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


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