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.

Controlled Drinking Program in NYC

Understanding the Harm Reduction Model (Controlled Drinking)

By Dr. Britt Gottlich, Psy.D.

According to the National Survey on Drug Use and Health performed by the NSDUH, “[A]bout 7.3 percent of adults ages 18 and older who had Alcohol Use Disorder in the past year received any treatment in the past year… People with Alcohol Use Disorder were more likely to seek care from a primary care physician for an alcohol-related medical problem, rather than specifically for drinking too much alcohol” (NIAAA). Why? Seeking help for substance abuse can be overwhelming and scary.

Often, clients report that coming in for the initial appointment is the hardest part due to the unknown of this type of treatment program. What clients often do not expect, is that substance abuse treatment can be flexible and meet them at a common ground. We like to call this approach “harm reduction.”

What is Harm Reduction?

Harm reduction is a term used to represent “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs” (National Harm Reduction Coalition).

The concept behind harm reduction is meeting the client where they are in terms of their commitment and motivation to change. Abstinence is a very overwhelming concept for individuals, which can often push them away from seeking or continuing treatment. Therefore, this approach allows the client and their treatment team to come up with a specific plan that allows them to use their substance of choice in a moderate and safe way.

Harm Reduction for Alcohol

We often find that clients seeking alcohol treatment are interested in a harm reduction model. This is likely due to alcohol being both legal as well as socially acceptable. Imagine, as a young adult, you are aware that you drink too much and want to seek help. Likely, the concept of abstinence would be overwhelming, as alcohol is a major part of our culture. We see alcohol in the media, at events/parties, and at dinners and happy hours. Expecting someone to potentially cut those events out of their lives to reduce the exposure to alcohol is not always realistic. According to research, “Many individuals experiencing problems related to their drinking (e.g., college students) are not interested in changing their drinking behavior and would most likely be characterized in the precontemplative stage of the transtheoretical model. Harm reduction provides a good method for matching these individuals at that stage and providing motivational incentives (e.g., discussing the negative consequences the person is experiencing) to motivate their desire for positive change” (Marlatt & Witkiewitz, 2002).

Therefore, for those clients who find complete abstinence to be overwhelming, we will come up with specific rules around their drinking. “It is essentially a practical approach; success is not measured by the achievement of an “ideal” drinking level or situation (i.e., abstention or low-risk levels), but by whether the introduction of the prevention measure reduces the chance that adverse consequences will occur” (NCBI).

How Does Harm Reduction Work in Therapy?

In regard to my therapeutic approach to harm reduction as a clinical psychologist, I usually start by understanding my client’s goals for drinking. We then start the process by monitoring their drinking as is, to understand the baseline they are starting at. This will include logging numerical data, but more importantly, triggers and impulses behind those drinks to better understand their motives. Together, we will come up with specific rules to help decrease their consumption. This could include the number of days they drink per week, the number of drinks they have at a time, specific types of drinks they allow themselves to drink, as well as building awareness behind the types of emotional drinking they may engage in. Most importantly, this treatment model provides accountability, where clients are working weekly and sometimes more with their providers to monitor their progress.

Harm Reduction VS Abstinence

While harm reduction can be effective and successful in helping a person be more cognizant of their drinking behaviors and therefore decreasing them, it is not for everyone. While, of course, no one is perfect, and we expect “mistakes” or “hiccups” along the way, there are some individuals who try harm reduction and are able to recognize they cannot exercise this type of self-control. In those cases, harm reduction can be a helpful tool as a last resort, to help the individual come to the conclusion themselves that abstinence is the right avenue for them, rather than having it enforced upon them at the start of treatment.

Is Harm Reduction Right for Me?

It is important to know when seeking treatment for substance use that there are options. A field that used to be very black and white in its approach has many areas of gray that may be a good fit for you. Reach out for help and engage in a conversation with your provider about all the treatment options that are available to you.

Dr. Sam Glazer, a NYU professor of Psychiatry, and his team at Fifth Avenue Psychiatry provide private alcohol addiction treatment in the Manhattan, New York City area and offer controlled drinking programs.

References:

  • G.A. Marlatt, K. Witkiewitz / Addictive Behaviors 27 (2002) 867–886

Cannabis: A New Drug Epidemic?

By Dr. Olga Megwinoff

During the late 1990’s when I was a psychiatry resident at NYU Langone Medical Center, the opiate epidemic was just beginning. We were taught that if a patient had pain, you had to give them prescription painkillers. At the time, “research” showed that they were necessary to control pain and did not have addiction potential when used to treat people for pain. This didn’t make sense to me, but who was I to question my teachers or “the research?” I was but a lowly resident.

The mood about marijuana reminds me of the early days of opioid painkiller use. Though I don’t believe marijuana will ever be understood to be as dangerous as prescription painkillers have proven to be, I do believe we are in a similar period of time that predated the opioid crisis. There are many market and industry powers that are working together in the same way to encourage more and more people to use marijuana, promote false medical claims, and reduce fear of any risk associated with use.

The Risks Involved with the Use of Marijuana

Currently, as an addiction psychiatrist working in a New York City outpatient addiction treatment center, I hear from patients how they perceive little risk in their use of Marijuana. It seems that as it has been medicalized, decriminalized, and now legalized, the message that most people get is that marijuana is a very safe drug, in fact “safer than alcohol which is legal” seems to be the catchphrase now.

This concerns me, however, because as an addiction psychiatrist, I am very well aware that Marijuana, though perceived as very low risk, actually does have addiction potential, can be abused, and can have major psychiatric consequences that include:

  • Aggravation of anxiety
  • Mood disorders
  • Psychosis
  • Dependence
  • Brain damage (in adolescents and young adults)

The Market Forces vs the Medical Field’s Perspective

In this blog, I’ll attempt to point out the different market forces pushing to legalize cannabis for medicinal and recreational use, in contrast to what is known in the medical field.

To start, legal cannabis sales in the U.S. passed $17.5 billion in 2020, a 46 percent increase over sales in 2019. Sales are expected to skyrocket to approximately $40 billion by 2025 (1). In terms of legislation, state governments are promoting legalization of cannabis because legal revenue will translate to huge taxes, instead of this money being lost to the black market. Legislators also hope to lower policing expenses and reduce the racial disparity in marijuana arrests – African Americans are four times more likely to be arrested for possession of cannabis than white Americans (2).

I will establish, first, that “Medical Marijuana” is a misguided industry term used in legislation, not a scientific medical term (3). As of 2021, 36 states have legalized marijuana for “medical” purposes and 18 states have recreationally legalized cannabis. Yet, in sharp contrast, on the federal level, research is limited regarding cannabis since it was a schedule I substance until December 2020. According to the DEA, “a schedule I drug has a high potential for abuse and the potential to create severe psychological and/or physical dependence. These drugs are determined to have no accepted medical use” (4). 

            As of May 2021, the FDA, responsible for approving treatments after appropriate and rigorous study, has not yet approved the cannabis plant as safe or as an effective drug for any medical indication. The only FDA approved cannabinoids products are Marinol, Syndros, and Cesamet (synthetic THC, cannabinoid analogs). They have been approved for the treatment of three different seizure disorders, chemotherapy related anti-nausea, and as a cancer related appetite stimulant. Nevertheless, the market has gone way ahead of the science resulting in a lot of concerning unknowns. There is ongoing scientific trials planned but interestingly enough, there’s little funding for them (3).

The media plays a large role as well. It promotes a narrative that transforms public reactions and reinforces drug policy implementation (5). It is of concern that cannabis legalization is promoted by the media without a critical lens; cannabis is promoted as a “magical fix,” and “safe” despite the lack of scientific evidence for it.

There are many unestablished facts about cannabinoids. Studies reveal there are more than 500 compounds in the marijuana plant, the majority of these are unknown. In addition, scientists don’t know basic details about the drug, such as what a standard dose should be. It is suggested that cannabis at low doses could help with anxiety, but at higher doses is anxiety provoking. Quality is also not controlled. Many CBD preparations in the market are contaminated with THC and other compounds, including Benadryl.

Furthermore, newer cannabis strains developed in the 1990’s have increased THC levels. Prior to the 1990’s, top grade pot had 20% THC levels. Newer products have concentrations as high as 40-80%. Moreover, synthetic cannabinoids and cannabis concentrate products can contain up to 80-90% THC (6). With these stronger strains we are seeing new afflictions. For example, Hyperemesis Syndrome (severe nausea and vomiting syndrome) was a rare occurrence in the emergency rooms and is now quite common.

Many patients with psychiatric disorders use cannabis with the idea that it may be helpful for treating primary depressive disorders, general anxiety disorders, post traumatic stress disorder, or psychosis to name a few. However, very low quality studies suggest that cannabis could lead to small improvements in anxiety, but there are no other quality studies thus far.

Potential Medical Complications Caused by Marijuana Use

Furthermore, exposure to cannabis can induce medical complications such as cardiovascular and respiratory problems. It can even impair brain function. Marijuana is a sedative and can reduce someone’s ability to drive and it decreases cognitive and memory function. There is some indication that there may be white and grey brain matter and cortical thickness alterations. In addition, cannabinoids cross the placenta and can affect pregnancy outcomes and neurodevelopment of the fetus (6).

In other words, inhaled herbal cannabis contains mutagens and can result in lung damage, exacerbations of chronic bronchitis and certain types of cancer. (7)

Cannabis is one of the most commonly used drugs in the global market, only second to alcohol and tobacco use (8). Similar to other psychotropic drugs, cannabis has the potential to produce rewarding/reinforcing effects by enhancing dopamine signaling in the addiction pathways in the brain (9). The rewarding effects of cannabis are directly associated to the actions of THC on cannabinoid CB1 receptors in the brain (9).

Understanding Cannabis Use Disorder

Cannabis Use Disorder, characterized in the DSM-5 diagnostic manual, consists of a pattern of cannabis use that causes significant psychiatric distress and social impairment within the context of repeated attempts to stop using. In other words, prolonged and sustained cannabis use is associated to an insidious addiction that is very hard to break. This addiction is often associated to psychiatric symptoms of anxiety, depression, and insomnia. These all can have profound effects on careers and relationships. In the words of Dr. Glazer (2020), “People go nowhere slowly.” In 2019, 4.8 million Americans ages 12 and older were diagnosed with Cannabis Use Disorder.

Other DSM-5 diagnostic disorders such as Cannabis Intoxication consists of the following:

  • Euphoria
  • Increased appetite
  • Tachycardia
  • Altered judgement
  • Possible anxiety
  • Psychosis

Cannabis Discontinuation Syndrome has been well established in the medical literature and consists of symptoms of the following:

  • Anxiety
  • Dysphoria
  • Sleep disturbance
  • Irritability
  • Decreased appetite

Evidence shows that cannabis use and Cannabis Use Disorder have increased in recent years in states that have legalized marijuana. These epidemiology studies have estimated that around one in six (1:6) of those who use cannabis during adolescence and one in two (1:2) of daily cannabis users will meet the criteria for Cannabis Use Disorder. This is of concern because in addition to the addiction aspect, epidemiological data proposes that recreational cannabis use is positively associated with psychotic disorders, depressive and anxiety symptoms, including panic disorder. Cannabis has also been negatively associated with bipolar disorder, it leads to lower remission rates and early onset of symptoms. To be specific, frequent use of high-potency cannabis has been associated with increased paranoia and elevated risk of psychotic disorders among individuals with no psychiatric history (11).

 THC vs CBD

It is speculated that many of cannabis’ negative effects are associated with THC. However, some patients with psychiatric disorders that use cannabis can see some possible improvements that are most likely due to its CBD component. CBD (cannabidiol) is the second major component of marijuana and is more promising for therapeutic use as mono therapy (6).  It is still unregulated, mislabeled, and it is frequently contaminated. Only 30% of CBD products that are available commercially are accurately labeled and many have THC.

Some evidence suggests that CBD may be anti-seizure, neuro-protective, antipsychotic, and anti-inflammatory.  Positive observational studies on social anxiety shows that it can decrease anxiety. In one study with cancer patients, fewer depressive symptoms were shown. Nevertheless, there’s no evidence that CBD can help people sleep and any topical application claims are false because it is not absorbed in the blood this way. CBD has a mostly pharmacologically benign profile, but it exhibits liver toxicity (10) at doses of at least 1,500 mg a day. CBD also has drug-drug interactions, specifically with morphine, epileptic drugs, benzodiazepines, some antidepressants, etc. Nevertheless the possible positive association to CBD, more rigorous and larger studies are needed to know for certain its effects on people.

Dr. Olga Megwinoff’s Perspective on Marijuana Use

My last point is that in my personal experience, it is very difficult to treat clients with chronic cannabis dependency. Marijuana is quite addictive and there is no good treatment or MAT (medication-assisted treatments) for Cannabis Use Disorder. In the last few years, only CBD has been suggested as being helpful with cravings and withdrawal symptoms.

In my opinion, the implications of legalizing marijuana remain to be seen, but it is clear that there are numerous contradictions in practice, policy, and scientific knowledge. Besides, the huge economic incentives driving the consumption of cannabis corrupt any well intended motivations of the market.  I’m concerned about the morbidity of prolonged cannabis use within the context of this widespread accessibility.

I do believe Marijuana should be legalized. The real issue is that there is an overwhelming amount of misinformation, mislabeling, and false claims as this drug is pushed into the market. This misinformation understates the risk and exaggerates the benefits of cannabis. Decreased perceived risk and overstated benefits led to an epidemic of prescription painkiller abuse. I fear the same may be true for legalized and “medical” marijuana.

Sources:

  1. Alfonso Tortolani, P. “Why the Pandemic Was a Breakout Moment for the Cannabis Industry”. com, May 31, 2021
  2. ACLU, (June 2013) “Report: The War on Marijuana in Black and White.” Retrieved from:https://www.aclu.org
  3. Hill, K., Williams, A.R., and Watkins,“Clearing the Smoke: Cannabis and Mental Health”, APA and AAAP Webinar, April 8, 2021
  4. deadiversion.usdoj.gov
  5. Rothstein, R. and Finnigan, R., “Marijuana and The Media: The Influence of Media Narratives on Legislation Outcomes”, sociology.ucdavis.edu, n.d.
  6. St. Marie, R. and Leo, R., “Cannabinoid-Based Medications for Pain”, Current Psychiatry, Vol.20, No.5, May 2021
  7. Ghasemiesfe, M., Barrow, B., Leonard, S., et al. “Association Between Marijuana Use and Risk of Cancer: a Systemic Review and Meta-Analysis”, JAMA Network            Open 2019;2(11)
  8. Carlinger, H., et al, “Cannabis Use, Attitudes, and Legal Status in the US: A Review”. Prev Med, 2017
  9. Zehra, A., et al, “Cannabis Addiction and the Brain: A Review”, Focus Vol 17, No 2, Spring 2019
  10. Ewing, L., Skinner, C., and Koturbash, I., “Hepatotoxicity of a Cannabidiol-Rich Cannabis Extract in the Mouse Model”, Molecules 2019 May;24 (9):1694
  11. 11. Sabioni, P. and Le Foll, B., “Psychosocial and Pharmacological Interventions for the Treatment of Cannabis Use Disorder”, Focus Vol 17, No 2, Spring 2019
Alcohol and Anxiety | Manhattan Alcohol Addiction Treatment

Anxiety and Alcohol Use

By Ronnit Nazarian, Psy. D

A common theme that I have found while speaking with patients who overdrink has been that they also experience an underlying anxiety disorder. Moreover, they have mentioned having difficulty finding something that helps them disconnect from their stress and anxiety that works as well as having a drink. To most people looking in from the outside, a person who experiences anxiety and a person who experiences drinking problems are often viewed as two separate individuals. Contrary to common belief, however, research shows that approximately 50% of individuals who experience alcohol problems also meet the criteria for one or more anxiety disorders.1 Alcohol use and anxiety are strongly linked and often called co-morbid disorders that interact with each other. One of the major contributors to an increased alcohol intake is a person’s level of anxiety.4

At Fifth Avenue Psychiatry, we recognize that many people who have an increased alcohol use will drink in order to cope with their anxiety (e.g., work stress, social stress, etc.). While alcohol may be used to help cope with anxiety, it can also have long-term consequences in increasing a person’s level of anxiety in the long term. In this blog, we discuss the ways anxiety and alcohol are linked, the consequences of using alcohol as a coping mechanism, alcohol-induced anxiety, and treatment approaches for dual diagnosis of anxiety and alcoholism.

Using Alcohol as a Coping Mechanism (Self-Medication Model)

A mild amount of anxiety is typical for anyone to experience as a reaction to a stressful situation. When someone suffers from an anxiety disorder, their reactions to stress can impact their daily functioning, relationships, sleep cycle, and work production. Those who struggle to cope may turn to the use of alcohol and drugs, engaging in compulsions, and avoiding events to decrease the anxious feelings.

Below are some of the ways people use alcohol to cope with anxiety:

  • Drinking at a party to feel confident, less shy, and to socialize
  • Drinking at the end of the week to destress
  • Drinking to numb negative thoughts and emotions
  • Drinking to feel included and connected to others
  • Drinking to relax
  • Drinking to forget bad memories
  • Drinking to feel happy
  • Drinking to no longer feel in control
  • Drinking to no longer make decisions
  • Drinking to take a break from reality
  • Drinking to fall asleep

What drinking starts as “liquid courage” or a “way to let loose” for a person, it easily becomes a way of self-medicating as it becomes a means of coping. Research shows that most individuals who experience drinking problems and self-medicate with alcohol also experience a generalized anxiety disorder, social phobia, and panic disorder.More specifically, it appears that alcohol problems begin after the onset of anxiety disorders. Many individuals who experience social phobia and agoraphobia have reported initially using alcohol as an attempt to control anxiety. Active alcohol use can exacerbate symptoms of anxiety, which plays a significant role in the difficulty of diagnosing anxiety disorders in the face of active alcohol use. The lines blur with distinguishing between symptoms of alcohol withdrawal versus anxiety disorders when symptoms of withdrawal appear like symptoms of anxiety. 3

Over time, as individuals continue to self-medicate with alcohol as a coping strategy, they may require increasingly higher doses of alcohol. Consequently, this can result in an individual developing an independent substance use disorder. Individuals who self-medicate with alcohol are at risk of increased psychiatric co-morbidity, suicidal behavior, levels of stress and dysfunction, and lower health-related quality of life.5

How Alcohol Increases Anxiety Levels (Substance-Induced Anxiety Model)

Using alcohol to cope with anxiety can in turn significantly increase anxiety levels. While alcohol can diminish feelings of anxiety and provide short-term relief, it can lead to increased anxiety. Specifically, alcohol can act as an “Anxiogenic,” which creates feelings of anxiety and panic attacks when withdrawing from alcohol. This feeling can lead someone to continue to drink alcohol to decrease those uncomfortable feelings. This leads to a vicious cycle in which alcohol and anxiety play off each other and makes it no longer clear which disorder (anxiety or alcoholism) is the operating cause.2

Treatment for Co-Occurring Anxiety Disorders and Alcohol Use Disorders

There are many treatment models available to assist individuals with co-occurring disorders. The selection of treatment approach depends on the way in which, and the reasons why a person uses alcohol to cope. For individuals who use alcohol to cope with social anxiety, a combination of Cognitive Behavior Therapy (CBT) and Exposure Therapy can be helpful to challenge thoughts and behaviors surrounding events that cause anxiety. Individuals who use alcohol to cope with stress or intense emotions would benefit from Dialectical Behavior Therapy to learn how to regulate their emotions and tolerate distress. At the root of all treatment models, it would be critical for patients to develop new healthy coping strategies to replace their unhealthy behaviors, such as drinking alcohol. Alongside engaging in therapy, it may be beneficial for the individual to receive pharmacological treatment to decrease the feelings of anxiety that drive a person to drink.

When developing a treatment plan, it is important for the clinician to understand the individual’s presenting problems and determine which of the problems should be the primary focus of treatment. A majority of treatment typically begins with the elimination of alcohol use first.  With alcohol out of the way, one can gain a better understanding of the primary reasons that drive a person to drink.  Sometimes with the reduction of alcohol use, many symptoms such as anxiety and depression are actually reduced. Ultimately though, in many cases, challenging and treating anxiety symptoms that resulted in overdrinking is the ultimate goal.

  1. Anker, J. J., & Kushner, M. G. (2019). Co-Occurring Alcohol Use Disorder and Anxiety: Bridging Psychiatric, Psychological, and Neurobiological Perspectives. Alcohol research: current reviews40(1). https://doi.org/10.35946/arcr.v40.1.03
  2. Brady, K., Tolliver, B., & Verduin, M. (2007). Alcohol use and anxiety: diagnostic and management issues. The American journal of psychiatry, 164 2, 217-21; quiz 372 .
  3. Kushner, M. G., Sher, K. J., & Beitman, B. D. (1990). The relation between alcohol problems and the anxiety disorders. The American Journal of Psychiatry, 147(6), 685–695. https://doi.org/10.1176/ajp.147.6.685
  4. Smith, J. P., & Randall, C. L. (2012). Anxiety and alcohol use disorders: comorbidity and treatment considerations. Alcohol research: current reviews34(4), 414–431.
  5. Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self-medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and anxiety35(9), 851–860. https://doi.org/10.1002/da.22771

 

What is an Addiction Therapist | Manhattan Addiction Therapist

What is an Addiction Therapist?

By Tracey Bassett Psy.D.

Deciding to take the step to seek addiction treatment is a very important and often difficult step. It can be complicated by the overwhelming amount of treatment centers, treatment modalities, and types of professionals that say they specialize in addiction. Today, our Manhattan addiction therapists will explore the different types of addiction treatment professionals and how to decide what is best for you.

Types of Addiction Treatment Professionals

Addiction Psychiatrist (MD)

A psychiatrist is a doctor who went to medical school and then specialized in mental health. Psychiatrists conduct evaluations for treatment planning and diagnosis, prescribe medication, and sometimes, but not always, conduct therapy as part of their practice. There are general psychiatrists who treat a wide range of issues and psychiatrists who focus on specific niches. A Board Certified Addiction Psychiatrist has undergone additional training and study and has passed board examinations to demonstrate a specialty in treating addiction.

Psychologist (PhD or PsyD)

A psychologist holds a Doctorate in Psychology and a Master’s degree in Psychology or a related field. Through graduate school education and multiple clinical internships working with clients, psychologists are trained to conduct diagnostic evaluations, work with multiple modalities of therapy, including group and family therapy, and assess various disorders through psychological testing. A practicing psychologist has to undergo specific education, meet clinical hour requirements, and pass an examination to possess a license. Specialties and areas of training and interest can vary widely.

Licensed Master Social Work (LMSW) and Licensed Clinical Social Worker (LCSW)

A LMSW has completed a masters level education examination and is working towards meeting clinical hour requirements. A LCSW has completed a masters level education, examination, and has supervised clinical experience. Social workers can perform a variety of functions, including therapy, needs assessments, advocacy, case management, and coordination of treatment planning among other things.

Licensed Mental Health Counselor (LMHC)

A LMHC holds a Master’s Degree in Mental Health Counseling. This person has met a combination of educational experience, clinical training, and examination requirements for licensure. A LMHC is trained in assessment and treatment modalities for mental health.

Substance Abuse Counselor

A Credentialed Alcoholism and Substance Abuse Counselor (CASAC) has met licensing requirements by the state that includes training courses and supervised experience through a certification process. A CASAC does not have to hold an advanced educational degree, nor a college degree. A CASAC’s experience is more geared specifically toward substance use and not the treatment of co-occurring mental health diagnosis.

Sober Coach

A sober coach does not have to hold any specific license or degree, although some do. A sober coach can be an important member of a treatment team that works directly with the client one on one outside of therapy and can provide support through coaching during triggers and cravings, ensuring clients get to appointments, helping develop routines, changing habits, advocating for clients, and many other aspects of sober living. A sober coach sometimes lives with clients or can assist with specific activities that have been identified as important to the recovery process.

Things to Consider When Seeking Addiction Treatment in Manhattan NYC

When seeking addiction therapy, there are a few important questions to ask yourself, including the following:

Are you looking for treatment to focus on only addiction or on other social, emotional, or behavioral factors that may be contributing to the cycle of addiction?

According to research, “As many as 6 in 10 people with an illicit substance use disorder also suffer from another mental illness; and rates are similar for users of licit drugs—i.e., tobacco and alcohol” (NIH, 2018).

If you believe that your substance use may be influenced or impacted by anxiety, depression, or other mental health disorders then working with a professional that is trained to treat both substance use and mental health concurrently would be a key component in your recovery.

Would you benefit most from therapy or a combination of therapy and medication management?

This is often a difficult question for an individual to answer on their own. Typically, a consultation with a psychiatrist can help to answer this question. Although medication can play an extremely important role in the detox process, maintenance off of some substances, providing a barrier to use, and treating underlying mental health diagnosis, often medication alone is not the best treatment plan for long term recovery.

Therapy should be a key aspect in a well-rounded treatment plan.  Research has shown that “combinations of behavioral therapies and medications (when available) generally appear to be more effective than either approach alone” (NIH, 2018).

Does the professional that you are looking to work with specifically state that they have training and experience to treat substance use?

The treatment professionals described above undergo required education, clinical experience and examination requirements to possess a license in their given field.  However, specific expertise in the diagnosis and treatment of substance abuse is not a requirement of any of these licensing bodies. It is extremely important to specifically ask the treatment professionals that you are considering working with if they have training and experience with this specialty. Although some general therapy and clinical knowledge is relevant, treatment of alcohol and substance use disorders is a specialty that requires a specific expertise. Without this knowledge, clients can be misdiagnosed or mistreated leading to less-than-optimal addiction treatment outcomes.

Fifth Avenue Psychiatry’s Manhattan Addiction Doctors Provide Discreet Treatment

There is no one-size-fits-all for every person. By considering how your specific needs and goals align with the type of professional addiction treatment that is available, hopefully you can make a more educated decision in what type of professional support is best for you.

Fifth Avenue Psychiatry provides fully confidential, private treatment for professionals and executives.   


Sources:

  • Principles of Drug Addiction Treatment: A Research Based Guide (Third Edition) (2018). Retrieved from: https://www.drugabuse.gov/download/675/principles-drug-addiction-treatment-research-based-guide-third-edition.pdf?v=74dad603627bab89b93193918330c223

 

The Effects of the Pandemic Lockdowns: Substance Use, Depression, Anxiety, Attention and Concentration

Written by Britt Gottlich, Psy D

As we begin to see an end in sight for the pandemic, I’ve spent time reflecting on my time as a psychologist for the past year. While the pandemic may be ending and places are starting to open up and as we return to a sense of normalcy, I can’t help but wonder what aspects of the pandemic will stick long-term and how I can use what I have learned over the past year to help prepare.

Attention and Concentration While Working from Home During the Pandemic

The two biggest complaints people have reported have been difficulty with attention/concentration and social isolation. Having to work from home, and quarantine, completely changed our lives in regard to daily coping skills we likely did not know we even had.

As humans, we are social beings. That does not necessarily mean we need to be socializing with friends and family throughout the day to meet that need; it can also be met by riding the subway with others, working in an office place, or interacting with a cashier. In fact, one source states:

According to a meta-analysis co-authored by Julianne Holt-Lunstad, PhD, a professor of psychology and neuroscience at Brigham Young University, lack of social connection heightens health risks as much as smoking 15 cigarettes a day or having alcohol use disorder. She’s also found that loneliness and social isolation are twice as harmful to physical and mental health as obesity.

Covid-19 took away that normal daily socialization and completely left us to ourselves.

Not only did we become socially isolated, but we lost the basics of self-care that we likely didn’t realize we had incorporated throughout our day until it was gone. For example, a commute to work, as frustrating as it may be at times, gave us the time to mentally prepare for the day and also wind down and let go of the day. The idea that our home is now our office and our office is now our home is one that has greatly affected the mental health of individuals. For individuals who find their job stressful, they may now associate their living space as a stressful place as well. If our homes, which by definition should be a place of happiness and safety, now represent places of stress, what do we do?

Depression, Anxiety, and Substance Abuse on the Rise During the Pandemic

We have seen a large increase in substance abuse, depression, and anxiety throughout this pandemic. In fact, according to the CDC:

Elevated levels of adverse mental health conditions, substance use, and suicidal ideation were reported by adults in the United States in June 2020. The prevalence of symptoms of anxiety disorder was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%).

We have do not have normal social interaction nor do we have the natural separation between work and home. Unfortunately for many, work at home may be one piece of the pandemic that is here to stay. Companies no longer need to pay expensive rent for office spaces or spend money on travel when we have had a year to learn that everything can be done remotely.

How to Create a Healthy Routine During the Pandemic

We need to learn how to incorporate a healthy routine that incorporates all these aspects of self-care. Here are a few tools I often provide to clients and use myself:

  1. Set specific work hours. Just because we don’t have a commute and have more time to dedicate to work does not mean we need to. We still have lives outside of our jobs. Make sure start and end times for your day are marked on your work calendar so others can be respectful of those boundaries.
  2. Take breaks! Working from home does not mean you are not entitled to a lunch break or a few minutes here and there to stretch your legs. You do not need to be glued to a screen—no one can work 9 hours straight!
  3. Create a separate workspace in your home. Don’t work in bed or on the couch as you may start associating those places with stress. Make sure to have a proper desk or setup to work from where you can leave your computer at the end of the day and move to your “living” space.
  4. Exercise. In New York City, especially, most of our commutes include at least some walking. A lot of people have found themselves not moving at all since working remotely. Carve out time each day to move your body. This can include a morning walk, stretching, or more intensive exercise. It doesn’t matter how you move, just try to get in around 20 minutes a day. Also, be mindful of the time of day you exercise. Some find mornings helpful to increase energy and get their day started on the right foot, while others find the evenings helpful to wind down. Do what works best for you!
  5. Socialization. Remember, we are social creatures. Whether it’s getting a coffee in the morning and seeing people on the street, meeting a friend for dinner, or FaceTiming with family, try to connect with one person throughout any given day.
  6. Healthy eating and sleep. We need to treat our bodies with love and respect. If we eat junk food, we likely won’t feel good both physically and mentally. We need to make sure we are treating our bodies well so that our mental capacity and overall mental health is at its best.

Our Manhattan NYC Psychiatrists are Here to Help

At Fifth Avenue Psychiatry, our New York City psychiatrists care about your mental health, and we are here for you. This has been a tough year for us all, but there is finally a light at the end of the tunnel. Let’s learn from this past year and apply some of these lessons to our futures and prioritize our wellbeing.

If you are in need of help, get in touch with our psychiatrists in New York City. We are prepared to provide science-based treatment.

Neuropsychological Testing and Substance Use Disorders

Written by Ronnit Nazarian, Psy.D.

Most of us are aware of the long-standing emotional and behavioral effects of substance abuse. However, the more subtle and detrimental effects that are harder to assess are the negative impacts substance abuse has on a person’s cognitive abilities (e.g., short-term memory, fluid reasoning, processing speed).

For example, we see that opioid addiction increases depressive emotions and behaviors. More subtle impacts of opioid addiction, according to research, are the effects on a person’s prefrontal cortex and temporal lobe.2 Consequently, these areas of impact, in turn, affect a person’s cognitive abilities, which our Manhattan psychiatrists can identify with a neuropsychological evaluation.

Specifically, with an impact on the prefrontal cortex (e.g., influences emotion, memory, and executive function) and temporal lobe (e.g., influences language and visual perception), we would find that most opioid users would have difficulty retaining visual memory, comprehending spoken language, planning, and making decisions.2

Before going into the most common areas impacted by substance abuse, our psychiatrists in Manhattan will discuss what neuropsychological testing is and how it can inform the type of treatment plan you receive medically and therapeutically.

What is a Neuropsychological Evaluation?

A neuropsychological evaluation is an in-depth assessment of a person’s cognitive strengths and weaknesses, academic achievement, and social-emotional functioning. The evaluation measures areas such as:

  • Attention
  • Emotions
  • Executive functioning
  • Memory
  • Visual-spatial reasoning
  • Processing speed
  • Verbal comprehension
  • Reading
  • Writing
  • Math

In order to assess a person’s neuropsychological functioning, a variety of measures are administered such as the Wechsler Adult Intelligence Scale, Woodcock Johnson Test of Cognitive Abilities, Wechsler Individual Achievement Test, Minnesota Multiphasic Personality Inventory, Conners 3, and many others. Typically, concerns that suggest neuropsychological testing are difficulties in the following areas: attention, memory, problem-solving, and comprehension. These concerns can be due to a variety of reasons (e.g., Anxiety, Depression), as well as an underlying effect of substance use.

What are the Benefits of a Neuropsychological Evaluation?

A major benefit of having a neuropsychological evaluation is using the results to assist professionals and clients in obtaining a comprehensive picture of the client’s concern and, consequently, informing their selection of an effective treatment for the client. For example, let’s imagine a client who is experiencing symptoms of anxiety: Neuropsychological testing can inform the patient in understanding that their presentation of anxiety impacts their processing speed (ability to complete tasks within the allotted time) and verbal memory. If this were an adult client, this information can be valuable in understanding the difficulty of working in high-pressure environments with timelines on projects and demand for high-quality work. Tying it back to therapy, neuropsychological testing assists the therapist to better understand the impact of the concern on the client’s life across different settings (e.g., work, school, home, relationships), which can in turn influence the therapeutic treatment to be centered around the client’s needs.

With neuropsychological testing, our Manhattan addiction psychiatrists can also find the current impacts of substance abuse on a person’s functioning. In addition, the evaluation can help identify long-standing underlying conditions (e.g., Post-Traumatic Stress Disorder, Anxiety Disorders, Bipolar Disorder, Depression) that may have driven substance use to begin with. For example, research shows clients who abuse specific substances may have presented with anxiety since a young age, which could have influenced their use of substances in order to cope with the anxiety.4 In other cases with neuropsychological testing, we may find that the client experienced a traumatic event, which triggered an increase in alcohol usage and leading to dependence in order to cope.3

What are Common Impacts of Substance Abuse on Cognitive Abilities?

An overwhelming amount of research shows that people with addiction typically have cognitive deficits affecting predominantly executive functions, decision making, emotion regulation, attention, and memory.1 The cognitive area impacted differs as a function of the principal drug of choice. Specifically, research has shown that “cocaine and methamphetamine are linked to deficits in working memory, response inhibition, cognitive flexibility, and decision making. Opioid addiction is associated with deficits in verbal episodic and working memory as well as fluency and decision-making. Alcohol addiction relates to cognitive deficits across the board, spanning from basic abilities such as speed and language to attention and memory and more complex executive functions and decision-making. Cannabis addiction, however, is linked to specific alterations in episodic memory although they can be short-lived. MDMA (ecstasy) users also show discrete alterations of memory processes. Most populations with addiction problems have deficits in emotion processing and regulation as well as social cognition and interaction problems.”2

Can Cognitive Abilities Improve after Being Impacted by Substance Use?

While these areas are heavily impacted, there are effective therapies out that can help alleviate the impact of substance abuse and result in improvements (e.g., Cognitive Behavior Therapy, Dialectical Behavior Therapy, Individualized Withdrawal Treatments, Motivational Interviewing, Medication Management, Group Therapy).6 With the ability to use neuropsychological tests to identify areas of concern and the influence on use of substance abuse, we can use this information to pave the way for treatment planning and effectively treat these areas to show improvements and change.

We Provide Neuropsychological Testing in Manhattan, New York City

At Fifth Avenue Psychiatry, our Manhattan psychiatrists strive to provide our clients with an integrative and client-centered approach. We gather pertinent information across all areas of a client’s life and then formulate a more tailored treatment plan. Neuropsychological testing is one aspect of informing an effective treatment plan that is individualized and improving recovery by understanding a person’s psychological functioning. It will allow you to understand the experiences, abilities, and areas that may impact you.

Our Manhattan psychiatrists provide neuropsychological testing in New York City. Get in touch with our team for more information.

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  1. Bruijnen, C., Dijkstra, B., Walvoort, S., Markus, W., VanDerNagel, J., Kessels, R., & DE Jong, C. (2019). Prevalence of cognitive impairment in patients with substance use disorder. Drug and alcohol review38(4), 435–442. https://doi.org/10.1111/dar.12922
  2. García, A.V. (2018). The neuropsychologist working in addiction: What to know? Ten questions and answers. Revista Iberoamericana de Neuropsicología, 1(2), 170-179.
  3. Khoury, L., Tang, Y. L., Bradley, B., Cubells, J. F., & Ressler, K. J. (2010). Substance use, childhood traumatic experience, and Posttraumatic Stress Disorder in an urban civilian population. Depression and anxiety27(12), 1077–1086. https://doi.org/10.1002/da.20751
  4. McCauley Ohannessian C. (2014). Anxiety and substance use during adolescence. Substance abuse35(4), 418– https://doi.org/10.1080/08897077.2014.953663
  5. Punzi, E. H. (2015). Neuropsychological Assessment in Substance Abuse Treatment—Focusing on the Effects of Substances and on Neuropsychological Assessment as a Collaborative Process. Smith College Studies in Social Work, 85(2), 128-145. doi: 1080/00377317.2015.1017357
  6. Sofuoglu, M., DeVito, E. E., Waters, A. J., & Carroll, K. M. (2013). Cognitive enhancement as a treatment for drug addictions. Neuropharmacology64(1), 452– https://doi.org/10.1016/j.neuropharm.2012.06.021

 

The Importance of In-Person Addiction and Alcoholism Treatment During the COVID 19 Pandemic

There have been many mental health challenges during the COVID-19 pandemic, including increased depression, anxiety and exacerbations of PTSD as a result of isolation, changes in lifestyle and fear. Along with increases in suicidality and domestic abuse, one of the most dangerous mental health effects of the pandemic has been increased substance abuse.1Along with all the dangerous effects of substance abuse there have been “an increasing number of reports from national state and local media,” including New York, of “an increase in opioid and other drug related mortality.”2

What is the Cause of Increased Substance Abuse During the Pandemic?

The cause of increased substance abuse is many. More people are using illicit drugs and alcohol to cope with their symptoms or to “self medicate.” Boredom, unemployment, as well as lack of structure in school and work are all triggers to increase alcohol and drug use. Traditional forms of treatment have been all but shut down, with many 12-step meetings and traditional outpatient programs transitioning to Zoom. Many mental health practitioners are unavailable for in-person treatment, and many residential rehabs are full.

Isolation is a Contributing Factor to Substance Abuse

Addiction and alcoholism thrive in isolation, and the pandemic has done all but assured that most people in New York are much more isolated. Although Telehealth is better than nothing at all when it comes to addiction treatment in Manhattan, we have found the results are much greater when in-person addition treatment is available. The limitations of a Telepsychiatry or Zoom meetings are well established by now.

We Provide Outpatient Addiction Treatment in Manhattan, New York

At Fifth Avenue Psychiatry, we have taken appropriate measures to provide in-person outpatient treatment for addiction and alcoholism in New York City. Our offices have good ventilation through open windows and air-purification systems. Our staff have seen the positive results of in person meetings and in balancing the health needs of our patients have agreed to provide “live” treatment. We provide counseling, medication management for depression, anxiety and OCD and PTSD, as well as Manhattan outpatient detoxification for alcoholism and opioid dependence. MAT is available for opioid use disorders, including Suboxone and Vivitrol.

For more information or to get in touch with our Manhattan, NYC addiction psychiatrists, please call 212-734-0506.

  1. Czeisler MÉ , Lane RI, Petrosky E, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1049–1057. DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1.
  2. Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic, American Medical Association, Issue Brief, October 6, 2020.

Coping Mechanisms Against Depression and Anxiety during the COVID -19 Pandemic

Written by Olga Megwinoff, MD

I did not want to write about anything related to the pandemic given that we are already so saturated by news and information related to it. However, I have realized it’s unavoidable. This pandemic and the ensuing quarantine have changed everything about the world as we know it. Most aspects of our personal, familial and social lives have been upended. Therefore, regardless of what I feel, I think that the most useful thing I can do is to write about coping mechanisms for how to endure social distancing and the fear.

I want to focus on what we can do to help each other and ourselves as we are starting week 11 of social distancing in New York. I, as a Manhattan psychiatrist, find myself, my family members, and my patients suffering in one way or another from the direct effects of the fear and social isolation, therefore, I have put together a compilation of simple techniques we can all apply to our lives, especially during this pandemic.

1. Fear and Anxiety

Often our fears are out of proportion to the reality of the situation. Our natural tendency is to over-estimate the risk and underestimate our ability to deal with it. Factors that can contribute to this phenomenon are how much uncertainty there is in a risky situation, how invisible the threat is, how much control people feel they have over the situation, how horrible the possible outcomes are, and how suddenly bad outcomes may occur (Leahy, PhD).

Regardless, the meaning we impose on fearful events contribute to our emotional states. Therefore, changing how we think about these events can reduce anxiety symptoms and improve overall wellbeing. The story we tell ourselves can be a conscious choice where we take a more neutral observer stand point and take into account the context.

You can train your brain not to blend with thoughts, instead to observe them from a distance. If you can do this, then it’s easier to recognize catastrophic or negative thinking. This can be done by monitoring the pros and cons of an event.

For example:

  • “What is the evidence for this thought?”
  • “Is this conclusion based on facts or feelings?”

We can also monitor and challenge negative anxiety-evoking self-statements.

For example:

  • “What are you predicting will happen and what is the likelihood it will actually happen?”
  • “If the worst case scenario were to happen, what would you do to cope with it?”
  • “What are the costs and benefits of worrying about this?”

To counter-balance your thoughts, it’s also imperative to control autonomic arousal through relaxation. Some examples of this are focused breathing, progressive muscle relaxation, exercise, and visualizations.

Your level of fear is inversely correlated to information. Be smart and know the facts. However, do this while limiting the time you expose yourself to the news media cycle and be aware that “the news” is often full of dramatizations instead of factual information.

2. Coping Skills for Stress During COVID-19

The ways in which individuals respond to stressors attenuate the presence of depressed mood and anxiety. This can influence both the duration and severity of their symptoms (Nolen-Hoeksema, 1991).

People have different coping styles, many of these are learned in childhood. Endler and Parker (1990) suggested that there are three basic coping styles: Problem-oriented, emotion-oriented, and avoidance-oriented.

Your coping style may stay consistent across different situations and experiences or the coping strategies you use can be varied. They may change over time as you face a particular stressor. For example, you can be using active coping mechanisms but decide to take a mental break because your anxiety is peaking and decide to use denial for a little while. You may stop looking at the news for a few days and get immersed in an engrossing book. While it is obvious that some of these coping strategies are more healthy than others, they all more or less serve the purpose of lessening anxiety in the moment. Nevertheless, while the less healthy coping mechanisms can still help not feeling anxious in the present moment, by suppression and displacement of the real feelings, these unhealthy coping mechanisms eventually can lead to depression and worsening anxiety.

Problem focused coping refers to overt behavioral attempts to modify or eliminate the sources of stress through one’s own behavior.

Examples include:

  • Active coping: “I tried to find out more about the situation”; “I took some positive action”; “I do what has to be done, but one step at a time”; “ I can’t change the situation but I’m taking action to try and make the situation better.”
  • Planning: “I concentrate my efforts on doing something about it”; “I have been trying to come up with a strategy about what to do.”

Emotional coping includes behavior or cognitive responses whose primary function is to attempt to monitor the emotional consequences of stressors and maintain one’s emotional equilibrium. One example of emotional coping is positive reinterpretation. This consists of monitoring one’s appraisal of the stressfulness of the event. In other words, someone may try to see the positive side of a situation or draw on their past experiences in similar situations.

Other examples of emotional coping:

  • Acceptance: “I have been learning to live with this.”
  • Denial: “This isn’t real.”
  • Turning to religion and/or spiritual beliefs
  • Humor
  • Exercise

Restraint/avoidant coping refers to the degree to which one refrains from acting to resolve a stressful situation.

Examples consist of:

  • “I have been doing something to think less about it”
  • Watching TV
  • Reading
  • Daydreaming
  • Sleeping
  • Substance abuse
  • “When I have a problem, I like to sleep on it”
  • “If I find a problem too difficult, I put it aside until I’m ready to deal with it”
  • “I try to let things work out on their own.”

Additional coping strategies consist of establishing social resources. Social support and willingness and comfort with help-seeking from others (Billings & Moos, 1981; Nadler, 1990) are also likely to influence an individual’s anxiety and depressed mood. One example is discussing your feelings with someone else. Talking to others can be very helpful because it can provide another perspective on the stressor in addition to getting advice about how to solve the problem. While “keeping my feelings to myself” tend to be detrimental in the long run.

3. Social Distancing

Interaction with peers is a powerful and universal human need. Attachment theory (Bowlby, 1980) describes how attachment serves the purpose of reducing anxiety. Attachment is the lasting emotional bond between two people, where one party (in childhood) or both of the parties (in adulthood) tries to maintain proximity to the attachment figure and takes action to ensure that the relationship continues.

Researchers believe that the style and history of an individual’s attachment affect loneliness. Attachment behavior activates when a person feels fear or sadness or contracts a disease. Therefore, during this time of forced social isolation, it is thought that a lack of face-to-face contact and separation from others may lead not only to lack of closeness in relationships, but also to loneliness and stress.

Attachment theory emphasizes that early childhood relationships form attachment styles and influence individual’s views about themselves, others, and the organization of interpersonal relationships. Attachment styles can be defined as patterns of thinking, feeling, and personal behavior in close relationships with a caregiver and other intimate partners. Attachments are made to others and correlates strongly to self-confidence, self-reliance, and ability to deal with the outside world. Accordingly, absence of an attachment figure makes a person feel lonely and/or anxious. Resulting in a lack of emotional stability. Consequently, separation from our parents, good friends, teachers, and mentors can profoundly impact a person’s emotional wellbeing in the many facets mentioned above.

Henceforth, it’s important we actively work on maintaining current relationships, renewing older ones, and cementing bonds. Consider being more loving and more expressive of love to your family, friends, teachers, and mentors. It’s not an exaggeration to state that your emotional well-being depends on it.

Our Manhattan Psychiatrists are Here to Help

At Fifth Avenue Psychiatry, our Manhattan psychiatrists understand how difficult the pandemic has been on us all. Should you find yourself in need of treatment, know that our team is here to help. We invite you to call our New York City office.


Resources:
Billings AG, Moos RH; the role of coping responses and social resources in attenuating the stress of life events.
J Behav Med. 1981 Jun; 4(2):139-57.

Daniel Brown, PhD, Living Meditation 3/30/2020; Using The Best of Western Psychology and Eastern Meditative Traditions as a Response to the Corona Virus Pandemic.

Charlie Silverstein MD. On My Mind: Coronavirus, fear, and anxiety. blog March 18, 2020.

Brief COPE

Active and Passive Coping Strategies: Comparing Psychological Distress, Cortisol, and Proinflammatory Cytokine Levels in Breast Cancer Survivors
Joana Perez-Tejada
Larraitz Garmendia
Ainitze Labaka
Oscar Vegas
Eneritz Gómez-Lazaro
Amaia Arregi

CJON 2019, 23(6), 583-590 DOI: 10.1188/19.CJON.583-590

Bartholomew K, Perlman D (1994). Attachment process in adulthood. London: Kingsley Publication.

Bowlby J (1988). A secure base: Parent-child attachment and healthy human development. New York: Basic Books.

Erozkan, A., The attachment styles bases of loneliness and depression.International Journal of Psychology and Counselling Vol. 3(9), pp. 186-193, December 2011

 

Treatment Approaches Designed for Women with Addiction and Alcoholism

By Britt Gottlich, Psy.D.

Through years of training and practice in the field of substance abuse, I have noticed some interesting gender differences. First, I have found that more men tend to seek substance abuse treatment than women. Second, I have noticed that often the core of what began the substance abuse problem is often different between men and women. Third, it has become evident that men and women do not always gain the same benefits from the same treatment approach. This month, my blog explores these interplaying factors and introduces addiction treatment approaches that may better fit the needs of female clients.

Women May Be Less Likely to Seek Substance Abuse Treatment

According to research, “Surveys in the early 1980s estimated the male/female ratio of alcohol-use disorder as 5:1, in contrast to more recent surveys that report a ratio of 3:1.” 1 Given these statistics, there is clearly a higher number of men seeking treatment for substance abuse. Supporting research, and my own clinical experience as Manhattan clinical psychologist shows that women may internalize more shame as part of their use, therefore making it less likely they will enter into treatment. For example, hormonal changes, body image issues, increased stress, and stressors or a history of trauma can all play into an individual’s perception of themselves and therefore willingness to seek treatment. So, it is not that there are fewer women who struggle with substance and alcohol use, but perhaps they are just less likely to ask for help.

The Link Between Sexual Trauma and Substance Abuse in Women

One specific area that has been researched extensively is women with a history of childhood sexual trauma. “Clinical studies have found elevated rates of childhood sexual abuse (CSA) in women seeking treatment for alcohol or drug abuse”. 2 Oftentimes, individuals who report a history of abuse describe feelings of guilt and other uncomfortable emotional responses. Substances can act as a means of coping with unresolved trauma and difficult emotions. It is oftentimes an effective form of self-medication for individuals to “numb” the memories or emotional experience that those memories provoke. Research often focuses on sexual trauma in women and substance abuse specifically; however, in my experience, there is a link between any type of trauma (physical, sexual and/or emotional) and substance use.

Understanding Dialectical Behavioral Therapy

Despite the type of trauma history or emotional stressor that leads a woman into substance abuse, one of the most effective forms of treatment for these women is Dialectical Behavioral Therapy (DBT). DBT is a therapeutic approach that helps provide individuals with life skills that help manage emotions and interact with people more efficiently. DBT consists of four modules:

  • Mindfulness
  • Distress tolerance
  • Emotional regulation
  • Interpersonal effectiveness

DBT was initially created for people with Borderline Personality Disorder, however, research shows it can be used for a number of different disorders including substance abuse. 3

I personally use different elements of DBT with nearly every person I work with, as I believe DBT skills can be beneficial for everyone (myself included!) in any given situation. DBT allows us to learn how to be more in touch with our emotions and control them in times of stress. Often times women that present to individual therapy for substance abuse disorders present with emotional dysregulation. Regardless of the reason behind their emotional regulation (any of the reasons mentioned above), I usually find that approaching therapy through a DBT skill-based lens is the ultimate first treatment approach.

In addition to individual therapy, DBT skills groups can be a helpful treatment approach. These groups allow individuals to learn and practice skills with the help of other members. Group members will be given skills and homework which are then revisited in the group, where group members will provide encouragement and support to each other.  Encouragement, support, and a sense of community are just a few of the many benefits that group work can provide, as my colleague Dr. Tracey Bassett highlighted in her blog last month about the importance of group work in treatment.

Our Manhattan Addiction Treatment Team Can Help

In being able to acknowledge that female clients have different needs than male clients and that perhaps they struggle differently with treatment barriers, we can begin to take a step in creating more informed and supportive treatment practices. In working in an informed way, we can offer the appropriate skills and support that each person needs. It is my belief, that once an individual can learn to manage their emotional reactions, they will feel less likely to resort to unhealthy coping skills, therefore not having to rely on substances to cope, and learning that they can rely on themselves and the support built around them.

Our addiction treatment team in Manhattan is ready to help. Call Fifth Avenue Psychiatry for science-based treatment.


  1. Greenfield SF, Back SE, Lawson K, Brady KT. Substance abuse in women. Psychiatr Clin North Am. 2010;33(2):339–355. doi:10.1016/j.psc.2010.01.004
  2. Maffei, Cesare & Cavicchioli, Marco & Movalli, Mariagrazia & Cavallaro, Roberto & Fossati, Andrea. (2018). Substance Use & Misuse Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial Dialectical Behavior Therapy Skills Training in Alcohol Dependence Treatment: Findings Based on an Open Trial. Substance Use & Misuse. 53. 10.1080/10826084.2018.1480035.
  3. Wilsnack, Sharon & Vogeltanz, N & Klassen, A.D. & Harris, T. (1997). Childhood sexual abuse and women’s substance abuse: National survey findings. Journal of studies on alcohol. 58. 264-71. 10.15288/jsa.1997.58.264.

 

Group Therapy for Executives with Addiction

Group Therapy for Executives with Addiction

By Dr. Tracey Bassett

In deciding what to write about this month, I drew from Dr. Glazer’s most recent post in which he said, “I now understand that my most important role as a physician and therapist for alcoholism and addiction is to help provide a safe space, a trusting, mutually respectful relationship where I can help guide a person through their own recovery process.” I could not agree more.

One of the things that I think makes our practice so unique is that when we meet with a client for the first time, we conduct an assessment for what the client really needs. Which therapist will they work best with? Which modality of treatment will they respond the best to? What do they feel like they need? We then take all of these factors into consideration and make a treatment plan that works for them. We try to create a plan in which the individual client is getting what they truly need in an environment in which they can feel respected, connected, and supported.

The Benefits of Group Therapy in Addiction Treatment

In working to identify key aspects in recovery, we started to see a gap in treatment. A majority of clients seeking substance use treatment report something similar—feeling that no one in their close circle quite understands what they are going through. As a result, they often feel alone in the process. As doctors, we try to validate and normalize these common feelings. Sometimes this is enough, but a lot of times it is not.

In addition to individual therapy, some clients work well with 12-step or other peer-led recovery programs as part of their recovery process. For example, 12-step meetings can be a really great place for social support and validation, which subsequently reduces isolation, guilt, and shame. This is one of the reasons that these programs can work to support sustained recovery. However, I have found that a lot of clients want the peer support that meetings provide, but they are turned off by other aspects of the program that they feel are too “all or nothing.”

In starting to research alternative options that provide peer support, I’ve found that there is not a lot. Small cohesive group work in a private practice setting for high functioning clients is missing from the treatment landscape. As doctors, we are able to provide a safe supportive environment in our office, but what about an environment in which peers can support each other through mutual experiences?

So why is this so important? Among other things, groups are helpful as they provide the following benefits:

  • Positive feedback and support
  • Decreasing isolation
  • Sharing useful coping mechanisms
  • Challenging self-judgment and negative self-talk
  • Giving the opportunity to witness the recovery of others
  • Providing support to members should they stumble in recovery

A cohesive group can be a very powerful tool in recovery.

Our Manhattan Addiction Treatment Doctors are Backed by Experience

I, along with my colleague Dr. Gottlich, have had the pleasure of seeing the benefits of cohesive group work first-hand. After a lot of thought and planning, we started our first group at the practice in September 2019. After six months, the group is going strong. We have been witnesses to the type of unconditional support, and subsequent rewards, that a group can provide. Although Dr. Gottlich and I are able to provide the space, it is truly the work of the group members that provide a safe and supportive space to navigate the ups and downs of recovery. I feel lucky to be a part of the process, and I hope that we can continue to build group work as a larger part of the practice, as it is a powerful tool that allows a lot of people know that they are not alone in their recovery.

At Fifth Avenue Psychiatry, award-winning doctors provide unique, individualized treatment of alcoholism and substance abuse in a discreet, private setting.


Substance Abuse Treatment: Group Therapy (2005). Retrieved From: https://www.ncbi.nlm.nih.gov/pubmed/22514847

 

 

Controlled Drinking Program in NYC

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