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.

Spilled Bottle of Pills NYC Stimulant Addiction Therapy

Adderall Addiction in the Workplace

By Britt Gottlich, Psy.D.

At Fifth Avenue Psychiatry, we often get new clients seeking stimulant medications for ADHD. These individuals are usually surprised with how cautious we tend to be with these medications, as our NYC psychiatrists require new or recent neuropsychological testing to confirm this diagnosis rather than just handing out medications based on reported symptoms. The reason we are more conservative with stimulant medications is because of the high rate of stimulant addiction that we see as a result of these controlled substances being prescribed too readily.

What are Prescription Stimulants?

The National Institute on Drug Abuse defines stimulants as “medications generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy- uncontrollable episodes of deep sleep. They increase alertness, attention, and energy” (NIDA, 2018). Stimulants affect the dopamine and norepinephrine chemicals in our brains, which is why people often report feeling a “rush” when they take these medications. The reason this type of medication can be helpful for clients with ADHD diagnoses is that it can help them focus for longer periods of time and curb impulsivity and hyperactivity. Some common names of these medications include:

  • Adderall
  • Vyvanse
  • Concerta
  • Ritalin
  • Focalin

Stimulant Prescriptions

If diagnosed with ADHD and prescribed appropriate doses of stimulants, the medications can be helpful and often do not necessarily lead to a substance use disorder. In fact, people who have ADHD and are prescribed these medications have lower rates of overall substance abuse because of the way these medications help curb their impulsivity.

The problem we are facing is the over-prescription of stimulant medications. This is usually a result of incorrect ADHD diagnoses which can be due to poor or no assessments. Some ways to avoid an incorrect ADHD diagnosis is using standard diagnostic assessments, and to receive comprehensive histories including:

  • Childhood symptoms
  • Parent/teacher reports
  • Past assessments

Prescription Stimulant Abuse

The Addiction Center reported that “prescription Stimulants are classified as Schedule II drugs under the Controlled Substance Act because they have high potential for abuse and addiction. Approximately 900,000 Americans abuse prescription Stimulants every month” (https://www.addictioncenter.com/stimulants/).

Our psychiatrists in NYC see a lot of stimulant medication misuse in high school and college-aged individuals. These individuals either buy pills off friends with diagnoses or from dealers in order to help them through finals season, to buy them a few more hours of focus to write a paper, or to take recreationally at parties to get “high.”

When it comes to abusing stimulants, our Adderall addiction psychiatrists in NYC tend to see that more in the workplace. In my own practice, the majority of clients I have seen who struggle with stimulant abuse are in law and finance careers and take these medications not to get high, but to enhance their performance in comparison to their peers, or simply to keep up with the volume of work they have and expectation of others. Another reason these individuals become addicted to these prescriptions is their physical dependence. Their brains become reliant on the dopamine from the drug to the point that if they do not take it, they will experience withdrawal. Therefore, individuals become physically dependent just to feel normal.

Health Effects of Prescription Stimulants

Yale Medicine reported that “stimulants increase the amount of neurotransmitters in the brain, including dopamine, which leads to heightened alertness and feeling of euphoria. At the same time, stimulants elevate a user’s blood pressure, heart rate, and breathing. Heavy use can cause irregular heartbeat, heart failure and seizures, and, in some cases, death” (https://www.yalemedicine.org/conditions/stimulant-abuse). Stimulant abuse can be very dangerous for the heart and, oftentimes, individuals who seek treatment can feel the effects or have been told by their doctors they are developing problems associated with the drug.

Treatment of Prescription Stimulant Abuse

There are a few things to consider when an individual is seeking treatment for prescription stimulant abuse. First and most important is the effect the prescription stimulant is having on their bodies, but we must also consider ADHD diagnoses and whether it is realistic for an individual to be completely off these medications or not. Once we can establish whether a person has a valid ADHD diagnosis (through assessments we can conduct ourselves, or past testing confirmation), we can discuss a plan as to whether the individual should be completely abstinent from stimulants or whether we may need to come up with a plan where they stay on a lower and more controlled dose.

Coming off stimulants can be uncomfortable due to the withdrawal. Since our clientele tends to use this as a performance enhancer in the workplace, we are very aware of the effect of withdrawal on work performance. Therefore, we work with the client to taper them off the medication at a pace that feels comfortable and manageable for them. In regard to the therapeutic aspect of this treatment, we work with clients using a behavioral model to identify patterns of their use both in regard to their emotions and cognitions. Our NYC stimulant addiction psychiatrists then work with them to reframe their thinking regarding their need for the substance. We teach healthy coping skills, emotional regulation, and relapse prevention.

When working with individuals with ADHD who plan on staying on a lower dose of the medication, the treatment can become a little more complicated. In regard to medication management, the medication is given in a much more controlled fashion to ensure there is no abuse. Regarding the therapeutic approach, there is a lot more emphasis on impulse control and redefining the way the client views the medication and the intention behind taking it.

There is not one plan that suits all, so treatment can be flexible and modified to a person’s needs, specific situation, and concerns. The road to recovery can be overwhelming but making an appointment and discussing the issue openly can be the first positive step in this journey.

Seeking stimulant addiction treatment in New York City? Fifth Avenue Psychiatry provides private addiction treatment for executives and professionals in the Manhattan, NYC area.

  1. https://nida.nih.gov/download/21875/prescription-stimulants-drugfacts.pdf?v=1309cc683fbac1633faaaaf5de02dc21
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518741/
Woman Seeking Addiction Treatment in NYC

How To Choose the Right Psychiatrist for Addiction Treatment

By Samuel Glazer, MD

Addiction is understood as a brain disease that is multidimensional, and, to this point, there are still very few effective treatments. What we also know is that addiction responds best to a combination of both medicine and psychotherapy for the addiction, as well as its underlying causes (only once the substance use stops). Unfortunately, though, there is still a great deal about addiction and its treatment that is misconstrued by both patients suffering with addiction and many psychiatrists and therapists treating them. Though there are many excellent therapists and skilled psychiatrists with variable levels of training, the following are some suggestions by our New York City addiction psychiatrist on how to find a psychiatrist who can best help you treat this very complex condition.

Evaluate the Training of an Addiction Psychiatrist

A psychiatrist is a physician who has completed medical school and has then spent four years as a psychiatry resident in training. The American Psychiatric Association (APA) and the American Board of Psychiatry and Neurology (ABPN) are the two organizations overseeing training and certification of Psychiatrists in the United States. The only certification that they endorse for treatment of substance use disorders is that of Addiction Psychiatrist. To become an Addiction Psychiatrist, a general psychiatrist must be accepted into, train in, and complete an ACGME accredited fellowship in Addiction Psychiatry. After successfully completing an Addiction Psychiatry Fellowship, the candidate must then pass a written exam to become Board Certified and must maintain a certain level of Continuing Medical Education credits, self-assessment and performance improvement in medical practice modules to maintain their status as a Board Certified Addiction Psychiatrist. It sounds like a lot, and it is. Essentially, to become an Addiction Psychiatrist, one needs to graduate college, then medical school, complete a 4-year General Psychiatry Residency program, and then successfully complete a Fellowship of 1-2 more years in Addiction Psychiatry.

Do No Harm: Look for Dangerous Signs

There are some psychiatrists (I know a few) who have great instincts, personal or family experience and understand addiction well, despite not having official ABPN certification in Addiction Psychiatry. Unfortunately, though, there are many who are truly ignorant (for lack of a better word). This can actually be dangerous. Things to look out for include any psychiatrist or psychotherapist who thinks they can medicate or give therapy for underlying depression or anxiety and the addiction will go away (this was actually the thinking decades ago and has since been proven wrong.)

Though self-medication of depression or anxiety is often the road that leads to a substance use disorder; once developed, addiction must be handled as an entity of its own. Once addiction is stabilized, the underlying condition can be treated. To only treat the underlying condition will only perpetuate the addictive behavior, sometimes amplify it, especially if habit-forming medications are prescribed.

Another potential pitfall is any treatment center or doctor who offers a “quick fix.” In my twenty-five years of practice, I have seen many new treatment approaches come and go. Some with good intentions, some truly just motivated by profit. But I would be careful of anything novel without years of trials in the general population. Whether it is a hallucinogen, hypnosis, or some other drug or approach, I have never seen anything that takes addiction away. The process of healing from addiction is just that, a process that takes effort, time, and skill.  To be seduced by a rapid effortless solution can be harmful in that it perpetuates the addiction by appealing to the need for a quick fix, or, at worst, be toxic to the brain.

Does My Addiction Psychiatrist Treat with Psychotherapy and Medications?

Addiction can now be effectively treated with medications, and once stabilized, there are many helpful medications for underlying conditions such as anxiety disorders, depression, ADD, OCD and other mood disorders. A research-proven fact is that medication combined with psychotherapy is the gold standard of treatment and most effective. Many psychiatrists, these days (because of poor training and lack of reimbursement from insurance companies), only prescribe medication. However, because of the complexity of having an addiction and an underlying condition, to get split treatment (having a separate psychotherapist) can be confusing at best and potentially harmful. The best Addiction Psychiatrists I know mostly do both psychotherapy and medication management in the same setting.

What Support Network Does my Addiction Psychiatrist Have?

With addiction being such a complicated condition, it can be helpful if your Addiction Psychiatrist has a support network of his/her own. Many of the best psychiatrists I know that treat addiction are often part of a group practice. Teaching at a medical school, having a relationship with a hospital and being a member of professional organizations such as the American Academy of Addiction Psychiatrists (AAAP) and the American Psychiatric Association (APA) are indications that your Addiction Psychiatrist is plugged in, staying fresh, have appropriate people to refer to, are keeping up to date, and are supported by others in their profession.

The Most Important Person in the Office is the Patient

The essential concept I have learned from my patients, over the years, is that as an Addiction Psychiatrist, I am an expert enlisted in helping the patient meet THEIR goals. Not everyone wants to be completely sober, some want harm reduction and moderation, some want to use medication, and others only want therapy. Some patients are open to trying AA, but others would rather do anything but try AA. I believe the best psychiatrist for addiction treatment is one who has a broad-based understanding of addiction (see paragraph 1), but can be flexible, humble, and caring enough to form a strong alliance with the patient to achieve the goals that are important to them.

These are a few suggestions that can help you choose the right psychiatrist for addiction treatment. I hope that it helps!

Seeking addiction treatment in New York City? Dr. Glazer and the doctors at Fifth Avenue Psychiatry provide private, sophisticated addiction treatment for professionals and executives in the Manhattan, NYC area.

What is Kratom? | NYC Kratom Addiction Psychiatrists

Kratom: Harmful or Helpful?

By Dr. Ronnit Nazarian

There is little information on Kratom, and there is much misinformation out there. Some people believe Kratom is a safe drug to use because it is legal, easy to obtain, natural, advertised heavily, and has “claimed” to treat many illnesses from anxiety to diabetes to opioid withdrawal symptoms. However, the consequences of Kratom use have shown that the drug can create dependence and addiction similar to the effects of opioids (e.g., pain relief and euphoria) and stimulant properties. In some cases, Kratom can actually create Opioid withdrawal symptoms and lead to opiate use disorders or even mimic them.2

Our New York City addiction psychiatrists are here to help provide the following information:

  • What is Kratom?
  • Why it is addictive?
  • The dangers of using Kratom
  • The recommended treatment approach

What is Kratom?

Kratom leaves come from a tree in Southeast Asia. Traditionally, Kratom has been cooked in food and brewed in teas as medicine for treating coughs, diarrhea, opiate withdrawal, chronic pain, and to boost energy and sexual desire. As of lately, it has become a recreational drug as well as drug that people have used to self-treat various emotional and behavioral problems (e.g., anxiety, ADHD, opiate withdrawal). Now, Kratom can be consumed by being ground up in pills, crushed, smoked, mixed into liquids, and produced into various products (e.g., soap bars).2

Is Kratom Addictive?

Kratom has the potential to cause dependence and addiction. This potential risk may be due to people using the drug for:

  • Reward-seeking behavior
  • Prevention of exhaustion
  • Improvement in energy
  • Improvement in productivity

Relatively recently, the phenomenon “drug instrumentation” was posed to discuss non-addictive drug consumption, such as Kratom, that are meant to be used in a purposeful and goal-directed manner. Though substances that fall under this category (e.g., Kratom, Nicotine, Marijuana, pain killers, alcohol) are meant to be used purposefully, they increase potential prolonged use and, consequently, addiction because of the positive effects they experience (e.g., completing tasks, focusing for extended time).2,5 In addition to the positive effects, people have relied on Kratom to assist as a harm reduction tool in place of using other substances (e.g., opiates). Using this as a harm reduction tool causes reliance and overstimulation. There is concern that because Kratom affects the same opioid brain receptors (like morphine), it can lead to risk of addiction, abuse, and dependence.4

What are the Side Effects of Using Kratom?

  • Nausea
  • Constipation
  • Sleep problems
  • Temporary erectile dysfunction
  • Itching
  • Sweating
  • Hyperpigmentation
  • Tremor
  • Anorexia
  • Weight loss
  • Hair loss
  • Addiction potential
  • Cognitive impairment
  • Enhanced punishment tolerance
  • Reward-seeking behavior
  • Organ system injuries (kidney injury, arrhythmia, lung injury, acute respiratory distress syndrome, hepatic injury)1,2

Dangers of Kratom Use

The misinformation regarding the content and potency of Kratom is a large reason for the dangers of Kratom use. Similar to other substances (e.g., Cocaine, Marijuana), Kratom is an unregulated substance that does not have regulatory oversight. The lack of oversight to ensure the authenticity, purity, quality, potency, and safety of Kratom has a negative impact on preparations and consumptions.2 For example, while Kratom products are being advertised as natural and safe, some products have been found to carry contaminations such as heavy metals (e.g., lead) and salmonella. In fact, in 2018 Kratom supplements were linked to an outbreak of salmonella.Users can potentially be at risk for Kratom toxicity, illnesses, and other potential risks because of the lack of regulation on this substance.

What are the Signs of Kratom Toxicity?

*(Kratom toxicity particularly occurs when Kratom powder has exceeded 8 grams)

  • Agitation
  • Tachycardia
  • Drowsiness
  • Confusion
  • Seizures
  • Hallucinations
  • Coma
  • Death2

What are the Withdrawal Effects from Kratom?

  • Muscle aches
  • Irritability
  • Mood disturbances
  • Runny nose
  • Diarrhea
  • Muscle jerking1

Treatment for Kratom Use

While there currently is no published guidelines on the treatment of Kratom, it has been beneficial to approach treatment similar to treatment for patients with opioid use disorders. Treatment includes: stabilization, alleviation of symptoms during acute withdrawal, and long-term maintenance of sobriety.2

Our New York City Addiction Psychiatrists Provide Evidence-Based Treatment

At Fifth Avenue Psychiatry, addiction psychiatrists in New York City can provide more psychoeducation on Kratom and meet you where you are in your treatment. Whether you would like to reduce your use or become completely sober. We can provide you the tools to assist you in understanding the role Kratom plays in your life and ways to replace it with healthier options. We provide tools for treatment that include everything from helping with motivation, Cognitive Behavioral Therapy for opines and opined like substance (Kratom) and Pharmacological treatment of Kratom Dependence and underlying disorders.

  1. Cinosi, E., et al. (2015). Following “the Roots” of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. BioMed research international, 2015, 968786. https://doi.org/10.1155/2015/968786
  2. Eastlack, S. C., Cornett, E. M., & Kaye, A. D. (2020). Kratom-Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review. Pain and therapy, 9(1), 55–69. https://doi.org/10.1007/s40122-020-00151-x
  3. https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigated-multistate-outbreak-salmonella-infections-linked-products-reported-contain-kratom#time
  4. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
  5. Müller, C. P., & Schumann, G. (2011). Drugs as instruments: a new framework for non-addictive psychoactive drug use. The Behavioral and brain sciences, 34(6), 293–310. https://doi.org/10.1017/S0140525X11000057

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.

______________________________________________________________________

  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.
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