Category: <span>Adult Psychiatry</span>

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.

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

 

Post Traumatic Stress Disorder and Addiction 

By Britt Gottlich, Psy.D.

I often meet with people who say they are unsure of whether they have experienced trauma or not. So, what is trauma? Most people define trauma based on how trauma is portrayed in the media. But, in reality, it is a very subjective experience. Something that may be traumatic for one person may not be traumatic for another.

The American Psychological Association defines trauma as “an emotional response to a terrible event like an accident, rape or natural disaster.” The way I like to understand trauma is based on an individual’s interpretation of the event. As children, we live under the assumption that “good things happen to good people and bad things happen to bad people.” When we experience a trauma, often our interpretation of this rule becomes clouded and confused. For example, it could change to, “If good things happen to good people, and this happened to me, then I must be bad.” Therefore, a person’s reaction to a traumatic experience often affects the way they see themselves, other people, and the world around them.

We can’t change or erase a traumatic experience, unfortunately. But what we can do is change the way we interpret it and ultimately the way we understand the world around us as a result of that event.

What is Cognitive Processing Therapy?

This is where Cognitive Processing Therapy (CPT), a 12-session behavioral psychotherapy, can be a useful treatment modality. It helps us identify the cognitive distortions that are derived from our traumas and, using evidence and facts, combat those thoughts with rational ones.

How is Cognitive Processing Therapy Used to Treat PTSD?

CPT has been a very effective treatment modality which is often used in treating veterans with Post Traumatic Stress Disorder (PTSD). In fact, in 2017, a study which analyzed the effectiveness of CPT on veterans found that veterans who completed the 12-session treatment had a significant difference in their symptoms and a decline in Post-Traumatic Stress Disorder Checklist scores than veterans who did not complete or comply with treatment.

Other Treatments Used to Treat PTSD

Other treatments that are used for PTSD are Eye Movement Desensitization & Reprocessing (EMDR) and Prolonged Exposure (PE). In my experience and training with all the above modalities, however, I have seen the most improvement and success with CPT.

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

The Common Connection Between PTSD and Addiction

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

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

In need of PTSD treatment in Manhattan? Contact our Manhattan PTSD psychiatrists for an individualized, science-based treatment plan.


Sources:

Cognitive Behavior Therapy (CBT) for Addiction and Alcoholism

By Tracey Basset, PsyD

Making the decision to seek help for a substance use problem is challenging enough. On top of that, for a lot of people, they face the challenge of choosing where to go, who to see, and what type of therapy will benefit them most. This can be a very confusing and daunting process.

My aim for this post is to provide some useful information about the benefits of one type of therapy, my favorite type of addiction therapy, Cognitive Behavioral Therapy (CBT).

What is Cognitive Behavior Therapy?

CBT is based on the notion that the way we think influences how we feel and, subsequently, how we behave. Think of it like a domino effect—something happens, you form a thought or belief about that event, that thought creates a feeling, and that feeling creates an action.

For example, if you try to reach out to a friend or family member and they do not have time to see or talk to you, then you might think that you are not important to them, that you are not worthy of their time, or that you are not good enough. That thought can lead to feelings of loneliness, rejection, sadness, or even anger. Those feelings can then lead to the desire to escape, which could ultimately lead to using a substance. Substance use leads to more isolation and less connection, so the cycle starts again and continues to build.

How is CBT Used to Treat Addiction?

In CBT, we explore these triggering events and identify patterns. We explore the thought patterns, or belief systems, and we challenge those patterns that may be problematic.  Some beliefs are true, and we work to problem-solve and change them. Others are not true and are simply believed to be true because they have been ingrained for a very long time. We learn to explore where beliefs come from, and we learn to challenge them.  In CBT, we learn strategies to cope with the uncomfortable feelings and strategies to help reduce the likelihood that certain feelings will trigger substance use.  This is just one example of how CBT can play out in therapy; There are dozens more.

The Benefits of CBT

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

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

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

Watch your thoughts; they become words.

Watch your words; they become actions.

Watch your actions; they become habits.

Watch your habits; they become character.

Watch your character; for it becomes your destiny.

– Upanishads

 Call our award-winning addiction doctors in Manhattan for one-on-one, discreet treatment. 

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By Samuel Glazer, MD Addiction is understood as a brain disease that is multidimensional, and, to this point, there are still …

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By Dr. Ronnit Nazarian There is little information on Kratom, and there is much misinformation out there. Some people believe …