work, vitals, organ damage monitoring, and coordination with PCPs.
5. Coordination of care
We collaborate with:
- family supports
- therapists
- IOP/PHP programs
- case management
- social workers
- rehab centers
A: PMHNPs provide comprehensive care that includes diagnosis, medication management, therapy, trauma-informed treatment, and coordination of care for substance use disorders.
A: Yes. PMHNPs are trained to treat dual diagnosis conditions such as addiction with depression, anxiety, PTSD, ADHD, and bipolar disorder.
A: Yes. PMHNPs can prescribe buprenorphine, naltrexone, and other evidence-based medications as part of medication-assisted treatment.
A: No. Comprehensive addiction care addresses brain chemistry, trauma, psychiatric symptoms, safety, and long-term recovery support.
Leave a Reply