Category: <span>Alcoholism and Recovery</span>

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

 

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.

Meditation and Mindfulness for Alcoholism and Addiction

Meditation and Mindfulness for Alcoholism and Addiction

Written by Olga Megwinoff, MD

There is so much referring to meditation and mindfulness. Every mental health guru speaks of mindfulness and media outlets are saturated with everything meditation. It is definitely trendy and even in my own neighborhood, in the non-trendy suburbs, we started a meditation group. When something is so trendy, it can be easy to dismiss as a valuable and important tool in psychotherapy.

Nonetheless, I am ever grateful that I pursued this method of treatment as it changed my views and opened the door to the great teachings and understanding of the mind from the eastern psychology perspective. In this, my first blog, I will try to explain in simple terms a novel theory of why mediation works for anxiety, depression, OCD and addiction.

Understanding Meditation and Its Use

The main goal of meditation in the Buddhist and Hindu traditions is spiritual enlightenment. Nevertheless, western psychology has appropriated a version of it for the treatment of mild to moderate anxiety, depression, obsessive compulsive disorder (OCD), and addiction. Meditation’s benefits on the mind are difficult to ignore given that at even the beginner’s level, its participants get a good glimpse of these benefits. Beyond the effect of slowing down the nervous system via purposeful control of the respiration and its secondary effect on slowing down the heart rate, (the “fight or flight” response) meditation also has immense and immediate effects in the brain.

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

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

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

The Absence of Thought in Meditation

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

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

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

Meditation Contributes to Changes in Brain Structures

There is a lot of research demonstrating correlations between the positive effects of meditation with changes in particular brain structures like the medial prefrontal cortex, the posterior cingulate cortex, the amygdala, the hippocampus and limbic system. However, there is not a global hypothesis integrating all these structures functions and meditation correlates.

What is the Default Mode Network?

The first such theory I have read about comes to life with the “discovery” of the Default Mode Network (DMN).

The DMN was identified via neuroimaging in 2001 by Marcus Raichle, a neurologist at Washington University. He published his findings in the Proceedings of the National Academy of Sciences. It is important to note that the concept of the default mode network is not yet globally accepted.

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

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

The DMN stands opposite to the attentional networks, when one is active, the other goes quiet, and vice versa. According to Judson Brewer, a researcher from the University of Massachusetts Medical School, Center for Mindfulness, states, “Scans of experienced meditators’ brains show the DMN activity decreases significantly.”

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

The Danger of Excessive Self-Reflective Thinking

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

With a regular meditation practice, many people with substance use disorders, anxiety, depression, and OCD can transform their minds by lowering the volume of the DMN and therefore quieting the self-consciousness, ruminations, and worrying that so characterizes these disorders.

If you’d like more information or would like to speak with one of our award-winning Manhattan addiction doctors, call Fifth Avenue Psychiatry. We provide discreet, private treatment.

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.


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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. 

Better Recovery With Medically Supervised Detox

The effects of alcohol account for one in three emergency room visits every year. This is due in part to the effects of alcohol detox and withdrawal. Alcohol withdrawal is the body and brain chemistry readjusting to a permanent sober state, once the individual is no longer consuming alcohol. Chronic alcohol use changes brain chemistry by inhibiting neurotransmitters that induce feelings of relaxation and excitability. Without alcohol these neurotransmitters work in overdrive, similar to a rebound effect.
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