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Tag: opioid addiction treatment

Where to Find an Opioid Recovery Center in Boulder

Posted on by cmarnew

Tens of millions of people in the US abuse opioids every year, with a few million developing tolerance and dependence on the drugs. Few of those who develop an addiction go to rehab, but many people choose to self-medicate. Those who try to stop without expert help experience relapse because of the overwhelming withdrawal symptoms. At the Colorado Medication Assisted Recovery (CMAR), we agree that checking into an opioid recovery center will help you overcome opioid abuse and regain sobriety. Contact CMAR at 833.448.0127 to learn more about our opioid recovery center near Boulder, CO.

Why Do You Need an Opioid Recovery Center?

Hundreds of Americans die daily because of opioid abuse and addiction-related cases. Furthermore, the number of opioid overdose deaths in America increased considerably in 2018 from the previous year. The statistics point to the dire need for opioids abuse treatment.

If you are struggling with an opioid use disorder, your top priority should be finding an opioid treatment program that will facilitate permanent recovery. Ask yourself: What unique aspect must such a program contain to ensure the unpleasant withdrawal symptoms do not force you to relapse?

Some of the opioid withdrawal symptoms that require immediate rehab help at an outpatient treatment program include:

  • Hypertension
  • Body tremors and shaking
  • Trouble concentrating
  • Slurred speech
  • Breathing problems
  • Emotional numbness
  • Nausea, vomiting, and diarrhea

An ideal recovery program offers customized opioid treatment to meet your individual needs. Different people face varied challenges that require personalized treatment plans. Those who do not access personalized care face a wide array of problems after recovery.

Where can you find a recovery center that promises you reliable aftercare and support once you complete your addiction treatment?

Opioid Addiction Treatment in Boulder, Colorado

At CMAR, we offer personalized treatment and aftercare programs to ensure that you do not experience relapse once you regain your sobriety. To enroll for a reliable opioid addiction treatment program in Boulder, reach out to our professionals today.

Our facility has a qualified and experienced team of therapists, clinical officers, and other healthcare providers who will handle your opioid abuse recovery process. The professionals will accord you the essential support, supervision, and guidance you need.

CMAR uses medication-assisted treatment and aftercare programs that are useful in achieving full recovery. We will teach you more about your condition and help you set attainable recovery goals.

Most individuals are unable to overcome substance abuse due to intense withdrawal symptoms. Having dealt with many other people in a similar situation, the therapists at CMAR understand how to offer you the much-needed help.

Why Addiction Treatment Is Vital

While you’re at our addiction treatment center, you’ll find that you have the support of our clinical treatment staff. You will work closely with your therapist to achieve set goals. Because it is an outpatient treatment center, you can go home at the end of the day’s treatment.

Once you indicate positive change and ability to manage withdrawal after leaving the opioid recovery center, our case management and aftercare programs can ensure long-term sobriety.

It is worth noting that the highly addictive nature of opioids makes aftercare programs critical in ensuring you can overcome relapse episodes as you return to the outside world.

During your treatment program, you will participate in several types of evidence-based treatment programs, such as:

Overcome Opioid Abuse at CMAR

Do not struggle with opioid abuse any longer. Reach out to the Colorado Medication Assisted Recovery for information on how to overcome addiction at our opioid recovery center. Contact CMAR today at 833.448.0127 to schedule an appointment.

Prescriptions Alone Don’t Work: The Need for Complete Medication Assisted Treatment to Effectively Treat Opioid Dependence

Posted on by cmarnew

According to the NIH, there are “…4 important components of MAT models of care” but in Colorado, over 90% of patients only receive 1 one of them. CMAR was developed to change that, by integrating all 4 components of effective Medication-Assisted Treatment into a single program. So how and why does our groundbreaking treatment approach matter so much? In 2018, research found that in Colorado, nearly every person in the state on “MAT”, only receives 1 of the 4 components of effective MAT. of the services. The causes are many, and the impact is clear: Coloradans on Medication-Assisted Treatment have been woefully and systematically underserved…until CMAR.

The 1st of the 4 main components of MAT, is pharmacological therapy, which is a fancy term referring to the prescription and administration of medications. This includes Buprenorphine (i.e. Suboxone) and Naltrexone (i.e. Vivitrol) based medications. Crucial and central to MAT, it’s the only part that Coloradans routinely have access to. At CMAR, we don’t just assess, diagnose, prescribe, and administer these meds, we carry them too. This creates unprecedented access to the medications that patients need consistently in order to avoid relapse and overdose.

The 2nd component of MAT is “provider & community educational interventions”. This involves engaging members of the community, particularly stakeholders in addiction treatment, on the value and importance of using & having access to MAT. This has the effect of increasing the number of opiate addicts that get onto MAT (therefore reducing overdoses), and it significantly reduces stigma. Although this component does exist in Colorado, it is almost entirely done not by the MAT providers, but rather by public health officials & organizations. As helpful as that is, this keeps the core elements of MAT fractured, and keeps the message of those who provide MAT faceless. People often need a smiling, trustable face to combine with service to fully let their guards down and destigmatize something completely. At CMAR, we integrate these services through our community engagement department.

The 3rd element of MAT is the integration of substance use disorder (SUD) treatment. In the context of MAT, this can be in either a residential or outpatient addiction treatment setting. Yet only a few residential facilities in the state provide both, and none of these programs provide continuing support. SUD treatment, at both intensive and standard outpatient levels, is central at CMAR. In fact, we’re Colorado’s only licensed Medication-Assisted Treatment Facility (OMAT) that is even licensed as an outpatient and intensive outpatient addiction treatment provider.

The 4th and final necessary component of MAT is called “psychosocial services”. These services focus on healthy social integration and the resolution of familial issues like marriage and other close relationships. Support within a community of recovering individuals is perhaps the most common form of case management, and one of, if not the most beneficial to many. Many MAT programs do offer these services in the form of case management, but they are unfortunately provided in lieu of, not in concert with, SUD treatment. Except, of course, at CMAR. Here we offer family support services as well as peer-based support groups and case management services.

 

Medication-Assisted Treatment is all about medication assisting actual, evidence-based treatment. It isn’t about merely prescribing medications and offering some case management, but about wrap-around opioid-dependence treatment. At CMAR, it is our mission to ensure that each of our patients receives the benefits of each element of MAT, and in so doing, change their lives for the better.

Learn More at www.Colorado-Recovery.com or call (720) 778-2627

The End of Cookie Cutters: Truly Individualized Opioid Recovery

Posted on by cmarnew

At CMAR, Colorado’s first recovery-oriented and clinically driven opioid recovery program, we work with our patients to identify the most appropriate course for them, while still ensuring that they receive all of the clinical care and social support necessary for recovery.

Medication-assisted treatment, pure harm-reduction, and abstinence-based care are the three primary “umbrellas” of treatment for opioid dependence. There are certainly other methods, but these are the most common and researched approaches offered in the US.

Any program that claims to be individualized, and then offers only one “path” to achieving abstinence, by definition is only partially individualized. At CMAR, we recognize those limitations, so despite a somewhat misleading name, we offer treatment for opioid dependence (and co-occurring disorders) using abstinence, medication-assisted, and harm reduction. Our goal is to meet our patients where they’re at and treat their needs. If those needs call for a patient to remain abstinent or achieve abstinence after a Suboxone taper, we support that. If a patient just wants Vivitrol and clinical care, we will proudly offer them that care. At CMAR, medication-assisted treatment is option, but therapy and community are not. We recognize that there is no alternative to the processing and learning of new “tools” derived from therapy and that there is no replacement for the support and love of one’s peers.

Recovery is a personal, ongoing process of personal development, yet one-size-fits-all programs cannot honor that truth. For that very reason, we built our program with the intention of guiding patients through the format of care that they seek, and that is clinically and medically indicated. We are proud to provide medication-assisted treatment, yet we fully recognize that this “MAT” is not the only way.

Learn More at www.Colorado-Recovery.com or call (720) 778 2627.

The Importance of On-Site and Remote Opioid Treatment

Posted on by cmarnew

Recovery from opioid dependence is a difficult, but life-saving endeavor. The process can involve many ups and downs and demands a lifelong commitment to change in order to avoid relapse. 

But the good news is that it can be done, through integrated-care including medications, clinical treatment, accountability, and peer-support. The only problem is that with only one integrated care program in Colorado (Colorado Medication-Assisted Recovery) only people in Metro Denver can actually get to the in-person program just North of the city limits.

Thankfully, no matter where someone lives in the state, CMAR’s remote treatment option offers unparalleled treatment services for people addicted to opioids. Both have their benefits, but they are equally effective at empowering patients to achieve a lasting, lifelong recovery.

CMAR’s in-person program is a completely unique approach to treatment for Colorado. We fuse addiction medicine, group, individual, and family therapy, with peer support and accountability for an unmatched recovery experience. Just off of I-25 in Thornton, CMAR is easily accessible to anyone in the central, west, east, and north metro Denver areas. But outside that part of the state, it’s not accessible in person.

Enter CMAR-Remote: Our Telehealth-based, HIPAA compliant, full-service integrated Medication Assisted Recovery program provides all of the services as our in-person program. CMAR-Remote is Colorado’s first and only web-based treatment program to offer a combination of addiction medicine, intensive outpatient counseling (including individual, group, and family therapy), wraparound case-management and peer support, plus urinalysis! Every aspect of a patient’s opioid dependence treatment is now accessible from home, enabling those with mobility issues, those outside of North Metro Denver, and those who are otherwise unable to make it to our physical center regularly, to receive the most comprehensive treatment available. 

Whether at our physical center or on the web, at Colorado Medication Assisted Recovery, we are 100% focused on treating individuals suffering from opioid dependence and any co-occurring addiction and mental health concerns.

Learn More at www.Colorado-Recovery.com or call (720) 778-2627

The Current Opioid Crisis: What You Need to Know

Posted on by cmarnew

The opioid crisis has reached new heights in the U.S. According to the National Institute on Drug Abuse (NIDA), 128 people die per day as a result of overdosing on opioids. Opioid addiction treatment centers in Colorado continue to see more patients as addiction rates soar. 

Opioid use disorder (OUD) includes addictions to prescription pain medication, fentanyl, heroin, and similar drugs. This epidemic has resulted in nearly $80 billion annually in treatment costs and criminal justice involvement. What is the opioid crisis? How did it start, and what are the solutions? To learn more about opioid addiction treatment, contact Colorado Medication Assisted Recovery at 833.448.0127 today. 

How Did the Opioid Crisis Begin?

The popularity of opioids began in the 1990s when pharmaceutical companies mass-produced prescriptions for pain relief and muscle relaxation. Although there was concern about the addictive properties of the drugs early on, pharmaceutical companies assured the medical industry and the public that patients would not become addicted to the substances.

Convinced of this, doctors and treatment specialists began prescribing opioids at alarming rates almost from the beginning. As the prescription rates increased, the addiction rates increased. By 2017 almost 50,000 Americans died from an overdose, and nearly 2 million people experienced substance abuse. Many Americans required help from a dual diagnosis treatment program.

Current Opioid Use Statistics

NIDA has currently released opioid use statistics that users and medical professionals should find alarming. These statistics include:

  • Nearly 30 percent of patients who use opioids for pain management misuse them
  • Over 10 percent of users develop an addiction or dependency to opioids
  • Up to 6 percent of users who abuse opioids end up using heroin
  • Nearly 80 percent of people who use heroin also abused their first opioid prescription
  • There was a decline in opioid-related overdoses in 38 states between 2017 and 2018

What are the Solutions to the Crisis?

NIDA and other agencies have declared that opioid use has become a public health crisis in the U.S. due to the number of overdoses, fatalities, and addictions in both men and women. Both government agencies and private entities have taken drastic steps toward alerting the public about the current problem. These steps include:

Improving Addiction Treatment Services

One of the biggest steps to addressing the current crisis is by improving the way treatment centers help clients. Addiction treatment services include evidence-based treatment (EBT), dual diagnosis treatment, and aftercare programs that promote a sustainable recovery without relapse.

Medication-Assisted Treatment

Addiction treatment centers in Colorado are including medication-assisted treatment (MAT) into their programs as a supplement to therapy and support. Buprenorphine, suboxone, and naltrexone are among the opioid antagonists that reduce cravings and the effects of withdrawal symptoms during recovery.

Increased Monitoring of the Crisis

Through advanced technology and accountability, agencies are improving the way they monitor the current opioid crisis. We are now getting a better understanding of how and why the drugs are being prescribed and how the public is responding to the accessibility of these drugs. Agencies are also obtaining more accurate figures about the crisis.

Better Practices for Pain Management

The more we understand what causes pain, the more we can come up with holistic alternatives to prescription medication. Support for research on pain and addiction has increased significantly, as researchers explore new options. It is important that we move beyond the crisis by giving patients better solutions to managing their pain. With our chronic pain management program, we give you the tools you need to manage your pain effectively without medication.

Are You Addicted to Opioids? Get Help at CMAR

In spite of the opioid crisis, help is available for addiction. Colorado Medication Assisted Recovery offers treatment for opioid addiction at our medication-assisted treatment center in Colorado. To find out more about your treatment options, contact us at 833.448.0127, and speak with a treatment specialist today.

Structured & Accountable Care at CMAR

Posted on by cmarnew

One of the biggest challenges we face in combating the opioid epidemic…is the fractured state of opioid treatment services.

 

Getting clean from opioid addiction can be complicated.

 

To fully recover, one must see a doctor for assessments, a pharmacy for treatment medications, a therapist for counseling, and (hopefully) find friends/mentors for guidance and accountability.

 

With such a “siloed” system, there are more opportunities to fail than there are to succeed.

 

All the while, an average of more than 5 Coloradan’s a day die from an overdose, and many wonder, “Why?”

 

There are myriad and complex reasons why opioids kill so many people despite improvements to treatment, but one reason is clear…

 

Few opioid addicts can achieve lasting recovery when care is so disparate, and accountability is rarely more than a monthly urinalysis.

 

Unless people can access structured, comprehensive, and accountable care, their ability to achieve lasting recovery is extremely low.

 

If a doctor, pharmacy, therapy program, case manager, and peer support were in one place, there wouldn’t be any cracks to slip through.

 

Well, that’s exactly what Colorado Medication Assisted Recovery (CMAR) has done…

 

CMAR offers addiction-medicine, medications, therapy (individual, group, and family), and peer-support all in a single location.

 

CMAR even offers a full-service, remote treatment option.

 

Learn More at www.Colorado-Recovery.com or call (720) 778-2627.

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Cortland Mathers-Suter

MSSA
Managing Partner

Cortland Mathers-Suter entered the treatment space after his own battle with addiction. He first worked as a peer mentor, before starting clinical work while completing his Masters of Science in social administration from Case Western Reserve University where he focused on policy and direct practice. Cortland moved to Colorado in 2015 to start his first addiction treatment program, AspenRidge Recovery. Under his tenure, AspenRidge Recovery became a two-location, nationally accredited organization. He has since spent the last two years researching and developing what is now Colorado Medication Assisted Recovery (CMAR).

According to Cortland, “Colorado Medication Assisted Recovery is the most important organization I have had the honor to help build. We’re offering a service that seeks to not only improve the lives of our patients but also evolve how we look at medication-assisted treatment in Colorado entirely. Most individuals receiving medication-assisted care only receive medication and urinalysis. Sure you can call that ‘treatment,’ but you can’t call that ‘recovery.’ Our model is about adding the missing recovery component, and thus affords an opportunity to achieve lasting change for each patient and the industry.”

Cortland and his treatment programs have received numerous honors. These include Colorado Business Magazine’s “GenXYZ” award, the 2020 “Titan 100” award, and his program AspenRidge Recovery was both a finalist for “Best Healthcare Company” and named in the “Company’s to Watch” by Colorado Business Magazine as well. He has been interviewed and quoted by numerous publications for his “addiction expertise”, including News Week, 5280 Magazine, the Denver Post, Elephant Journal, Colorado Biz Mag, and TheRecoverySource.org.

Tyler Whitman

Compliance/HR Administrator

Tyler is originally from Omaha, Nebraska. He worked in manufacturing administration for 18 years until he chose to pursue recovery from alcohol addiction, which led him to Chicago, Illinois. Since then, Tyler gained experience in retail, retail pharmacy, and healthcare as a vaccine coordinator for a local Colorado clinic. At the clinic, Tyler discovered that healthcare was the career change he had been looking for. His newfound passion for healthcare, combined with his lived experience with addiction, brought him to Colorado Medication Assisted Recovery as an Office Administrator.

In his free time, Tyler enjoys cooking, hiking, and skiing. He is currently pursuing a master’s degree in Health Services Administration from Regis University.

Simmeren Boanvala

BA
Outreach and Admissions Representative

Simmeren comes to CMAR after several years working admissions in inpatient psychiatry and addiction. A first-generation Colorado Native, Simmeren attended CU Boulder, where she earned a BA in psychology. Simmeren is currently completing her CAC III while working toward her master’s degree in marriage and family therapy.

According to Simmeren, “I joined CMAR because I believe in the quality and importance of the program whole-heartedly. My goal at CMAR is to guide each prospect who calls CMAR to find the best possible pathway to their recovery”. Simmeren currently lives in her hometown with her dog and cat.

Tyler Hale

Tyler Hale

Community Partnership Lead

Tyler Hale began his career in addiction treatment following a decades-long fight with his own substance abuse issues. Since achieving long-term recovery, Tyler has held various positions in direct care, client services, admissions and outreach departments at various addiction treatment organizations. From sober living program director to outreach director to admissions director at a drug and alcohol treatment program, Tyler consistently finds himself in leadership roles within the addiction treatment space.

Tyler is originally from Chicago, IL, where he graduated from Loyola University Chicago with a Bachelor of Arts in Sociology and Bioethics. Thereafter, Tyler built a successful career in the tech industry, before finding sobriety and a subsequent calling to help others. Tyler joined the team at CMAR because he believes in the efficacy of comprehensive and patient-centered outpatient treatment. In his free time Tyler enjoys camping, hiking and spending time with his newborn son.

Kirstin O’Carroll

MSW
Engagement and Relations Director

Kirstin O’Carroll started her career in addiction and mental health services 23 years ago after graduating with an MSW from The Oho State University. Hired directly from an internship program, she served as a case manager and vocational specialist on a community treatment team in Columbus, OH, working to help severely mentally ill adults remain at home and in a community setting. Within the same organization, she later transitioned to clinical assessment and crisis intervention services with children, adolescents, and adults. Through these experiences, she learned the importance of providing empathetic, high-quality care and the need to “start wherever the patient is” with regard to finding the best treatment & solutions for her patients.

After seven years, Kirstin made a career change to diagnostic sales and worked for several Fortune 500 companies as an acute care sales specialist. She is delighted to return “home” to her passion for helping others and believes her new role as community engagement coordinator for CMAR is the perfect alignment of both her clinical and sales skills. When not promoting CMAR, she can be found reading, running, hiking, watching movies, and spending time with her husband Dennis and senior canine son Reggie.

Thomas Mazzarella

LAC
Primary Therapist

Thomas is a Licensed Addiction Counselor (LAC) in the State of Colorado and a Licensed Addictions Specialist (LCAS) in the State of North Carolina with particular expertise in the treatment of chronic Substance Abuse Addiction and Dependency.

Thomas is dedicated to Individual, Couples, Family, and Group Counseling and Therapy for individuals with Substance Use and Mental Health issues and concerns.

James Jackman

CAS
Primary Therapist

James Jackman is a Certified Addiction Specialist and has been practicing addiction treatment in Colorado since 2015. James is pursuing his bachelor’s degree in psychology from Metropolitan State University Denver. James is a traditional CBT therapist specializing in childhood events that lead to adult addictions.

James has received special training in Family Systems, Inner Child, Maladaptive Schemas, and Adverse Childhood Experiences. James has worked in many treatment settings throughout his career and uses a client-centered treatment approach to help one recover from destructive patterns that facilitate addiction. In addition, James enjoys working with rescue animals and advocates for several local rescue organizations outside of work.

Outside of the office, Megan enjoys spending time with her two German Shepherds and her cat. She is passionate about fostering animals through various local rescues to find adoptive homes for dogs and cats in need.

Megan Hanekom

LPC, LAC, NCC
Therapist & Clinical Compliance Officer

Megan is a licensed counselor who has worked in various mental health and addiction treatment environments. She practices cognitive behavioral therapy and motivational interviewing and believes in pulling from various therapeutic approaches to best support each individual. Megan received her bachelor’s in psychology and Spanish from Concordia College. She relocated from North Dakota to Colorado where she earned a master’s in counseling psychology from the University of Denver.

Outside of the office, Megan enjoys spending time with her two German Shepherds and her cat. She is passionate about fostering animals through various local rescues to find adoptive homes for dogs and cats in need.

Maggie Coyle

MA, LPC
Primary Therapist

Maggie Coyle, MS, MA, LPP, LPCC has worked in the mental health and addictions counseling field for the past six years. She has extensive experience in working in the varying levels of mental health and addictions treatment as well as with diverse populations.

She practices cognitive-behavioral therapy and dialectical behavior therapy as primary intervention methods. She has earned a bachelor’s degree in sociology as well as a master’s degree in clinical mental health counseling both from Northern State University in Aberdeen, SD. She has also earned a master’s degree in addictions counseling from the University of South Dakota in Vermillion, SD. Maggie moved from South Dakota to Colorado in June 2020 and is excited to be a part of the CMAR team.

Michael Damioli

LCSW, CSAT
Clinical Director

Michael Damioli has been passionately working in the fields of addiction treatment and mental health since 2012. He has held a variety of different roles within the addiction recovery space, ranging from peer support to direct clinical practice. Notably, Michael was part of a leadership group that developed a small therapy practice into a nationally branded addiction treatment program, which offers multiple levels of care to recovering professionals. Michael is a strong believer in the family disease model of addiction and has focused much of his clinical work and training on supporting families impacted by addiction. He also specializes in treating individuals suffering from co-occurring chemical and process addictions.

Michael is honored to be leading the clinical care team at CMAR and believes that excellent clinical care begins by simply treating a patient with dignity and respect. Michael is a strong advocate for ethical reform within the addiction treatment field and is excited to promote CMAR as an ethical and thought leader throughout the treatment & recovery industry. Michael earned his master’s degree in social work from the University of Denver and is independently licensed as a clinical social worker with the state of Colorado. He holds an advanced post-graduate certificate in marriage and family therapy from the Denver Family Institute as well as an advanced certificate in sexual addiction counseling from the International Institute of Trauma and Addiction Professionals.

Dwight-Duncan

Dwight Duncan

Psy.D
Psychologist

Dr. Duncan was born and spent most of his early life in California. He received his doctorate in clinical psychology from the University of Denver in 1987. He is a licensed psychologist as well as a licensed addiction counselor. He has had extensive training and experience throughout his professional career in medical psychology, mindfulness, integrated behavioral healthcare, and substance abuse.

Dr. Duncan is married and has one daughter, a neurologic physical therapist in Los Angeles.

Susan-Miget

Susan Miget

NP
Medical Provider

Susan has been in healthcare for more than 20 years. She was an ICU nurse for nine years, then returned to school and completed her master of nursing and family nurse practitioner degree at the University of Missouri-St. Louis in 2007. She practiced pain management for many years before developing her current passion for addiction treatment.

Susan has transitioned her practice to focus entirely on addiction treatment. She has worked in residential treatment, partial hospitalization (PHP), and intensive outpatient (IOP) programs. Susan most enjoys working with patients one-on-one in a private office to protect their confidentiality and ensure top-rate care. Knowing that addiction can affect anyone, anywhere, and at any time, Susan continues to strive to make treatment more accessible and confidential.

Whitney-Grant

Whitney Grant

MSN, FNP-BC, ARNP, RN, CPN
Medical Provider

Whitney Grant is an experienced family nurse practitioner with experience and expertise in medication-assisted treatment. Whitney earned her BSN at the University of Miami before moving on to achieve a master of science in nursing degree there as well, becoming a nurse practitioner immediately thereafter.

Whitney has since achieved board certification from the ANCC as a family nurse practitioner. After spending her entire formative and educational years in South Florida, Whitney moved to Denver in 2018 to pursue a career as a provider in family practice, sub-specializing in addictions medicine. Whitney has worked under the guidance of Dr. Nathaniel Moore, CMAR’s medical director, since moving to Denver.

Nathaniel Moore

MD
Medical Director

Dr. Nathan Moore is board-certified by the American Board of Family Medicine. Dr. Moore attended Stanford University in Palo Alto, CA for his undergraduate work and then attended Duke University School of Medicine and obtained his M.D. in 1995. Dr. Moore then came to Colorado and completed his residency in family medicine at the University of Colorado’s Family Medicine Program at Rose Medical Center.

Dr. Moore practices primarily at our Aurora location. He provides comprehensive family medicine services and has a special interest in addiction medicine, treating patients with opioid use disorder as well as alcohol addiction.

Dr. Moore is married with three children. He enjoys mountain biking, running, and golf.