An Overview of Integrative Chiropractic Care & SUD Treatment

Enhance your recovery journey with SUD treatment and integrative chiropractic care focused on holistic wellness solutions.

Abstract

In this educational post, I discuss how thoughtful, evidence-based care transitions can improve outcomes for individuals living with substance use disorders SUDs, especially after hospitalization, incarceration, pregnancy, childbirth, and adolescent exposure to high-risk substances. I review why continuity of care, bridge prescriptions, co-located services, telehealth, care navigation, harm reduction, and medications for opioid use disorder MOUD are essential clinical tools. I also explain how pregnant and postpartum patients, justice-involved individuals, and adolescents require specialized, compassionate, and nonjudgmental support.

As Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, I also describe how these ideas fit into an integrative chiropractic and functional medicine model. At Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic, in El Paso, Texas, I work within a multidisciplinary framework supported by medical oversight from Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine, NPI #1164426749, Texas MD License #J2933. Dr. Cardenas has more than 40 years of experience as an internist and serves as the Medical Director and Collaborative Physician for our practice. Together, our model integrates chiropractic care, medical direction, functional medicine, personal injury care, rehabilitation, case coordination, and patient-centered recovery support.

This post presents current research and clinical reasoning on care transitions, MOUD, pregnancy-related substance use, adolescent risk, justice involvement, genetic testing, and emerging therapies such as GLP-1 receptor agonists. My goal is to make the science understandable, practical, and clinically meaningful for patients, families, and healthcare professionals.

A Patient-Centered Approach to Substance Use Disorder Care Transitions

When I care for patients with substance use disorders, I focus on one central principle: recovery is most successful when care is continuous, accessible, compassionate, and coordinated.

A patient may receive excellent care in the hospital, emergency department, rehabilitation setting, or specialty clinic. Still, if that care does not continue after discharge, the patient may be left vulnerable. This is especially true for individuals with opioid use disorder OUD, because the period after hospitalization, incarceration, childbirth, or a major life transition can carry a high risk of relapse, overdose, withdrawal, isolation, and disengagement from treatment.

From a clinical standpoint, I see care transitions as one of the most important phases of recovery. Starting treatment is not enough. We must build a bridge from one setting to the next.

That bridge may include:

• Continuity with the same provider
• Bridge prescriptions for medications
• Warm handoffs to community clinicians
• Telehealth options
• Co-located behavioral health and medical services
• Care navigators
• Transportation resources
• Social support
• Peer recovery support
• Family education
• Naloxone distribution
• Integrated rehabilitation and functional medicine support

The research increasingly supports this model. Studies on MOUD, especially buprenorphine and methadone, show that these therapies reduce overdose deaths, improve treatment retention, and stabilize neurobiological pathways involved in opioid dependence (National Academies of Sciences, Engineering, and Medicine, 2019; Wakeman et al., 2020).

In an integrative clinic, I view this not as a single-service issue but as a whole-person care challenge. The body, brain, nervous system, musculoskeletal system, endocrine system, immune system, sleep patterns, pain pathways, stress biology, nutrition, and social environment all influence recovery.

How Continuity of Providers Improves Recovery After Hospital Discharge

One of the most useful strategies in substance use disorder care is maintaining continuity between acute care and community care.

For example, if a provider sees a patient in the hospital and starts buprenorphine, that same provider or team can ideally see the patient again in a bridge clinic after discharge. This matters because trust has already begun. The patient does not have to retell the entire story to a new clinician. The clinician already understands the patient’s risks, fears, withdrawal symptoms, pain history, social barriers, and treatment goals.

In my clinical experience, patients are more likely to remain engaged when they feel seen and respected. A familiar provider can reduce anxiety and improve follow-through.

Why Provider Continuity Matters Physiologically and Behaviorally

Substance use disorder is not simply a matter of willpower. It involves changes in:

• Dopamine signaling
• Reward prediction
• Stress reactivity
• Pain modulation
• Prefrontal cortex decision-making
• Amygdala-driven threat responses
• Autonomic nervous system balance
• Sleep and circadian regulation
• Withdrawal physiology
• Craving pathways

When a patient is discharged from the hospital, the brain and body may still be unstable. The patient may have cravings, pain, anxiety, insomnia, gastrointestinal distress, autonomic symptoms, and fear. A trusted provider helps regulate the care experience by reducing uncertainty and increasing the likelihood that the patient will continue treatment.

A therapeutic relationship can function as a stabilizing clinical anchor.

Bridge Prescriptions for Medications for Substance Use Disorders

When patients leave the hospital after starting treatment for OUD, they should generally receive a bridge prescription that lasts long enough for them to connect with outpatient care.

For instance, if a patient starts buprenorphine during hospitalization, best practice is often to provide at least a short-term prescription at discharge. This gives the patient time to attend a follow-up visit without interruption in medication.

Without this bridge, the patient may experience:

• Withdrawal
• Cravings
• Return to illicit opioid use
• Exposure to fentanyl-contaminated substances
• Emergency department visits
• Overdose risk
• Loss of trust in the healthcare system

Why Bridge Prescriptions Are Clinically Important

Buprenorphine is a partial opioid agonist. It binds strongly to mu-opioid receptors and helps reduce withdrawal and cravings while having a ceiling effect on respiratory depression compared with full opioid agonists. This pharmacology makes it highly useful for OUD treatment (Substance Abuse and Mental Health Services Administration, 2021).

A treatment gap can destabilize the patient’s opioid receptors and stress systems. When medication is interrupted, the patient may experience physiologic distress. In the current illicit drug environment, where fentanyl and counterfeit pills are common, even one episode of return to use may be fatal.

A bridge prescription is not just a convenience. It can be a life-saving intervention.

The Value of Co-Located Services in Substance Use Disorder Treatment

Whenever possible, services should be co-located. This means patients can receive multiple forms of care in one place or through a highly coordinated system.

Examples include:

• Primary care and addiction medicine
• Mental health counseling and SUD treatment
• Chiropractic care and rehabilitation
• Pain management and functional medicine
• Social work and case navigation
• Peer support and recovery coaching
• Maternal care and infant care
• Telehealth and in-person care options

Patients with substance use disorders often face logistical barriers. These may include lack of transportation, unstable housing, childcare needs, employment demands, legal involvement, financial limitations, pain, disability, and stigma. Every additional appointment location can become another barrier.

Co-location improves care retention by reducing friction.

How This Applies to Integrative Chiropractic and Injury Care

At Injury Medical Clinic PA in El Paso, Texas, our multidisciplinary model is designed around coordination. As a chiropractor and nurse practitioner with functional medicine training, I evaluate the patient’s musculoskeletal injuries, pain generators, neurologic function, metabolic health, inflammatory status, rehabilitation needs, and lifestyle factors.

With Dr. Maria Guadalupe Cardenas, MD, serving as Medical Director and Collaborative Physician, our clinic benefits from internal medicine oversight. This is especially important when patients have complex medical histories, chronic disease, medication concerns, trauma-related injuries, or overlapping pain and behavioral health issues.

This type of structure is common in integrative and injury care clinics. The chiropractor provides neuromusculoskeletal diagnosis, rehabilitation, and conservative care, while the physician provides medical direction and internal medicine oversight. Together, the team can better address the whole patient.

Telehealth and Flexible Care Options for Better Treatment Retention

Patients should be offered choices in care modality and location whenever clinically appropriate. For some individuals, telehealth may be the difference between staying in care and dropping out.

A patient may prefer telehealth because of:

• Work responsibilities
• Lack of transportation
• Childcare limitations
• Physical disability
• Anxiety in clinical settings
• Rural location
• Postpartum recovery
• Legal or probation requirements
• Stigma concerns
• Pain with travel

Telehealth is not appropriate for every clinical scenario, but it can be a powerful tool for follow-up, medication monitoring, counseling, care navigation, and patient education.

Why Flexibility Supports Recovery Biology

Recovery requires consistency. When care is rigid, patients with unstable lives may miss appointments and lose access to medication. Missed care can increase stress, and stress can activate the hypothalamic-pituitary-adrenal HPA axis, increasing cortisol and worsening cravings, sleep disruption, pain sensitivity, and emotional dysregulation.

Flexible care reduces stress load and supports adherence.

Care Navigators and Warm Handoffs Improve Transitions

Care navigators with specialized knowledge of community resources can be essential. These professionals help patients move from one level of care to another.

They may help with:

• Scheduling follow-up appointments
• Finding MOUD prescribers
• Connecting patients with mental health services
• Coordinating transportation
• Helping with insurance issues
• Locating housing resources
• Linking to food assistance
• Supporting legal and social service needs
• Providing reminders
• Explaining treatment options
• Connecting with peer recovery support

A warm handoff is especially powerful. Rather than simply giving the patient a phone number, the current provider directly introduces the patient to the next provider or service. This can happen in person, by phone, or virtually.

Warm handoffs build trust. They reduce the emotional burden of navigating a complex system alone.

Justice-Involved Individuals and Overdose Risk After Release

Justice-involved individuals face unique challenges, particularly immediately after release from jail or prison. Overdose is a leading cause of death following release from incarceration (Binswanger et al., 2007).

Several factors contribute to this risk:

• Loss of opioid tolerance
• Interrupted healthcare
• Loss of insurance
• Limited access to MOUD during incarceration
• Poor discharge planning
• Stigma
• Housing instability
• Lack of transportation
• Limited knowledge of treatment systems
• Untreated trauma
• Low self-worth after incarceration

Loss of Opioid Tolerance and Overdose Physiology

When a person stops using opioids during incarceration, opioid tolerance decreases. If that person returns to the same amount of opioids after release, the body may no longer tolerate the dose. This increases the risk of respiratory depression.

Opioids suppress breathing by acting on brainstem respiratory centers. With reduced tolerance, a dose that was previously tolerated may now slow breathing enough to cause hypoxia, unconsciousness, and death.

This risk is magnified in the fentanyl era because fentanyl is highly potent, fast-acting, and commonly present in counterfeit pills and illicit drug supplies.

MOUD in Carceral Settings

Medications for opioid use disorder are often unavailable in jail or prison systems. When they are available, they may be poorly implemented or underdosed.

If a patient receives a dose that does not adequately treat cravings or withdrawal, the patient may conclude that the medication does not work. This can reduce willingness to continue MOUD after release.

Effective correctional healthcare should include:

• Screening for OUD
• Access to buprenorphine or methadone
• Adequate dosing
• Discharge planning
• Naloxone distribution
• Warm handoffs to community treatment
• Insurance reactivation
• Peer support
• Follow-up appointments before release

Pregnancy, Substance Use, and the Need for Nonjudgmental Care

Pregnant and postpartum individuals with substance use disorders are at high risk for negative outcomes, including fatal overdose. They also face significant barriers to care.

These barriers include:

• Stigma from healthcare professionals
• Fear of child custody loss
• Fear of legal consequences
• Shame
• Trauma history
• Lack of transportation
• Lack of childcare
• Housing instability
• Partner violence
• Mental health conditions
• Limited access to pregnancy-capable SUD treatment

One of the most concerning findings in this area is that some pregnant women avoid medical care altogether to avoid detection of drug use.

That means stigma and punitive policies can unintentionally increase harm.

Substance Use Alone Does Not Automatically Equal Child Maltreatment

As healthcare professionals, we are mandated to report suspected abuse or neglect of children or elderly adults. However, substance use alone does not automatically establish child maltreatment.

The federal Comprehensive Addiction and Recovery Act CARA requires states to address the effects of substance misuse on infants and families and to support early identification and intervention. It also requires healthcare providers to notify child welfare when an infant is born affected by substances. However, federally, that notification does not necessarily need to be a report of suspected abuse or neglect.

Each state determines how these notifications are handled and whether they trigger investigations.

Why Punitive Policies Can Harm Mothers and Babies

Research has shown that punitive policies can delay prenatal care and reduce postpartum follow-up. A 2022 cross-sectional study of 4,155 pregnant women who used substances during pregnancy found that women in states with more punitive or stricter mandatory reporting policies initiated prenatal care later and were less likely to receive adequate prenatal care and postpartum healthcare visits compared with women in less restrictive states (Atkins & Durrance, 2020; Faherty et al., 2019).

This matters because prenatal care improves outcomes for both mother and baby.

Punitive approaches may increase:

• Fear
• Avoidance of care
• Untreated withdrawal
• Overdose risk
• Poor nutrition
• Untreated infections
• Mental health deterioration
• Unsafe delivery risk
• Family separation
• Loss of trust in healthcare

A treatment-centered approach is more clinically sound than a stigma-centered approach.

How I Counsel Pregnant Patients With Substance Use Disorders

When a pregnant patient with a substance use disorder enters care, I believe the first words should communicate safety and respect.

A simple statement such as, “Thank you for coming in today,” can matter deeply.

Many patients have overcome major barriers to arrive at the appointment. They may be afraid, ashamed, judged, or worried that honesty will be punished. My goal is to create a clinical environment where the patient can tell the truth, because accurate information improves care.

Core Principles for Pregnancy-Related SUD Care

I focus on:

• Nonjudgmental communication
• Person-centered care
• Clear discussion of risks
• Evidence-based treatment
• Respect for the patient’s goals
• Protection of maternal and fetal health
• Care coordination
• Postpartum transition planning
• Mental health support
• Social service connection

I also believe in being honest. Substance use during pregnancy can carry risks, but untreated substance use disorder also carries serious risks. Evidence-based treatment should be offered, not withheld.

Medications for Opioid Use Disorder During Pregnancy

For pregnant women with opioid use disorder, buprenorphine and methadone are both considered safe and effective options. Major clinical guidance supports MOUD during pregnancy because the risks of untreated OUD and withdrawal are generally greater than the risks of medication treatment (American College of Obstetricians and Gynecologists, 2017; Substance Abuse and Mental Health Services Administration, 2018).

Why Withdrawal Can Be Dangerous During Pregnancy

Opioid withdrawal can cause:

• Maternal stress
• Dehydration
• Poor sleep
• Elevated catecholamines
• Uterine irritability
• Return to illicit opioid use
• Fentanyl exposure
• Overdose risk
• Poor prenatal engagement

The fetus is affected by maternal physiology. Severe maternal stress and instability can influence fetal oxygenation, nutrition, and neuroendocrine signaling.

Neonatal Opioid Withdrawal Syndrome

Pregnant patients often ask, “Will my baby go into withdrawal if I start this medication?”

The answer requires compassion and clarity.

There is a risk of neonatal opioid withdrawal syndrome NOWS, also called neonatal abstinence syndrome. However, the benefits of MOUD usually outweigh the risks. Importantly, the risk and severity of NOWS are not simply dose-dependent. The best maternal dose is the dose that adequately treats cravings and withdrawal.

Underdosing the mother to try to protect the baby can backfire if it leads to relapse, illicit opioid exposure, or overdose.

Why Pregnant Patients May Need Higher MOUD Doses

Pregnancy changes medication metabolism. As pregnancy progresses, especially in the third trimester, blood volume, hepatic metabolism, renal clearance, and body composition change. These physiologic shifts can reduce medication levels and increase withdrawal symptoms.

Some pregnant patients may need higher or more frequent dosing of buprenorphine or methadone.

After birth, metabolism gradually returns toward the pre-pregnancy state. The timing varies, but it may occur over approximately 3 to 12 weeks postpartum. Therefore, postpartum dose reductions should be individualized.

Clinicians should monitor for:

• Sedation
• Respiratory depression
• Cravings
• Withdrawal
• Sleep deprivation
• Depression
• Anxiety
• Pain
• Breastfeeding status
• Social stressors
• Return-to-use risk

Postpartum Care Transitions and the Mother-Baby Dyad

The postpartum period can be medically and emotionally intense. A mother may be healing physically, caring for a newborn, managing sleep deprivation, attending pediatric visits, and possibly visiting a baby monitored in the NICU for NOWS.

When I think about postpartum care transitions, I think about the mother-baby dyad. The health of one affects the health of the other.

Important considerations include:

• Does the mother have stable housing?
• Does she have transportation?
• Can she visit the newborn if the baby remains hospitalized?
• Does she have family or social support?
• Is she experiencing postpartum depression or anxiety?
• Does she have enough medication until follow-up?
• Does she need lactation support?
• Does she have food resources?
• Does she need childcare for other children?
• Does she have a safe recovery environment?

Example Case: Liz, One Day Postpartum

Consider a 32-year-old woman, Liz, who is one day postpartum after delivering a baby girl. She has a history of OUD and illicit fentanyl use. During pregnancy, her primary care provider started buprenorphine. Her dose was titrated to 8 mg four times daily in the third trimester, for a total daily dose of 32 mg.

For Liz, I would consider:

• Continuing buprenorphine at discharge with an adequate bridge prescription
• Scheduling follow-up before discharge
• Monitoring cravings and withdrawal
• Discussing possible dose reduction over 3 to 12 weeks postpartum
• Watching for sedation as metabolism changes
• Supporting transportation to the NICU if needed
• Connecting her with social work
• Offering telehealth follow-up when appropriate
• Coordinating pediatric and maternal care
• Connecting her with mental health services
• Providing naloxone
• Offering peer recovery support
• Addressing food, housing, and childcare needs

This is how we scaffold recovery. Medication is essential, but medication alone is not the entire recovery environment.

Adolescents, Substance Use, and Brain Development

Adolescents require a distinct approach because the adolescent brain is still developing.

The reward system develops earlier than the prefrontal cortex. This means adolescents can experience strong reward signals from substances, novelty, peer approval, and risk-taking before their executive control systems are fully mature.

The prefrontal cortex, which supports planning, impulse control, risk evaluation, and long-term decision-making, continues developing into the mid-20s.

Why Adolescents Are Vulnerable

Adolescents may use substances because of:

• Peer pressure
• Curiosity
• Low self-esteem
• Anxiety
• Depression
• Trauma
• Family instability
• Desire to fit in
• Weight loss motivations
• Sleep problems
• ADHD symptoms
• Social media influence
• Experimentation
• Lack of awareness about fentanyl

Many adolescents do not understand that counterfeit pills may contain fentanyl. This is a major public health concern.

Recent prevention data suggest that targeted education can reduce willingness to misuse prescription drugs. When adolescents learn about fentanyl and fake pills, many report they are less likely to consider misuse.

Education works when it is honest, direct, and nonjudgmental.

Treatment Differences Between Adolescents and Adults

Treating adolescents differs from treating adults in several ways.

Key differences include:

• Brain development is ongoing
• Use may be experimental rather than daily
• Co-occurring mental health conditions are common
• Polysubstance use is common
• Family involvement may be needed
• State consent laws vary
• Treatment retention is often low
• Adolescent-specific programs may be limited
• Medication data are less robust
• Confidentiality concerns are complex

Clinicians must know state laws regarding consent for substance use and mental health treatment. In some states, adolescents can consent to SUD treatment at a specific age without parental permission. Even when parental involvement is not legally required, it may still be clinically helpful when safe and appropriate.

Medications for Opioid Use Disorder in Adolescents and Young Adults

For adolescents and young adults with OUD, buprenorphine is generally considered a first-line option. It is FDA-approved for patients age 16 and older. Some clinicians use buprenorphine off-label in younger adolescents, but evidence is more limited.

Medication approval considerations include:

• Buprenorphine: FDA-approved for age 16 and older
• Naltrexone: Approved for adults age 18 and older
• Methadone: Generally approved for adults age 18 and older, with specific regulatory considerations
• Long-acting injectable buprenorphine: Not approved for individuals under 18, and evidence is limited

Young adults ages 18 to 25 who receive MOUD have better retention in care than those who do not. While evidence is less complete for adolescents under 18, the clinical argument for offering MOUD can be compelling when the risk of overdose is high.

Optimizing Your Wellness- Video

Important Dosing Considerations

Not every adolescent with opioid exposure is opioid dependent. Some use episodically. For patients who are not opioid dependent, buprenorphine can cause sedation, especially at higher doses.

A common clinically meaningful dose for preventing withdrawal and overdose risk may be around 8 mg, but this must be individualized. The clinician must weigh:

• Opioid tolerance
• Frequency of use
• Fentanyl exposure
• Withdrawal symptoms
• Overdose risk
• Sedation risk
• Family support
• Mental health status
• Patient preference

The patient and, when appropriate, the parents or guardians should be involved in shared decision-making.

Naloxone Distribution and Harm Reduction for Youth

For adolescents and young adults, naloxone distribution is essential.

Naloxone can reverse opioid overdose by displacing opioids from mu-opioid receptors. When administered quickly, it can restore breathing and prevent death.

Youth should be educated on:

• How to recognize overdose
• How to administer naloxone
• Why rescue breathing matters
• Why calling emergency services is important
• Why counterfeit pills are dangerous
• Why using alone increases death risk
• Why fentanyl test strips may reduce risk where legal and available
• Why polysubstance use increases overdose risk

Harm reduction is not permission to use substances. It is a public health strategy that keeps people alive long enough to recover.

Genetics and Substance Use Disorder Risk

Research has increasingly identified genetics as one factor that can influence SUD risk. However, genetics is only one part of the picture.

Substance use disorder risk may be influenced by:

• Genetics
• Trauma exposure
• Early life stress
• Mental health conditions
• Chronic pain
• Social environment
• Peer group
• Family history
• Poverty
• Sleep disruption
• Brain development
• Access to substances
• Neuroinflammation
• Stress biology

Some companies now market genetic tests that claim to identify people at higher risk for SUD. In theory, this sounds useful. If we could identify risk early, we might intervene earlier.

However, there are important limitations.

Concerns About Genetic Testing for SUD Risk

Current concerns include:

• Lack of large, well-controlled validation trials
• Limited predictive accuracy
• High cost
• Limited access
• Privacy concerns
• Third-party data sharing
• Risk of stigma
• Risk of discrimination
• Ethical concerns
• Potential racial or socioeconomic bias

Genetic information must be handled carefully. A genetic risk marker does not determine destiny. Patients should never be reduced to a test result.

From a functional medicine perspective, I view genetics as part of a broader systems biology map. Genes may influence vulnerability, but environment, nutrition, stress, inflammation, sleep, trauma, pain, and social support also shape outcomes.

GLP-1 Receptor Agonists and Emerging Addiction Research

Another evolving topic is the potential role of GLP-1 receptor agonists in substance use disorders. These medications include:

• Semaglutide
• Liraglutide
• Dulaglutide

They are primarily used for diabetes and weight management, but researchers are studying their effects on reward pathways, craving, and addictive behaviors.

A recent randomized controlled trial found that adults with alcohol use disorder who received a GLP-1 receptor agonist consumed lower amounts of alcohol than those not taking the medication. Additional claims-based studies by Wang and colleagues found associations between semaglutide use and lower risk of medical encounters for tobacco use disorder, cannabis use disorder, and opioid use disorder compared with other diabetes medications.

These findings are promising but still evolving. Association does not prove causation. More randomized clinical trials are needed.

Why GLP-1 Medications May Affect Addiction Pathways

GLP-1 receptors are found not only in metabolic tissues but also in brain regions involved in reward, appetite, satiety, and motivation. These pathways overlap with addiction neurobiology.

Potential mechanisms may include:

• Reduced reward response
• Reduced craving
• Improved insulin signaling
• Reduced inflammation
• Altered dopamine signaling
• Improved satiety and impulse regulation
• Effects on gut-brain communication

This is an exciting area of research, but it should be approached carefully. GLP-1 medications are not currently standard treatment for SUDs, and they have side effects and contraindications that require medical evaluation.

How Integrative Chiropractic Care Fits Into Substance Use Disorder Recovery

As a chiropractor and nurse practitioner, I often see patients whose substance use risk is connected to pain, trauma, injury, stress, sleep disruption, and loss of function.

Many patients with OUD were first exposed to opioids after:

• Motor vehicle collisions
• Work injuries
• Sports injuries
• Spine pain
• Surgery
• Chronic pain syndromes
• Neuropathy
• Musculoskeletal trauma
• Repetitive strain injuries

Integrative chiropractic care can support recovery by helping reduce pain and improve function without relying solely on opioid medication.

Clinical Goals of Chiropractic and Rehabilitation Support

In an integrative setting, chiropractic and rehabilitation care may help with:

• Spinal mobility
• Joint mechanics
• Neuromuscular coordination
• Pain modulation
• Postural control
• Gait restoration
• Soft tissue function
• Range of motion
• Strength
• Balance
• Functional capacity
• Injury recovery
• Patient confidence
• Return to work or activity

Physiological Rationale for Conservative Pain Care

Pain is not only a local tissue signal. It involves:

• Peripheral nociceptors
• Spinal cord processing
• Brain pain networks
• Descending inhibition
• Inflammation
• Autonomic tone
• Muscle guarding
• Fascia and connective tissue mechanics
• Sleep quality
• Psychological stress
• Prior trauma
• Movement fear

Chiropractic adjustments, therapeutic exercise, soft tissue work, mobility training, and rehabilitation may support better movement and reduce mechanical stress. Exercise also influences endogenous opioid and endocannabinoid systems, which can improve pain regulation and mood.

For a patient in recovery, improved function can reduce relapse triggers related to pain and disability.

The Multidisciplinary Model at Injury Medical Clinic PA in El Paso, Texas

At Injury Medical Clinic PA, also known as Mission Plaza Injury Medical Clinic, in El Paso, Texas, we operate within a multidisciplinary care model.

I, Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, provide integrative chiropractic, functional medicine, rehabilitation, and injury-focused care. My clinical observations, reflected in my professional work and educational resources, emphasize the relationship between injury biomechanics, metabolic health, inflammation, gut-brain communication, chronic pain, and recovery resilience.

Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine, NPI #1164426749, Texas MD License #J2933, serves as Medical Director and Collaborative Physician. With more than 40 years of internal medicine experience, Dr. Cardenas provides medical direction and oversight that supports safe, coordinated, and clinically responsible care.

How Our Team-Based Model Supports Patients

Our team integrates:

• Chiropractic care
• Internal medicine oversight
• Functional medicine
• Personal injury care
• Rehabilitation
• Diagnostic review
• Care coordination
• Lifestyle medicine
• Nutrition support
• Patient education
• Referral coordination
• Pain and function assessment

This structure helps us identify when a patient needs conservative care, medical evaluation, specialist referral, behavioral health support, emergency care, or social services.

Functional Medicine and Recovery Resilience

Functional medicine asks why a patient is vulnerable, not only what diagnosis is present.

For patients with chronic pain, injury, stress, or substance use risk, I consider:

• Nutrition status
• Blood sugar regulation
• Inflammation
• Sleep quality
• Gut health
• Hormonal balance
• Mitochondrial function
• Stress response
• Trauma history
• Physical conditioning
• Medication burden
• Environmental exposures
• Social determinants of health

Why Metabolic Health Matters in Recovery

The brain requires stable energy metabolism. Blood sugar swings, poor sleep, micronutrient deficiencies, inflammation, and chronic stress can worsen mood, cravings, pain sensitivity, and impulse control.

A functional medicine plan may include:

• Anti-inflammatory nutrition
• Protein adequacy
• Hydration
• Sleep restoration
• Movement therapy
• Stress regulation
• Gut health support
• Laboratory evaluation when appropriate
• Coordination with medical providers
• Education on pain and recovery physiology

This is not a replacement for MOUD or behavioral health treatment. Instead, it can complement evidence-based addiction care by improving the physiologic terrain in which recovery occurs.

Personal Injury Care and Substance Use Risk

In personal injury care, especially after motor vehicle collisions or workplace injuries, patients may develop acute or chronic pain. If pain is poorly managed, the patient may be at increased risk for opioid exposure or misuse.

A responsible injury care model should emphasize:

• Accurate diagnosis
• Conservative care when appropriate
• Functional restoration
• Avoidance of unnecessary opioid reliance
• Coordination with medical providers
• Documentation of objective findings
• Rehabilitation progression
• Patient education
• Monitoring for red flags
• Referral when needed

Why Early Rehabilitation Matters

After injury, the nervous system may become sensitized. Muscles guard, joints stiffen, sleep worsens, and fear of movement can develop. If the patient avoids movement too long, deconditioning increases pain and disability.

Rehabilitation helps restore:

• Strength
• Mobility
• Proprioception
• Tissue tolerance
• Confidence
• Work capacity
• Daily function

For patients at risk of substance use disorder, non-opioid pain strategies are especially important.

Why Compassionate Care Is Evidence-Based Care

Stigma is not just emotionally harmful. It is clinically harmful.

When patients feel judged, they may avoid care. When they avoid care, they are more likely to experience untreated disease, overdose risk, pregnancy complications, mental health deterioration, and preventable harm.

Compassionate care includes:

• Respectful language
• Shared decision-making
• Clear education
• Harm reduction
• Evidence-based medications
• Realistic planning
• Cultural humility
• Trauma-informed care
• Support for autonomy
• Recognition of social barriers

As clinicians, we do not improve outcomes by frightening patients away from care. We improve outcomes by creating care systems patients can actually use.

Key Clinical Takeaways

The strongest care transition models include:

• Bridge prescriptions after hospitalization
• Continuity with trusted providers
• Co-located services
• Telehealth flexibility
• Care navigation
• Warm handoffs
• MOUD access
• Naloxone distribution
• Nonjudgmental pregnancy care
• Postpartum recovery support
• Justice-involved reentry planning
• Adolescent-specific education
• Functional and rehabilitative support
• Medical oversight in multidisciplinary clinics

For patients with OUD, pregnancy, adolescence, incarceration history, trauma, chronic pain, or injury-related disability, care must be proactive rather than reactive.

Recovery is not a single appointment. It is a coordinated journey.

Conclusion

As Dr. Alexander Jimenez, DC, APRN, FNP-BC, CFMP, IFMCP, ATN, CCST, I believe that the future of substance use disorder care depends on integration. Patients need medical treatment, but they also need trust, movement, nutrition, stability, pain relief, behavioral health support, social resources, and continuity.

In collaboration with Dr. Maria Guadalupe Cardenas, MD, Board Certified in Internal Medicine, who serves as Medical Director and Collaborative Physician at Injury Medical Clinic PA in El Paso, Texas, our multidisciplinary model reflects a broader principle: complex patients benefit when clinicians work together.

Whether we are discussing buprenorphine after hospital discharge, methadone during pregnancy, naloxone for adolescents, rehabilitation after injury, or functional medicine strategies for recovery resilience, the goal remains the same.

We want patients to survive, stabilize, heal, and regain function.

That requires evidence, compassion, coordination, and a healthcare system designed to keep people connected.

References

• American College of Obstetricians and Gynecologists. (2017). Opioid use and opioid use disorder in pregnancy. Committee Opinion No. 711.
• Atkins, D. N., & Durrance, C. P. (2020). The impact of state-level prenatal substance use policies on infant health. Health Policy, 124(7), 721-728.
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