How to Find Addiction and Chronic Pain Treatment

You know the drill by heart. The back locks up before you’re out of bed. The knee reminds you of a bad landing you took twenty years ago. Somewhere in the middle of the day, the pills that used to help stopped being enough — or the drinks after dinner turned into drinks before dinner. And now you’re stuck between two truths that shouldn’t have to fight each other: the pain is real, and the way you’ve been managing it has started to cost you.

If you’re a veteran here in Ohio, you’ve probably heard some version of the same speech. Get sober first. Then we’ll talk about the pain. Or the opposite: keep taking what you were prescribed, no questions asked, until suddenly the taper letter arrives and no one has a plan for what comes next.

That bind is not a personal failing. It’s what happens when pain care, substance use care, and trauma care get treated as three separate problems handed off to three separate offices. The clinical guidance actually says the opposite. SAMHSA’s TIP 54 is direct about it: assessment of pain, function, and substance use belongs in the same conversation, and treatment for pain and any co-occurring conditions should be integrated, not sequenced ¹. The CDC says the same thing in plainer language — people with co-occurring pain and opioid use disorder still require ongoing pain management ⁴.

So no, you don’t have to pick. The rest of this piece walks you through what integrated care actually looks like, what Ohio’s rules already require, and how to tell whether a program will meet you where you are — pain, PTSD, substance use, and all.

Here’s the version of the story you may already know. You walk into a rehab intake with a back that hasn’t stopped hurting since a rollover in 2007 and a prescription bottle that stopped lasting the month somewhere around last spring. The clinician nods, takes notes, and tells you the plan is to get you off everything first. Once you’re stable, once you’ve proven yourself, then someone will figure out the pain. Except that day rarely arrives on the calendar anyone showed you.

What you lived through has a name in the guidance documents: sequenced care. Detox first. Pain later. Trauma whenever there’s room. It fails for a plain reason. Untreated pain doesn’t wait patiently in the corner. It drives sleep loss, it spikes PTSD symptoms, and it is itself a well-documented relapse trigger — something SAMHSA names directly when it warns that poorly controlled pain can put recovery at risk ³. Ask any veteran who’s white-knuckled a knee flare-up in week two of a program that told them Tylenol was the plan.

“patients with co-occurring pain and substance use disorder require ongoing pain management,”

The alternative isn’t complicated in principle. One team. Three needs held at once: the pain in your back or knee or head, the substance that’s gotten louder than you meant it to, and the trauma that never quite went quiet after you came home. That’s what the rest of this piece is about — and what you have every right to ask for when you make the call.

You’ve probably wondered, in the quiet hours, why the three of these show up in the same body at the same time. The back pain that never fully healed. The nights you don’t really sleep. The drink or the pill that quiets things down for an hour. It isn’t coincidence, and it isn’t a character flaw. The systems in your brain and body that handle pain, threat, and reward overlap more than most people realize.

A 2025 review of the shared biology behind these conditions points to three intersecting drivers: genetics, neurobiology, and environment. Stress responses and reward circuitry get pulled into both chronic pain and substance use, which is one reason they so often co-occur ¹⁶. In plain English — the wiring your body used to survive a deployment is the same wiring that keeps a pain signal loud and makes a substance feel like relief.

Add PTSD to that picture and the loop tightens. Hypervigilance keeps your muscles braced. Braced muscles hurt more. Pain wakes you up. Poor sleep worsens mood and the pull toward something that dulls the edge. That’s why the position paper from pain management and addictions nurses calls for team-based care that treats both conditions with dignity, not one at the expense of the other ¹⁰.

Understanding the loop is the first step to interrupting it — and to knowing what to look for in a program that actually can.

Here’s something worth knowing before you make another call: the state of Ohio is not asking prescribers to choose between treating your pain and paying attention to substance use. The rules already say to do both. If a program tells you otherwise, they’re behind on their own state’s expectations.

Ohio Administrative Code Rule 4731-11-14 spells it out. Before starting or continuing an opioid for subacute or chronic pain, an Ohio physician has to consider and document non-medication and non-opioid options first. If there’s evidence of a substance use concern, urine drug screening is expected. And if you have a co-occurring substance use disorder, the rule says the physician “shall offer a prescription for an overdose reversal drug” — naloxone — as part of your care, not as a punishment ⁷. That’s the floor, not the ceiling.

The 2024 Ohio chronic pain guidelines add a stepped structure most patients never get shown. As your daily morphine-equivalent dose (MED) climbs, the state expects more of your prescriber — not less of you:

• At 50 MED, clinicians should reassess how you’re functioning, look for signs of prescription misuse, and consider offering naloxone.
• At 80 MED, offering naloxone becomes the expectation, along with a check of OARRS (Ohio’s prescription monitoring database), a fresh look at addiction and mental health risk using SBIRT tools, and re-established informed consent.
• At 120 MED and above, specialist consultation enters the picture ^{8, 6}.

Read that ladder carefully. Every rung is about knowing you better — your function, your history, your risks — and layering in safety, not stripping away care. Screening for a substance use disorder isn’t supposed to end your treatment. It’s supposed to change what treatment looks like so both problems get addressed. That’s the whole point of SBIRT: identify, have a real conversation, and refer to appropriate treatment when needed.

What this means for you as a veteran walking into an Ohio program: the language of “integrated care” isn’t a marketing phrase somebody in Columbus made up. It’s baked into the rules your prescribers are supposed to be following. A rehab or pain program that dismisses your pain because you have a substance use history, or that hands you an opioid without any of the screening and support the state expects, is out of step with Ohio’s own standards.

You have the right to ask a program how they handle these thresholds. You have the right to ask whether they check OARRS, whether naloxone is part of your discharge plan, and whether a specialist gets looped in when your care gets complex. Those aren’t rude questions. They’re the questions Ohio already expects your care team to be asking themselves.

It helps to picture what a real week looks like when one team is holding all three needs at once. Not a brochure version. The actual rhythm of the days.

Say you’re in a partial hospitalization program (PHP) in Massillon or Cleveland. Monday morning starts with a check-in on your MAT — a short visit to make sure your buprenorphine dose is doing what it should, that cravings are quieter, and that the pain in your back or knee is being tracked as its own line item, not brushed aside. If your prescriber has divided the dose across the day to get more analgesic mileage out of it, that’s the kind of practical strategy the pain-and-OUD literature actually recommends ⁹. You’re not being asked to choose between craving control and pain relief.

Later that same day you might sit down for CBT focused on pain coping — how thoughts about a flare-up spiral into a long night, and what to do differently when they start. Tuesday could bring an EMDR session for the piece of your service that still shows up in your sleep. Wednesday, group therapy with other veterans who don’t need the shorthand explained. Thursday, a gentle movement or yoga session that helps you notice where you’ve been bracing without knowing it — the kind of mind-body work a 2019 meta-analysis found produced moderate pain improvements and small opioid dose reductions in people with concurrent pain and substance use ¹⁷.

Woven through the week: motivational interviewing, mindfulness practice, a family session if that fits your situation, and coordination between the clinician managing your MAT and the one working on your trauma. That’s the integration SAMHSA’s TIP 54 asks for — pain, function, and substance use assessed and treated together, with co-occurring conditions folded in rather than referred out ¹. The 2024 advances review describes this same shape: collaborative teams running CBT plus mindfulness or motivational interviewing alongside MOUD, producing small-to-moderate improvements across pain, substance use, and depression at the same time ¹³.

If you’re working, an intensive outpatient (IOP) schedule compresses this into evenings or a few days a week. The pieces don’t disappear. They just fit around a shift.

The phone call is the first real test. You can tell a lot about a program in about ten minutes if you know what to listen for. Here are the questions that separate a place that will actually treat all three pieces of you from a place that’s going to hand you off.

1. “Do you treat my pain and my substance use at the same time, or do I have to detox first?” The answer you want is clear: same time. If they say you need to be off everything before the pain team gets involved, that’s out of step with what SAMHSA and the CDC actually recommend for people in your situation ^{1, 4}.

2. “Do you offer MAT — buprenorphine or methadone — and can it be used to help with pain, not just cravings?” A program that knows the current guidance will say yes and be able to explain how. Split dosing across the day for better analgesia is one strategy the clinical literature specifically describes ⁹.

3. “Who is on my team, and do they talk to each other?” You want one coordinated group — prescriber, therapist, trauma clinician — not three referrals that never meet. Collaborative, interdisciplinary care is what the research keeps pointing to ¹².

4. “How do you handle PTSD alongside pain and substance use?” Look for a specific answer — EMDR, trauma-focused CBT, veteran groups — not “we can refer out.”

5. “Do you offer non-medication tools like CBT, mindfulness, and gentle movement?” These aren’t extras. They’re part of the treatment ¹⁷.

6. “Will you check OARRS and offer naloxone as part of my plan?” In Ohio, that’s the baseline your care team should already be doing ⁷.

If the person on the other end can’t answer these plainly, keep calling.

If you’re reading this from somewhere between Massillon and Cleveland — or Stark County, Akron, or anywhere the VA hospital sits an hour away on a bad traffic day — here’s the plain version of what Arrow Passage Recovery does with veterans in your situation.

The care is built the way the research says it should be: one team holding your pain, your substance use, and your trauma at the same time. Medication-assisted treatment is on the table, including buprenorphine, which the CDC recognizes can help with both opioid use disorder and concurrent pain when it’s part of a comprehensive plan ⁵. EMDR and trauma-focused therapy address the PTSD piece — the part of your service that still shows up at 3 a.m. — rather than getting pushed to a separate referral. CBT, motivational work, group therapy with other veterans, family sessions when that fits, and holistic pieces like yoga and art therapy round out the week. That mind-body layer isn’t decoration; it’s the kind of work the NIH HEAL review found produces moderate pain improvements in people with concurrent pain and substance use ¹⁷.

The continuum matters, too. Residential care if you need to step fully away for a while. PHP and IOP if you’re working a shift, raising kids, or holding down a job you can’t leave. Standard outpatient and aftercare for the long tail. Most major insurance is accepted, Tricare included.

You will not be told to detox before your pain is taken seriously. You will not be handed off between three offices that don’t talk. Making the call is already a step. When you’re ready, a confidential conversation is how you find out if this is the right fit for you.