Integrated Psychiatric Care for Addiction & Mental Health at Skyward
60%+
with SUD also have a mental health condition
21.2M
U.S. adults with co-occurring disorders (SAMHSA, 2024)
Addiction rarely travels alone. At Skyward, our in-house psychiatrist works alongside your addiction treatment team to address both conditions simultaneously — because treating one without the other leaves the door open for relapse.
Dr. Brams
Medical Director & Psychiatrist, Skyward Treatment
MD
Board Certified
Addiction Psychiatry
Dual Diagnosis
“Addiction and mental health conditions share biology, share circuitry, and share solutions. Treating them as separate problems is one of the most costly mistakes in addiction medicine.”
THE CLINICAL CASE
Why Psychiatric Care Is Essential During Addiction Treatment
The relationship between addiction and mental health is not coincidental — it is neurological. The same reward and stress circuits that drive substance use disorder are dysregulated by depression, anxiety, PTSD, and bipolar disorder. They reinforce each other in a well-documented self-medication cycle that, without clinical interruption, perpetuates indefinitely.
Research from NIDA is clear: integrated treatment (addressing addiction and mental health simultaneously) produces significantly better outcomes than treating them sequentially. When the mental health condition is left untreated, substances become the only available coping mechanism, and relapse is almost certain.
A further complexity: some mental health conditions are masked by substance use and only emerge fully after sobriety begins. This is why having an in-house psychiatrist from day one isn’t a luxury. It is a clinical necessity.
People with mental disorders are more likely than people without mental disorders to develop a substance use disorder. Evidence indicates that treating both the mental disorder and the substance use disorder produces the best outcomes.”
— National Institute on Drug Abuse (NIDA)
The Self-Medication Cycle — Why It Doesn’t Stop Without Intervention
Untreated Mental Health Condition
(depression, anxiety, PTSD)
Substance Use to Cope
Substance Worsens the Condition
Increased Use & Dependency
Addiction + Worsened Mental Health
✓ Integrated treatment breaks this cycle at the source.
DUAL DIAGNOSIS TREATMENT
Mental Health Conditions We Treat Alongside Addiction
Each condition below is treated concurrently with your substance use disorder — not as a separate program, not as a referral after discharge, but as part of your integrated treatment plan at Skyward.
Depression
Most Common Co-Occurring Condition
Each condition below is treated concurrently with your substance use disorder — not as a separate program, not as a referral after discharge, but as part of your integrated treatment plan at Skyward.
PTSD & Trauma
High Prevalence in Opioid & Alcohol SUD
Trauma history is present in the majority of people seeking addiction treatment. Unresolved trauma drives both the initiation and maintenance of substance use. Skyward addresses PTSD through EMDR, trauma-focused CBT, and psychiatric medication management, since recovery from addiction cannot proceed meaningfully on top of unprocessed trauma.
ADHD
Common in Stimulant Use Disorder
ADHD is significantly overrepresented among people with stimulant use disorder — many of whom were self-medicating undiagnosed attention difficulties. Skyward manages ADHD with non-stimulant alternatives, including Strattera (atomoxetine), Wellbutrin (bupropion), and Qelbree to address symptoms without addiction risk.
Anxiety Disorders
Generalized · Social · Panic
Anxiety is among the most frequently self-medicated conditions. Alcohol and benzodiazepines provide temporary relief that progressively worsens underlying anxiety. Treatment focuses on non-addictive alternatives (buspirone, SSRIs, hydroxyzine), CBT for anxiety, and addressing the physiological anxiety that accompanies early withdrawal.
Bipolar Disorder
Mood Stabilization Required
The impulsivity of manic episodes and the despair of depressive episodes both strongly increase substance use risk. Accurate diagnosis is the first step. Dr. Brams manages mood stabilizer therapy with careful monitoring throughout the treatment stay, adjusting as mood patterns emerge more clearly after detox.
Personality Disorders
DBT · Schema Therapy
Borderline, antisocial, and other personality disorders frequently co-occur with substance use disorder, complicating treatment significantly. Skyward’s clinical approach uses Dialectical Behavior Therapy (DBT) and schema-based approaches to build the emotional regulation and interpersonal skills that support lasting recovery.
MEDICATION MANAGEMENT
Medication Management During Addiction Treatment
One of the most common fears patients bring to treatment is about medication: being over-medicated, given addictive substances, or having decisions made without their input. Skyward’s approach directly addresses these concerns.
Our process involves:
1. Psychiatric Assessment at Admission
Dr. Brams conducts a comprehensive psychiatric evaluation at intake, including a review of all current medications, mental health history, and any prior psychiatric treatment.
2. Review of All Current Medications
Patients often arrive on medications that may be contributing to dependency, such as benzodiazepines, sleep aids, and certain pain medications. Each is reviewed with full transparency and adjusted safely, with your knowledge and consent.
3. Safe Tapering When Indicated
Problematic medications are tapered under medical supervision — never abruptly discontinued. Appropriate non-addictive alternatives are introduced where clinically indicated.
4. Ongoing Monitoring and Adjustment
Psychiatric medications are not set and forgotten. Dr. Brams monitors your response throughout treatment, adjusting as your mental state evolves, particularly as substances clear your system and underlying conditions become more clearly visible.
5. Discharge Medication Plan
Your discharge includes a clear medication plan and referral to a community psychiatrist for continuity of care. You leave with a full understanding of your medications and a plan for managing them after treatment.
Holistic & Wellness Therapies
“I’m worried about being over-medicated.”
This is one of the most common concerns we hear — and a legitimate one. At Skyward, our psychiatric team prioritizes non-addictive alternatives and always discusses medication decisions with you, not just for you.
No medication is added to your regimen without explanation and your input.
MAT Options Available
Suboxone (Buprenorphine)
Opioid use disorder
Vivitrol (Naltrexone)
Opioid & alcohol use disorder
Campral (Acamprosate)
Alcohol use disorder
Non-Stimulant ADHD Meds
Stimulant use disorder + ADHD
WHAT TO EXPECT
What Happens During a Psychiatric Assessment at Skyward?
One of the most common reasons people delay seeking treatment is fear of the unknown — particularly the psychiatric evaluation. Not knowing what questions will be asked, what will happen to the information, or how it will affect their treatment plan creates a barrier that the existing content on this page doesn’t address.
A psychiatric assessment at Skyward is not an interrogation, and it is not a judgment. It is a structured clinical conversation designed to understand the full picture of your mental health, so that your treatment plan addresses everything, not just the substance use on the surface.
The process is confidential, conducted by Dr. Brams, and is the foundation on which your entire individualized treatment plan is built.
A Note on Confidentiality
Everything you share during your psychiatric assessment is protected by federal confidentiality laws (42 CFR Part 2 and HIPAA). Information is shared only within your clinical care team and only to support your treatment. It is not reported to employers, family members, or law enforcement without your explicit written consent.
60–90
Minutes for an initial full psychiatric evaluation
Day 1
Assessment begins at admission — no wait for psychiatric care
100%
Of Skyward patients receive a psychiatric evaluation regardless of presenting complaint.
Ongoing
Psychiatric review continues throughout the full treatment stay
Our Testimonials
FAQ
Frequently Asked Questions About Psychiatry at Skyward
Yes. All patients receive a comprehensive psychiatric assessment during admission. Ongoing sessions with Dr. Brams are scheduled based on your clinical needs. Unlike many facilities that rely on outside referrals or telemedicine, Skyward's psychiatrist is physically present in your treatment team. You will not be waiting for an appointment two weeks after discharge.
Dr. Brams reviews all current medications at intake, including any that may be contributing to dependency or interfering with recovery. No medications are changed without your knowledge and explicit consent. If a medication requires tapering or adjustment, this is done safely and gradually under direct medical supervision, with alternatives introduced as needed.
Yes. Medication-Assisted Treatment (MAT) is available at Skyward for eligible patients. Buprenorphine (Suboxone) is available for opioid use disorder, and naltrexone (Vivitrol, in injectable form) is available for both opioid and alcohol use disorder. MAT decisions are made by Dr. Brams based on clinical assessment and are integrated into your full treatment plan rather than managed in isolation.
A psychiatrist is a medical doctor (MD) who can diagnose mental health conditions, prescribe medications, and manage complex psychiatric presentations. A licensed therapist or counselor provides talk therapy in CBT, DBT, trauma-focused therapy, and motivational interviewing. At Skyward, you receive both: Dr. Brams manages your psychiatric assessment and medication, while your licensed therapist conducts individual and group sessions. The two work as a coordinated team, not in silos.
This depends entirely on your diagnosis and how you respond to treatment. Some conditions, such as depression, bipolar disorder, PTSD, and ADHD, benefit from ongoing medication even after treatment. Others resolve or improve significantly with sustained sobriety and therapy alone. Your discharge plan will include a clear, specific medication strategy and a referral to a community psychiatrist if continued care is recommended.
When You Treat Only the Addiction, You Leave the Door Open for Relapse.
At Skyward, we close that door. Our integrated psychiatric approach treats the whole person — the addiction and the mental health condition driving it. Call for a confidential assessment today.
Confidential · Seven days a week · Same-day available
Skyward Treatment
Skyward Treatment’s addiction psychiatry program serves Houston, Sugar Land, and the greater Houston metro area, TX. Our in-house psychiatric team provides integrated dual diagnosis treatment addressing substance use disorder alongside co-occurring depression, anxiety, PTSD, bipolar disorder, ADHD, and personality disorders within a single, coordinated treatment program.