Your Brain on the Holidays
Your brain is always busy, but it feels busier during the holidays, and rightly so. There’s a lot for it to think about during the holiday season: what to buy, for whom, and how much to spend, how to make time to visit family as well as friends, how to dodge certain co-workers at the office Christmas party, and hopefully how to squeeze in holiday naps in between eating some good home cooking. Because holiday time tends to pile on the stress, researchers are fascinated with the subject of what is happening in our brains while we’re trading time wrapping presents and plastering on a smile to spread genuine holiday cheer.
Researchers believe that not only does the brain actually change over the holidays, but that they even know what culprit is: nostalgia. Essentially, nostalgia is that bittersweet feeling of love for what is gone, and the longing we feel to return to the past. The holidays lead to a special feeling of nostalgia that is unlike any other. Reminiscing with family, watching old holiday movies, eating favorite dishes, smelling the familiar smell of your grandparent’s house, and maybe even sleeping in your childhood bed….the holidays are a heady mix that induce nostalgia on steroids. But even more than this, therapists actually say that we should basically “expect to regress” during the holiday season. Who doesn’t want to be a kid again, to look forward to going home for the holidays? While “home” means different things to different people, I think even Ebenezer Scrooge can relate to the notion that when we celebrate the holidays with loved ones, something in us changes; it feels different. There is a child-like nostalgia, a forward-looking feeling of anticipation. Research suggests that’s because there are some serious changes in our brains during the holidays. Here are some examples of things that you might experience as a result of nostalgia:
1. You Want to Eat All of the Food
That’s pretty much what happens when you’re back in your mom’s or grandma’s kitchen, eating a meal with your siblings, is it not? You’re not just eating a meal, you’re living a memory, so you want it all! Eating a lot during the holidays is totally a real thing, and science says it’s largely because aromas trigger vivid memories, just like the smell of your grandparent’s house takes you right back to being seven years old. And socially, the same thing happens. Just because you and your siblings or cousins are grown-ups doesn’t mean you’ll act that way. Remember, if you’re regressing over the holidays, so are they. But just remember to be an adult and use your manners around the dinner table.
2. You Want to Drink All the Alcohol
There are many reasons that people drink more during the holidays. Studies have shown that the average American sees a 100% increase in their alcoholic drinking habits between Thanksgiving and New Year’s. Along with the holly jolly holidays comes an increase in social functions, holiday parties and dinners out, which inevitably leads to more alcohol consumption for most adults. Many of us look forward to celebrations during the holidays, but it’s amatuer hour when it comes to drinking… a time when some people who don’t normally drink actually drink far beyond their limits. Some of these people will suffer adverse consequences that range from fights and falls to traffic crashes and deaths. Sadly, people often put themselves and others at great risk just for an evening of celebratory drinking. So please, get a clue and get an uber. There is no reason to drive after drinking…remember: more than two means an uber for you!
3. You Want to Buy All of the Things
Holiday shopping, for most of us, feels pretty miserable. The music is loud, the mall is crowded, and you’re half way to the checkout before you realize you don’t actually know your uncle’s shirt size and you didn’t double check if your office Secret Santa recipient has any allergies. What’s worse? Apparently, shopping during the holiday season changes our brain, and even the most self-controlled shoppers can fall victim to marketing masters. That cheerful holiday music? Those festive colors? Those free samples around every corner? The bright cheery lights? Marketing. Allllll marketing. And, all pretty much intended to get you to relax, have a good time…and loosen that hold on your wallet and kiss that money goodbye. And not even any misteltoe!
4. Maybe You Don’t Want to Get Out of Bed
Not everyone enjoys the holidays. For some people, it can trigger serious battles with mental health, depression and anxiety. Between 4 and 20 percent of people experience a form of Seasonal Affective Disorder, otherwise known as SAD, which is a depression that generally sets in during early winter and fades by spring or early summer. Even people who are not diagnosed specifically with SAD may still experience depression and anxiety over the holidays. Why? Well, we postulate that people’s desire for perfection can become crippling during holiday time. People see more of each other and have more than the usual amount of time to compare themselves to others during the holiday season, in terms of what they can or cannot afford to spend on gifts or where they may travel for vacation. People often try to do too much and end up over-extending themselves.
The holidays are meaningful to people for many different reasons. For some it is a religious holiday, for others a time to spend with family and friends, and even a time of sadness and loneliness for some. Whatever the holidays mean to you, you really need to make it a point to take good care of yourself during this busy season…it’s the best gift you can give yourself.Learn More
Given the legalization of marijuana in many states, I wanted to have an open discussion on the ramifications and repercussions of its legalization, and why choosing to use might not be the best choice for everyone.
Marijuana is so readily accepted everywhere now, in both legal and illegal states and in any and every social circle; regardless of its legal status, its use is suggested by so many people for everyone and everything under the sun…it’s a revolution that makes Woodstock look like a quilting circle. Grandmas and grandpas, CEO’s, lawyers, actors, the butcher, the baker, and the candlestick maker….everyone’s using marijuana, legal or not, and they’re not afraid to tell the world. And the marijuana of today ain’t yo mama’s marijuana…today many people prefer to smoke marijuana wax rather than the green herbacious stuff, because wax is a minimum of 90% pure THC, miles away from the 15% green stuff.
The legalization of marijuana has created a slippery slope. Now it’s basically off the radar for police, meaning that most officers will give a pass for possessing up to a certain amount of it, even in illegal states. The police officers have discretion in the field, and most just confiscate it and maybe write a fine ticket for it, or maybe not…it’s not worth the time or effort for them to fight it any further, even in illegal states. If they just wrote every possessor a fine ticket for marijuana possession, they’d be buried in tickets, so imagine the paperwork if they arrested them all. I watch a live police program on weekends, and the first question an officer asks the driver they’ve pulled over is if they have any weapons or drugs in the car. They then emphasize that “honesty goes a long way” when it comes to their decision-making process in drug possession. Sometimes they’ll employ a K-9 officer to find drugs, and I swear that at least 85% of the cars they pull over contain drugs of some sort. And most times (after the officer makes it clear that they can’t get in trouble for it) a driver will readily admit that they have smoked within the last hour or minutes before getting behind the wheel, or even just smoked while driving. This is apparently due to a general consensus that marijuana doesn’t cause impairment, which is debatable; more recent studies are suggesting otherwise.
Because marijuana has essentially vacated its spot in the illegal drug hierarchy, the next “least worse” drugs, meaning cocaine and methamphetamine, have moved up, becoming “less illegal” in a way. Now officers even have some discretion when it comes to the possession of cocaine and meth; if the possessor only has a small amount, they may not necessarily go to jail. As hard as it is to believe, I have seen it on the live police program, people issued a ticket for possessing a small amount of coke or meth. The only difference is the type of ticket issued: while a marijuana ticket is just for a steep monetary fine, the ticket for coke or meth possession is essentially an order to appear before a judge, who then decides if the offender goes to jail or gets off with just a steep monetary fine and/ or probation, community service, etc. I wonder if lawmakers ever imagined that the legalization of marijuana in some states would lead to the near decriminalization of even minute amounts of drugs like coke and meth, but it seems it has. Similar to marijuana, I think it’s likely due to the amount of time and effort it takes to haul every coke and/ or meth possessor to jail: small amounts are permissible when weighed in the face of 100% rule of law…it’s certainly faster, easier, and more profitable to fine someone through the nose (no pun intended) than to house them in our overcrowded and expensive jails.
Enough of the legal ramifications. Of course as a physician, I see the more personal, medical side of the legalization of marijuana. I am literally asked about it by patients every day, and I am a medical marijuana prescribing physician- I jumped through all of the state’s many hoops so that I can prescribe marijuana. I believe that used properly, marijuana has definite value as a drug. The key is for whom. I think it’s good for someone with cancer, with brain tumors, for AIDS, for neurologic disease like ALS (Amyotrophic Lateral Sclerosis), for Crohn’s disease, irritable bowel syndrome, for post-traumatic stress disorder, for specific types of chronic pain, and for certain seizure types. While I don’t prescribe marijuana willy-nilly, I definitely do prefer prescribing marijuana over other controlled drugs like opiates. But as I tell patients, just because it’s legal doesn’t mean it’s useful for everyone or even reasonable for everyone to use it. In fact, I think that for a subset of the population, up to age 30-ish, marijuana is counterproductive at best and damaging at worst. I call marijuana “the nothing drug.” If you give marijuana to a young developing mind, let’s say someone aged 14, the person belonging to that mind has their life course altered. From the day they start smoking marijuana, nothing happens. Their motivation drops off. They think a lot of good thoughts about what they can do or would like to do, but they do nothing. So nothing gets done. That’s what alters their life course. Dreams are great, but the key is to act on them. I tell my patients that when they use marijuana, nothing happens. Nothing bad, but nothing good. Nothing scary, but nothing awesome. Just nothing. Users do nothing, and if they continue to use habitually, they may amount to nothing. They may not fail, but they definitely will not excel. When you ask that marijuana-smoking 14-year-old what they’ve been up to, they’ll say ‘’nothing.’’ When you ask what they did in school that week, they’ll say ‘’nothing.’ When you ask them what they did over the weekend, they’ll say ‘’nothing.’ When you ask them what happened at the football game, they’ll say ‘’nothing.’’ When you ask them what they do when they get high, they’ll say ‘’nothing.’ Now you get the picture. Marijuana… The Nothing Drug. There’s a PSA campaign for ya’.
Using marijuana is mostly about being alone, being high, and being out of touch. You cause no problems. As a matter of fact, the last thing you want is conflict…it would harsh the mellow. My patients who smoke tell me that when they use it, they just want to keep using it, because it makes them feel so good. But there are qualities to marijuana that make people prone to isolation, where they don’t communicate with others as much. Think about it. When was the last time you went to a wild, raging party with people smoking only marijuana? Do you hear a lot of meeting and greeting, talking and laughing? Nope. But you do hear the sounds of lots of lighters striking and water bongs gurgling. And some muffled coughing- that wierd upper throat/ nasal cough that comes from people holding their breath and trying hard not to cough up the hit they just took. You may hear a woo-hoo or two, but that’ll come from the direction of the couch, which will be replete with reclining stoners. In my experience, people who smoke pot waste a lot of time doing so. It’s the kind of drug that can be used constantly, for hours and days on end, because there’s no concern of overdose. There’s a lot of time wasted, no pun intended, on thoughts not thought through and things left undone. When I warn patients about isolation, I often hear back from them that they do spend time with people, that in fact, they get high with people. I tell them that they may think they’re spending time with friends, getting high with their buddies, but that most of the time they’re getting high and playing video games or listlessly bobbing their heads to music and they just happen to all be in the same room. There’s no real interaction…it’s a very solitary pursuit, but in the presence of others, a mental masturbation marathon.
Obvi, I have many patients that complain that their lives aren’t going well, that they’re depressed and generally unhappy, and many of them smoke marijuana to “relax.” When I ask the marijuana users why they’re unhappy, they seem completely devoid of any insight as to what’s going on. I have a list of questions I ask, and it starts with “How much do you smoke?” I can probably count on one hand the number of people who tell me the truth, that they smoke a lot of marijuana; they always say they smoke “a little” marijuana. When I ask what form they use and how much “a little” is, some admit to using wax, and many tell me they use “only at night, never during the day” like that makes all the difference in the world, given that there are basically 12 hours of night in a 24 hour day.
The best “medicine” I can dispense to these marijuana-using patients is education. I have given a version of the same talk at least a thousand times, tailored to the patient’s age and condition. It basically goes something like this: “You’re unhappy because marijuana alters you. It makes it so you’re just going through the motions of life; when you’re directed to do something, you can do it, but you never do anything of your own volition. You have no original thoughts or ideas or insight into your life, because you don’t bother to examine it. You don’t have any meaningful interactions with other people. You spend your time playing video games and eating junk food. You never see the sun, unless you have to venture out in daylight for a marijuana-related errand. You’re lacking a creative outlet, because marijuana isn’t conducive to creativity. Marijuana is robbing you of motivation, memory, ambition, desire, and energy. It blunts your emotions so that you feel nothing, so you smoke more to feel high because that’s better than feeling nothing. It’s a vicious cycle. You’re just like a rat on a wheel in a cage.” These facts are why marijuana is most damaging for people up to about age 30, because by this time at the latest they should be expending great effort trying to establish themselves and their lives, deciding where they want to go and setting goals to get there. Instead, they use marijuana and all that goes out the window. For an 80-year-old woman with cancer or rheumatoid arthritis, marijuana isn’t going to affect her life nearly as much as a 20-something-year-old looking for a job or deciding what career path they want to take.
As an example to show that using marijuana is not exclusively for the young, take my patient Frederick, who is 68 years old. He started smoked marijuana at ten and basically smoked all day, every day since. Consequently, he did nothing his whole life, so 58 years. That’s 58 years completely wasted, again no pun intended. Somehow he got on disability years ago. As far as I could tell, his only disability was that he wanted to smoke all day, that he liked to be high. I have another patient, a 23- year-old named Skylar. He’s basically a trust fund baby, living in his parents’ Palm Beach mansion full time while they spend 48 weeks of the year living up in Massachusetts. Skylar’s “job” as caretaker of the mansion, supposedly overseeing a staff of six, has always left him with more than ample time to do, well, nothing…except smoke wax. And he was a hard case, because he was able to afford the strongest wax and he smoked a lot of it- one of the handful that admitted to doing so. I saw him in my office a couple of months ago, and he told me he had wasted enough time using marijuana, he wanted off, and would I help him? Once I recovered from the shock and picked myself up off the floor, I of course told him that I’d be glad to, and I explained the deal. Most people think there’s no withdrawl from marijuana, but that’s not true. There is about a ten day withdrawl period that typically includes insomnia, restlessness, and irritability. It then takes six weeks for green marijuana to eight weeks for wax for all traces of THC to leave the body. I use medications like clonidine and trazodone to minimize the effects of withdrawal, and they make it much easier. At the two-week mark, the four-week mark, the six-week mark and the eight-week mark, patients are amazed at how they feel clearer and clearer at each point. They’re able to see how impaired marijuana was actually making them- they were totally unaware of their impairment at the time, how slow they were, how dopey and lazy. Once it’s completely out of their systems, they tell me how they’re more active, how they’re getting up in the morning and showering and getting dressed, how they’re going outside and exercising, and how things are happening in their lives. I’m happy to report that Skylar was no exception. His withdrawl from marijuana wax was uneventful, and after eight weeks, he was shocked at how different he felt, describing it as like being awake after years of being asleep. For the first time in recent memory, he was thinking, he was weighing his options (now that he had some) and he was planning his future. When I asked his greatest revelations, he said, “I have to make things happen. I have to be proactive. I have to look for and seize opportunities. No one can do that for me.” I really couldn’t have said it better than that.
Re-reading this, I noticed that I said that marijuana is ‘robbing you’ of this and ‘taking away’ that, but really, marijuana doesn’t take things away from you, you give those things away when you choose to use. Marijuana has its place in treating certain illnesses and diseases; but remember that just because something is legal to use doesn’t make it reasonable to use it. If you’re faced with a choice to use, just think about Frederick, with 58 years wasted, no pun intended, and Skylar, who got a late start in adulting but has an unlimited future…now that he’s no longer letting marijuana limit his present.
For lots more entertaining stories and information about marijuana and other drugs, check out my book, Tales from the Couch, available on Amazon.com. It makes for a great read and an ever better gift!Learn More
Well, it’s another Saturday. My avid blog readers might know what that means…I’m at the carwash again for my Inside-Out Wash and Hand Wax. And yes, I know I’m pretty particular about the state of my car, thank you very much, but in my professional opinion there’s no pathology there whatsoever. Anyway, I’m stuck for a minimum two hour sentence at this joint. It’s always the longest two hours of my life, and if I don’t find something to occupy my mind I might just lose it. I usuallly sit inside for the A/C, but the weather was beautiful, so I sat outside on what barely passed as a patio: two of those round concrete table jobbies with the rough curved benches encircling them, surrounded by tall but sparse hedges on three sides. I wasn’t the only one with the bright idea to sit outside- Floridians get very excited in November when the temperature dips below 75 for a second and the cooler breezes make it onshore- we flock to outdoor spaces like Aztecs worshipping the sun. I spied a concrete bench that was empty and sat down with my coffee from my fave place on US-1. There was a dude at my table on the bench across from me, and he didn’t so much as acknowledge my presence when I sat, so engrossed in his phone was he. Fine by me. As I surveyed my company, what struck me was that there were literally zero words being exchanged among the other waiters, even those that were clearly there together. It was like a freaking monestary- if the monestary was right next to a carwash with its particular “music” of Inside-Out Washes and Hand Waxes in the background. I don’t know why I still find the lack of communication, especially in the very most basic sense, to be so alarming, almost disturbing even. I know I’ve gotten into this in so many different blogs and videos, and of course in my book, but it seems like no one talks to anyone anymore. People talk more to Alexa and Siri these days than other people. Anyway, what were my fellow waiters doing while they weren’t talking? They were of course on their phones, just like everyone always is, always on freaking cell phones. I wasn’t the least bit shocked to see what looked like a ten-year-old girl buried in a phone. These days, young kids, I’m talking like age three and up, have phones to play games on, because moms can’t bear to give up their phones to allow the kids to play on them, and if the kids don’t have phones to play on, they’ll drive their moms crazy and make it impossible for the moms to be on their phones. So the obvious solution, nay, the only solution, is to get your four-year-old a phone. I wonder what Dr. Spock or Mr. Rogers or Bert and Ernie would say about the Romper Room set having phones, or even worse, needing phones.
Anyway, as I sat on the hard and scratchy concrete bench on the “patio” surrounded by the sparse hedges, a woman entered the scene. She walked up and asked if anyone was sitting next to me, to which I said no. The way these benches are curved and situated, it makes it a little awkward to sit at one with a stranger, but she smiled and took a seat next to me. She looked about 40 or so, medium height and weight, with jet black hair. I guessed she had more than a little Latin blood in her. She was not dressed Saturday casual like the rest of us waiters: she wore a nice black skirt suit with a bright pink blouse, and I assumed she was on her way to work. At where or doing what I had no clue, but realtor was at the top of my guess list. I noticed she wore no wedding ring, though that doesn’t really mean anything these days. She looked like a woman of means, and she was fairly attractive, but something was off. She looked kind of shocked for lack of a better term, like psyche shocked, and she nearly visibly vibrated, like she was plugged into a light socket. She was clearly very unsettled by something, or maybe several somethings, and it or they were simmering just below the surface. I could see she was accustomed to the valiant effort to keep them there, but they were clear as the day to me. Your average person on the street wouldn’t see any of this in her, but I’ve made my living watching and listening to people as they lay bare their pain and fear, and this woman had plenty of both.
She said her name was Pilar, and that and her slight accent confirmed my previous guess that she was of Latin descent. I knew damn well that something was wrong with Pilar, something that I might be of help with, but also that I might not. My mental machinations continued. She could be in denial, and she could be offended if I offered an opinion. I mean, how many people want to be analyzed by a shrink they just met while waiting at the carwash? I decided that I would not open Pandora’s box. Not going there. I’m just going to sit here in the sun and be polite, but be surface. Mind my own business. Polite, surface. After a moment sitting at the little concrete table, she asked me how long the carwash takes. I dutifully explained that the Inside-Out Wash and Hand Wax took a bare minimum of two hours, especially on a Saturday morning, but that it was well worth the wait. At this, she blew her bangs out on a long resigned sigh. Then motioning to my cup, she asked where she could get good coffee. I gave her directions to my fave spot, which was just up the street on US-1 and told her to ask for “Bailey the Barista, the best barista in the Easta” I had given this name to a barista named Bailey at my fave place because she really is the best barista ever in the vast history of baristas. (ADD side note: what the hell did we call the people who made our coffee prior to the advent of Starbucks?) Pilar laughed and said she’d be back; right after she left, even the guy across from me stood up and said that with my glowing recommendation, he just had to go for a cup as well. How to win friends and influence people…with coffee…who knew, I mused. Maybe the next book? I filed that under ‘Later’ in the grey matter.
I took Pilar’s absence as an opportunity to remind myself not to get involved, to not play the curious shrink role. No matter how bored to tears, how desperately in need of a distraction I became, I would be strong. I would not go there. Be polite, be surface. You may be wondering why I don’t just announce my profession and delve into stuff with people at every opportunity. First, that would mean I’d have to be ‘on’ and wearing my Dr. hat a lot when I’m at social events and such, when I’d really prefer to be chill. But it goes beyond that. Here’s the thing. Unless someone asks me straight up what I do, I don’t usually tell random people I’m a psychiatrist, because invariably I end up spending a lot of time listening to a story about someone’s Aunt Edna from Des Moines who has 53 cats and hasn’t left her home in 12 years because she’s purposely hoarded it with old newspapers, jars full of pee, and her old fossilized poopy diapers, all as an excuse to never leave, and do I think that maybe she’s depressed and can I give her a prescription for Prozac? There’s a lot of that kind of thing. Another issue that can happen is someone tells me their story, and in my opinion they may actually need help, but when I tell them they should seek that help, they get all pissed off at me. Plus, when I talk to people when I’m out and about, they don’t know that they should have no expectation of privacy because they aren’t patients and we aren’t in my office, and they may tell me some deeply private things, and it just gets messy for me that way. So, for those reasons, and a lot more, I don’t generally just announce that I’m a psychiatrist. But there is a flip side. It’s no secret that I hate to do nothing. I hate waiting for my car to have its Inside-Out Wash and Hand Wax because I have nothing to do while I wait. And remember: I hate doing nothing. So sometimes, like during my interminable wait for my car, when I’m bored out of my skull and climbing the walls, I might be less averse to telling people I’m a psychiatrist, because 100% of the time, it starts what might be an interesting conversation, one that might help pass the time until my car is ready. All I have to do is introduce myself and my profession, “Hi, I’m Dr. Mark Agresti, I’m a psychiatrist. What’s up?” and we’re off to the races. People spill their guts. Other times, I don’t use my last name or announce my profession, but I still engage in the conversation. So it’s kind of like the little cartoon with the angel on one shoulder and the devil on the other and do I dive in or mind my own business? It’s an internal tug-of-war I’m familiar with. Earlier, I had simply introduced myself to Pilar as Mark. In this case, I knew that Pilar was genuinely troubled, but if I told her that I was a psychiatrist, I wasn’t sure how she would take it; she seemed fragile to me. All the more reason for me to be polite but be surface. But on that flip side, I did have time to kill, and Pilar seemed very nice, and maybe I could help her just as another human rather than as a physician. So much for polite and surface. Maybe she wouldn’t even want to open up to me. But maybe she would. I had the feeling it could get deep on this carwash patio. Guess I’d find out.
With time to kill, I decided to be like everyone else and get on my phone to check my Facebook, or Fakebook as I like to call it. They recently refused to boost one of my posted blogs. Interestingly, it was called “Carwash Psychiatrist” and was all about a different Saturday morning conversation with a steroid-raging mountain-sized man. Fakebook refused to boost it citing inappropriate content. I call total bs on that. I thought it was really informative and interesting, if I do say so myself. It’s on my website if anybody wants to read it and decide for themselves. I re-read it again as I sat there, and still I didn’t think it was inappropriate. I wished I could figure a way to get around Fakebook to boost it. As I considered that, Pilar returned and sat down next to me with her cup of coffee. Her expression was more open than it had been. I think she was more comfortable with me because now we had this coffee connection. Somehow, sitting next to each other drinking coffee together set a mood to talk, a vibe like we were old friends catching up. Glancing at my watch, I saw that I still had an hour until my car would be ready. More than enough time for a conversation, if one arose. I had given up the mental jujitsu match and decided to be polite and open. I could feel Pilar’s dis-ease, referring to her uneasiness, not illness, though she always kept it hidden…or tried to. She looked at her watch and sort of tisked the time, saying that she hoped her car would be done soon because she had to get to work. When I asked her what she did and if she usually worked weekends, she said that she designed and sold high end kitchen cabinetry, and that no, she didn’t normally work weekends, but she was behind because she’d missed a lot of days recently because she’d been sick. This was it. This was the turning point. I could be in or out. Polite and surface or open. I know something’s going on with her, maybe there’s something I can do to help her, so I go there, unable to resist the psychiatrist in me, but at this point still unwilling to tell her there was one. So I went there, I asked her the obvious question that her answer had begged: what was wrong?
She answered, “I thought I was dying.” Okay, I’m looking directly at this woman, and while she looks troubled, she is definitely not dying. I’ve seen dying. I know dying. I decided to take the light-side approach and gave a little non-committal laugh as I said she’d have to narrow that down with some details. She began, “A month ago, I had to go to the emergency room.” I expressed surprise and asked what happened to land her in the ER. She replied, “I woke up one morning and I had this tightness in my chest. I couldn’t breathe, and my heart was racing. I was sweating buckets, and I was so uneasy, like something awful was happening. I thought for sure I was having a heart attack. I had this sensation of pins and needles in my fingers. I didn’t know if I was losing my mind or really actually dying, because I felt like I didn’t know who I was or where I was…I felt like it wasn’t real. Crazy, right?” Before she had even finished her second sentence, I knew that Pilar was describing anxiety, maybe a panic attack, so I said, “Let me take a wild guess, when you went to the ER, they took your vitals, started an IV, drew blood for labs, did a chest x-ray and an EKG and when the results came in, they told you everything was normal, that you just had anxiety.” Surprised, she said yes. When I asked if she’d had other similar episodes, she said, “You know, I have been getting these attacks in the middle of the night when I’m sleeping. When it happens, I wake up and I’m sweating, I can’t breathe, my heart’s hammering, and I feel like I’m honestly losing my mind, because I can’t calm down. I really feel like I’m dying, like I’m having a heart attack, and I’m sure I’m going to die.” When she followed up with her family doctor, he repeated the same tests that the emergency room doctor did and came up with the same conclusion of anxiety, so he gave her 2mg Xanax and told her to break them in half and take a half twice a day. She said it helped a lot, but that she had been living on them for the past 3 weeks, and she was very worried about becoming addicted, because she had read that they are very addictive. She was definitely right on that count. Xanax is very effective at treating anxiety and panic disorders, but it’s a dual edged sword at best and not good as a long term solution. Then she told me that about two weeks ago, she had another attack, and she wanted to try to avoid going to the ER if possible, but she wanted to be close in case she needed them. So she decided to drive to the ER but not go in. She parked and sat in the lot for about 90 minutes, waiting for the attack to subside, but she didn’t go in. She did that same thing twice. Then, she said that she had plans to go out with her friends about a week ago, and she had an attack in her house. She was just about to get in her car to meet them, and she had an another attack. She said that this one was the same deal: shortness of breath, sweating like crazy, feeling like she isn’t real, like she is losing her mind, like she’s having a heart attack and that she’s going to die. It seemed that this had been going on for about a month. Then she said that she was living in a constant state of fear, always scared that she was going to have an attack. And that was why she was working this weekend, because she had called out of work so many times in the past 4 weeks that she was really behind on some projects. I asked her how things stood now, and she said she had stopped all social engagements. She was pretty much confined to her house, only leaving for necessities like going to her office, grocery store, and gas station. It seemed like that was pretty much it, and she needed a Xanax just to do those few things. She was living in constant fear of having the attacks, but now that fear had expanded; now she had fear of getting in her car, fear of driving, fear of being out in public, and even fear of meeting up with her friends. She’s pretty much stuck in her home, only leaving if she absolutely must. So a month into her anxiety and panic attacks, that’s where she stood. It wasn’t good. She’d have to get help to get it under control.
Keep in mind, Pilar doesn’t know what I do, but I kind of needed to push the envelope a little. I asked what her family practice doc’s diagnosis was, and she said he had told her that it was just plain old anxiety. That didn’t jive for me; this wasn’t garden variety anxiety. When I told her that I didn’t think it was just anxiety, she kind of freaked out, eyes wide, asking if she could die from it, if she would be like this for the rest of her life, and if there was a cure for it. And only then did she finally think to ask what it was. I told her with a smile, “I think you’re going to live. I’m pretty sure you have something called panic disorder. I’ve read about it. You should see a psychiatrist, because there are ways to treat it without using addictive drugs like Xanax.” She looked relieved as she asked what panic disorder was. I explained that it’s not a physical illness, it’s a psychiatric illness with attacks exactly like she was describing, and that Xanax works, but that there were other medications for it, and that’s why she should see a psychiatrist. When she asked how I knew about all this, I told her that I had read up on it a lot because I had a sister who was diagnosed with panic disorder. I went on to say that her doctor gave her Zoloft, and that seemed to work really well for her. After two weeks on it, her attacks had basically stopped, and it wasn’t addicting at all like Xanax. When she asked if I knew what caused the attacks, I told her that I’d read that the panic attacks were the result of a false alarm going off in the brain, a suffocation alarm. You think you’re suffocating, you think you’re about to die, but you’re really not. She said she never imagined that something in her brain could cause her to feel like she was really dying, but that she was glad that it was treatable. I told her that when she got on the right medicine, the attacks should go away, just like they had for my sister. She thanked me profusely and assured me that she would see a psychiatrist. Then she lifted her coffee cup, took a big sip, and said she was so relieved. I told her that by the way, caffeine wasn’t the best idea, that my sister had to give it up because it encouraged more attacks. She said she understood, but that between waking up with attacks and taking the Xanax, she was exhausted and needed the boost, but that she would make the effort to stop the caffeine. I reiterated that she should get off the Xanax asap, that it was just a very temporary fix, and she smiled and gave me a funny salute and an “Aye aye, Captain!”
We continued to talk, and she said that she was glad she had sat down next to me. I kind of felt badly about my little white lies, not telling Pilar that I was a psychiatrist while telling her that I knew about anxiety and panic disorder because I’d read up on it when my sister had been diagnosed with it. The next thing I knew, I heard two last names called, mine being one. The other actually turned out to be Pilar’s. We stood up simultaneously, laughed, and then shook hands as she thanked me again. I told her no problem and to be well. And that’s how it was left. As I got into my freshly Inside-Out Washed and Hand Waxed car, I assuaged the bit of guilt I felt by reminding myself that there is risk in telling people you’re a psychiatrist these days. I didn’t tell Pilar. Maybe I should have, I don’t know. I think I helped her despite holding back the truth, and I felt good about that. I was sure that she would see a psychiatrist and make the effort to stop the Xanax. How weird would it be if she actually came to me, to my office to see me? It could happen. If it did, she might be angry. I’d have to cross that bridge when and if I came to it.
Pilar’s panic disorder is not at all uncommon, unfortunately. By some estimates, approximately two million adults in the United States suffer with panic disorder each year. There are two types of panic disorder: with agoraphobic features and without. Agoraphobia is defined as an extreme or irrational fear of entering open or crowded places, of leaving one’s own home, or of being in places from which escape is difficult. Most people with panic disorder start off without agoraphobia, but if the condition persists without adequate treatment, it can progress to include agoraphobia, where people find it almost impossible to leave their homes. It can be very debilitating, but it doesn’t have to be. Emma Stone, Amanda Seyfried, Sarah Silverman, Oprah Winfrey, John Mayer, Kristen Bell, and Caitlyn Jenner… What do these people have in common? They’re just a few of the many notable people that have panic disorder. That just goes to show that having a psychiatric illness like panic disorder isn’t the end of the world, and it doesn’t have to hold you back. You just need to make the choice to seek appropriate treatment if you suspect that you have it or have been told that you have it. Don’t make the mistake of ignoring it with the hope that it’ll just go away, because it won’t…it’ll only progress.
For more “psych stories,” check out my book, Tales from the Couch, available on Amazon.com.Learn More
Ivan’s Addictions: Alcohol Detox
I want to discuss what people can expect when detoxing off of alcohol, inspired by my patient Ivan. He was a long-time patient, though I hadn’t seen him in a while. He was big time addicted to opioids years ago, and he had dragged his sorry butt into my office, barely coherent, begging for help. That’s how we met. I managed to get him clean off of the oxy’s he so dearly loved, but I would learn that Ivan had a very addictive personality…this guy could get addicted to oxygen. Anyway, that’s where it started with Ivan, and over the subsequent years I saw him in the office here and there. Now fast forward twenty years and in walks Ivan. It looked like the years had not exactly been kind to him. He looked like an alcoholic. Red swollen nose, check. Ruddy grey skin, check. Blood shot eyes, check. Balance just slightly off kilter, check. Gaunt frame with distended belly, check. I could go on, but suffice it to say that after so many years of doing what I do, I can spot an alcoholic from 50 yards. He said he was still clean, off opiates, but admitted to drinking in excess for many years. I burst his bubble with a sharp prick of cold harsh truth: he was an alcoholic. When I said it, he might’ve flinched, but he didn’t argue.
I asked him what he was doing for work. He said he was rehabing properties. He had inherited some money, bought a bunch of properties, fixed them up and rented them out. He collected the rent paychecks every month from his “magic money mailbox.” That sounded great, but the down side of this equation was that he wasn’t expected to be anywhere at any given time. And that left a lot of time for drinking. When I asked how much he was drinking, he admitted to drinking at least ten of those 2 ounce airline mini bottles a day. He had found some place where they only cost a buck a bottle. I was floored. That is an incredible deal. But I digress. I told him that we would have to do a medical detox, and he was on board. What follows are all of the things I told him.
To start, I explained that he needed to hydrate. Even though alcohol is liquid, it is very dehydrating, so there must be copious amounts of water during detox. As I told Ivan, drink water until you think you’ll burst. Next, start eating healthy foods. This is critical, getting food in your system, because alcohol causes irritation of the walls of the stomach and intestines. Also, you have to kick start the digestive tract, because alcoholics don’t eat well, if they eat at all. Next, start taking an over the counter stomach proton pump inhibitor like Prilosec or Prevacid. This will help to decrease the acid in the stomach as well as heal the stomach wall and the esophagus. Next, start taking B complex vitamin and multivitamin to replenish the system. He said he understood as he dutifully wrote all of this down.
Next, I explained the important warnings about detox, the reasons why it’s important to medically detox. We have to use a type of drug called a benzodiazepine to prevent severe alcohol withdrawal. Without it, you will start shaking, you can become delirious and confused and have grand mal, full body seizures. There is a possibility of death: up to 25% of people actually die from severe alcohol withdrawl when they don’t use the benzodiazepines. I use medications liberally to prevent the withdrawl and safely detox. My goal is to keep patients comfortable with meds, but never nodding out. I wrote a scrip for 2mg alprazolam and told him to take one 2 or 3 times a day. I also gave him one to take immediately in the office because it had been 16 hours since his last drink and he was really starting to feel it. He had all of his instructions, so I told him I’d call him at 8pm that night as well as every six hours thereafter, and that he could call my cell phone anytime with questions or problems. With that, he left.
That night when I called, he said he was feeling not so great, but that he had eaten, was drinking lots of water, and taking the vitamins. When I called him the next morning, he said he woke up feeling very uneasy, very tense, and with some slight tremor. I told him to take the alprazolam right then and to take another in the afternoon around 2 or sooner if he felt tremulous. He repeated the alprazolam schedule on day 2 and also took it that night. When day 3 came, I explained that this is the most dangerous time. While seizures and delirium can happen at any time, they are most likely to happen on day 3. It’s also the worst day. It was really tough for Ivan. He was sweating. He had tremors. He was a little confused. His girlfriend came over and made him chicken soup, served with some TLC, and checking to be sure he was hydrating and taking the vitamins. He took the alprazolam three times that day, but didn’t sleep much. I gave him a drug called mirtazapine for sleep, and this helped. The fourth day dawned and Ivan saw the light at the end of the tunnel. Day 4 was better than day 3, but he was still feeling tremor, still sweating, and still needed 2 alprazolam that day. On day 5, he had no tremor. The sweating had lessened, but he still felt restless. He took just 1 alprazolam that day. As of the 6th day, he didn’t need the alprazolam at all. The detox was done. I told him to continue the vitamins and the Prilosec stomach meds for 2 months, keep up the improved diet, and keep hydrating.
Ivan followed all of my instructions and he came out the other side and did pretty darn well. He got in great shape by walking his dog Malcom for a minimum of 3 hours a day, and he felt better every day. In fact, Ivan had dodged some serious bullets in that he had no major organ damage from the alcohol. There are several very common things that go bad with alcoholism. Most didn’t happen to Ivan, but let me caution you what can happen with alcohol abuse. Pancreatic issues are common. The pancreas is the most important organ for blood glucose regulation and digestion. You become a diabetic if your pancreas shuts down. Gastritis quickly becomes a potentially lethal problem. Gastritis is extremely dangerous, it is irritation or bleeding of the stomach, leading to bleeding ulcers. Aspiration pneumonia is a concern: where you are so drunk that you throw up or cough up stomach contents and you breathe the stomach contents into your lungs, causing a serious and life threatening infection. A very common issue with alcoholics is that they get drunk, fall, and break a bone or hit their head, causing subdural hematomas of their brain. And you can’t forget liver disease. One of the key features of chronic alcohol abuse is liver failure and liver cirrhosis. The liver shuts down and so the body diverts the blood flow around the liver because the liver is so scarred and gnarly that it no longer accepts blood. As a result, you get big vessels forming in the esophagus and rectum, and they explode, causing hemorrhage and death. Ivan was lucky… he didn’t have any of those things. But he didn’t get off scott free. The most common thing I see with alcohol- that no one escapes- is cognitive damage. The brain slows down. It is permanently damaged. As a result, you cannot think straight. You are not as coordinated as you were. You become less active so there can be muscle wasting. These had happened to Ivan. As I said, no one escapes this. So Ivan was little bit slower, a little less coordinated, legs a little weaker. But he’s not drinking, and that’s a major accomplishment. I’ll continue to follow him in his clean and sober life. If you are abusing alcohol, Ivan would advise you to medically detox, as would I. If you would like to read more about alcohol withdrawl, medical detox or more patient stories, check out my book, Tales from the Couch, available on Amazon.com.Learn More
Time to Log Off?
Technology addiction, electronic addiction, digital addiction, social media addiction, internet addiction, mobile phone addiction…. No matter the name, the common thread in these addictions is that they’re all impulse control disorders that involve the obsessive use of mobile phones, internet, and/or video games, despite the negative consequences to the user of the technology. For simplicity, I’ll combine all of the above names together and refer to the phenomena as a digital addiction.
*** A new special called “Digital Addiction” will air on the A&E Network (Comcast HD ch 410 / SD ch 54) on Tuesday, September 17th at 9pm. There will be stories of people addicted to video games and social media and discussion on how people are trying to recover from digital addiction. It should be very interesting, so check it out.
Do you play video games in excess? Are you compulsively shopping or gambling online? Do you spend hours taking the perfect picture to post or ‘Gram or tweet? Do you feel a need to constantly monitor all of your social media outlets to look for likes and loves and to track people to see what they’re up to? Is your excessive use of all of these things interfering with your daily life- family, relationships, work, school? If you answered yes to any of these questions above, you may be suffering from a digital addiction disorder. These disorders have been rapidly gaining ground as they are more recognized as truly debilitating, and as a result, they are recently receiving serious attention from many researchers, mental health counselors and doctors. The prevalence statistics vary wildly, with some reports stating that the addiction disorder affects up to 8.2% of the general population, but others state it affects up to a whopping 38%. In my opinion, it affects far more than 8.2%, but not quite 38%, so my educated guess is about 20%. That’s one-fifth of the population… a staggering number of people. And we have the explosion of the digital age to thank. Advancing technology is the ultimate double-edged sword. One of the most troubling things about this disorder is that we are endlessly surrounded by technology. Most of what we do is done through the internet. And we’re enticed to do things online. Take Papa John’s as an example- if you place your order online, you get an extra discount or a free small pizza. Lots of company sites offer similar discounts. And if you do buy online, most companies then include you in their email blasts with info on sales and discounts. Even if you’re just doing research on something online, not shopping, you’ll get little photo pop-ups from online stores you’ve ordered from before. Gamers make up a huge subset of the digitally addicted. Ask any mother of a male child aged 10 and up if she and her son argue about his spending too much time playing games, and chances are she’ll tell you that it happens all the time. Of course, to the developers of these games, that’s a total eargasm! These game developers have a strategy to keep people, especially kids, glued to their seats with eyes on the screen. Many games, especially the huge multiplayer roleplaying games like World of Warcraft and Everquest, may lead to a gaming addiction because as players play together, they spur each other on. In addition, these games have limitless levels, so in effect, they never end.
Just because you use the internet a lot, watch a lot of YouTube videos, shop online frequently, or like to check social media often does not mean you suffer from a digital addiction disorder. It only crosses over into the trouble zone when these digital activities start to interfere with, or even negate, your daily life activities. Every tweet, every phone alert DING! is an interruption in your thoughts, your psyche, and your day. I have a handful of patients that struggle with just turning their phones off during a session with me. They literally get anxious being without it, being unable to check it. They have to hold it, have it in their hands. I have one patient that couldn’t turn it off but agreed to put it in her purse. That stupid thing dinged and blipped and bleated every freaking 5 – 10 minutes, I swear. And every time, I could see her leave the appointment….it interrupted her train of thought with every stupid, annoying noise it made. I told her that next time, and for every time thereafter, the phone would be off and in my drawer. She grudgingly agreed, but she regularly panicked without it, so I had to begin every session by talking her off the edge.
Like many disorders, it can be difficult to pinpoint an exact cause of digital addiction disorder, but there have been some risk factors identified. These include physical impairments, social impairments, functional impairments, emotional impairments, impulsive internet use, and dependence on the internet. The digital world can be an escape for people with various impairments, so they are at higher risk.
Digital addiction disorder has multiple contributing factors. Some evidence suggests that if you have it, your brain makeup may be similar to those of people that have a chemical dependency, such as drugs or alcohol. Some studies even report a potential link between digital addiction disorder and brain structure- that the disorder may physically change the amount of gray and white matter in a region of the brain associated with attention, remembering details, and planning and prioritizing tasks. As a result, the affected person is rendered unable to prioritize their life, so the digital technology takes precedence over necessary life tasks.
Digital addiction disorder, as in other dependency disorders, affects the pleasure center of the brain. The addictive behavior triggers a release of dopamine, which is the happy, feel good chemical. Note the name dopamine. Drugs of all sorts are often referred to as dope, and this is not happenstance; they are called dope because drugs elicit the release of dopamine as well, causing the pleasurable high. So chemically speaking, the high that gamers or internet surfers or Facebook hyper-checkers get from indulging their addiction is exactly the same as when a drug addict takes drugs. Win a game or get a like or love on Fakebook, get a dopamine hit. And, just like with drugs, people develop a tolerance over time, so more and more of the activity is needed to induce the same pleasurable response that they had in the beginning. Ultimately, this creates a dependency.
There are also some biological predispositions to digital addiction disorder. If you have this disorder, your levels of dopamine and serotonin may be naturally deficient as compared to the general population. This chemical deficiency may require you to engage in more behaviors to receive the same pleasurable response that individuals without the addiction have naturally.
Another predisposition to digital addiction disorder is anxiety and/or depression. If you already have anxiety or depression, you may turn to the internet or social media to fill a void or find relief, maybe in the form of online retail therapy for example. In the same way, people who are very shy or socially awkward may turn to the internet to make electronic friends because it doesn’t require actual personal interaction.
The signs and symptoms of digital addiction disorder can present themselves in both physical and emotional manifestations.
Emotional symptoms may include:
Feelings of guilt
Feelings of euphoria when indulging
Inability to prioritize tasks
Problems with keeping schedules
No sense of time
Avoidance of work
Boredom with routine tasks
Physical symptoms may include:
Carpal tunnel syndrome
Poor nutrition: not eating or junk food
Poor or zero personal hygiene
Dry eyes and other vision problems
Weight gain or loss
Digital addiction disorder impacts life in many ways. It affects personal relationships, work life, finances, and school life. Individuals with it often hide themselves away from others and spend a long time in this self-imposed social isolation, and this negatively impacts all personal relationships. Trust issues may also come up due to the addicts trying to hide, or lying to deny, the amount of time they spend online. Sometimes, these individuals may create alternate personas online in an attempt to mask their online behaviors. Serious financial troubles may also result from the avoidance of work, as well as bankruptcy due to continued online shopping, online gaming, or online gambling. They may also have trouble developing new relationships, and they often withdraw socially, because they feel more at ease in an online environment than an actual physical one.
One of the overarching problems with the internet is that there is often no accountability and no limits. You are hidden behind a screen, so you may say or do some things online that you would never consider doing in person. To some, that can be a very attractive proposition. One iissue that happens in digital addiction is that people who may be shy or awkward or lonely may create a new identity for themselves. They find that on the internet, they can be the person that they can’t be in real life. They develop this perfect fantasy world where everything goes their way. The problem is that the more they get into that fantasy wotld, the more distant they become from the real world. The results can be a disaster emotionally when they’re forced into the real world; they find they can’t function there and desperately need help. There’s a flip side to a created persona, where it’s done to intentionally hurt others. By now, I’m sure most people are familiar with “catfishing” from the eponymous movie and television program. For those who are not familiar, catfishing is the purposeful act of luring someone into a relationship by means of a fictional online persona. Catfish steal pictures of an attractive person, usually from that person’s social media, and they create a fictional persona and post it online with the stolen pictures to see who bites. If they get an attractive bite, they message that target to begin a relationship for their own devious purposes, which is usually just to get their rocks off, to hurt someone because they hurt, to get nude pictures, or to weasel people out of money. Catfish often do this with multiple people, leading them on, and are usually pretty proud of themselves for it. I think they’re lowlife cowards. My point is that the internet is full of people that feel brave online but who cower in real life. Online and social media digital addicts are more likely to be targeted, simply because they spend so much time on their devices, on the internet, or monitoring their social media.
As for diagnosis, because it was only very recently added to the Diagnostic and Statistical Manual of Mental Disorders as a disorder that needs more research, a standardized diagnosis of digital addiction disorder has not been developed. This is likely due to the variability of the different digital applications that people may become addicted to, as well as the fact that digital addicts can have anxiety and/or depression as well, and therefore would have difficulty, or may be averse to, seeking help.
As to treatment options for digital addiction disorder, the first step in treatment is the recognition that a problem exists. If you don’t believe you have a problem, you’re not likely to seek treatment.
Developing a compulsive need to use digital devices, to the extent that it interferes with your life and stops you from doing things you need to do, is the hallmark of an addiction. If you think you or a loved one may have a digital addiction, you should definitely see a psychiatrist, because there may be an underlying issue like anxiety and/or depression that is treatable with talk therapy and/or medication. I specialize in addiction, and I work with many patients with digital addiction with a great deal of success. There is a right way to utilize technology without it running and ruining your life, so please seek help.
Digital addiction disorder has become such a common theme in my practice that I cover this topic in several stories in my book, so check out Tales from the Couch, available on Amazon.com if you’d like to read patient stories and get more information on the digital addiction phenomenon.Learn More
A woman named Marianne messaged me wanting to know how to get off of Klonopin, which is a benzodiazepine, or benzo for short. She has been taking them regularly for more than twenty years, which is a very long time to be on a benzo. That will certainly complicate things. Before I go into how to stop taking benzos, I want to tell you what they are and what they do.
What are they?
Benzos are medications designed to treat anxiety, panic disorders, seizures, muscle tension, and insomnia. Some of the most commonly prescribed benzos include: Xanax (alprazolam), Klonopin (clonazepam),Valium (diazepam), Restoril (temazepam),
Librium (chlordiazepoxide), and Ativan (lorazepam). A 2013 survey found that Xanax and its generic form alprazolam is one of the most prescribed psychiatric drugs in the United States, with approximately 50 million prescriptions written that year. Unfortunately, this class of drug is also highly abused. Another 2013 survey found that 1.7 million Americans aged 12 and older were considered current abusers of tranquilizer medications like benzos. When abused, benzos produce a high in addition to the calm and relaxed sensations individuals feel when they take them.
How do they work?
Benzos increase the levels of a chemical in the brain called GABA. Meaningless trivia: GABA stands for gamma amino-butyric acid. GABA works as a kind of naturally occurring tranquilizer, and it calms down the nerve firings related to stress and the stress reaction. Benzos also work to enhance levels of dopamine in the brain. Dopamine is the feel good chemical, the chemical messenger involved in reward and pleasure in the brain. In simple terms, benzos slow down nerve activity in the brain and central nervous system, which decreases stress and its physical and emotional side effects.
Why can using them be problematic?
Benzos have multiple side effects that are both physical and psychological in nature, and these can cause harm with both short-term and extended usage. Some potential short-term side effects of benzos include, but are not limited to: drowsiness, mental confusion, trouble concentrating, short-term memory loss, blurred vision, slurred speech, lack of motor control, slow breathing, and muscle weakness. Long-term use of benzos also causes all of the above, but can also cause changes to the brain as well as mental health symptoms like mood swings, hallucinations, and depression. Fortunately, some of the changes made by benzos to the different regions of the brain after prolonged use may be reversible after being free from benzos for an extended period of time. On the scarier flip side of that coin, benzos may in fact predispose you to memory and cognitive disorders like dementia and Alzheimer’s. They’re many studies currently focusing on these predispositions. A recent study published by the British Medical Journal (BMJ) found a definitive link between benzo usage and Alzheimer’s disease. People taking benzos for more than six months had an 84% higher risk of developing Alzheimer’s dementia, versus those who didn’t take benzos. Long-acting benzos like Valium were more likely to increase these risks than shorter-acting benzos like Ativan or Xanax. Further, they found that these changes may not be reversible, and that the risk increased with age. Speaking of age, there are increased concerns in the elderly population when it comes to benzo usage. Benzos are increasingly being prescribed to the elderly population, many of which are used long-term, which increases the potential for cognitive and memory deficits. As people age, metabolism slows down. Since benzos are stored in fat cells, they remain active in an older person’s body for longer than in a younger person’s body, which increases the drug effects and risks due to the higher drug concentrations, like falls and car accidents. For all of these reasons, benzos should be used with caution in the elderly population.
A big problem with taking benzos for an extended period is tolerance and dependency. Benzos are widely considered to be highly addictive. Remember that benzos work by increasing GABA and dopamine in the central nervous system, calming and pleasing the brain, giving it the feel goods. After even just a few weeks of taking benzos regularly, the brain may learn to expect the regular dose of benzos and stop working to produce these feel good chemicals on its own without them. Your brain figures, “why do the work if it’s done for me?” You really can’t blame the brain for that! It has become dependent on the benzo. But as you continue to use benzos, you develop higher and higher tolerance, meaning that it takes more and more of the drug to produce the regular desired effect. This tolerance and dependence stuff really ticks off your brain. It’s screaming “why aren’t these pills working anymore?!” The answer is that it has become dependent and tolerant, so it needs more. Just to prove its point, it makes you feel anxious, restless, and irritable as it screams “gimme gimme more more more!!!” The problem is that the body is metabolizing the benzo more quickly, essentially causing withdrawl symptoms, and a higher dose is needed. The longer you’re on a benzo, the more you’ll need. It’s a vicious cycle and it’s sometimes tough to manage clinically.
The most severe form of physical harm caused by benzos is overdose. This occurs when a person takes too much of the drug at once and overloads the brain and body. The Centers for Disease Control and Prevention (CDC) cites drug overdose as the number one cause of injury death in the United States. A 2013 survey reported that nearly 7,000 people died from a benzo overdose in that year. Since benzos are tranquilizers and sedatives, they depress the central nervous system, lowering heart rate, core body temperature, blood pressure, and respiration. Generally, in the case of an overdose, these vital life functions simply get too low.
When combining other drugs with benzos, obviously the risk of overdose or other negative outcome increases exponentially. But mixing benzos with alcohol is a special case, deserving of a strong warning as it is life-threatening. BENZOS + ALCOHOL = DEAD. One of the most common and successful unintentional and intentional suicide acts in my patient population is mixing benzos with alcohol. The combo is lethal, plain and simple. The body actually forgets to breathe. People pass out and just never wake up. If you’re reading this and you take benzos with alcohol and you’re thinking that you don’t know what the big deal is, you do it all the time and have never had a problem, then my response to you is that you’re living on borrowed time, and I strongly suggest you stop one of the two, the booze or the benzos, take your pick.
What about withdrawl from benzos?
Benzo withdrawal can be notoriously difficult. It is actually about the hardest group of drugs to get off of. The level of difficulty is based on what benzo you’ve been taking, how much you’ve been taking, and how long you’ve been taking it. Obviously, if you’ve been on benzos for 25 years, it’s not going to be a walk in the park. To be honest, it’s going to be a rough road. Sorry Marianne. But it can be done. The first and most important thing is that you should never just stop benzos on your own, as it can be very dangerous and can include long or multiple grand mal seizures. Withdrawal from benzos should be done slowly through medical detox with a professional. It is best done with an addiction specialist like myself, because a specialist has the most current knowledge and experience. This is the safest way to purge the drugs from the brain and body while decreasing and managing withdrawal symptoms and drug cravings. As for the symptoms of withdrawl, these can include mood swings, short-term memory loss, seizure, nausea, vomiting, diarrhea, depression, suppressed appetite, hallucinations, and cognitive difficulties. Stopping benzos after dependency may also lead to a rebound effect. This is a sort of overexcitement of the nerves that have been suppressed for so long by the benzos, and symptoms can include an elevated heart rate, blood pressure, and body temperature. There may also be a return of the issues that lead you to take the benzos in the first place, insomnia, anxiety, and panic symptoms, and they can possibly be even worse than before.
I’m sure that just about everyone currently taking benzos is thinking “I’m NEVER stopping!” right about now. It is not easy to do, but there is a way to manage all of this, to come off of the benzo and deal with all of the physical and cognitive aspects of withdrawl. I do it everyday. I set up a tapering schedule to lessen the specific benzo dosage over time, sometimes over a period of months. I will also often add or switch to a long acting benzo, which can be very helpful. I use several drugs to deal with the withdrawl symptoms: clonidine for tremor and high blood pressure, neurontin for pain and to help prevent seizures, anti-psychotic like seroquel for sleep, and an anti-depressant for depression, thank you Captain Obvious. The drug regimen varies from patient to patient. I also utilize psychotherapy to help work out the psychological kinks associated with withdrawl and rebound effect symptoms. Another trick I strongly recommend to many of my patients, not just those withdrawing from alcohol or any drugs, is transcranial magnetic stimulation or TMS. This is a non-invasive procedure done in the office that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression and anxiety, and I’ve found that it seems to calm the nerves and offer relief to some people in withdrawl. Electrodes are placed on the forehead and behind the ears and painless stimuli are passed into certain regions of the brain for 40 minutes in each daily session for about a month. Many patients say it’s the best 40 minutes of their day.
I’d like to wish Marianne good luck. Please feel free to call me at the office at 561-842-9950 if you have any questions.
To everyone else: If you can avoid ever having to take benzos, I strongly suggest that you do. If you’re currently taking them, give some serious thought to finding an alternative medication. I can help with that. For more information and stories about benzos, other drugs, and the process of medical detox, check out my book Tales from the Couch on Amazon.com.Learn More
As an addiction specialist, I see patients abusing substances of all kinds. Today I’d like to talk about alcohol. It is so ingrained and accepted in our society. Pop culture would have you believe that you can’t have any fun or lead a fulfilling life without alcohol. During nearly every commercial break on television, there is an advertisement for alcohol, full of smiling people having the time of their lives like they’re on a permanent vacation. As a matter of fact, as I write this, I have a television on in the background, and there was just a commercial for a Mexican beer. It was a fiesta, with women in bright costumes dancing around and people cheering and cheersing with cold cervezas. The message: you’re clearly missing out if your life doesn’t resemble the lives of these people, but if you drink their beer, your life can be as awesome as theirs.
Fermented grain, fruit juice and honey have been used to make alcohol for thousands of years. Even early Greek writings warned of the perils of alcohol. In our modern world, the dangers of alcohol are well studied and well known. Despite this fact, alcohol is the most common drug used and abused by people. Here are some sobering facts and figures: an estimated 15 million Americans suffer from alcoholism, and nearly 90,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. 40% of all car accident deaths in the United States involve alcohol, claiming approximately 10,000 lives a year. According to the Institute of Alcohol Studies, consuming larger amounts of alcohol can cause more than 60 different health issues and hundreds of physical conditions.
Day in and day out, I witness the ravages of alcoholism, and it’s not pretty. Alcohol in any amount affects every part of a person, inside and out. It’s just a matter of degrees.
What are these effects? Let’s start with the outward appearance. While drinking moderately may not have immediate disadvantages, over time you’ll start to notice them- especially when you look in the mirror. Drinking alcohol dehydrates you, which makes hair follicles dry and brittle and more likely to cause hair to fall out. What hair you have will look crispy with split ends. Heavy alcohol use can lead to permanent damage to the health of your hair. It can also cause hormonal issues like increased estrogen, which can cause problems with hair growth and loss, particularly in men.
Drinking too much also dehydrates and deprives the skin of vital vitamins and nutrients. Instead of being soft and hydrated, your skin will begin to look cracked and wrinkled. This will leave others thinking you may be older than you actually are. Excess alcohol also alters blood flow to the skin, leaving an unhealthy appearance for days.Alcohol can also cause your face to look pale, bloated and puffy.Sometimes the blood vessels on your face burst and the capillaries break, causing a chapped look. Not only can your face become red, but the tiny blood vessels in your eyes become irritated and rupture, causing bloodshot eyes. Not cute.
Over time, drinking heavily can have other, more permanent, detrimental effects on your skin. Rosacea, a skin disorder that starts with a tendency to blush and flush easily is linked to alcohol consumption. Continued alcohol consumption can eventually lead to a condition called rhinophyma, a facial disfigurment that is a subtype of rosacea, where large, red, pus-filled bumps develop on the face, commonly on the cheeks, chin, and especially the nose, where it can cause severe bulbous distortion. If you have rosacea, I strongly urge that you google rhinophyma and that you don’t drink.
Let’s not forget that alcohol is fattening, high in empty calories. A couple of gin and tonics and a pint of beer equal about the same calories as a big fast food burger. You might be surprised to find out what the junk food calorie equivalents are for your favorite drinks. Alcohol also bloats your stomach. “Beer belly” is real people, but not only caused by beer. And then there’s cellulite; many believe the toxins in alcohol contribute to its build up.
A less often discussed result of drinking heavily is B.O. Yes, the bad odor emanating from the body after a long night of drinking is directly related to the alcohol seeping from it. According to the Institute of Alcohol Studies, over 10 percent of alcohol consumed leaves the body unused through your sweat, breath, and urine. While pretty much everyone can smell it, non-drinkers are generally especially susceptible to the odor. And it is gross. Keep that in mind the next time you wake up after a bender. Your body odor could leave a lasting impression.
Let’s move from external effects of alcohol and go inside the body, starting with the brain. Obviously, when you’re drunk, your brain is impaired. There is loss of inhibitions, confused or abnormal thinking, and poor decision-making. But I want you to understand the chronic effects of alcohol on the brain and cognition, the long term effects. So, how does alcohol impact cognitive ability? Clearly, the impact is directly related to the frequency and quantity of alcohol consumed.
Occasional and moderate drinkers:
– Memory impairment
– Impaired decision-making
Heavy and/or chronic drinkers:
– Diminished gray matter in the brain
– Inability to think abstractly
– Loss of visuospatial abilities
-Loss of attention span
In general, heavy alcohol use causes the brain to shrink. Any alcohol use causes clouded thinking, slow thought process or delays in cognition. If you drink at night – even two drinks – the next day, your thoughts aren’t as fluid, you’re not as clear, you’re not as creative. Alcohol use changes behavior. You may develop psychological issues, personality issues. It is well established in the mental health field that alcohol consumption can exacerbate underlying mental health disorders. People become more irritable, anxious, and depressed when they drink. So why do it? People use it as a coping skill. It lowers inhibitions, gives “liquid courage” and allows us to do things we wouldn’t normally do. Some people use it to keep a job they hate, or to stay in a miserable marriage. It numbs pain, it’s an escape hatch for the psyche. It becomes a solution to a problem, or a way to mask the problem. Just as we are all different, the way alcohol affects us all differently.
The following factors have been shown to influence how alcohol impacts a person’s brain functioning over time:
-The volume a person drinks
-How often a person drinks
-The age at which drinking began
-The number of years a person has been drinking
-The person’s sex, age, and genetic factors
-Whether the person’s family has a history of alcoholism
-Whether the person was exposed to alcohol as a fetus
-The person’s general health
One of the biggest problems with alcohol that I see is trauma, people getting hurt. When you drink alcohol, your decision making is impaired. The brain that usually protects you is suddenly impaired, so you fall, you fight, you drive a car recklessly, and your coordination is off. You’re going to fall or make a bad decision and get hurt. So many accidents and deaths are attributed to alcohol. It’s especially disturbing because they’re preventable.
There is no bodily system that alcohol does not affect. What are other physical dangers of alcohol? Drinking alcohol increases the risk of cancers of the mouth, esophagus, pharynx, larynx, liver, and breast. The common thing that everyone understands is liver damage with alcohol. It causes fatty liver and cirrhosis of the liver which eventually kills you. There are a host of digestive problems with alcohol consumption: peptic ulcers, bleeding ulcers, diarrhea, pancreatic cysts/disease/failure. Alcohol can lead to diabetes, a compromised immune system, lung infections, stroke, and heart disease. It can be associated with memory issues, learning disorders, and neurological problems, where you have numbness in your arms and legs, lack of coordination, and slurred speech.
Alcohol plays a role in other issues as well. Family problems, legal problems, and social problems. One of the biggest concerns with drinking frequently is (or should be) dependency, becoming an alcoholic. Right now, I’m sure almost 100% of you are thinking ‘I‘d never become an alcoholic.’ There’s a television show called Intervention that documents the trials, tribulations, lifestyles, and consequences of alcoholics and drug addicts. None of them planned on becoming alcoholics back when they drank socially or just had a few drinks at night. The great news is that if you never make alcohol a part of your life, guess what? You’ll NEVER have to be an alcoholic or deal with all of the issues that come with it. I can’t stress enough how strongly you should take this to heart.
By now I’m certain that you understand the ravages and damages of alcohol use and abuse. But the dangers are minimized and we’re desensitized to it by pop culture; it’s so ubiquitous that we accept it as a part of life. If you tell someone that you don’t drink, they look at you like you have three heads. It is ingrained in every aspect of our society in terms of weddings, funerals, bars, restaurants, hotels, public events, private events, and clubs.
Have you ever noticed how glorified alcohol is? They put it in these beautiful bottles. I admire alcohol bottles. The artistry and sculpture of the bottles…they’re just beautiful. They look like there must be something very good inside, so you want to find out. When you go to a restaurant, the first question is always, “Would you like a drink?” Now, children’s birthday parties even serve drinks to the adults. If it’s so safe, why don’t we serve it to children? It’s because we know it’s poison, we know it’s dangerous, but it’s minimized. It’s socially acceptable. I’m not for prohibition; I think there is a place for alcohol in our society, but it shouldn’t be so glorified and so easily accessible. We need to acknowledge it’s dangers and be more restrictive with it. Take all-you-can drink mimosa or bloody mary brunches or happy hours for example, where drinks are two-for-one. These things encourage drunkenness, and then people leave with alcohol-induced poor decision skills and car keys in hand. These sorts of events need to be seriously restricted. There should be no event where we encourage people to get drunk. We should not condone its overuse or extoll its virtues.
With all of that said, how does an individual stop drinking alcohol? It’s a simple theory. You make a decision to stop, and then you stop. There is no other way. If you’re not in control of stopping, then who is? I’ve spent more than thirty years medically detoxing and working with people with alcohol and drug addictions, and I assure you that there is no other way to stop other than the person making the decision to stop and living with it. I’m not saying it is easy, especially with alcohol all around us in grocery stores, restaurants, on television, on billboards…it is everywhere. But it can be done. I see it every day, people living fulfilling lives without alcohol. If you want to be one of those people living without alcohol, make an appointment. I can help you. I talk more about this in my books, A Chance to Change and Tales from the Couch, both available on Amazon.Learn More
Attention Deficit Disorder
ADD, Attention Defecit Disorder is a chronic condition marked by issues with attention. It is most often seen in childhood, but can persist into adulthood, and there are 3 million US cases per year. Due to it’s high prevalence, I want to take the opportunity to discuss the diagnosis, symptoms, and treatment of ADD.
ADD has a sister disorder called ADHD, Attention Defecit Hyperactivity Disorder. What’s the difference between them? It’s pretty simple. ADHD includes the symptom of physical hyperactivity or excessive restlessness. That’s what the “H” is for. In ADD, the symptom of hyperactivity is absent.
What are the hallmarks of this disorder? Basically, it is a disorder of concentration, marked by problems concentrating and the inability to stay on task. These individuals are easily distracted and readily bored. They move from project to project without finishing and start projects without all of the appropriate tools needed to complete them. This all leaves them very anxious. In cases of ADHD, they are also impulsive, intrusive, disruptive, and hyperactive, often constantly fidgeting.
What percent on the population are we dealing with here? Roughly 20% of boys and 11% of girls have some type of attention deficit disorder.
What are the causes of attention deficit disorder? While we don’t know exactly, there are several suspects. Maternal use of alcohol or cocaine while in utero is an extremely common finding. Brain infections when pregnant or during early childhood, head trauma, and any birth defects that affect child development are also suspected. Exposure to enviromental toxins and pesticides are suspect. Excessive video games alter brain chemistry, as does a diet of processed foods and sugar, and these are also suspected causes for attention deficit disorder. I would say the number one cause of ADD is most likely genetic, inherited from mother or father.
What is the result of having attention deficit disorder? How does it affect one’s life? It results in having problems fitting into the academic world or the job world. People with attention deficit disorder don’t fit into a regimented or organized educational or work environment. They can be very intelligent and productive people, but they don’t fit into what we would consider the stereotypical or standard type of academic setting or work setting. Also, due to their impulsivity and their disorderly conduct, they can wind up getting in trouble in school and in trouble with the law. They can be unsuccessful at work, not because they aren’t smart enough, but because they cannot stay focused. In terms of lifestyle, they also have a much higher rate of obesity. This is likely due to lack of impulse control, causing them to overeat. They have problems in relationships, and their divorce rates are much higher. Their propensity toward domestic violence may also be higher. They may also be more prone to Alzheimer’s disease. Because of all of these failures and shortcomings in the stereotypical organized worlds of education and career, they have much lower self-esteem. There are studies that report that up to 52% of people with attention deficit disorder have drug or alcohol problems.
So how can we help these people? How do we treat these illnesses? The number one treatment is behavioral training with a mental health professional. The gist of that is educating them to focus on one thing at a time. They are not able to handle instructions with multiple levels at once, but they can focus on one thing at a time and have success with that. Pharmacologically, ADD and ADHD are generally treated with amphetamine stimulants. Some antidepressantants may also benefit people with attention deficit disorder. Essentially, a combination of behavioral therapies, special education programs and medications show the most promise in the treatment of attention deficit disorder. But a diagnosis of ADD or ADHD isn’t all future doom and gloom. Eventually, people find their niche in the world and can become successful. The actor Ryan Gosling takes medication for his ADD and says that it may take him longer to read his scrips than other actors, but he manages to get the job done. Uber successful comedian Howie Mandel has successfully done just about all there is to do in Hollywood. I have met a lot of CEO’s with ADD, and they function well because they have people around them to take care of all the boring mundane tasks, giving them the chance to think freely and create business opportunities. They are creative and capable people. They are another example of why you can’t judge a book by it’s cover…you can’t assume that someone with a psych diagnosis will never make it in the world. Ask Richard Branson. I think he’s done pretty well for himself in the corporate world despite his ADD. Justin Bieber has ADHD and has managed to record a few hit songs. Olympian Michael Phelps has ADD, depression and anxiety, and that hasn’t stopped him.These are some examples of people that have adapted and overcome their diagnoses rather than be labeled by them. If you have ADD or any psych diagnosis, I’d suggest you follow their lead.
For more patient stories, check out my book Tales from the Couch, on Amazon.com.Learn More
Slumber, shuteye, repose, siesta, snooze…Sometimes we have a love-hate relationship with it…we love it when it’s good and curse it when it’s bad, but we all need it. Whatever you call it, one complaint I hear from patients day in and day out is that they have difficulty sleeping. It’s so prevalent that I want to discuss how to get better sleep. In my 30 years of practice, I’ve compiled a list of 14 things in no specific order that you can do that should have you snoozing at night night in no time.
Rule 1: Bright light during the day. Your body has to have bright light during the day; sunshine is best, but even sitting in a bright room, like by a window, is helpful. Bright light tells your brain that it is day time, time to be awake. Darkness or the absence of bright light tells the brain it is night time, time to sleep. If you’re in a dark room all day, you probably won’t sleep well at night. So remember, in the day time, bright light is right.
Rule 2: Limit blue light. What is blue light? Blue light is what is emitted from your computer, laptop, and smartphone. The more blue light you are exposed to, especially at night, the more disruption you’ll have in sleep, as it disrupts circadian rhythm. Lots of people climb into bed with their cell phone or iPad, and that’s the worst thing to do. You should avoid looking at bright screens beginning two to three hours before bed. There are apps you can install on your phone that filter out the blue light. There’s also something called “F. Lux” that you can put on your computer or iPad which will block out the blue light. You never hear about it, but blue light exposure, especially at night, is a major factor in hindering sleep.
Rule 3: Captain Obvious here with a newsflash. Caffeine will keep you up at night. Don’t think you’re going to have coffee or tea after dinner or before bed and expect to sleep. And if you’re drinking sodas, coffee, or iced tea all day, it’ll still disrupt your sleep. I tell patients to limit caffeine consumption to under 250 – 300mg a day. As a guide, an 8oz cup of coffee has about 100mg caffeine, the same amount of tea has 24mg, a 12oz can of soda has 34mg, and those gnarly energy shots have 200mg of caffeine! I strongly advise against consuming caffeine after lunch if you plan on a bedtime between 10pm and midnight.
Rule 4: No naps! Boo! Hiss! Why is it that as kids, just the word nap sent us into a tizzy tantrum, but as adults we love naps? If anyone has an answer, please let me know. Anyway, as satisfying as it is, napping disrupts your sleep-wake cycle, temporarily resetting it to where you’re not likely to be able to go to bed between 10pm and midnight. Bummer.
Rule 5: Melatonin. I recommend 2 to 4mg of melatonin at bedtime; it really seems to help a lot of my patients. I do find that some patients get daytime hangover from it though, so you’ll have to see where you fall on that one. But it’s definitely worth a shot if you’re suffering from insomnia.
Rule 6: Get up at the same time every day, and go to bed at the same time every day. Yeah, it’s kind of a drag not sleeping in on weekends, but a sleep routine can make a big difference in your relationship with Mr. Sandman. You can’t regulate when you’ll fall asleep, but you can regulate when you wake up. So set your alarm and get up at the same time every day, no matter how tired you are. Don’t nap and go to sleep between 10pm and midnight, and you should fall asleep. If sleep still eludes you, stick to the same plan, and you should surely sleep the second night. You can’t decide when you’ll fall asleep at night, but you can regulate your sleep-wake cycle by deciding when you wake up. Stick to setting your alarm for the same time every day, and hopefully your brain will get the idea.
Rule 7: I recommend taking a glycine or magnesium supplement at night as well as L-theanine and lavender. They don’t make lavender teas, pillow sprays, lotions, and sachets for nothing. I have heard from people that swear by lavender as part of their wind down routine before bed. You can find these supplements on Amazon.com. Shameless plug: handily enough, you can also find my book, Tales from the Couch for sale there too. Check it out.
Rule 8: This is the Mac Daddy, numero uno, absolute, not-to-be-broken rule. Alcohol. If you consume alcohol before sleep, you will not sleep. Why? As the body metabolizes the alcohol, it goes into a withdrawl-like reaction and disrupts sleep. I know what you’re thinking. You’re thinking that a little nightcap helps you sleep. Wrong. Some people will tell you differently, but trust me…alcohol and sleep do not play well together.
Rule 9: A comfortable bedroom. Your bedroom should be an oasis of calm serenity. There should be no office or desk in the bedroom. It should be uncluttered. Anything not conducive to sleep should be out. Make sure it’s dark and quiet at bedtime. The weight of multiple blankets can help sleep. You can even purchase weighted blankets expressly for this purpose. The weight is comforting and relaxing to the body.
Rule 10: This sort of goes hand in hand with #9 above. Try a low temperature in the bedroom. I personally make sure my bedroom is at 70 degrees. The blankets from rule number 9 come into play here too. There’s something very comforting about burrowing under fluffy blankets to go to sleep. I mean, they’re called comforters for a good reason.
Rule 10: No eating late at night. People seem to mostly make terrible food choices at night, all in the name of snacks…chips, candies, baked goods. Sugary foods are especially bad. When you eat, the body goes into digestive mode, not sleep mode; it is very interfering to sleep. Sugars especially are no bueno. Evening or night snacking is one of the worst things you can do If you want to sleep.
Rule 11: Relax and clear your mind. There’s an older pop song that has a lyric, Free your mind and the rest will follow. It’s true. We all have problems and stresses throughout the day, and they seem to pop up when your head hits the pillow. You have to come to some resolution on how you’re going to handle the problems in your life and put them to bed so that you can put the rest of you to bed.
Rule 12: Spend money on a comfortable quality mattress. You’re going to spend a third of your life in your bed. Just suck it up and spend the money on the mattress. Don’t cheap out. Another place to spend money is on good linens. Few things are as inviting as a comfortable mattress covered in minimum 1,000 thread count all-cotton sheets. If you’ve never had nice linens, try them.You can pick them up on a white sale or online. You can thank me later.
Rule 13: No exercising late at night. When you exercise late at night, you raise blood pressure and heart rate, which will hype up the body, which is the antithesis of what you want when it’s time to sleep.
Rule 14: No liquids prior to sleeping. No rocket science here. If you put liquids in, you’re going to need to get liquids out. In other words, you’re going to have to get up in the middle of the night to pee. And you’re probably going to stub your toe. Not good.
This is my handy dandy guide on the do’s and don’ts when it comes to sleep. Anything is better than counting sheep. I don’t know who came up with that, but I would like to inform them that I have never in 30 years heard of it working. I’ve never before wanted people to fall asleep as a result of reading something I wrote, so this is a first! I hope you’ve learned some things here that will put you out like a light.Learn More
The Agresti Addiction Quiz is designed to provide you an idea of whether a drug addiction or drug abuse problem exists. The drug addiction quiz is not perfect and the drug addiction quiz should only be seen as a guide.Learn More
In response to the opiate epidemic and the pill mill phenomenon, the state of Florida instituted a prescription tracking system under Rick Scott. The system is called NarxCare. It tracks the pharmacy, the physician, and the patient when they fill a prescription for a controlled substance.Learn More
Dr. Mark Agresti discusses the benefits of stopping drug use.
Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist
Call (561) 842-9550 or email: email@example.com Dr. Agresti today to get psychiatric help today.Learn More
Dr. Mark Agresti discusses the ways that you can reduce the and minimize the dangers of smoking.
Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist
Call (561) 842-9550 or email: firstname.lastname@example.org Dr. Agresti today to get psychiatric help today.Learn More
Dr. Mark Agresti discusses the hidden dangers of marijuana use.
Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist
Call (561) 842-9550 or email: email@example.com Dr. Agresti today to get psychiatric help today.Learn More
1. Psychological and physical problems of stopping opiates
Let’s look at the opiates first. An opiate is a narcotic pain killer like Roxycodone, Oxycodone, Loratabs, Loracet, Methadone, Vicodin, Actiq, and Stadol. The action of these drugs may last varying amounts of time and has varying doses. For example, some people can be on 100mg a day of oxycontin while others may take 1000mg a day of oxycontin. (more…)Learn More
Dr. Mark Agresti discusses ways of coping with losing your job. By understanding the stress and overwhelming scenarios, Dr. Agresti talks about the best way to continue forward and cope appropriately when dealing with a major change in your life.
Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist
Call (561) 842-9550 or email: firstname.lastname@example.org Dr. Agresti today to get psychiatric help today.Learn More
Dr. Mark Agresti discusses the recent news with Charlie Sheen; his actions, his outbursts and his personality.
Dr. Mark Agresti, West Palm Beach Drug & Alcohol Detox Specialist, Psychiatrist
Call (561) 842-9550 or email: email@example.com Dr. Agresti today to get psychiatric help today.Learn More
I’ve been a psychiatrist for a long time, and my patients say: “I don’t have a problem. I don’t use drugs (alcohol) every day.”
Then they tell me some version of the “binge” story, and I’ve seen some pretty severe ones.
They might start out by saying: “You know, every two weeks, I just have to go out and binge drink.”
And then they say, “I’ll have 12 drinks.” Or. “I’ll have a bottle of wine.” Or. “I’ll drink vodka and shots.”
Just yesterday, a patient told me: “Every week, just to relax, I’ll take some Xanax with some alcohol and maybe mix it with a 30 mg Roxicodone.”
Still others tell me they never use drugs or alcohol, but once a month, they’ll smoke marijuana with their friends. (more…)Learn More
Dr. Agresti was interviewed by WPBF Local ABC Channel 25 in South Florida. News Channel 25 asked Dr. Agresti, as a psychiatry expert, his professional opinion on the sex addicts topic.
“According to Dr. Mark Agresti, a psychiatrist at Columbia Hospital, ‘the difference with a sex addict is that it’s not an expression of intimacy, but an obsession about the act. The obsession about the act consumes the person. They spend an inordinate amount of time during the day thinking about sex, when they’re going to have sex, how they’re going to have sex.'”Learn More