Category

Addiction

Ketamine + Mindfulness Therapy Treats Cocaine Addiction

By Addiction, ADHD, Anxiety, Bipolar Disorder, Co-Occurring, Cocaine, Depression, Ketamine, Mental Illness, PsychopharmacologyNo Comments

This image shows cocaine addiction

A Single Ketamine Infusion Combined With Mindfulness-Based Behavioral Modification to Treat Cocaine Dependence: A Randomized Clinical Trial

Am J Psychiatry 2019; 176:923–930; doi: 10.1176/appi.ajp.2019.18101123

Elias Dakwar, M.D., Edward V. Nunes, M.D., Carl L. Hart, Ph.D., Richard W. Foltin, Ph.D., Sanjay J. Mathew, M.D.,
Kenneth M. Carpenter, Ph.D., C.J. “Jean” Choi, M.S., Cale N. Basaraba, M.P.H., Martina Pavlicova, Ph.D., Frances R. Levin, M.D.

A study recently published in the American Journal of Psychiatry found that Ketamine, an NMDA blocker that promotes synaptogenesis, plus Mindfulness Therapy effectively treated cocaine dependent patients. Fifty five cocaine dependent subjects were treated with either ketamine or midazolam combined with mindfulness behavior therapy. The study found that ketamine was significantly more effective in treating cocaine cravings and was associated with a significantly higher rate of abstinence than patients treated with midazolam, a medication used as a control. Craving scores were 58.1 % lower in the Ketamine group than the control group. At six month follow up, 44% of patients treated with Ketamine were abstinent compared with 0% of patients in the control group. The authors found that ketamine infusions given at a dose of 0.5mg/kg over 40 minutes was well tolerated, and promoted abstinence in cocaine addicted patients. Ketamine was associates with a lower likelihood of cocaine use, lower levels of cocaine craving and longer time to relapse. This study represents a promising treatment modality for cocaine addiction, an illness for which, until now, has had no effective treatments. 

Ketamine: An Effective, Novel Approach To Treating Depression

By Addiction, Anxiety, Depression, Ketamine, Mental Illness, PsychopharmacologyNo Comments

The purpose of this image is to show ketamine molecule

Ketamine, an anesthesia medication, is an old drug that has emerged over the past several years as a rapid and effective treatment for depression and suicidal thinking. Most people who seek out ketamine have tried other treatments such as medications and even psychotherapy with either little success, or an inability to tolerate side effects. Some people who have had earlier success with conventional antidepressants, have found that over time, efficacy has worn off.

Ketamine was approved in 1970 as an anesthetic, and since that time it has been widely used, mainly by anesthesiologists for that purpose. It has been used for decades to treat refractory pain syndromes.  Unlike most anesthesia drugs, ketamine does not require that a patient be intubated since it actually opens the airways and increases circulation.  

Ketamine is known as a “dissociative anesthetic” because at doses required for anesthesia, it causes hallucinations and feelings of dissociation – an “out of body” experience.

Ketamine is used at significantly lower doses to treat depression, and while patients receiving ketamine for this purpose often feel some dissociative feelings, they are of a much lower magnitude and most often described as being pleasant.

            Ketamine for depression is usually delivered by IV infusion over a 45-50 minute period under the guidance of experienced, licensed staff. It can also be given as an intramuscular injection or even as a nasal spray.

After the infusion, most people relax for about 20-30 minutes and then go home accompanied by someone.

            Many people feel better after only one infusion! However, many people do require several infusions before they notice improvement.  Also, patients vary in terms of how long the benefits of ketamine will last.

            Ketamine is normally well tolerated and treats depression via a different mechanism of action than other antidepressants. While most antidepressants work by blocking the re-uptake of serotonin, ketamine actually works by blocking another receptor called the NMDA-receptor which modulates the excitatory neurotransmitter known as Glutamate.  In fact, lab experiments have shown that ketamine actually re-generates neurons in the brain that are damaged due to long-term depression. This is known as synaptogenesis (see Fig 1 below) which may also help explain ketamine’s mechanism of action.

            If you are someone who has suffered from long-standing depression, or have had difficulty tolerating, or adequately responding to antidepressant medication, then ketamine may be appropriate for you.

Please call us for more information, or to be medically evaluated for Ketamine.

 

This picture shows the mechanism of action of ketamine to treat depression

Fig 1.

Scott Bienenfeld, M.D. 

Stacey Cohen-Meissner, Ph.D.

Synthetic Drugs – Beware…

By Addiction, Mental Illness, RecoveryNo Comments

K2 – “Spice”

K2, Spice, Bath Salts

 Parents and Doctors Beware and Be Prepared!

Over the past several years, there has been increased concern about kids using “synthetic” drugs – substances that are developed in a laboratory and intended to mimic more “familiar” drugs such as marijuana and amphetamines.  Two factors make these compounds particularly frightening: 1) They are packaged as “legal” substances in order to avoid DEA scrutiny, and 2) They are quite difficult to test for using routine drug screens.  

A synthetic form of marijuana known as “K2” or “Spice” which is usually marketed legally as plant food or incense and is obtainable at head shops, gas stations and via the internet, has been a matter of serious concern in recent years.   Emergency rooms nationwide have reported an increase in the number of kids presenting with an array of bizarre symptoms and negative drug screens.  Symptoms usually consist of agitation, hallucinations, panic-like reactions, suicidal ideation, seizures and strange behavior.   Now technically illegal in The United States (http://www.deadiversion.usdoj.gov/fed_regs/rules/2011/fr0301.htm), these compounds are still relatively easy to get a hold of, especially via the internet.  Certain labs can test for the presence of these synthetic cannabinoids, but routine testing will not detect them.  Brand names of these compounds include: Spice, K2, Chill Zone, Sensation, Chaos, Aztec Thunder, Red Merkury, and Zen.

“Bath Salts” are another example of synthetic substances that mimic more familiar drugs of abuse.  The compounds, which are marketed as bath products, mimic amphetamines, which are powerful stimulants.  As with synthetic marijuana, “Bath Salts” are very hard to detect with routine drug testing, and increasing numbers of cases of kids in emergency rooms are popping up.  Kids high on these drugs often have increased blood pressure, rapid heart-beat and even hallucinations and other psychotic symptoms.  Street names for these compounds include: drone, bubbles, meow-meow, MCAT, Ivory Wave, Vanilla Sky, Cloud 9, Red Dove, and White Rush.

It is important for clinicians and parents to be both aware of and educated about these new types of substances that are becoming widely abused by kids.  The DEA is beginning to crack down on these dangerous products, but as one substance becomes illegal, another one is likely to take it’s place.

Scott Bienenfeld, M.D.

Alpine Psych Solutions

 

Video Game Addiction: Is It Real?

By Addiction, Anxiety, Co-Occurring, Gaming, Mental Illness, RecoveryOne Comment

This photo demonstrates how video games are addictiveVideo game addiction

http://www.cnet.com/news/south-korean-government-to-debate-game-addiction-law/

Is it real? Can people actually be addicted to video games? Where does the idea of being “addicted” end, and is it ever used just as an excuse for any bad behavior?  Internationally, “I have a disease” seems to have become a modern day way to relieve people of responsibility. Could the US see a similar problem?

Regarding video games, addictive mechanisms are certainly in play, and technically people can be addicted to anything. Current research focuses on the reward system in the brain. The cultural aspects of it are less clear. We have seen trends in the culture where proclaiming oneself an addict is in fashion, the card to be pulled when someone asks for accountability. The treatment plan for a video game addict may in fact be more than the “off switch” and there have been special programs to treat this behavior. The truth is, though we don’t like to admit it, these addictive behaviors are a “spectrum” phenomenon that range from mild to severe. We all have tendencies, the question is whether or not there is functional impairment, that impacts our lives to the point where we need to do something about it. The policy in South Korea seems extreme. Recovery Spot NY treats a wide swath of addictive behaviors as well as addiction to substances. Often times there are psychiatric underpinnings of these behaviors. Our program, with it’s strong emphasis on psychiatric issues, can help. #video game addiction.

https://www.cnet.com/news/south-korean-government-to-debate-game-addiction-law/

Just Got a DWI or other “Drug Charge” – We Can Help

By Addiction, Alcohol, Alcoholism, Co-Occurring, Mental IllnessNo Comments

This photo shows a DWIBeing charged with a drug offense, or incurring a “drug charge” can be a daunting, humiliating and fear provoking experience. Laws vary from state to state and can seem unfair. Legal council is paramount without question, but what lawyers won’t tell you is that outcomes can be vastly improved by seeking treatment alternatives.

Many judges remain open to the idea of eliminating or dramatically reducing jail time and other penalties providing that that one is in comprehensive treatment for addiction, alcoholism or other treatable mental health issues. The thing that judges want to know is this: whatever crime or behavior that brought the person before them won’t be happening again. Many social problems including: domestic violence, theft, vandalism, sexual assault, etc…dramatically reduce in frequency when use of alcohol or other drugs declines, and judges are well aware of this.

While lawyers approach the problem of addressing “drug charges” by looking to maximize billable hours and finding loop holes, it is a far better idea to promote the fact that the individual charged is healthier and therefore less of a risk because they went into treatment.

We can help negotiate the issues by creating a file of evidence for the judge that includes: documentation of treatment, randomized breathalyzing, randomized toxicology screenings, and medication management.

Noted interventionist, Todd Urese has acted as court liaison on numerous cases, appearing with the charged individual to support them in court and to speak directly to the judge. We work closely with your legal team to maximize the best possible outcome.

Last year, “Jason” was arrested and charged with “intent to distribute”, a felony charge that could have ruined his young life. After a comprehensive assessment it was clear that Jason was suffering from untreated bipolar disorder in addition to chemical dependency. Jason remained in comprehensive treatment and we worked closely with his lawyer and thus were able to document his progress in treatment for the court. Jason ended up with “probation” pending his continued progress with his mental health issue and verified sobriety. Jason could have ended up with jail time but instead, he is returning to college, and focusing on his sobriety & mental health issues.

    Another example is a young mother who was facing a nasty divorce and bitter custody battle. Her ex-husband made claims about her “past drug use” and “unstable behavior” alleging that she was unsuitable to be a custodial parent. She came into treatment and was detoxed off a drug which was being used to treat her underlying anxiety disorder. She learned knowledge, values, and skills to manage anxiety and demonstrated in family court that she was drug free and capable of caring for her children appropriately. Without our advocacy it is likely that she would have had only supervised visits with her young children.

Mental health problems, addiction and crime often intersect. It’s common for people to come into treatment on the heels of a crisis with the law. If this has happened to you or someone you know, we can help. While legal council will be needed, legal fees can be dramatically reduced and outcomes improved when treatment is part of the solution.

Scott Bienenfeld, M.D. and Stacey Cohen-Meissner, Ph.D.

A Final Common Pathway of Addiction:

By Addiction, Alcohol, Alcoholism, Heroin, Mental Illness, Recovery, UncategorizedNo Comments

            Recently, at a clinical conference on addiction, I overheard an intern ask a straightforward question about why a person recovering from a severe cocaine addiction should not consume alcohol, a drug they never really had a problem with.  As it turns out, this is a common question asked by both clients as well as their spouses, families and friends (who often want to be able to drink socially with them).  Seasoned clinicians, long-standing AA members and others who have successfully managed their addictions all seem to understand that a person battling a substance use disorder will be at a serious risk of relapse or “cross-addiction” if they start drinking or using another drug.  The question as to why this is the case is of great interest medically and, as it turns out, has major implications not only for promoting abstinence among those with addictive disorders, but also for one day developing medical treatments that can directly target brain areas that are directly involved in both addiction and recovery. 

            Over the past twenty years, advances in brain imaging and neuroscience have greatly enhanced our understanding of several aspects of addiction.  For a really good and technical overview read the article:  (Nestler EJ. Is there a common molecular pathway for addiction? Nature Neuroscience. 8(11):1445-9, Nov 2005).  One of the most interesting findings has been that when drugs of abuse are absorbed by the brain, certain important areas become activated in a predictable manner.  This is only true for drugs that can be abused and/or cause addiction, and not true for drugs or other substances that cannot.  The areas that “light up” on MRI scans during ingestion of drugs of abuse are located deep in the brain in an area called the ‘mid-brain’ (see fig. 1) which is considered to be responsible for feelings of reward, pleasure, euphoria, compulsion, salience, and  perseveration.  Although different drugs of abuse cause a variety of feelings when ingested (e.g., cocaine, alcohol, marijuana and heroin have very different effects emotionally and physiologically), they all have a very similar effect on these sensitive yet powerful mid-brain areas.  These areas activate very quickly and, frequently unbeknownst to the person.  In fact, it has been clearly demonstrated that these important brain areas become activated even before the addicted individual actually ingests an addictive substance!  So, when an alcoholic walks into a bar, or sees a beer commercial on television, it is quite likely that her mid-brain is firing and activating – a situation that probably accounts for what is known as “cue-induced relapse”.  

            There are three major reasons why this is important.  First, if highly sensitive mid-brain areas can be activated by thoughts, sights, smells, etc…it is a very good reason why those with addiction need to avoid people, places and things associated with drug use.  Second, as it turns out, the mid-brain communicates directly with the frontal part of the brain, the area responsible for decision making, weighing risk vs. reward, and managing impulsivity.   In those suffering from addiction, the frontal brain areas (which by comparison activate slowly), seem to be overwhelmed by the impaired mid-brain areas which continuously fire and dominate the person’s actions and behaviors.  Finally, since all drugs of abuse have a common effect upon sensitive mid-brain areas that are associated with feelings of reward, pleasure, euphoria, compulsion, salience, and perseveration, then it stands to reason that a person who suffers from an addiction to one substance should avoid ALL substances that could cause addiction!

Addiction Center of Brain

Figure 1.

VTA (Ventral Tegmental Area), part of the mid-brain and Nucleus Accumbens, part of the limbic system connect and communicate with the Frontal Cortex.

 

Scott Bienenfeld, M.D. – Alpine Psych Solutions

 

Co-Occurring Psychiatric Disorders

By Addiction, Anxiety, Bipolar Disorder, Co-Occurring, Depression, HeroinNo Comments

Clients who suffer from mental health disorders such as depression, anxiety or attention deficit disorder, (in addition to substance abuse issues), present challenges, as their “co-occuring” conditions are more difficult to diagnose and treat.  We address the complex needs of these clients.

Conditions commonly occurring with chemical dependency may include:

  • Mood disorders (depression, bipolar disorder)
  • Anxiety disorders (panic attacks, social phobia)
  • Eating disorders (anorexia and bulimia)
  • Attention deficit hyperactivity disorder (ADHD)
  • Obsessive-compulsive disorder (OCD)

 

When Is Drinking A Problem?

By Addiction, Alcohol, Alcoholism, Co-Occurring, Mental IllnessNo Comments

This photo demonstrates what it is like to live with alcoholismProbably the most long-standing debate in the field of addiction medicine is the question about how a person should determine whether or not they have a drinking problem.  As anyone in the field knows, this can be a lengthy argument, which at the end of the day, often results in more questions than answers, and frequently a good deal of frustration!  This needn’t be the case.  Over the years, I have reduced this issue down to a few key points which, if addressed, can make the answer a bit less cloudy. 

First, if there is any question about whether or not a person has a problem with alcohol (or any substance), they should seek professional advice, usually in the form of a formal evaluation with an addiction specialist.  This seems like a burdensome answer, but the truth is that a skilled professional, with years of experience is in the best position to weigh in on the answer.

At the end of the day, I believe that addiction, and/or substance abuse can be boiled down to three main components, and this is important because when people get bogged down in fancy textbook definitions, things get complicated.  The first two questions apply more to addiction and the third question applies more to substance abuse.  (If you drink only once per month but wind up in jail every time because of your behavior – you probably have a drinking problem even though you are not technically “addicted”.)

Ask yourself these three questions and see if they apply. 

  • Do I have a mental obsession about drinking?
    1. Do I think about alcohol all, or a lot of the day, most days?
    2. Do I think about drinking after work obsessively or do I look forward to that drink every night a little too much?
  • Is it difficult to stop?
    1. Can I imagine going a few days without alcohol? A week? A month? Three months?  A year?
  • Is alcohol causing problems in my life?
    1. DWIs, fighting with loved ones, problems at work, physical problems?

The truth is that a ‘yes’ answer to any of these questions warrants further investigation.  Think of it this way: most people do not obsess about drinking, they can stop easily for long periods of time and alcohol doesn’t interfere with their lives. If this isn’t the case, it’s probably a good idea to check into it!

Scott Bienenfeld, M.D