Michael Sore, Medical Director, Riverside Recovery of Tampa

Invest: spoke with Dr. Michael Sore, medical director of Riverside Recovery, about its expansion of outpatient and detox programs to improve addiction care access. Challenges include referrals, insurance, and hiring, but its recovery-focused culture helps, he said.

What have been the key achievements or highlights for Riverside Recovery in the past 12 months?

We are looking into expanding our outpatient treatment programs into areas that are underserved in high-quality addiction medicine care. This is due to two factors: insurance companies increasingly want patients to step down sooner from inpatient care and complete treatment as outpatients, and the difficulty in finding good follow-up care for patients in certain geographic areas. It is disappointing when patients, after being helped to get off substances, receive follow-up care from primary physicians who are not well-versed in treating specific addictions. For example, a patient with a history of methamphetamine use might be diagnosed with ADHD and prescribed an amphetamine-based stimulant, which is not ideal.

Since the new year, we have focused on developing an outpatient program and an ambulatory detox program. The ambulatory detox program is for patients with substance use disorders not severe enough for inpatient detox but still requiring specialized treatment. Patients come to the facility in the morning for evaluation, start medication, and return home with a family member or friend. They return the next day for reevaluation and the next dose of medication. This approach allows treatment in the comfort of their home, is medically supervised, and is far less costly than inpatient treatment

What are some of the main challenges facing Riverside recovery and rehabilitation treatment centers?

Specifically for Riverside, the challenge we face is similar to other treatment centers: patient referrals, getting patients in the door for treatment, and negotiating with insurance companies for reasonable reimbursement rates to cover expenses and keep the doors open. Hiring challenges are no different than other healthcare facilities, whether major hospitals, academic centers, or small community hospitals. Finding appropriately trained, empathetic staff who treat patients with substance use disorder without stigma is a challenge, but less so at Riverside.  

We’ve created a strong culture, hiring people who genuinely want to help, including those in recovery themselves who want to give back. This is our strength. While we face the same challenges, we overcome them by hiring the right people from the start, offering competitive reimbursement, good benefits, and flexibility. These factors position Riverside well in addressing hiring challenges.  

Most of our staff is in recovery, which makes a difference. When someone calls for help, speaking to a staff member who has been in their position fosters empathy and hope. Realizing the person on the other end has been through similar struggles and achieved long-term sobriety provides perspective.  

Our staff wants to be here and help people. Their drive is unmatched. Having worked in hospital systems and other behavioral health centers, this is by far the best job I’ve had because of the culture and dedication of our staff.

Have you noticed an increase in the use of illicit drugs, stimulants, opioids, or alcoholism among your patients? 

Fentanyl headlines are warranted due to its potency and the risk of overdose when mistaken for heroin. However, alcohol remains the primary reason people seek treatment. Alcohol causes significant morbidity and mortality, though its effects are more prolonged than the immediate overdose deaths seen with fentanyl. Alcohol is the top substance, followed by opioids, which are now primarily fentanyl-based, whether in pill form, snorted, or injected.

Sedative-hypnotics like Xanax are another major issue, often used in combination with other drugs. Methamphetamine remains popular, though less common than alcohol, opioids, and sedatives. Cocaine, especially crack cocaine, has seen a resurgence. A small subset of patients uses all of the above.

The opioid landscape has shifted from pill mills and drugs like hydrocodone and oxycodone to predominantly fentanyl. Kratom, a plant derivative sold online, has also caused significant addiction issues. Additionally, high-potency marijuana now poses addictive risks, particularly in younger populations, unlike lower-strength marijuana in the past. These trends highlight the persistent and evolving nature of substance use disorders.

What are some of the underlying reasons that lead individuals into cycles of substance abuse and addiction? 

Many factors contribute to developing a substance use disorder. Family history of addiction increases the risk. Trauma, such as psychological, physical, or sexual abuse, can also play a role. Untreated PTSD, common in veterans, often leads to substance use disorders. However, even individuals with supportive families and no significant challenges can develop a disorder if they use substances.

Dependency differs from addiction. Dependency occurs when prolonged drug use, like opioids for cancer pain, requires increasing doses for the same effect. Addiction involves maladaptive behaviors, such as stealing medication or money to obtain drugs. At Riverside, we focus on overcoming addiction and reducing stigma. Unlike cancer patients needing pain medication, those with addiction face blame and shame. We educate patients and families about addiction as a chronic disease, emphasizing early intervention and relapse management.

Prevention starts with avoiding illicit substances. Friends and family should watch for early signs and intervene quickly. Like other chronic diseases, early intervention minimizes damage. We teach that addiction requires lifelong attention, and we reduce stigma by helping families understand the condition. Relapses, similar to heart failure episodes, happen, but early recognition and extra support are key. This approach helps patients and families feel more comfortable and reduces shame.

What innovative methods is Riverside incorporating to treat patients?

We use evidence-based medicine to the best of our ability. Riverside is affiliated with USF College of Medicine, specifically the Department of Psychiatry, allowing psychiatry residents and addiction psychiatry fellows to rotate here. This is a significant achievement as we are committed to providing comprehensive care that extends beyond substance use treatment.

Additionally, through our partnership with USF Health College of Nursing’s Mo-Bull Nurse Medical Clinic, we offer on-site primary care visits twice a month for all levels of care. This collaboration ensures our clients have access to essential medical services, including annual exams, sick visits, pregnancy testing, women’s wellness care, vaccines, referrals, medications, and lab testing. These services are provided at no cost, helping to remove barriers to healthcare, particularly for our most vulnerable populations.

Riverside is a medically based program, not psychiatric. Patients in psychiatric programs may be sent to the ER for minor medical issues, leading to unnecessary tests or hospital admissions. At Riverside, providers with ER experience manage medical issues directly, ensuring patients remain comfortable during detox and residential treatment.

We focus on evidence-based practices, including medication-assisted treatment (MAT). For opioids, we use buprenorphine to prevent relapse. For alcohol, we use naltrexone or Campral to reduce cravings. For cocaine and cannabinoid use, we use N-acetylcysteine (NAC), a safe supplement shown to help reduce cravings.

These treatments do not work 100% of the time, but reducing cravings by 75% can help patients make better decisions, such as calling a sponsor or friend instead of relapsing. We also use therapeutic techniques like cognitive behavioral therapy.

I stay informed about emerging treatments, such as transcranial ultrasound, which shows promise for addiction but remains experimental. If approved, we will be among the first to adopt such advancements. In a few years, if psilocybin gains approval, our approach may evolve further.

What other key points would you highlight?

I’ve been an emergency doctor for many years, starting as a tech in 1983 and becoming a board-certified ER doc. In early 2017, I was approached by the founders of Riverside Recovery, which hadn’t yet opened. I was skeptical because the addiction treatment industry has many unethical practices, especially in South Florida, where fraud and unnecessary testing are common.

I had two requirements: no unethical practices and no focus on corporate profits. I wanted to build a program where I’d feel comfortable sending family or friends. To my surprise, the founders, respected Tampa Bay business leaders, fully supported this vision.

At Riverside, I’ve never been questioned about hiring highly trained staff or maintaining nursing ratios above DCF requirements. These standards ensure safety and quality care, which is why I believe Riverside stands apart. It’s the kind of place I’d trust for my family or friends, and I plan to stay there as long as I can.