Addiction Psychiatry

The Recovery Process

Going it alone increases the likelihood of returning to addictive behavior. Dr. Weiss’ treatment approach is to help you:

• Develop insight into your behavior and goals with supportive therapy.
• Diagnosis to know what we are dealing with. Treat what is not helping, encourage what is.
• Guidance in the physical and mental health aspects of treating withdrawal.
• Dual Diagnosis and Treatment. Dual Diagnosis is the term for treatment that addresses together a psychiatric condition with a substance abuse disorder. This can be a more comprehensive and effective approach than treating one condition independent of the other.
• Individual and/or group therapy. We decide together what is best for you.
• Managing and collaborating with your other doctors and medical and psychotherapy care providers, who may be treating medical, psychiatric, and psychological conditions that can impact recovery.
• If indicated, medication.

Drug, Alcohol & Addictive Behaviors (Process Addictions)

Dependence on substances like alcohol, cigarettes, or drugs get a lot of attention in our society, but other addictions exist that operate differently and are more complex behaviorally and can be more difficult to treat. Substance abuse addictions have a strong physical component–that’s why detox is medically monitored.

Treatment for any addiction is more successful after a “deep dive” into physical and emotional interactions.

TYPES OF ADDICTIONS

Substance Abuse

Addiction tends to fall into two categories: Substance Abuse Disorder and Process Addictions. See below for more about process addictions.

Common Addictions

Alcohol. Alcoholism is insidious because alcohol is freely and legally available and people perceive and thus define their alcohol intake differently. One person might drink only beer and believe it is not addictive because it isn’t hard alcohol. Another person may justify social drinking. Cocktails are alcohol. A “cigar and whiskey-tasting” event involves two addictive substances. Abuse, not the substance, is the medical concern.  If alcohol use is damaging your life, job, family, and/or mental health, then it is worth looking at with a psychiatrist. Conversations don’t come with judgment.

Nicotine. Cigarette addiction has been studied for more than a century. It is a notoriously difficult “habit” to kick. While there are many treatments available, success usually requires an understanding of a person’s physiology, lifestyle (e.g., living with another smoker or another condition that impacts addiction to nicotine), and psychological factors.  Like alcohol, use of nicotine is widespread and legal. Nicotine use is expensive and poses obvious health dangers like cancer or COPD (Chronic Obstructive Lung Disease or Bronchitis/Emphysema). The desire to overcome a nicotine addiction is unique to each person and incumbent upon them. Consider the opposite: Addiction to illegal drugs can alert law enforcement and is socially unacceptable–meaning the addict is scrutinized and the stakes are high.

People may incorrectly believe that vaping and e-cigs do not deliver nicotine and are not addictive like cigarettes. Unlike cigarettes, damage to the lungs may be less, but dependence on nicotine in any form is an addiction.

• cigarettes
• e-cigs
• vaping
• chewing tobacco, snuff

Street Drugs

Heroin and other opiates, cocaine, and crack cocaine are extremely addictive. Also sold as “street drugs” are performance-enhancing drugs (e.g., steroids,) and drugs that are medically prescribed but illegally sold, such as pain medications like fentanyl (also known as Actiq, Duragesic, and Sublimaze.)  These substances go by many names. Substances are not equally addictive and side effects of taking the substance on a regular basis vary widely.

People from all walks of life can encounter and become dependent on an illegal drug or other substance. The trajectory of the addiction creates an addiction roadmap, that can be helpful to discuss when Dr. Weiss works with a patient to overcome an addiction.

Correct identification of the problem from a physical, psychological, emotional, and family/societal basis makes treatment and hope for recovery possible.

Overlapping Conditions and Addictions

Co-Addictions and Dual Diagnosis

In some cases, people are addicted to more than one substance (alcohol and smoking, for example) or a substance abuse and a process addiction together. For example, drinking, smoking and drugs are substances of abuse. Gambling or pornography/sexual compulsion are process addictions. Co-addictions can be treated together. Drinking and smoking, or drinking and gambling, drugs or drinking and pornography/sexual compulsion, for example. The combinations are endless!

Substance abuse that is not strictly speaking an “addiction” may accompany another condition, which might make it worse.  An example might be use of steroids to build strength or muscle, which is in turn associated with a process addiction, like so-called exercise addiction. Use of an addictive stimulant may be associated with an eating disorder where the person wants to be thin. Similarly a person may take on a form of “purging” (e.g., self-induced vomiting, misuse of laxatives or medications, excessive exercise, or fasting, behaviors that can be associated with Anorexia or Bulimia). When an addiction and another psychiatric disorder co-exist in the same individual, this is called dual diagnosis. As one condition oftentimes plays off the other, both must be considered and addressed. In this regard, Dr. Weiss has developed Dual Diagnosis programs as a teacher and treater.

Prescription Drugs

Prescription drugs can be powerful aids to treat a medical condition, like chronic pain, or anxiety. See some of the examples below.

If the drug’s impact on the body, however, puts the patient at risk for developing an addiction, the responsibility often falls to the patient to disclose to the prescribing doctor that the medication is causing them be out of control. Non-disclosure can reflect “denial”–the patient is unaware or unwilling to acknowledge the drug’s adverse impact on them.

This “vicious circle” or unconscious “conspiracy of silence” between the prescriber and patient must be recognized and addressed. Dr. Weiss has the training and skills to help the patient (and sometimes his or her own prescribing doctor) recognize that the use of the pharmaceutical has become counterproductive and help reverse what was seemingly an uncontrollable decline.

In some cases, discontinuing a prescription drug requires a slow reduction in dosage to limit withdrawal-type symptoms. Another strategy to help with withdrawal is to switch up the addictive substance for a less addictive or harmful drug on a temporary basis (e.g., nicotine that does no damage to the lungs like nicotine gum or patches). Adjunctive medications may be used as well. Witness the “oldie but goodie” Antabuse or disulfiram, which causes a physical “reaction” when the patient drinks, designed to cause negative reinforcement.

In the end, this does not mean a medication with a risk of addiction should never be taken. It just means close monitoring with a doctor is essential, along with honest and open communication skills.

Familiar Prescription Medications That Can Be Addictive

Your doctor may prescribe a medication to which you develop a dependence. This is not necessarily an addiction. It does not mean you are taking it to excess, are scheming to obtain more of it, or the use of it is unconsciously wrecking your life. It just means that your body has to have it and your mind believes you cannot function without it. Thus, there is a fine line between dependence and addiction.

Doctors are not equally knowledgeable about treating a condition with an addictive medication. In fact, many physicians get poor or little education or training in the field of chemical addiction.  If you are wondering if the medication you are taking could put you at risk, Dr. Weiss finds it can be helpful to work with your general practitioner and/or specialist.

Common prescription medications that can lead to substance abuse and addiction:

PAIN: Percocet (oxycodone), Duragesic (fentanyl), Vicodin or Norco (hydrocodone)

SLEEP: sleep medicines such as Ambien (zolpidem) and Lunesta (eszopiclone)

ADHD: Ritalin (methylphenidate), Adderall (amphetamine/dextroamphetamine), and Concerta (long-acting methylphenidate).  They can be a powerful tool for helping patients with Attention Deficit (Hyperactivity) Disorder or AD(H)D. “Prescription stimulants have a calming and “focusing” effect on individuals with ADHD. They are prescribed to patients for daily use, and come in the form of tablets or capsules of varying dosages. Treatment of ADHD with stimulants, often in conjunction with psychotherapy, helps to improve ADHD symptoms along with the patient’s self-esteem, thinking ability, and social and family interactions.” (Drugabuse.gov). Nevertheless, it must be recognized that ADHD medications are stimulants that carry a risk for dependence. (Read more about ADHD /ADD.)

Process Addictions

“Process Addictions” are different from substance abuse disorders. They are by definition behavioral compulsions that result in impairment in the person’s life socially, family-wise, financially, or in their work. They may include an element of OCD (Obsessive-Compulsive Disorder) or Anxiety that, when treated, may improve recovery success.

Psychiatric treatment for process addictions can differ from treatment for substance abuse disorders, though the desire to “quit” requires the same strong commitment. Process addictions can include:

• gambling
• overeating
• hoarding
• shopping 
• sex
• internet immersion, which can include gaming or porn

In fact, the individual suffering from a process addiction often finds it more difficult to reverse than “drinking and drugging.” This is because the addiction lies in the behavior itself, which due to the complexity of the mind, brain and body interaction, is subtle yet insidiously entrenched—even over years or decades.

The techniques used to recover from a process addiction can be different than a substance abuse disorder though there are overlaps. In both, though, the approach to be considered is a combination of treatment resources. For example, psychotherapy with a licensed mental health professional (individual/group), medication management, self-help support groups (without a licensed mental health professional but often very effective,) such as “12 Step” programs of the “Anonymous” groups derived from AA “meet-up groups,” and/or religious based organizations designed to help those suffering from these disorders. 

Dr. Weiss finds that treatment for any addiction is more successful after a “deep dive” into physical and emotional interactions, using any and all of these resources in a combination tailored to the individual.