Chronic pain and substance use rarely show up alone — and treating one without the other rarely holds. Awkward Recovery's intensive outpatient program coordinates with your pain prescriber and treats the whole picture, in a schedule that fits a real life.
Chronic pain is real. The pain rating you got tired of giving on a scale of 1 to 10 was real. The substance — whether it was the prescription you were given, the alcohol that quieted the night, or something you found on your own — was doing a job. It was numbing pain, buying sleep, keeping a body going when nothing else was. That job needed doing. It also stopped working, or started costing more than it gave back.
Chronic pain treatment at Awkward Recovery isn't about taking pain care away. It's about coordinating it differently — between you, your therapist, your prescriber, and (where you have one) your pain-medicine specialist — so the pain gets treated and the substance use stops being the only tool in the room.
Chronic pain shows up in different shapes alongside substance use. We treat all of them.
The most common pairing we see. A real injury or condition led to a real prescription. The prescription worked. Then it didn't, or it stopped being enough, or the prescriber tapered too fast, or the pharmacy closed and the gap got filled by something off-prescription. None of that means the pain wasn't real. It means the system around the pain didn't hold. We coordinate with your prescriber (and, where appropriate, MAT providers using buprenorphine or naltrexone) so pain management and recovery aren't fighting each other.
We treat chronic pain alongside substance use in three phases. Pairing therapies has no fixed order — but stabilization comes first.
Before any deeper work, the foundation goes in. Stabilization means getting safely settled on whatever medication regimen is appropriate (coordinated with your prescriber and pain-medicine specialist), using DBT skills — distress tolerance, grounding, sleep hygiene — to handle pain flares and cravings without the substance, and building a daily structure the body can predict. For clients coming off high-dose opioids or benzodiazepines, medical stabilization happens before IOP starts. We don't do medical detox; we refer and coordinate the handoff.
Once the floor is steady, the core therapies start. CBT for Chronic Pain (CBT-CP) restructures the thought-behavior loops that amplify pain — catastrophizing, activity avoidance, the all-or-nothing pacing that drives flare-crash cycles. ACT teaches you to make room for pain that isn't going to fully resolve while still doing what matters to you. Both run alongside the substance-use work in CBT and DBT. None of this is sequenced in a fake order — these therapies pair, and your therapist paces them to what your system can hold and what it needs.
For clients whose pain has trauma underneath it — a crash, a surgery, an assault, chronic relational trauma — EMDR and trauma-focused CBT come into the plan once stabilization is real. CPT is also used for clients whose trauma is more about beliefs (about safety, the body, being believed by doctors) than about specific memories. IFS often helps with the "the part of me that's in pain" framing — treating pain as a part of the system rather than the enemy. Integration loops back to skills, family therapy where it helps, and a written plan for managing pain and recovery together after IOP ends.
The VA-endorsed protocol for chronic pain. Targets the catastrophic thinking, activity-avoidance, and pacing patterns that amplify pain over time. Strong evidence base across back pain, fibromyalgia, headache disorders, neuropathic pain, and post-surgical pain.
Learn moreSome of the strongest evidence in chronic pain treatment. ACT doesn't try to argue you out of pain. It builds psychological flexibility — the capacity to make room for pain that isn't going to fully resolve while still doing what matters. Especially useful for clients who've been told "you'll have to live with it" and aren't sure what that's supposed to mean.
Distress tolerance, emotion regulation, mindfulness. The toolkit that holds when a pain flare hits at 2 a.m. and the substance used to be the answer. Woven into IOP group work and individual sessions from week one.
Learn moreFor chronic pain with trauma underneath. EMDR processes the trauma piece directly so the nervous system stops running threat protocols on top of the pain signal. EMDR is always individual — group EMDR protocols exist but are uncommon and aren't the standard for trauma-linked pain.
Learn moreReframes pain as a part of the system rather than the enemy. Asks what the pain part is protecting — the exile underneath it — what the substance-use part was doing as a firefighter, what the "push through it" manager has been carrying. Especially useful when chronic pain comes with complex trauma or chronic shame around being labeled drug-seeking.
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Most major insurance plans cover IOP-level care, including the therapy, group work, and dual-diagnosis components used in chronic pain treatment. We'll quickly verify your insurance and follow up — no cost, no commitment.
IOP is the right level of care for most adults managing chronic pain alongside substance use. Some situations need a higher level of care first:
In any of these cases, we refer when that's the right call. No ego. No sales pitch.
Taken seriously. The drug-seeker label is something we actively push back on. The pain is real. The substance use is a clinical problem with a clinical history — usually one that started with a legitimate prescription or a legitimate attempt to function. We don't moralize it and we don't dismiss it.
No. Awkward Recovery coordinates with your prescriber and (where you have one) your pain-medicine specialist. Decisions about pain medication are between you, your therapist, your prescriber, and your pain-medicine specialist — not something we dictate from outside that conversation.
Both are evidence-based and we work with them. Many of our clients are on MAT (medication-assisted treatment) when they start IOP. MAT and IOP therapy are designed to work together.
Honestly, it depends. If your prescriber and pain-medicine specialist have you on a stable, monitored regimen and the clinical concern is the mental-health or co-occurring substance-use piece, often yes. If a medical taper is needed first, we'll say so and coordinate the handoff. The intake call sorts it out.
Most clients report the opposite. CBT-CP and ACT both reduce pain interference (how much the pain limits your life) even when the underlying condition doesn't fully resolve. Stress, poor sleep, and substance-rebound effects all amplify pain — addressing them reliably brings the pain level down.
Yes. The CBT-CP and ACT protocols apply across pain conditions because they target the nervous-system and behavior patterns that amplify pain — not a specific diagnosis. We've worked with clients across all of these.
Yes. We have a Mental Health Primary track for clients whose mental-health condition is the primary issue and substance use isn't an active concern. The intake call sorts which track fits.
Yes. When the pain itself is well-managed but the depression, anxiety, or trauma riding alongside it isn't, that's exactly what our Mental Health Primary track is for. You don't need an active substance-use problem to belong here — the intake call sorts which track fits.
Most major plans cover IOP-level care including the dual-diagnosis components. Verify your insurance — no cost, no commitment.
Most clients notice the pain-substance loop loosening inside the first four to six weeks — better sleep, fewer flares triggered by stress, the substance pulling less hard. The deeper trauma and chronic-pain restructuring work takes the full 12–16 weeks, sometimes longer.
Chronic pain treatment doesn't have to mean choosing between pain care and recovery, or between getting better and keeping your life intact. It can fit your schedule. It can coordinate with the doctors you already trust. And it can finally treat the whole picture, instead of one piece at a time.
Confidential. No sales pitch.
