We think we know the usual suspects who push this pastime a little too far and end up getting in fights, driving drunk, or waking up the next day feeling like they were the one who got hit head-on by that 350-pound offensive lineman. Although you might think binge drinking is the territory of 20-somethings, in fact, 36 percent of binge drinking occurs in people age 35 and older.

Whatever age they are, binge drinkers will tell you it is all harmless fun. They only do it on Friday nights or on the weekends. But is it really harmless? As more medical research shows the toxic effects of binge drinking and the damage being done to memory, is it time to reconsider downing a 6-pack before halftime?

What Alcohol Does to Memory & Learning

Memory is essentially the storing of learned information and the ability to recall what you learned. Without memory, there is no learning.

Researchers now think that the most significant alcohol-related injury to memory and learning results from repeated withdrawal from alcohol. But withdrawal doesn’t necessarily mean severe detox such as when someone goes to rehab after long-term heavy drinking.

Mark Twain once joked that quitting smoking is the easiest thing in the world; he quits smoking every night and he starts again every morning. With alcohol it’s the same thing; if you binge drink you eventually go to sleep and your body metabolizes all the alcohol that you’ve consumed. By morning you are in withdrawal. A hangover is essentially a cluster of symptoms related to alcohol withdrawal. The truth is if you go out a single night and have six drinks of alcohol and you stop, you’re going to have withdrawal of the kind that can injure memory and learning.

If you are questioning whether you are binge drinker, remember that the only criteria is a pattern of drinking that brings blood alcohol concentration to 0.08 grams percent or above. For men, that’s about five drinks in two hours. For women, it’s four drinks in two hours. If you aren’t sure what a standard drink is, this chart will help.

Another thing that binge drinking does is injure your ability to learn from bad experiences that happen while you are drunk. You might get into a dangerous situation when you are binge drinking and experience some very real negative consequences. You swear next time you won’t get into that situation, but chances are you won’t remember to avoid it next time you binge drink.

Studies of rats show that when “sober” they will learn to avoid environments where they receive negative stimuli (foot shock), but give them alcohol and they don’t seem to learn how to avoid the environment where they actually experienced the shock.

Their learning is very limited when under the influence of alcohol.

Interestingly, binge drinkers behave like these rats. They fail to learn associations in aversive conditioning tests and they have much more limited learning. As a result they are not able to avoid situations that are going to be dangerous to them.

Alcohol essentially interferes with your ability to remember threatening situations.

You might ask what a real-life equivalent is to this. Let’s say you binge drink at a football game and drive home drunk. You wake up in your driveway and realize you took out your mailbox. You feel sick to your stomach, yet you’re lucky it didn’t end worse than this. Next time, you swear, you will not drive if you get that drunk.

Unless you make it impossible to drive before you start drinking, chances are you will drive again when you get drunk. Once you are drunk again, you will make the same bad decisions because your alcohol-intoxicated brain has not learned the lesson. (This is also referred to as state-dependent learning.) In fact, binge drinkers are 14 times more likely to drive under the influence than non-binge drinkers.

During the withdrawal period that occurs after any binge drinking episode, your brain tries to re-adjust to being alcohol-free; it often misses the baselines, however, and overshoots the mark. This is the most vulnerable period when brain cells die.

You might read this and think, “Well, it’s just short-term memory loss.” But the damage is more pervasive than that. If new information cannot be retained in short-term memory, it has no chance of being consolidated in long-term storage. Research shows that few cognitive functions escape the impact of alcohol.

Just scan some of the academic literature on binge drinking and the titles alone will make you wonder if this style of alcohol consumption is such a good idea. Words like neurotoxicity, neuronal degeneration, cognitive deficits, and the more easily understood phrase “brain damage” abound in the scientific literature on binge drinking.

So the next time you break open that second six pack during the game, ask yourself if it really is just harmless fun.

The Scope of Physician Addiction

Estimates of the number of doctors addicted to substances vary, but recent studies suggest that approximately 10 to 12 percent of physicians will develop a substance use disorder at some point during their careers. This is a rate that is similar to or greater than that in the general population.

But the incidents of substance use disorder as well as the drug of choice appears, according to several studies, to vary by physician specialty. Among physicians, alcohol abuse is the drug of choice for most doctors with addiction. In comparison, only about 10 percent of anesthesiologists enter treatment for alcohol addiction. Instead, studies have found that anesthesiologists are addicted to opioid drugs, particularly potent intravenous opioids, such as fentanyl and sufentanil.

One study by McLellan et al (2008) involved a five-year outcome of 904 doctors, 87 percent of whom were male, and who were enrolled in 16 different state physician health programs (PHPs). In this cohort longitudinal study, alcohol was the primary abused drug in 50.3 percent, opioids in 35.7 percent, stimulants in 7.9 percent and other substances in 5.9 percent.

That wasn’t all. Fifty percent of the doctors reported abusing multiple substances, 13.9 percent had a history of intravenous drug use, and 17 percent reported previous treatment for addiction.

In this study, the authors discovered that certain specialties appeared to be overrepresented in these programs relative to the national pool of physicians. The specialties included anesthesiology, emergency medicine, and psychiatry. The authors suggested that contributing factors may include work stress, ready access to narcotics and psychotropic drugs at work, and even possibly a selection bias in the type of doctors who seek these specialties.

Doctors Delay Seeking Treatment

One point that numerous researchers make is that by the time that doctors with substance use disorder or addiction actually seek treatment, they are usually in the advanced stage of addiction.

Why do doctors delay seeking treatment? For one thing, there is a profound stigma attached to the addicted doctor. One point that numerous researchers make is that by the time that doctors with substance use disorder or addiction actually seek treatment, they are usually in the advanced stage of addiction.

Doctors are also understandably worried that coming forward and seeking help for an addiction will cause them to lose more than prestige in the community. They fear that such a disclosure will also jeopardize their job, including revocation of their license to practice and, with that, economic ruin.

The family and coworkers of the physician abusing substances also play a part in the “conspiracy of silence.” They may be reluctant to confront the doctor or talk with anyone else to arrange an intervention because to do so would have a ripple effect of economic ruin caused by the doctor’s loss of a job and income.

Signs and Symptoms of Possible Abuse or Addiction

Looking at the problem of trying to recognize and identify possible substance abuse or addiction in physicians requires the ability to put two and two together. Not every sign or symptom, in and of itself, necessarily indicates that the doctor has a substance abuse problem, but more than one or a succession of them should certainly be cause for worry.

Gathered from various sources, here are some possible signs that may be suggestive of alcohol dependence:

• Acting in an “out-of-control” manner at social events
• Alcohol smell on the breath
• Ataxia
• Domestic or marital problems
• Erratic performance or decline in performance
• Failure to remember conversations, commitments, or events (otherwise referred to as “blackouts”)
• Frequent hangovers
• Hidden bottles
• Irritability
• Isolation
• Leaving the workplace early on a regular basis
• Moodiness
• Poor performance in the early morning
• Poor personal hygiene
• Problems with law enforcement, such as those arising from episodes of domestic abuse, driving while intoxicated
• Slurred speech
• Sweating
• Tardiness
• Tremulousness
• Unexplained absences
• Unusual traumatic injuries
Possible signs that may suggest dependence on opiates include:
• Adoption of wearing long sleeves (to hide needle tracks)
• Assay of waste drug returned that shows evidence of being diluted
• Dilated pupils (a sign of opiate withdrawal)
• Excessive narcotic use charted for patients
• Excessive sweating
• Frequent breaks to go to the bathroom (to take another dose)
• Frequent unexplained absences from the job during the workday
• Never returning any waste at the end of a case
• Patients arriving in the postsurgical recovery room with pain out of proportion to their charted narcotic dose
• Periods of agitation (sign of withdrawal) alternating with calm (sign the drug was just taken)
• Pinpoint pupils (a side effect of opiate use)
• Rummaging through sharps containers
• Sloppy record-keeping or discrepancies between the charted dose and the dose actually administered
• Spending more hours at work than necessary (to access the source of drug of choice)
• Volunteering for extra call
• Volunteering to clean operating rooms
• Volunteering to provide extra breaks or refusing breaks
• Volunteering to return waste drugs to the pharmacy

Suspected Physician Addiction

Let’s say that someone who works alongside the physician notices one or more signs or symptoms of alcohol or opiate addiction. He or she feels like something should be done but is nevertheless extremely reluctant to “blow the whistle” or get involved. The coworker may feel like it’s not his or her place to say anything, although by remaining silent, the situation could deteriorate to the point where the addicted physician causes the death of a patient.

The coworker could also be afraid of getting sued by the physician that they accuse of being addicted. A counter to this is the addition by medical licensing boards in many states that include the possibility of sanctions if a doctor knows of or becomes aware that a colleague is addicted or suspected of being addicted and fails to either intervene or notify the state PHP.

As seen in the previous section, the signs and symptoms of alcohol or opiate addiction vary considerably. They range from subtle and mile to blatantly apparent, even to the casual observer.

There’s also the fact that many physicians may be able to operate at a high level of functioning, so-called functioning alcoholics, although the same is also true with doctors addicted to certain opioids. There may only be the faintest hint that there’s a problem, and that, only over time.

Still, with the health and safety of their patients at stake, doctors who are addicted really need to have someone intervene to force the issue.

Intervention for the Addicted Doctor

There are many different ways of looking at an intervention. In the context of an intervention for the addicted doctor, it is, in essence, a confrontation with the suspected addict with the goal of forcing the individual to accept or submit to a formal chemical dependency evaluation by experts.

It is important to note that if a doctor is suspected of acute intoxication or addiction and is in charge of patient care, or who may be on-call or in charge of patient care in the near future, he or she should be immediately removed from such patient responsibility. In other words, the doctor should not be allowed to continue to care for patients.

The difficulty in arranging an appropriate intervention or even providing the intervention is something to take into consideration. No one should ever just go up to a doctor suspected of addiction and in a one-on-one exchange, either ask if the doctor is addicted or suggest that the doctor stop using alcohol or drugs. The doctor will be quick to deny it, in the first place, and such a confrontation could even be dangerous to the accuser. After all, the threat of disclosure jeopardizes the suspected doctor addict’s livelihood and career.

So, how should coworkers or superiors proceed if they suspect a colleague or employee doctor is addicted to alcohol or drugs? In an article on physician dependence The Mayo Clinic Proceedings lays out a generalized approach that may be useful to consider.

First, if doctor addiction to substances is suspected, a review of policies should take place, followed by notification of the appropriate contact, and then performing a discreet investigation. If the problem is identified, the next step is to notify the PHP and/or intervene. If the problem is not identified or is inconclusive, the recommendation is to observe. But if the problem has been identified and the PHP notified or there has been an intervention, the suspected addicted doctor should be referred to chemical dependency evaluation. If he or she refuses, termination should be considered.

If the chemical dependency evaluation identifies the problem, the suspected addicted physician should go immediately into treatment, either inpatient or outpatient chemical dependency treatment. If the doctor refuses to cooperate, termination should be considered. Should the chemical dependency evaluation prove inconclusive, the doctor should be allowed to return to work and overt or discreet observation should continue.

Following treatment, if a return to work is recommended, the doctor must sign a mandatory contract with PHP to monitor his or her recovery. If a work return is not recommended after treatment, the doctor should either be retrained or terminated.

Treatment for Substance Abuse or Addiction for Doctors

What exactly does treatment for substance abuse or addiction for doctors consist of? Do they just go into the same type of treatment setting that the general population suffering from substance abuse or addiction goes to? Is the treatment the same or is it markedly different?
In one sense, the evaluation of doctors with substance abuse is similar to that of any person being evaluated for dependence or addiction to substances. They both require a thorough evaluation, a detailed substance use history, and additional collateral information gathered from family, friends, coworkers and pharmacies. But with addicted doctors, skilled at rationalization, denial and resistance, a multidisciplinary team with experience working with such doctors is an absolute necessity.

As with almost all addicts, the addicted physician will be adamant in his or her denial that there is a problem. Thus, obtaining an accurate and detailed history of substance use may be extremely difficult. Reliance on reports from family, friends, coworkers, etc., may also require the use of signed releases or waivers by the addicted doctor to obtain.
In order to properly diagnose addiction, to determine whether it does exist and the extent of the problem, the substance use evaluation has to be as complete as possible.

During this evaluation phase, a complete medical history is obtained and a physical examination is performed. Addicted doctors very often neglect their own health. An evaluation with the family seeks to gather information on how the individual doctor functions and how the family has been affected by the doctor’s suspected addiction.
Psychiatric and psychological evaluations are also conducted, due to the fact the co-occurring psychiatric illness, also called a dual-diagnosis disorder, is common among addicted physicians. A substance use disorder in conjunction with a simultaneous major depressive disorder, anxiety or panic disorder, or bipolar disorder, can sabotage the physician’s recovery from addiction – if both disorders are not treated concurrently.
Cognitive screening is also conducted. This is because there is often substantial memory and cognitive impairments in doctors with alcohol or methamphetamine dependence.

Getting to the treatment phase, the addicted doctor needs to be in a program that specializes in the treatment of physicians with dependence or addiction. Detoxification is a necessary first step prior to initiation of any treatment. The alcohol and/or drugs have to be out of the doctor’s system before formal treatment begins.

Most treatment programs aimed at addicted doctors have curricula that are similar to treatment for addicts in the general population, although there are specific therapeutic modalities that are targeted at physicians. With the addicted doctor treatment program, then, the doctor can expect to participate in individual and group psychotherapy, addiction education (learning about the disease of addiction), and peer fellowship.

Most physician-oriented substance abuse treatment programs are abstinence-based and adhere to the 12-Step program philosophy. Addicted doctors will attend 12-step groups, such as Alcoholics Anonymous or Narcotics Anonymous, as part of their overall treatment program.

Doctor-specific modalities include group meetings with multiple addicted-physician peers. In fact, this is a primary feature of treatment programs for doctors with substance addiction. During these meetings, the addicted doctors learn how to recognize their own addictive behaviors. Their peer discussions cover such issues as problems with licensing, guilt and shame, dealing with patients, access to addicting medications, and the often-thorny issues around returning to work.

The treatment plans are tailored to the specific addicted doctor and are crafted to align with the goals of the patient – i.e., to get clean and sober – as well as their employers, the state PHP, and other interested parties (which may include the Drug Enforcement Administration, for example). Recommendations include attendance at self-help meetings post-treatment, as well as continuing therapy, monitoring and any workplace limitations.

Returning to Work

Should the doctor return to work following treatment for substance use or addiction? The research shows that doctors who successfully complete treatment for addiction and participate in rehabilitation programs have a very high abstinence rate. These abstinence rates range between 74 percent and 90 percent, which is similar to the higher-than-average abstinence rate of airline pilots.

Returning to work generally requires the doctor to sign a mandatory contract with the state PHP, involving monitoring, random and for-cause drug screening, workplace education and monitoring, and so on. Failure to comply with the program may result in reporting to the state medical licensing board, disciplinary action, possible public disclosure, sanctions, and suspension or revocation of license to practice.

Some doctors, before they can return to work, will have limitations placed on their ability to prescribe medications, particularly opioids or other addicting medications.

In the case of anesthesiologists who are addicted, who have access to and use of highly addictive drugs, following treatment their professional activities may be limited to nonclinical roles. They may be directed to a new practice specialty or to roles such as teaching, research or administration. This is because the relapse rate for anesthesiologists is very high and is associated with a consequent high risk of death.

In Conclusion

There is no doubt that addicted doctors can cause great harm to their patients if they continue to abuse substances and no one intervenes. It is not in the best interests of anyone concerned to allow an addicted physician, or one that is suspected of having an addiction, to continue to practice as usual.

While the hurdles to getting an addicted doctor to acknowledge the problem and accept treatment may be high, the success rate for doctors who do successfully complete specialized treatment for their addiction and also participate in self-help meetings, monitoring and continuing peer and other therapy is encouraging. These doctors are highly motivated to be able to return to the practice of medicine.

As it is true of addiction in any individual, the addicted doctor has no guarantee of continued abstinence. It takes continued dedication, vigilance and hard work to ensure sobriety is maintained. But it can be done. Thousands of addicted doctors have gone through substance abuse treatment programs successfully, completed their PHP contracts, and have returned to work.

But is it really recovery, or is using methadone just a substitute addiction? Let’s explore the subject further.

What is Methadone?

Methadone is a synthetic narcotic pain reliever with effects similar to morphine. Methadone is also used to help reduce the withdrawal symptoms in people addicted to heroin and other narcotic drugs without producing the “high” associated with those narcotics.

Most opioids are derived from the opium poppy, and include heroin, morphine, codeine, and hydrocodone. Methadone, on the other hand, is totally a synthetic opioid. Even though it is structured dissimilar to naturally derived opioid products, methadone nevertheless acts on the same sites in the body as the other opioids. It’s for this reason that methadone has been used in the treatment of heroin addiction.

What is different about methadone versus heroin and other opioids? For one thing, the onset is slower and it lasts longer in the body. Methadone is usually taken orally as a syrup, rather than by injection.

But methadone is still a narcotic, and it is addicting. Granted, it is less addicting than heroin or other opioids, but addiction is addiction. Why substitute one addictive substance for another?

There isn’t the rush that’s associated with heroin, and the withdrawal phase is not as severe. This is the primary reason many heroin addicts choose methadone as a kind of middle ground between heroin use and total abstinence. Indeed, going “cold turkey” from heroin addiction is almost never successful. Addicts are simply unable to tolerate the severe withdrawal pain and the cravings are insurmountable. It’s far easier to just revert to heroin use.

How Methadone is Used

Tapering off and gradually reducing the dosage of methadone is one way of kicking the heroin habit. Another use for methadone is as daily maintenance. Why would someone choose methadone maintenance? Using methadone in this manner allows the heroin addict to try to rebuild parts of their lives that have been damaged by heroin addiction. It’s not a perfect solution, but it can be useful as a temporary one.

Still, methadone is not a safe drug, as many accounts and numerous studies have found. It is a Schedule II narcotic under the Federal drug classifications, requires a special license to dispense, and carries a high risk of dependence.

Brand names of methadone include Amidone®, Methadose® and Dolophine®.

Side effects of methadone, depending on dose, include dizziness, drowsiness, constipation, lethargy, lowered respiration rate and elevated mood.

Methadone can also serve as a gateway drug for other narcotics. Another reason methadone isn’t safe is that it is dangerous in combination with alcohol and other types of drugs an individual may be taking, particularly barbiturates. Both alcohol and barbiturates act on the central nervous system

Why Methadone is not Recovery

Many addicts do not like methadone and will use the synthetic opioid only until they can return to using heroin, or when they procure a regular supply of heroin once again.

Methadone can also be considered a way to extend addiction, rather than going through the withdrawal that is necessary to get addictive substances out of the body. Extending addiction puts off the likelihood that a person will go into treatment to overcome addiction to heroin or other opioid drugs.

When a patient is dependent on methadone, it should always be dispensed with an approved treatment program. Such a treatment program should also include testing to ensure that the patient doesn’t continue to use heroin on the side.

Methadone use has other side effects as well, which may cause problems for the individual. He or she may be refused a job because they are on methadone and the job includes operating heavy machinery or equipment for which mental alertness is necessary. It is also possible that the individual’s employer will find out about the methadone use, especially if an insurance company is paying for the methadone treatment.

Newer Drugs for Treatment of Heroin Addiction

While methadone is the oldest treatment for heroin addiction, there are newer drugs that have been approved by the U.S. Food and Drug Administration (FDA) for treating opioid addiction.

One of these drugs is naloxone, marketed as Suboxone, which the FDA approved for opiate treatment in 2002. With methadone, a patient has to travel to a clinic to receive a daily dose. With Suboxone, doctors can prescribe a month’s supply of the drug, which is much more convenient for many individuals.

But methadone is less expensive than Suboxone and is more widely available.

Buprenorphine is another drug that has been FDA-approved and is useful in helping to block cravings. The combination of buprenorphine and Suboxone has proven effective in some patients.

Another medication-assisted therapy for opioid dependence is naltrexone, although studies have found that naltrexone treatment is poor except for highly-motivated patients under strong external pressure to comply with treatment regimen. With the introduction of once-monthly injectable formulations, such as Vivitrol, however, this situation may be changing. Vivitrol has been approved by the FDA for preventing relapse to opioid addiction.

Treatment for Opioid Addiction

If methadone or Suboxone and buprenorphine are helpful in allowing an individual to better manage opioid withdrawal symptoms while they are getting treatment to overcome addiction, what kind of treatment works best?

Traditional treatment for opioid addiction includes a period of detoxification (also called detox), followed by counseling and therapy that are designed to help the patient stay off the drug. There are also specific therapies that include Chinese medicine, hydrotherapy, mindfulness meditation and spiritual counseling, restorative yoga, nutritional wellness and detoxification juicing, hypnotherapy, massage therapy, dry sauna, and EEG biofeedback (neurofeedback).

How should you go about finding treatment for opioid addiction? You can start by asking your doctor for a recommendation to a treatment facility that specializes in treating patients addicted to heroin.

Office-based opioid treatment providers often refer their patients to substance abuse counselors, social workers, psychologists or nurses for counseling, but physicians can also provide counseling to their patients as part of medication management. Weekly urine testing early in treatment has been recommended by most clinicians. That is because it is expected that patients will have at least some ongoing use. Prescription intervals can be used as a contingency to help motivate patients to abstain from opioid use, or at least spur them on to a recovery trajectory.

Another avenue to finding therapy is to use the Treatment Facility Locator (http://dasis3.samhsa.gov/) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). This is an online searchable directory of drug and alcohol programs showing the location of facilities around the country that treat alcoholism, alcohol abuse and drug abuse problems.

Included are listings for residential treatment centers, outpatient treatment programs and hospital inpatient programs for drug addiction and alcoholism. Select “Detailed Search” and click the box for specific services desired to search for treatment facilities offering such services in addition to detoxification and treatment (including counseling).

Heroin relapse rates are quite high which often necessitates repeated stints in rehab. For this reason, recovery from opioid addiction is usually considered an ongoing process.

In combination with treatment, participation in various 12-step self-help groups such as Narcotics Anonymous is strongly recommended. Indeed, most treatment programs include mandatory participation in 12-step meetings as part of the overall treatment plan.

Outcome for Opiate-Dependent Individuals Entering Treatment

While the path toward recovery from opioid addiction may seem uncertain, with relapse rates high and multiple stays in rehab often required, the outcome is not negative. Indeed, with each treatment stay completed, patients do seem to make progress, according to numerous research studies.

The fact that many opioid-dependent individuals also have other substance abuse problems, specifically alcohol abuse or addiction, and/or use of cocaine or other illicit substances, along with possible co-occurring mental health disorders (including depression, anxiety, bipolar disorder and others), means that it may take longer for the comprehensive treatment to begin to work effectively.

Bottom line: If you are addicted to heroin or OxyContin or other opiates, going into treatment, sticking with it, and developing a strong support network will put you on the road to recovery. It may take you a while to get there, but you can and will see progress as long as you remain committed to sobriety and do the hard work necessary to maintain it.

Is recovery worth it, no matter whether you go the methadone route or another of the FDA-approved treatments for opiate addiction, coupled with counseling, 12-Step meetings and so on, of course? Only you can decide. But your future very much depends on your decision. Why wait? Seek help today so that you can begin to learn how to overcome what very likely is impacting your life in a negative way.

Although Xanax abuse occurs by individuals of all ages, there is a growing problem with young people who are using this powerful depressant for recreational purposes. Combined with the ease of getting the drug without a prescription, this has led to Xanax being one of the most abused prescription drugs on the market today.

Xanax’s Appeal

Xanax is a member of a class of controlled medications known as benzodiazepines. Drugs in this category affect the brain and nerves in order to create a sense of calmness. They can also produce a feeling of euphoria. This euphoric feeling is what makes Xanax so appealing to those who abuse it. They seek the high Xanax can produce and use the drug for recreational purposes rather than a medical treatment.

The euphoric feeling from Xanax is further enhanced when the pills are crushed into powder and inhaled. The more they use the drug, the greater their tolerance to its effects become. As a result, they need increasing amounts of the drug in order to get the same high. The increased use typically creates a physiological dependency on the medication. In many cases, a full blown addiction develops that can be difficult to overcome.

Accidental Xanax Abuse

Xanax abuse also occurs in individuals who have been prescribed the medication, often by accident. Xanax may be prescribed for use in patients who are experiencing acute anxiety in order to give them short-term relief. Because of its intense addictive properties, it is not meant to be used for more than just a few weeks at the most. However, more and more people are becoming reliant on Xanax to keep them calm on a regular basis. This has led to an increasing number of people who abuse it by getting additional prescriptions from other physicians – “doctor shopping” – until addiction prevents them from discontinuing the medication.

Xanax is generally considered safe, and produces only mild side effects such as drowsiness or light-headedness when used in the intended and prescribed manner. However, the potential for abuse increases with extended use. Because the amount needed to get the euphoric results increases, so do the risks from side effects.

Two Types of Addiction

There are two different types of addiction including physical and psychological. Xanax abuse can lead to both. It is physically addictive because of the direct effect that it has on the brain. Physical addiction results in potentially dangerous withdrawal symptoms that occur when the individual abruptly stops taking the drug. The psychological addiction comes from the instant relief from anxiety that the individual comes to rely on. It can also come from the gratifying feeling of euphoria that it produces for those who use it recreationally.

Problems with Discontinuing Xanax

When regular Xanax abuse leads to dependency or addiction, stopping the medication suddenly is very dangerous. It can cause the brain to become overactive, resulting in serious withdrawal symptoms. These include:

• Heart palpitations
• Nausea, vomiting, and diarrhea
• Depression
• Sensitivity to light or sound
• Memory loss
• Rapid heartbeat
• Hallucinations
• Changes in personality
• Anxiety, tension, or panic attacks
• Seizures
• Death

Seizures are the one of the most dangerous withdrawal effects from abruptly stopping Xanax after using it for an extended period of time. This is why it is so important to gradually decrease the dose under a doctor’s supervision. However, since many people who are abusing the drug have obtained it illegally or are ashamed that they’ve become addicted, they are hesitant to seek help to discontinue it. As often occurs with drug abuse, they continue using it. Without professional help to wean them off the drug, the potential for stopping Xanax abuse is unlikely.

Easy Access

While some individuals abuse Xanax by seeking additional prescriptions once their current one expires, others have no difficulty getting the drug in the quantity they desire in order to self-medicate. There are thousands of websites where you can purchase Xanax online without a prescription. The combination of its use as a party drug and the ease with which it can be obtained has made it a very widely abused prescription drug. Even though the largest group of Xanax abusers is comprised of young people seeking recreational drugs, people of all ages – including seniors – abuse it as well.

There are additional dangers when purchasing Xanax over the internet or from vendors in foreign countries. Just as distribution laws differ from one country to the next, regulation of ingredients may also vary. Drugs obtained online may contain unsafe ingredients, including other types of drugs that may be even more dangerous and/or addictive than Xanax.

Effective for Short-Term Use

Although the potential for addiction is always present when taking Xanax, it does provide a good treatment option under some circumstances. Anxiety disorders can be potentially devastating and greatly reduce a person’s quality of life. If used properly, Xanax can restore quality of life without causing any detrimental effects. While it is not intended for extended use, the need for the drug helps keep it available and accessible to those who may abuse it.

High Risk for Addiction

Xanax should never be used as a recreational drug, particularly in conjunction with other drugs and alcohol. Repeated users who become tolerant to the drug and continue to increase their dose have a high risk for overdose. Even if they are using the drug for its intended purpose, they may not realize how potentially addictive it is.

No one should hesitate to get help if an addiction or dependency develops, regardless of whether it’s from prescription or recreational Xanax abuse. The longer it persists, the more difficult it becomes to treat. Like many other addictive substances, Xanax addiction should be treated with a combination of detox and counseling for best results. The proper treatment will help people overcome their addiction and prevent relapses in the future.

One by Portia de Rossi, Unbearable Lightness: A Story of Loss and Gain, while a couple of years old, is still a fascinating read and a book that can provide not only a comprehensive insider’s view of what it means to have an eating disorder, but also how to find one’s way out of the vicious cycle.

Who is Portia de Rossi? As readers of the book will discover, if they don’t already know, she is an actress best-known for her portrayal of an all-competent, successful female attorney on the popular TV series, Ally McBeal, now cancelled. Her character on the show, Nelle Porter, was in sharp contrast to the anxiety-ridden, shy and self-conscious Portia de Rossi.

What would happen, of course, should be familiar to others who struggle daily with an eating disorder: de Rossi engaged in a constant fixation on counting calories, measuring every morsel of food that went into her mouth, bingeing and purging in an obsessive compulsion to become even thinner. At the time she collapsed on the set of Ally McBeal, de Rossi weighed a scant 82 pounds. Eighty-two pounds! That’s barely enough to be alive, let alone walking around.

The thin, blond, glamorous actress looked to the entire world the successful, happy star of the hit TV show. On the inside, it was another matter altogether. Portia de Rossi wasn’t happy at all. In fact, she was literally close to dying.

How she got to this point is, once again, all too familiar to those who also suffer from an eating disorder. Here are de Rossi’s own words, describing how she became anorexic: “I didn’t decide to become anorexic. It snuck up on me disguised as a healthy diet, a professional attitude. Being as thin as possible was a way to make the job of being an actress easier…”

It took years of the same kind of fixation on becoming thinner, of self-loathing at her reflection in the mirror, of feeling not good enough, not pretty enough, certainly not thin enough to ever compete with other girls and, later, women.

Rituals became de Rossi’s best friend. She had to eat out of certain dishes. The arrangements had to be just so. She would literally starve herself and then binge to reward herself following completion of a certain goal – like being able to fit into the perfect sample size six. How agonizingly close to what some of us have known. Here’s the real deal, someone who’s been there and come back from the edge.

But, of course, coming back isn’t easy. It’s not easy for anyone, not even a glamorous celebrity like Portia de Rossi.

In Unbearable Lightness: A Story of Loss and Gain, we’re treated to a story told by an individual with a keen sense of detail, a fine wit, and one who relates what happened, how tormented and anxious she felt, how completely out of sync with whom she was supposed to be, and how she ultimately found the courage to climb back from her close brush with death, literally.

De Rossi, an Australian native, went on to appear in Arrested Development and Better Off Ted. Some may know that de Rossi is a lesbian, married to Ellen DeGeneres. In fact, de Rossi is an outspoken advocate for both gay rights and women’s health issues.

Here’s another reality that those suffering from an eating disorder may know all too well. If we try so desperately to push down and keep hidden from view a secret we’re afraid will destroy us, we will likely succumb to one or another type of addictive or obsessive behavior. For Portia de Rossi, it was an eating disorder, her way of coping with the fear that others would discover the truth of her sexuality. For others, it could just as easily be alcohol or drug abuse as the drug of choice to hide from this or that unbearable truth. If we can’t find means to cope, if we cannot find ways to boost our self-esteem, something has to give.

Not everyone will find themselves in such a position. Who’s to say which person will use food (or the deprivation of it) as a coping measure, or turn to alcohol or drugs, or gambling or compulsive sexual behavior, or workaholism? We each find our way through life, and none of us chooses the same path.

Still, the fact that we can be undone by our behaviors and then find a way out of it so that we become healthy, productive and happy individual is a testament not only to the human spirit but our own uniqueness. The account of Portia de Rossi’s struggle to be whole and complete – for the first time in her life – is one that should both encourage and inspire all of us.

So, the next time any of us with a yen to be super-thin hear that little voice – okay, that incessant, harping voice – inside our head telling us that we’re not good enough, not thin enough, not pretty enough, not anything enough, tell it to shut up. Then recognize that there’s more to life than obsessing over what the mirror does or does not seem to show us. Life is about living, not being a rail-thin, near-death corpse that somehow still looks good.

Portia de Rossi is living proof that there is life after such misery. And it’s incredibly more happy and healthy, at that. Can we all relate? Let’s look at it this way: If she can do it, we can too. Thankfully, Unbearable Lightness: A Story of Loss and Gain is a brutally honest, and heartfelt look at the way back.

Although I’m not a doctor, it was impossible to sit at home in front of my television that night and not fear for the safety of those wading in to the gray ash cloud that hung over lower Manhattan. Very few wore actual respirators; some wore no face coverings at all. Commentators spoke about how the steel on the Towers was supposed to be protected by fire-retardant asbestos, but few pointed out that this same cancer-causing asbestos was now flying around downtown. During those initial hours and days no safety equipment was available and few of the responders considered the potential consequences on their long-term health in the frenzy to rescue friends and family. Now we know that participation in the Ground Zero rescue, recovery and clean-up efforts has made these heroes sick, both physically and mentally.

Many first responders either knew people who worked in the Towers or had co-workers who got trapped when the buildings fell. In addition, those on the scene while the buildings still stood witnessed horrific scenes of “jumpers” from above hitting the ground or, worse, hitting those who were trying to help. Firefighters of the FDNY lost 343 “brothers” that day. Nobody can walk away from these situations completely whole.

To be blunt, the FDNY failed to adequately treat personnel for PTSD and other emotional issues related to 9/11 and, much like the US military, actively sought ways to get rid of those who had been harmed on the job.

In the immediate aftermath of the tragedy, graduate student interns from various mental health facilities were charged with counseling firefighters, providing little relief and often making things worse. These jobs lasted no more than six months, as internships ended and new students rotated through, requiring the therapeutic relationship to begin anew.

In addition, the FDNY Counseling Services Unit (CSU) did not promise to keep information gleaned during sessions confidential and was located above a firehouse, in full view of peers. These issues caused many to shun the program; only 5% surveyed indicated that they would get professional help for substance abuse problems. Which, it turns out, was a good thing, as FDNY offered very little in the form of substance abuse treatment for these workers.

Although cases of PTSD and depression were anticipated, medical professionals who were involved with treatment of 9/11 first responders noticed a gradual increase in the incidence of alcoholism and drug abuse after the attacks. Many had been self-medicating to avoid remembering the images; others suffered acute episodes after new traumas such as a death in the family. In 2004, there were 50% more FDNY firefighters and EMS workers treated for drug and alcohol addiction than in 2003. In the seven years after 9/11, twelve firefighters died from accidental overdose, and suicides were at unprecedented levels.

The Smithers Institute at Cornell University undertook a study to determine how the events of 9/11 affected emergency personnel. It found that FDNY personnel were twice as likely to develop alcohol problems than the national average and that over 25% were at risk of developing moderate to severe drinking problems. Disturbingly, FDNY brass has been accused of terminating for substance abuse violations those very same people who risked their lives on 9/11 and were self-medicating to treat their PTSD.

In 2004, right around the time that first responders were exhibiting signs of trauma-related substance abuse, the FDNY commissioner implemented a Zero Tolerance policy. Many first responders who were self-medicating with alcohol or drugs failed surprise drug tests and were told to leave quietly or risk public outing – none were given the option to enter treatment. Many were left without health insurance and with no way to get treatment on their own.

The first 9/11 Victim Compensation fund focused on providing economic support to the families of those who died and to those where injured directly as a result of the events. Cases were settled over the course of a few years and the fund was closed. However, we now know that many of the illnesses suffered by first responders took years to manifest, leaving these heroes with little in the way of compensation for their losses. Some have now lost their jobs as a direct result of their emotional scars.

Thankfully, and after much prodding, The US Congress recently passed The 9/11 Health & Compensation Act of 2010. This new fund recognizes that first responders have serious physical and mental problems as a result of their participation that were not necessarily observable before the first compensation fund closed. Congressmen from New York led the way in making this bill a reality, including the now infamous Anthony Weiner. The Act makes certain that first responders will receive specialized health care and compensation over the next five years. There are twenty-two covered health conditions covered by provisions of the new Act. In addition to respiratory issues, mental health conditions such as PTSD, depression, panic and anxiety disorders, and substance abuse are also covered. The Act also reopens the Victim Compensation Fund of 2001 and adds $2.5 billion to the bank account; as before, compensation awards will be decided by a Special Master.

A recently published study, conducted over the previous 10 years, investigated how diet sodas affected five hundred men and women. The results were presented at the American Diabetes Association’s (ADA) recent Scientific Sessions. The subjects who drank 2 or more cans of diet sodas per day gained five times as much around their waistlines as those who did not drink diet soda. All diet soda drinkers saw their waistlines expand at a rate of approximately 70 percent faster than those who did not drink diet soda. Surprisingly, even those who drank regular, sugary, soda did not gain as many inches as the diet soda drinkers.

How is it possible that a near calorie-free substance could make us fat? One professor at the University of Texas claims that diet sodas, and the artificial sweeteners that they contain, make us crave sweets, increase appetite, and may even damage cells within our brains that control feeling full. When we taste sweet and sugary foods, our brains are wired to expect a comparable amount of caloric intake and release insulin accordingly. Thus, the body will not bother to turn fat into needed energy and we will need to continue eating until the promised calories are delivered. Because diet soda does not deliver these calories, however, the brain becomes confused and craves food. Unlike regular sugar, artificial sweeteners do nothing to satisfy the appetite that has been generated; in fact, they make the person hungrier than before they drank the beverage. To make matters worse, artificial sweeteners are not used solely in diet sodas; the majority of yogurts bought in the supermarket also contain the stuff.

For years I was addicted, yes addicted, to Diet Coke but switched to Diet Coke with Splenda once I learned how bad aspartame (NutraSweet) can be. Studies indicate that aspartame can mimic symptoms of multiple sclerosis, Parkinson’s disease, and a host of other neurological disorders. Once my shaking started waking me up at night, I knew that I had to find an alternative. Research on mice has revealed that aspartame, the most common sweetener in diet sodas, can damage the pancreas to the point where fasting glucose values skyrocket to diabetic or pre-diabetic levels. Other research suggests that artificial sweeteners slow down the body’s metabolism and release insulin, which leads to weight gain.

But, as I mentioned, I’m primarily a Splenda drinker, not an aspartame drinker. So, why is Diet Coke not helping me lose weight? Well, even though Splenda is made from sugar, it turns out that the brain does not treat Splenda (sucralose) the same as it would treat regular sugar. In fact, it treats Splenda just like it treats aspartame. Sadly, a University of California, San Diego study of twelve women confirmed this hypothesis. Each woman underwent a functional MRI exam while sipping both sugar water and water sweetened with Splenda. Although both substances affected the taste and pleasure centers of the brain, the sugar affected the pleasure centers more than the Splenda. Another study on rats found that those who consumed Splenda put on more weight then the control group.
When the brain fails to detect the calories promised by the Splenda, we will need to consume more food in order to satisfy it.

So, should we switch back to regular Coke? Probably not. Today’s regular soda is not the same as it was thirty years ago, before Diet Coke came along. Back then, Coke was made with real sugar. Today, most “regular” sodas are made with high fructose corn syrup (HFCS). HFCS is made by converting glucose (real sugar) into fructose in order to provide a sweeter taste with less cost. HFCS is almost everywhere in the American diet – breads, cereals, yogurts, soups and drinks. Studies have suggested that much like artificial sweeteners, high fructose corn syrup interferes with the body’s normal appetite functions and causes more weight gain that actual sugar.

If plain water isn’t your thing, you may want to try water sweetened with natural ingredients, such as real fruit juice or mint.

Lead researcher Dr. Russell Callaghan—a specialist in social and epidemiological research at CAMH—and his team conducted a longitudinal cohort study following the progress of more than 280,000 patients from California where methamphetamine abuse is significantly more prevalent than most of the country. For the study, the researchers included individuals over the age of 30 who were admitted to statewide inpatient hospitals for methamphetamine/amphetamine abuse-related conditions, and tracked their health status for up to 16 years between 1990 and 2005. A total of 40,472 patients were identified as having methamphetamine/amphetamine abuse-related conditions based on their admissions or death records during the study’s time frame. For comparison, the researchers matched the methamphetamine group with a representative population group consisting of 207,831 patients who were admitted for appendicitis, as well as a drug control group of patients admitted for cocaine-use disorders (35,335 patients). All of the patients were matched based on age, race, gender, date of admission, and number of admissions in order to make similar comparisons. Overall, the researchers sought to identity whether a history of methamphetamine/amphetamine abuse raises one’s risk for Parkinson’s disease, which is typically not diagnosed until later in life.

As a result of their analysis, the researchers found that the methamphetamine group was 76% more likely to develop Parkinson’s disease in later life than both the cocaine group and the appendicitis population group. Additionally, the cocaine group did not show an elevated risk of Parkinson’s disease when compared to just the appendicitis population group. Within a ten-year span, the researchers found that 21 in 10,000 individuals who abuse methamphetamine will develop Parkinson’s disease in middle or old age, yet only 10 in 10,000 individuals from the general population will end up developing Parkinson’s disease in later life.

Furthermore, the researchers caution that the methamphetamine abuse–Parkinson’s disease link may be even higher than indicated by their data since many individuals who abuse methamphetamine do not receive medical treatment due to lack of health insurance, and therefore were not accounted for by the study. The researchers also comment that prescribed use of amphetamines, such as that for attention deficit-hyperactivity disorder, is not associated with this increased risk since these prescriptions contain very low amounts of the substance compared to abused levels. The new study confirms similar findings discovered in previously conducted animal studies that identified an association between methamphetamine abuse and higher risk for Parkinson’s disease in mice.

Methamphetamine and amphetamine-like drugs make up the nation’s second leading type of illicitly abuse substances. Callaghan and his colleagues suggest their study is evidence of yet another long-term consequence of methamphetamine abuse, of which clinicians should inform their patients with methamphetamine/amphetamine abuse-related conditions.

The study is currently available online in the journal Drug and Alcohol Dependence.

REFERENCES/RESOURCES:

Callaghan, Russell C., James K. Cunningham, Jenna Sykes, and Stephen J. Kish. 2011. Increased risk of Parkinson’s disease in individuals hospitalized with conditions related to the use of methamphetamine or other amphetamine-type drugs. Drug and Alcohol Dependence. DOI:10.1016/j.drugalcdep.2011.06.013. Available online July 26, 2011: http://www.sciencedirect.com/science/article/pii/S0376871611002766.

http://www.medicalnewstoday.com/articles/231844.php

http://www.camh.net/research/scientific_Staff_profiles/bio_detail.php?cuserID=93

http://www.webmd.com/parkinsons-disease/default.htm

Faced with a shortage of medical professionals trained to combat America’s rising substance abuse and alcoholism epidemics, the medical establishment was forced to acknowledge that lack of training opportunities for non-mental health doctors makes early intervention for substance abuse nearly impossible. These same leaders have also had to acknowledge that lack of respect for addiction as a bona fide area of practice contributed to the problem.

In the past, even medical doctors debated whether addiction to alcohol was more a lack of willpower and less of a physical ailment like high blood pressure, which needs ongoing monitoring and treatment. This unwillingness to accept substance addiction as a bona fide medical disease was likely a result of lack of understanding of the brain and has been replaced over the last fifteen years by knowledge gained from studying MRI scans of addicts. There is now an acknowledgment that addiction to drugs or alcohol results in physical brain changes. The good news is that, because there is a physical component to addiction, managing the disease with medicine and therapy could eventually be as standard as caring for those with diabetes or other chronic illnesses.

The American Board of Addiction Medicine (ABAM) was founded in 2007 in order to encourage treatment of addiction within general medical practices. ABAM’s goal is to eventually get addiction medicine accredited by the Accreditation Council for Graduate Medical Education so that the specialty would be treated as a primary residency that would be started after graduation from medical school. As a first step to accreditation, the addiction medicine program must be adopted at a minimum of twenty medical schools across the country.

The first group of ten medical schools has recently unveiled their own, novel, year-long residency programs in addiction medicine; to qualify for a spot, students will have to have finished medical school and their primary residency. The programs, which started at the beginning of July, will allow twenty students to study the interaction between addiction and brain chemistry or heredity. During the course of the addiction residency, students will care for people addicted to substances such as prescription drugs, alcohol, illicit drugs, and cigarettes. Medical schools in New York, Maryland, Massachusetts, and Pennsylvania will be participating. An additional ten schools are expected to join the program within the next year.

Although each school has been left to develop its own curriculum in addiction medicine, training will focus on recognizing and diagnosing substance abuse among their patients and carrying out brief interventions to discuss treatment options for detoxification and recovery. Students will also be trained on various legal and everyday consequences of addiction.
Another focus of the new addiction training will be overcoming the belief that the majority of addicts can attain lasting recovery with just one month in rehab. Given the permanent physical changes that take place in the brains of some addicts, this is just not realistic. Instead, the doctors in this new residency program will be taught that treatment for addiction does not necessarily result in a cure. Instead, patients must remain under routine care of a doctor in order to avoid relapse.

Although few addiction professionals believe that recovery can be attained solely by ingesting anti-addiction drugs, many have come to believe that pharmaceutical intervention combined with therapy, like self-help or 12-step programs, provides many addicts the best opportunity for getting and staying clean. Drugs like methadone and buprenorphine (Suboxone) have been shown to block cravings and lessen withdrawal symptoms in those addicted to opioids. The interaction between drug therapy and mental health treatment will be just one of the topics under investigation during the new addiction residency.

A challenge for every residential addiction treatment center is the client that suddenly glazes over and announces to his or her treatment team that it is time for them to go home, despite the fact that it is only Day 9 or day whatever of their 30 day program. Sometimes they are glazed and dazed. Sometimes they are highly agitated. Studies show that the longer the client stays in treatment, the better their outcomes. But how do you help that client who suddenly decides they don’t need treatment?

In the past, the standard reaction to AMAs (leaving against medical advice), was to say, “Susie hasn’t hit bottom yet,” “Joe needs to want recovery more,” and similar statements. The truth is, some of those people might not make it back to treatment because addiction is a powerful, and sometimes deadly, disease. What if there was a way to help these clients focus and overcome the fight/flight response they have while in treatment and in early recovery?

Enter EEG Biofeedback, also known as Neurofeedback. At Promises Treatment Centers, we have made Neurofeedback an elemental part of addiction treatment, and it has been immeasurably helpful for clients who have a tendency to bolt from treatment.

Before we discuss further how Promises uses Neurofeedback, let’s discuss what it is exactly.

EEG biofeedback and neurofeedback are synonymous terms. This treatment modality utilizes audio and visual feedback to guide over and under aroused brainwaves, as well as unstable brainwaves, into a more effective mode of operation. Individuals with symptoms and diagnoses as broad as substance abuse disorders, ADD/ADHD, affective disorders (depression, bipolar, anxiety), insomnia, hypersomnia, chronic pain, and traumatic brain injuries can be effectively and measurably helped with EEG Biofeedback.

There is frequent confusion between EEG Biofeedback and Peripheral Biofeedback. Peripheral Biofeedback teaches people how to make seemingly involuntary bodily processes, such as body temperature, voluntary. For example, an individual with chronically cold extremities can learn to voluntarily warm their hands and feet. In the case of brainwave training, or EEG Biofeedback, making brain functioning voluntary is never the objective since the learning happens in the brain, not the mind. Clients simply need to focus and relax while the software teaches their brain, the organ, how to better self-regulate. The objective is to train your brain to automatically be more effective and efficient for the task at hand.

At Promises, we start Neurofeedback sessions as soon as the client is stabilized after detox. If we see within three sessions atypically heightened alpha amplitude, we know that client is at risk to leave Against Medical Advice. We know before the client is even formulating his or her exit strategy that the flight/fight response is kicking in. With appropriate intervention – peer support, clinical interventions, a 12 step meeting, more biofeedback, meditation, everything we offer – we can help the client relax and focus on treatment. If we can’t get them to complete treatment, we can’t help them.

The importance of this information is far reaching. It proves that old beliefs about needing to hit a worse bottom or needing to want it more are simply not accurate. The addicted brain responds to treatment strategies with heightened alpha amplitude, a fight or flight reflex. The addict wants to use drugs. Treatment is about not using drugs. When an individual chooses to leave treatment prematurely and they appear highly agitated or glazed over, they are often quite literally in an altered state of mind – in fight or flight -and without an intervention that meets them where they are it will prove ineffective almost every time.

A study, “Effects of an EEG Biofeedback Protocol on a Mixed Substance Abusing Population,” by William C. Scott, David Kaiser, et al., and published in the American Journal of Drug and Alcohol Abuse, showed significantly improved treatment outcomes for those clients who received neurofeedback vs. those who did not during a 12-week residential treatment experience.

Why Does EEG Biofeedback work on addictions and prevent fight/flight response? For the addicted brain, the threat of ongoing recovery triggers the survival cortical defensive bypass (“If I don’t get my alcohol/cocaine/Oxy I will die!” might be the false survival message they get), but EEG biofeedback trains the cortex to avoid this reactive state. This causes it to integrate the treatment process more effectively. Essentially, the fight/flight response is soothed. One’s resistance to the principles of recovery becomes closer to the nonresistance one would have in following the instructions to set the clock on a DVD player. The unconscious reactions of “not feeling like” reading recovery literature, going to meetings, etc. resolve and there is a greater enthusiasm for recovery activities. Clients are far less likely to regress into primitive maneuvers in response to effective treatment strategies.

If EEG Biofeedback is evidenced based (It Is) Why isn’t it more prevalent?

Up until 3 years ago, equipment was not user-friendly—now there is equipment on the market, which is fully automated and highly effective. The symptom-based evaluation process was very difficult to learn and operator-dependent, therefore results were not consistent before automation. The QEEG methodology is labor intensive and quite expensive to administer. When a technician would leave it would take months to train a replacement. Now with automated symptom-based neurofeedback systems, a new technician can be trained to hook someone up within hours and can become proficient within weeks.

How many sessions does it take?

The broad answer is that it depends on the symptoms. That having been said: Individuals (children, adolescents and adults) with ADD/ADHD often begin to see results in focus and concentration within 5-7 sessions and will frequently conclude treatment in 25 sessions. Clients with anxiety disorders, unipolar depression and substance use disorders often benefit from a more lengthy course of treatment—often 40—45 sessions show tremendous (and permanent) change.

Bipolar depression, long term, chronic relapsers, migraine sufferers, and individuals with chronic pain will benefit from an even longer course of treatment. Although improvements will typically be experienced throughout the course of treatment, for these
conditions, more really is better. Sometimes as many as 75—100 sessions have been reported to be helpful.

How long is a session?

Each session is approximately 35 minutes, but beginning sessions are sometimes shorter in duration.

Shari Stillman-Corbitt, Psy.D., Senior Executive Director, Promises Treatment Centers, has enjoyed an adventurous career performing both clinical and administrative work. She was most recently Executive Director at TouchStone
Treatment Centers. Her past experience includes Clinical Director of the Indian Health Council, Inc. on the Rincon Indian Reservation in Pauma Valley, CA; Program Director at Casa Palmera, an Eating Disorders and Chronic Pain  Management inpatient treatment facility in San Diego, CA; and Clinical Director at Sierra Tucson. Originally from New York, she earned her Masters and Doctoral degrees from Yeshiva University in New York City. Her areas of specialization include the treatment of addictions, eating disorders, trauma, and personality disorders.