Pressing Questions About Addiction and Mental Health: Part 1

日本av色情片, in conjunction with the听, presented a full-day summit about mental health for the public.听Throughout the day, experts from 日本av色情片 shared their insights about mental health, mental illness, and other important topics, answering attendants鈥 questions along the way.听

During one session, Dr. Richard Friedman joined Dr. Mitchell Rosenthall to answer questions from attendants about mental illness and addiction.听

Dr. Richard Friedman听is a Professor of Clinical Psychiatry and听Director of the Psychopharmacology Clinic at听日本av色情片. His clinical and research specialties include anxiety and mood disorders, as well as psycho-pharmacology and refractory depression. In addition to treating patients and conducting research, Dr. Friedman also frequently contributes to听The New York Times听as an听.听

听founded the听听in 1967 in New York City. Under his leadership, the organization grew to become the nation鈥檚 leading provider of alcohol and drug treatment. Currently, there are 52 locations across nine states that offer 97 programs for 3,530 patients. Dr. Rosenthal also founded the听, an organization that provides information to individuals and families grappling with addiction, healthcare professionals, and policy makers.听听

Understanding that there is strong interest in the correlation between mental health and addiction鈥攁s well as pervasive misinformation and misperceptions鈥擠r. Friedman and Dr. Richard invited attendants to ask their pressing questions. Here is a summary of this important discussion.听

There are new drugs being used to treat addiction. Are these really 鈥渕iracle drugs鈥? Can they 鈥渃ure鈥 addiction?

鈥淔or almost all addictions, it鈥檚 never simply a drug that鈥檚 enough to solve the problem,鈥 asserted Dr. Friedman. 鈥淚t鈥檚 never simply a drug that鈥檚 enough to solve the problem because although the drugs target the brain, they involve a whole host of听behaviours听that are linked up with everyday life. You can definitely cut craving and make it easier for people to stop drugs by using, let鈥檚 say opiate blockers.鈥澨

鈥淟et鈥檚 say,鈥 he continued, 鈥渢hat someone is addicted to an opiate like heroin or Oxycontin. Drugs like naltrexone can be lifesaving. They cut the craving for the drug by blocking the receptors in the brain. But they don鈥檛 change patterns in your life. They don鈥檛 change all the associations that you have with this drug, your past experiences with this drug. And you still have to learn to live your life without the drug. That requires a lot more than just the pill.鈥澨

鈥淒rug use used to be considered a character problem鈥攁nd is too often still thought of this way鈥攄rug use is a character problem, it's a weakness,鈥 detailed Dr. Friedman. 鈥淏ut we really know that addiction is a brain-based problem. There are differences between people who get addicted versus those who don鈥檛. And it鈥檚 not weakness, it鈥檚 not character weakness. It鈥檚 actually genetic biological differences.鈥澨

鈥淪o you can鈥檛 just say to somebody who is addicted, 鈥榊ou know what? Cut it out. Just pull yourself up and stop using that drug.鈥 Drugs like naltrexone are effective because they deal with the biological process.鈥澨

Dr. Rosenthal continued, 鈥淭his is such an important point, because there are many people who believe that these new miracle drugs are all that you need. But it really is a beginning. It allows you to get the biological cravings out of the picture and get yourself engaged in听self examination听and social interaction and jobs鈥攁nd all the things that will go on to make you successful.鈥澨

鈥淥ne of the worries that I have had in the last couple of years鈥攁s we have these wonderful adjunctive drugs鈥攊s that people say, 鈥極h, this is all that I have to do.鈥 And that would be a terrible mistake,鈥 concluded Dr. Rosenthal.听

Does the brain heal after drug use stops?听

鈥淭his is a wonderful question,鈥 said Dr. Friedman. 鈥淵ou鈥檝e been exposed and, let鈥檚 say, begin abusing the drug and become dependent, and then stop. Does the brain somehow restore itself and go back to how it was before using the drug?鈥澨

鈥淲e know from studies in humans and animals that the brain is very plastic and changes and does reset,鈥 he explained. In studies on animals, evidence suggests that the changes are not permanent, unless the drug contains a contaminant.听

What is dopamine? How do drugs affect dopamine levels?听

Dopamine is a type of neurotransmitter that the body produces. It affects many aspects of our mental and physical function, including how we feel pleasure.听

Drug use causes a surge in dopamine. 鈥淥ne of the things that predisposes people to use drugs in the first place is having too few dopamine receptors,鈥 detailed Dr. Friedman. 鈥淒rugs release dopamine in the brain, and this release is what makes people feel euphoric and tells the brain a message. This is an important experience, and it helps set the person up for addiction.鈥澨

Interestingly, many mental health disorders听are associated with having either too many or too few dopamine receptors.听

鈥淲hen they get chronically exposed to a drug, the brain actually changes,鈥 continued Dr. Friedman. 鈥淭he receptors actually get smaller in number and they become less sensitive. And what does that do? It makes the person more wanting to use the drug because if you have fewer of these receptors, you鈥檙e basically walking around in an under-stimulated state. But if you stop using the drug, the receptors do go back up.鈥澨

Nature versus nurture: what is more important when it comes to being predisposed to addiction?听

鈥淟et鈥檚 say,鈥 described Dr. Friedman, 鈥測our parents had an addiction to cocaine, there are specific genetic variants that might increase the risk of addiction. And there are different variants with different frequencies, and they only contribute a very small amount to the outcome. So, the answer is that you鈥檙e probably at a slightly higher risk, but it鈥檚 not that high.鈥澨

Learned behavior and exposure are more influential, but much more difficult to understand or study. 鈥淏ehavior is a very complicated thing with lots of inputs,鈥 said Dr. Friedman.

鈥淚f you have parents who have not recovered, who are using drugs or alcohol, and whose behavior is out of control in different ways鈥攊ncluding different types of abuse鈥攖hen you鈥檙e talking about a very different equation,鈥 explained Dr.听Rosenthal. 鈥淎nd certainly, a lot of the people who have seen鈥攎aybe most of the people we have seen at Phoenix Houses over the years鈥攈ave had real troublesome backgrounds.鈥澨

鈥淚f you take somebody who鈥檚 at low risk, genetically, for addiction and put them in a situation where they have easy access and exposure to drugs,鈥 detailed Dr. Friedman, 鈥測ou will actually convert them from low risk to high risk.鈥澨

The good news is that this is reversible. 鈥淵ou can take away the drugs, be in a program, and remove the influence. By doing this you will actually lower the risk and change the brain,鈥 said Dr. Friedman.听听

鈥淟et鈥檚 say you got high in your friend鈥檚 house, stopped using the drug, and then later visited that friend again鈥 he continued. 鈥淲ell, guess what happens? You go into that room and, without听 you being consciously aware, you start to crave the drug because your brain has linked to all these situations.听People experience craving to all the cues that are linked to the听experience of using a drug. You can't just get rid of the craving. You have to rewire experience to change the link between these cues and the craving.鈥澨

Is there hope for recovery?听

Dr. Rosenthal has worked extensively with people struggling with addiction to rewire these experiences and change their lives through treatment.听

鈥淵ou really want to change the social fabric, you want to create new relationships, that鈥檚 what long-term treatment is about,鈥 he explained. 鈥淲hether it鈥檚 seeing a counselor or alcoholics anonymous, narcotics anonymous, or these other wonderful institutions. Because forming relationships with people who have been able to change their lives, who have become reflective about their lives, who understand themselves, having the support of these people while you make that journey is critically important.鈥澨

鈥淎nd it鈥檚 inspiring! It really is inspiring to see somebody who comes into a program homeless, addicted, very unhappy, with maybe little education, and then a year or so later starters to go to school, finds out he or she is actually quite bright. One person I saw go through treatment graduated from Harvard Divinity School.鈥澨

鈥淚n the midst of the raging problems that we have now, it can seem very hopeless. I like to remind people that we have more than 20 million people in America who are in recovery. This is a very treatable illness, but it has to be treated.鈥澨

Learn more about the听therapy and behavioral health services offered by our skilled and compassionate psychiatrists, the Midtown Center for Treatment and Research, and the听.

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