Addiction Treatment and Mental Health Blog

The team at Fifth Avenue Psychiatry aims to help both adults and adolescents with substance abuse and mental health issues.

Meditation and Mindfulness for Alcoholism and Addiction

By Olga Megwinoff, MD

There is so much referring to meditation and mindfulness. Every mental health guru speaks of mindfulness and the media outlets are saturated with everything meditation. It is definitely trendy, in fact, even in my neighborhood in the non-trendy suburbs we started a meditation group. When something is so trendy it can be easy to dismiss as a valuable and important tool in psychotherapy. I am ever grateful that I pursued this method of treatment and it changed my views and opened the door for me to the great teachings and understanding of the mind from the eastern psychology perspective.

The main goal of meditation in the Buddhist and Hindu traditions is spiritual enlightenment. Nevertheless, western psychology has appropriated a version of it for the treatment of mild to moderate Anxiety and Depression, Obsessive Compulsive Disorder (OCD), and Addiction. Meditation’s benefits on the mind are difficult to ignore given that at even the beginner’s level, it’s participants get a good glimpse of these benefits.

In this, my first blog, I will try to explain in simple terms a novel theory of why mediation works for anxiety, depression, OCD and addiction.

Beyond the effect of slowing down the nervous system via purposeful control of the respiration and its secondary effect on slowing down the heart rate, (the “fight or flight” response) meditation also has immense and immediate effects in the brain.

The first goal of meditation at the beginner’s level is to draw attention to the breath in an attempt to get rid of any other thoughts. It doesn’t really matter what you focus on, it can be your big toe or your right ear. The objective is to chose a part of your body you can feel, therefore you don’t think. The focus is on the feeling, on the somatic sensation of this body part. The only purpose of this initial learning phase is to train the mind to focus on only one thing fully.

A lot of people say, “I can’t do this”, “I have ADD”, “it’s too much work”, but I am fully convinced that if you have a brain, you can certainly develop the ability to meditate. It does take effort and discipline (maybe this will be the topic of my second blog, I find this is the aspect that most people struggle with, the discipline to practice every day, NOT with the ability to sustain attention).

If the participant can focus on the breath fully, and therefore clear the mind of any other thoughts, for a few seconds, the relaxation is immediately palpable. This was a big surprise for me, that the mere absence of thoughts created relaxation in the mind. My training in psychiatry was heavy on psychoanalysis and Cognitive Behavioral theory, the basis of anxiety and depression is understood as a conflict arising from conscious and unconscious thought (psychoanalysis) and/or distorted thoughts (CBT). Therefore, the content of thoughts are indirectly considered ever present.

However, in meditation, if you achieve the goal of having an absence of thought, (not a resolution of any unconscious conflict, or the identification and correction of a distorted thought pattern), just a quiet mind for a few seconds, this relieves symptoms for those few seconds.

Eastern psychology is not as invested in the content of the mind as western psychology is. The target, at these early levels, is absence of content. If a patient is able to achieve this for a few minutes every day, they can ultimately achieve relief from these symptoms during a greater period of time.

As you continue to progress in meditation, you can “open” the mind to thoughts and feelings, and as you ‘notice” the thoughts and feelings, the participants learn that they don’t have to react to them, introducing some distance from negative thoughts and feelings and realizing that they do not define you.

There is a lot of research demonstrating correlations between the positive effects of meditation with changes in particular brain structures like the medial prefrontal cortex, the posterior cingulate cortex, the amygdala, the hippocampus and limbic system. However, there is not a global hypothesis integrating all these structures functions and meditation correlates. The first such theory I have read about comes to life with the “discovery” of the Default Mode Network (DMN). The DMN was identified via neuroimaging in 2001 by Marcus Raichle, a neurologist at Washington University. He published his findings in the Proceedings of the National Academy of Sciences. See also Randy L. Buckner, Jessica R. Andrews-Hanna, and Daniel L. Schacter, “the Brain’s Default Network,” Annals of the New York Academy of Sciences 1124, no1 (2008). It is important to note that the concept of the default mode network is not yet globally accepted.

The DMN forms a critical and centrally located locus of brain activity that links parts of the cerebral cortex to deeper and more primitive structures involved in memory and emotion. It is stipulated that the DMN is responsible for wandering, daydreaming, rumination, worrying and self-reflection. It is also involved in mental constructions, moral reasoning and the concept of “the self”, among other functions. Some neuroscientist call it “the me network”.

Self-reflection can be responsible for powerful thinking and understanding but it can also be responsible for destructive forms of self-regard. Psychologists have identified a strong correlation between unhappiness and time spent in wandering, a principal activity of the DMN.

The DMN stands opposite to the attentional networks, when one is active, the other goes quiet, and viceversa. Scans of experienced meditators brains show the the DMN activity decreases significantly. (Judson Brewer, a researcher previously at Yale, now at the University of Massachusetts Medical School, Center for Mindfulness).

A theory by the British neuroscientist, Robin Carhart-Harris, is of ‘the spectrum of cognitive states”. He describes high-entropy mental states (psychedelic states, infant consciousness, early psychosis, creative thinking) and low-entropy mental states (rigid thinking, addiction, obsessive-compulsive disorder, depression, anesthesia and coma). Carhart-Harris suggests that the psychological disorders at the low entropy end of the spectrum are not the result of lack of order in the brain (as the established theories postulate), but rather an excess of order.

When self-reflective thinking becomes excessive, heavy self-consciousness gradually shades out reality, this may be the result of a hyperactive default mode network, which can trap us on repetitive and destructive loops of rumination – this is a substantial part of addiction, obsessions, anxieties and depression.

With a regular meditation practice, many people with Substance Use Disorders, Anxiety, Depression and OCD can transform their minds by lowering the volume of the DMN and therefore quieting the self-consciousness, ruminations, and worrying that so characterizes these disorders.

Post Traumatic Stress Disorder and Addiction 

By Britt Gottlich, Psy.D.

I often meet with people who say they are unsure of whether they have experienced trauma or not. So what is trauma? Most people define trauma based on how trauma is portrayed in the media. But in reality it is a very subjective experience. Something that may be traumatic for one person may not be traumatic for another. The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.”

The way I like to understand trauma is based on an individual’s interpretation of the event. As children we live under the assumption that ‘good things happen to good people and bad things happen to bad people.’ When we experience a trauma, often our interpretation of this rule becomes clouded and confused. For example, it could change to, ‘if good things happen to good people, and this happened to me, then I must be bad.’ Therefore, a person’s reaction to a traumatic experience often affects the way they see themselves, other people, and the world around them.

We can’t change or erase a traumatic experience, unfortunately. But what we can do is change the way we interpret it and ultimately the way we understand the world around us as a result of that event. This is where Cognitive Processing Therapy (CPT) can be a useful treatment modality. It helps us identify the cognitive distortions that are derived from our traumas, and using evidence and facts, combat those thoughts with rational ones. 

CPT has been a very effective treatment modality which is often used in treating Veterans with Post Traumatic Stress Disorder or PTSD. CPT is a 12 session behavioral psychotherapy. It has been found to be highly effective in treatment for PTSD. A study conducted in 2017 that studied the effectiveness of CPT on Veterans found that Veterans who completed the 12 session treatment had a significant difference in their symptoms and had a decline in Post Traumatic Stress Disorder Checklist scores than Veterans who did not complete or comply with treatment. Other treatments that are used for PTSD are Eye Movement Desensitization & Reprocessing (EMDR) and Prolonged Exposure (PE). In my experience and training with all the above modalities, I have seen the most improvement and success with CPT.

While there are treatments such as CPT that are very effective in treating trauma, one of the most important pieces in this type of therapy is rapport. It is important in all therapy to have a positive relationship with your therapist where you feel comfortable and not judged. But especially when disclosing a trauma, and going deep into the event, feelings, and cognitions related to it, it is important that you feel trusting of the person providing that treatment.

From my experience working at a VA and currently here at Fifth Avenue Psychiatry, I see that there is a high comorbidity for substance abuse and PTSD, especially when PTSD goes undiagnosed or untreated. VA statistics note that more than 2 out of 10 Veterans with PTSD also have a substance use disorder, and 1 out of 3 Veterans seeking treatment for substance use disorders also meet criteria for PTSD. The American Addictions Center reported that 55-60% of individuals who suffer from PTSD have comorbid addiction or alcoholism. They also note that “people who suffer PTSD are between two and four times more likely to also battle addiction than their peers who do not also struggle with PTSD.”

Again, traumas are not something that can be erased, but they can be something you can learn to live with. You can begin to see the world, people, and yourself in healthier ways again. You may never fully believe that ‘good things happen to good people,’ but eventually you may believe that ‘bad things sometimes happen to good people.’

https://journals.sagepub.com/doi/abs/10.1177/0033294117727746?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=prxa

https://americanaddictioncenters.org/ptsd

Cognitive Behavior Therapy (CBT) for Addiction and Alcoholism, An Evidence Based Treatment

By Tracey Basset, PsyD

Making the decision to seek help for a substance use problem is challenging enough.  On top of that, for a lot of people, they face the challenge of choosing where to go, who to see, and what type of therapy will benefit them most.  This can be a very confusing and daunting process.  My aim for this post is to provide some useful information about the benefits of one type of therapy, my favorite type of therapy, Cognitive Behavioral Therapy, or CBT.  

CBT is based on the notion that the way we think influences how we feel, and then subsequently how we behave.  Think of it like a domino effect- something happens, you have a thought or a belief about that event, that thought creates a feeling and that feeling creates an action.  For example, if you try to reach out to a friend or family member and they do not have time to see or talk to you, then you might think that you are not important to them, that you are not worthy of their time, or maybe that you are not good enough.  That thought can lead to feelings of loneliness, rejection, sadness, or even anger.  Those feelings could lead to the desire to escape, which could ultimately lead to using a substance.  Then substance use leads to more isolation and less connection.  The cycle starts again, and builds.  

In CBT, we explore these triggering events and identify patterns.  We explore the thought patterns, or belief systems, and we challenge those patterns that may be problematic.  Some beliefs are true and we work to problem solve and change them.  Others are not true, and are simply believed to be true, because they have been ingrained for a very long time.  We learn to explore where beliefs come from and we learn to challenge them.  In CBT we learn strategies to cope with the uncomfortable feelings, and strategies to help reduce the likelihood that certain feelings will trigger use.  

This is just one example of how CBT can play out in therapy.  There are dozens more.  CBT can be a great therapy for individuals struggling with substance use along with co-occurring anxiety and/or depression because it provides tools, strategies and a roadmap for how to gain control when you feel out of control. If you are someone that struggles with anxiety and/or depression in addition to substance use, it may feel like there are too many things to tackle, and you may even feel stuck, helpless or hopeless.  However, CBT works on exploring, challenging, and changing the relationship between symptoms of depression, anxiety and substance use.  Therefore, it is a very practical, effective and efficient approach to tackling co-occurring substance and mental health needs that feel complex in nature. 

So, why is CBT my favorite type of therapy?  Because there is a lot of evidence to show that it works.  CBT is empirically based, meaning that there are a lot of research studies that consistently show that it helps individuals to reduce anxiety and depression, and successfully address substance use.  

In closing, I will leave you with a quote.  It is one that I recently stumbled upon in my personal life and I instantly connected with it because it just made so much sense to me given my predisposition to think of life through the lens of CBT.  So, despite what you may be going through, and my guess is that it may be something quite challenging since you are here reading this page, the good news is that at any time you can choose to take the steps to change your destiny.  

“Watch your thoughts; they become words. 

Watch your words; they become actions. 

Watch your actions; they become habits. 

Watch your habits; they become character. 

Watch your character; for it becomes your destiny. 

– Upanishads”

Why Outpatient Treatment for Addiction and Alcoholism may be a better choice than Inpatient Rehab, and why you rarely hear this

This is my first blog entry and my hope is that through monthly posts, I and my associates, Dr.s Megwinoff, Bassett and Gottlich can help shed some light and insight on our various expertise and experiences in addiction treatment. In listening to my patients and their families, I realize that there is a great deal about addiction and its treatment that is misunderstood. There are many misconceptions about addiction treatment. Often, people looking for help for addiction are hopeless and vulnerable to exploitation. Many messages are misconveyed in order to justify expensive and unnecessary treatments. Inpatient rehab and its utility is one of them. Read more

Why More Attorneys Are Searching for an Addiction Therapist Near Me

The Lawyer: The Partyer and the Alcoholic

It’s a tired popular media trope: the attorney, burdened by the stresses of work, pours a glass of bourbon at the end of a long day. Maybe he is waiting for a verdict to come in after an impassioned speech in front of a jury, maybe she is prepping for a long day at the Supreme Court ahead. Alcohol as a coping mechanism in pop culture is as old as television itself. Read more

Opiate Detox for Lawyers, Even Attorneys Get Hooked on Heroin

The Path to Opioid Abuse for Attorneys

Popular culture portrayals of the legal profession may draw young people to law school: giving impassioned arguments in front of a jury, laying out a compelling case in front of a judge. A promising young law student may enter school with hopes of helping the disfranchised or aiding in the reform of the criminal justice system. However, once they exit the hallowed halls of their law school, reality paints a grimmer picture. Read more

The Wolf of Wall Street

Why Financial Execs Can’t Manage Stress, Leading to Addiction Treatment

The world of financial executives has long been the subject of fascination. The Wolf of Wall Street, a movie starring Leonardo DiCaprio based on a memoir by Jordan Belfort of the same name, tells a compelling story of a financial executive’s meteoric rise and equally spectacular fall. Read more

Dual Diagnosis and the Benefits of Treating Co-Occurring Disorders Simultaneously

Co-Occurring Substance Use and Mental Health Disorders

A person struggling with a substance use disorder (SUD) may experience significant barriers to recovery that may range from social support to lack of quality treatment options. One common barrier is a lack of dual diagnosis treatment when necessary. The Substance Abuse and Mental Health Services Administration (SAMHSA) states that a third of substance use admissions in 2017 involved a co-occurring mental health disorder. When a person suffers from two behavioral health conditions simultaneously, failure to effectively address them both with evidence-based treatment could affect the recovery process. Here’s how dual diagnosis treatment can help.
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Can You Treat Drug Addiction with Vivitrol?

As people, we may be different for a variety of reasons. But a common denominator amongst us is the existence of stress in our lives and how it impacts mental health. Oftentimes, it isn’t the stress itself that causes us harm but how we choose to perceive it or how we cope (or not) that poses the most risks.
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Meditation and Mindfulness for Alcoholism and Addiction

By Olga Megwinoff, MD There is so much referring to meditation and mindfulness. Every mental health guru speaks of mindfulness …

Post Traumatic Stress Disorder and Addiction 

By Britt Gottlich, Psy.D. I often meet with people who say they are unsure of whether they have experienced trauma or not. …

Cognitive Behavior Therapy (CBT) for Addiction and Alcoholism, An Evidence Based Treatment

By Tracey Basset, PsyD Making the decision to seek help for a substance use problem is challenging enough.  On top of that, …