All posts by Scott

Major League Sports Needs To Get With The Program…

Addiction in the News Addictive Behaviors Alcoholism blog Drug Addiction Heroin Addiction Marijuana Legalization Prescription Painkillers

images-5No other system is entrenched in the idea of drug addiction being characterlogical then sports. Any issue with drugs is pegged with the cliches of addicts “waste of talent” “cheater” “undeserving of their talent” “a disgrace to kids”. What is never heard in the alcohol financed sports world is “disease” “Mental health issue” or “Pathology”. There was a time when Ryan Leaf was thought to be a once in a decade type quarterback, one of the greats. What could have happened if the NCAA and NFL had a comprehensive policy and program to deal with issues before they reach a crisis level. As it is, Ryan Leaf is another cautionary tale of lost potential working at a car dealership of maybe a high school coach if he can stabilize. The drug policy in professional sports is arcane and rooted in punishment. That is bad policy rooted in shame and the result is stories like Ryan Leaf’s.

www.espn.go.com/dallas/nfl/story/_/id/11495757/ryan-leaf-sentenced-5-years-prison-violating-probation

Joe Schrank

Drugs To Treat Drug Addiction???

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images-4So – is it possible that an effective treatment for drug addiction could be, well, drugs? The short answer is ‘probably’. Recent headlines have pointed out that there is a clear and significant drop in opioid-related overdose deaths in states where medical marijuana is legal. The Washington Post (8/25, Millman) reports in its “Wonkblog” blog that states that have medical marijuana laws witnessed “24.8 percent fewer deaths from painkiller overdoses compared to states that didn’t have such laws.”
There already exist a number of FDA approved medications that are useful to treat certain types of addictions. Suboxone (Buprenorphine) for example, is an opiate that is extremely useful for treating those suffering from heroin or painkiller addictions. Methadone is also a well-known medical approach. The FDA has approved three medications for the treatment of alcoholism – they are: Antabuse (Disulfiram), Revia (Naltrexone and Vivitrol) and Campral (Acamprosate). For nicotine dependence there is Chantix (Varenicline). So now there is evidence that smoking pot may be an effective treatment for opiate dependence –or, if not actual treatment, at least it may lead to a reduction in opiate-related overdose deaths.
In the world of addiction treatment, cultural change is as important as scientific advancement. If there isn’t a cultural shift in attitudes then the benefits of scientific discovery won’t take root – there needs to be external validity. American shame runs deep and so does our romance with the “just say no” fantasy that will never and can never be an effective treatment for addiction.
The fact is that most humans like intoxication – they always have and they always will. The trouble begins when they lose their ability to control or manage it, which creates a situation that sets many people up for a chronic problem.
If our only standard of “success” is an act of providence and a life spent listening to gossip in church basements drinking bad coffee and never being intoxicated again, then millions are set up to fail. Smoking marijuana is not a cure for opiate addiction. It is however, harm reduction. Better smoking weed than dead of an overdose. Maybe, just maybe, it’ll be a stepping-stone to a life of abstinence for some people. That’s 12-step “blasphemy” for sure, but it makes scientific sense and if you think about it, is it really counter to the idea of “faith in a power greater than yourself”? Certainly well researched science is a power greater than ourselves. It’s not even counter to faith – scientific inquiry can certainly be framed as a gift from God. What it isn’t is folklore and the homespun wisdom that many people connect to (and some are helped by) in 12-step life. Sooner or later, we need to drive treatment plans and drug policy based upon evidence and experience as opposed to unobtainable, idealized visions that don’t lead to sustained, clinical outcomes. The medical community needs to have a loud voice in that shift.
– Scott Bienenfeld, M.D.
– Joe Schrank

Robin Williams: Depression, Addiction, Open-Heart Surgery, Parkinsons…

Addiction in the News Addictive Behaviors Alcoholism blog Drug Addiction Heroin Addiction Marijuana Legalization Prescription Painkillers

Robin Williams is dead. Is this a shock? No. Is it a tragedy? Absolutely. Without knowing any of the details about his psychiatric treatment, from a purely statistical standpoint Mr. Williams had a number of risk factors that are often identified ‘after the fact’ in suicidal patients – he suffered from a serious mood disorder, addiction to drugs and alcohol and he had open-heart surgery which is well-known to be associated with severe depression even years later. Now we are finding out that he suffered from early stage Parkinson’s Disease.  images-3To the general public his comedic veneer and successful acting career probably made it seem like he was impervious to the ravages of depression and addiction – clearly a falsehood.
It’s fascinating that in the wake of his death, one of the immediate reactions among pundits and medical professionals is that “we hope that Mr. Williams’ death brings to light issues about depression and addiction and helps end stigma so that people come forth and get help.” The implication is that those who are too ashamed to ask for help for depression and/or addiction suffer the consequences. While we are all in support of ending the stigma associated with mental illness and addiction, the fact is that Robin Williams was totally open about both of his struggles not only with depression but also addiction. Without knowing any of the details about his illness or his treatment, it is difficult, if not impossible to speculate about exactly what happened to him. Yet it is possible that he survived as long as he did because he was open about his problems and received a good deal of help for them. The sad fact is, that people who have multiple risk factors for early death often die young. This is true for those suffering from illnesses like diabetes, cancer and heart disease, and it is also true for those who suffer from certain mental illnesses – primarily mood disorders and psychotic disorders – and certainly addiction.
While the field of psychiatry has its limits, one thing we know well is that the risks and consequences of major mental illness are real and severe, and are clearly exacerbated by the use of drugs and alcohol. We know that Robin Williams suffered from a mood disorder, either Bipolar Disorder or Unipolar Depression complicated by addiction – a combination that is possibly the most catastrophic of all the major mental illnesses. Whether or not he actually suffered from Bipolar Disorder or just “Unipolar” Depression is irrelevant – we will probably never know the exact details of his psychiatric treatment.
Bipolar disorder, otherwise known as Manic Depression is a disease of the brain characterized by major shifts in mood that vacillate between high energy manic states, periods of relative calm, and very low mood depressive and often suicidal feelings – it is a major mental illness that is almost entirely treated with medication. People who suffer from Unipolar Depression experience periods of severe depression, sometimes resulting in suicidal thinking that lasts for days to weeks or even months, followed by periods of relatively normal mood. The good news is this: with medication, therapy and avoidance of drugs and alcohol, many patients who suffer from both Bipolar Disorder and Unipolar Depression can keep the symptoms check and live a relatively stable life. The bad news: Many patients who suffer from these mood disorders are at a heightened risk of a number of tragic problems including suicidal behavior, substance abuse, violence, job loss, relationship problems and serious health issues.
The statistics are impressive: About 2 million Americans suffer from bipolar disorder with an equal distribution between men and women. Depression probably affects upwards of 20% of Americans at some point in their lives. In 2012, 16 million adults over 18 (6.9% of the population) suffered at least one Major Depressive Episode in the prior year. Up to 50% of patients who suffer from Bipolar Disorder make a suicide attempt at some point in their lives and about 10-15% succeed in killing themselves. Life stress, addiction, broken relationships, social isolation, physical health problems and medication non-compliance all increase the risk of suicide.
One of the major challenges patients suffering with Bipolar Disorder face is the need to continually take “mood stabilizing” medications despite that fact that they can cause feelings of “dullness”, and emotional blunting. They even need to take the medication during times of “euthymia” (normal mood). Many patients complain that “normal” living feels like depression to them – they enjoy and often thrive on the highs associated with manic behavior – which is often a source of creative and/or athletic genius. Many Bipolar patients stop medication despite their doctors telling them that they need to continue taking them, even when they are stable and doing well. They like being manic. Further complicating the picture is the fact that for many people, manic episodes, while ominous, can be a source of major creative and intellectual inspiration.
The fact is, Mood Disorders are chronic, relapsing, remitting diseases of the brain that require on-going treatment and monitoring by mental health professionals. Studies clearly show that every time a person suffers from an episode of mania or depression, the brain becomes somewhat de-stabilized which results in a more insidious course of the illness. That is, future episodes last longer, are more severe and come more frequently – thus the recommendation to treat these illnesses early and aggressively with medication, psychotherapy and cognitive behavioral therapy.
A final point about suicide: despite decades of serious research and study, predicting suicide, and other violent behaviors remains a difficult task since it is a relatively rare, though tragic problem. The problem is that while people who commit suicide almost always demonstrate a number of risk factors, the overwhelming majority of people with the same risk factors as Robin Williams, will never attempt or commit suicide or other violent behaviors.
We need to take depression, addiction and all mental illness seriously as diseases that require treatment. The behaviors associated with these illnesses are not simply “bad choices”, but manifestations of chronic brain problems that we are still trying to understand.

 

— Scott Bienenfeld, M.D.

“Andrea Peyser Is Addicted To Stigma”

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You probably don’t know who Andrea Peyser is because she isn’t widely known outside the New York City Metropolitan area. She is a daily columnist in the New York Post with a serious axe to grind with people who suffer from addictive disorders, and any type of substance abuse problems. In short, she believes that addicts are people who make bad decisions, and deserve the consequences they receive, even when the end result is overdose and death. Armed with an extensive amount of research about absolutely nothing, she not only pontificates about addiction but also prattles on about addicts, beating the same drum every time addiction catches her eye. Without any sense of compassion or empathy, Peyser regaled us with her ignorance in a February 9th, 2014 NY Post article when Philip Seymour Hoffman died ( http://nypost.com/2014/02/09/philip-seymour-hoffman-cast-as-a-victim-of-disease/) , and did the same this week when Kevin McEnroe, son of Tatum O’Neil and John McEnroe, was arrested on a serious felony drug charge (http://nypost.com/2014/07/16/tatum-oneals-sad-twisted-family-affair/) . Her non-clinical and totally biased opinion is that anyone from the addiction treatment community who dares to weigh in on these highly publicized cases are merely in it for their own secondary gain and self-aggrandizement. Peyser does not believe that addiction could ever possibly be considered a disease (really, Dr. Peyser?) but rather considers it to be simply selfish and poorly judged behavior – i.e. a “bad choice”. Her themes are consistent with the familiar refrain that people suffering with addiction ‘should stop’, ‘are selfish’, ‘are simply making bad choices’ ‘are lazy’, ‘are unable to learn their lesson’, and ‘deserve their plight’.
In her scathing February 9th, 2014 NY Post article about the death of Phillip Seymour Hoffman, she writes, “glorifying and enabling drug abusers is what those in the multibillion-dollar addiction industry do best.” I don’t even know what this means exactly. Isn’t it the duty of our treatment professionals to at least weigh in on national public health debates? It’s true – the addiction treatment arena is plagued by large numbers of ‘self-proclaimed recovery gurus’ with no or minimal training who proselytize that the only way to beat addiction is the way they did it. And yes, AA and other 12-step modalities may only help a percentage of those who are exposed to them. However, despite these problems, the past 10 years has seen the field of medical addiction research explode with fascinating discoveries about the ways that people suffering with addictive disorders have problems in the areas of the brain involved in making decisions and managing “reward”. Also, while not extensive, there have been promising advances in FDA approved medications that treat certain types of addiction. In short, the medical community takes the disease of addiction seriously, and instead of blindly opining, is studying the problem from many different angles. Admittedly, we have a long way to go.
Stigma3Yet whether we consider addiction to be a disease, a problem with underlying psychological conflict or both, the problem has reached the level of a public health crisis and it is killing people at an alarming rate.
Here are some actual statistics: The prescription drug problem has gotten to the point where more than 100 people a day nationwide die from drug overdoses, and about 6000 people a day are treated in emergency rooms for drug related problems. Drug deaths are now the number one injury-related deaths in the United States surpassing automobile accidents. Enough narcotic pain medication prescriptions have been written to medicate every American for an entire month and the cost of the prescription drug problem has been estimated to be over 50 billion dollars per year. The point is this: these are extremely complex socio-medical problems that cannot be boiled down to this many people “making a bad choice”. If anything, a “reporter” writing a NY Post article about the death of celebrities from addiction should be asking more questions about how to better address the problem, and what can be done to prevent such tragedies. If anyone is grandstanding here, it is Peyser, who is using high-profile drug deaths as a soapbox from which to spew her un-informed opinions and garner ratings for herself – a dangerous combination indeed.
We have challenged Peyser on several occasions to a public discourse on the subject of addiction. She has declined. When we observed that she was acting “cowardly” given her sure and steady knowledge and certainty on the subject of addiction, she replied with “Name calling won’t solve anything”. (By the way, one of her favorite names for addicts is “common junkie”. Peyser has responded to other questions by saying, “I am politely asking you to stop”. The schoolyard adage: you can dish it out but you cant take it clearly applies.
We have persisted in asking her additional questions:
Do diabetics who fall off of their management plans deserve amputations?
Do obese people deserve hypertension, heart disease, and type II diabetes?
And then of course there is HIV. Remarkably, roll the clock back 30 years and replace “drugs” with “AIDS” and Peyser’s logic is equivalent to those who believed that a generation of young people who “made their bed with HIV” do not deserve to be treated. Yes, that is what people thought. Scary.
Stigma1Should we as addicts and treatment providers just sit and be marginalized, shamed and judged by Peyser and people like her? That is one option, or we could push back and let her know about our struggles and our families’ struggles: the result of a complex brain malady that requires treatment and maintenance in order to remain in remission. Peyser is denying fact, science, common sense and compassion like those who deny climate change.

Apeyser@NYpost.com is her email.

Come on Recovery Community, tell her what YOU think.

Joe Schrank &
Scott Bienenfeld, M.D.

Alcohol and The Distilled Spirits Lobby

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10527747_10152315957952266_1773217055947964853_nVery few people are aware that there is a powerful lobby that strongly influences policy on alcohol and subsequently American life. Alcohol moves among us, stealthily, and we often forget to hold it accountable in any way. There is something about it, it is so woven into the fabric of our daily lives that we lose sight of the damage it does to families and communities. The Distilled Spirits Lobby is a powerful lobby that is dedicated to the growth of alcohol sales state by state, ensuring that states lift decades old “Dry Sunday” laws. They are also very focused on keeping taxes low, making sure that people can get drunk on the cheap. Many states haven’t raised taxes in generations and it is largely accepted that taxation reduces use. Herein lies the conflict: as treatment providers, we consider ‘lower use” to be a good thing. Yet while reducing use diminishes many of the problems that come with alcohol, it also reduces the high profit margin that has long been enjoyed by the distilled spirits industry. The distilled spirits lobby likes to remind us of the amount of money they inject into the economy. While this may be true, it is also important to remember the amount of money that drinking costs the economy. So, who pays the cost? The taxpayer does while the distilled spirits lobby gets rich.
The industry runs a fairly large campaign about ‘responsible drinking” and “moderation” which are both fine ideas, but the treatment community is not walking around saying “why didn’t we think of that?” It’s the same “just say no” rhetoric that has been ineffective for generations and yet we still keep trying to apply logic to a malady that does not respond to logic.

Here at “Rebound Brooklyn” we are certainly interested in helping people “get out of the ditch” but we are also interested in discussing the ditch itself. A simple .10/100 tax on all forms of intoxication would dramatically improve the situation. The money could provide public treatment options and reentry programs for people returning to the community from prison, and even housing for addicted veterans. In short, we can clean up some of the mess created by alcohol. How co-dependent are we as a nation? Consumers have a party, producers get rich and we clean up the mess. Seems a bit dysfunctional.

– Joe Schrank &
– Scott Bienenfeld, M.D.

“Rebound Brooklyn”

We Support AA…But It’s Not For Everyone: Lessons From A One-Day Retreat

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My wife recently surprised me with a 1-day retreat at The Kripalu Center – a world-renowned wellness center located in the heart of The Berkshires in western Massachusetts. Kripalu offers a huge array of wellness experiences including classes, clinics and outings, all devoted to wonderful goals such as stress reduction and mind-body integration. Our first experience was titled, “The Six Senses” – a class of 30 people that focused on re-invigorating the idea that our abilities to see, hear, smell, touch and taste need to be supported by a sixth sense, our need to be mentally aware of what is going on around us. We did fun things. We smelled grapefruits and lemons, we tasted cherries, we looked out the window at trees and we walked around blindfolded trying to find our partners using animal sounds. In the end it was fun, somewhat interesting and a bit thought provoking. The most interesting aspect of all of this for me was the people, and it reminded me a lot of AA and other 12-step recovery programs. I will explain. First, I was struck by the fact that each member of the class was absolutely thrilled to be there. Everyone was polite, looked interesting, and was totally participatory and involved in what was going on. I also realized that each person in the class looked like someone I would probably be able to hold a meaningful conversation with, perhaps over a meal or while standing in line at the bank. The point is, this was clearly very much a self-selected group of people, who all signed up for the “Six Senses” class because of a mutual desire to learn about, and experience a class about wellness and self-improvement.   I tried to imagine 2 things: first, I imagined each person in the class, returning home trying to convince their stressed out friends and family members about the amazing benefits of “The Six Senses” class, in order to instill them with a dose of “wellness” which they could certainly use. I also imagined myself dragging someone who was not willing or ready to experience the “Six Senses” class into the room and insisting they “try it” and demanding they stay for the whole class, like it or not. Then I laughed at the idea of imagining certain people I know trying to “tolerate” this experience. Many would have walked out within the first 30 seconds. Here is my point: there are aspects of Alcoholics Anonymous and other 12-step programs that are very similar to what we experienced today. Yes, AA helps people who are devoted to it, fully buy in and participate with the program. However, the idea that AA or the 12-step approach is the answer for everyone, and that all addicts should stick with the program regardless of how they feel about it is ridiculous and concerning. Like people coming out of the “Six Senses” class I attended, AA success stories abound, but what is rarely discussed is the idea that those who succeed in AA are those who are typically, fully devoted to the program, and participate vigorously. Unfortunately, there are huge numbers of people who attempt AA, even try it for a while, yet are totally unable to connect to the program for a variety of reasons. Like the people I know who would never tolerate what went on in “The Six Senses” class, many people are unable to tolerate what goes on in AA “rooms”. Yet Instead of addressing this problem meaningfully, the AA community identifies such detractors as “not being ready for sobriety,” and casts them aside as inappropriate for “The AA Program”. The fact is that AA, while helpful for many, is not a helpful approach for everyone. At Rebound Brooklyn, we want clients to be versed in mutual help options and 12-step culture.  However, we know that some people simply cannot tolerate it and need to find other roads to mutual help that are more appropriate for them. –Scott Bienenfeld, M.D.

Shia Laboef – One Size of Addiction Treatment Does Not Fit All…

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images-2After his most recent public calamity, the young actor is “seeking treatment for alcohol problems” confirms one of his handlers. What is unique about the rote Hollywood tale is that he is doing it without checking in to a tony Malibu rehab with an ocean view. There seems to be an air of skepticism about how effective this type of rehab can be, mainly because outcome studies are scant, if the exist at all. The “traditional” 28 day acute care modality of alcoholism treatment is statistically very ineffective. In fact, the idea that 28 days is what is required to treat addiction is purely a financial insurance play, and has absolutely nothing to do with evidence based medicine. While “success” is an individual’s definition which may not align with what the people around them want, it can never be a theoretical process. That is, it is one thing to feel better, dry out and learn skills while living in a plush environment thousands of miles from home, but the rubber hits the road once a person returns home and has to face all of the stressors that contributed to problems in the first place. There is no doubt that change is needed, but creating change is one thing, maintaining change is quite another.

Based on the public information, we don’t know much about the treatment Laboef is experiencing. It could be effective, managed by a physician that specializes in addiction medicine who is looking to medications that can help. Perhaps he has a sober companion or is attending daily group process. Clearly the treatment options available to a young movies star are plentiful and varied and not so for most people. What is interesting about this is the eyebrow raised naysayers who think he needs to be “in rehab”. Maybe he does but what happens when he is out of rehab?

At Rebound Brooklyn we offer three tiers of care, residential, partial, and an even more autonomous level of residential care. Some of our patients seek to address their problem without the residential aspect, some find great success, some don’t. We specialize in helping people evaluate and treat their addictive problems here in New York City where they need the help. We do not have a crystal ball, and we have to be honest about all treatment options. Addiction treatment cannot be a “cookie cutter” process. We can speculate and be informed by experience and the literature but we also have to address each client’s individual needs. Laboef could be successful with this level of care, if not, we hope his providers level with him and try another road.

Joe Schrank

Scott Bienenfeld, M.D.

Why Do We Continually Blame The Victim??? Veterans Deserve Better

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The psychological phenomenon of “blame the victim” has a few cultural applications but it’s not often thought of in terms of veterans returning from combat. We ask so much of them and give little in return. After all we are not what we say, we are what we do, that goes for us as a culture. There is much rhetoric and posturing about respect and even cannonizing vets but when it comes right down to what do they have? Chronic pain, a tepid economy, a health care agency in crisis, and little understanding of their experience. So what do we do? Cut the wires to the alarms that are going off by over medicating their pain and setting them up for addiction. We train them to not show weakness, uncertainty, or vulnerability not to mention to kill and then set them up for failure when they try to re-enter society and marginalize them as “difficult”, “angry” “violent” and “unreachable” there is no doubt that the combat vet is a difficult population, but we are not doing a very good job of taking care of them from an emotional and psychological perspective. Consider that almost 1/2 of returning vets are on potentially dangerous narcotics to manage pain. Consider that some research informs us that as many as 22 vets a day commit suicide. It doesn’t sound as though we are a thankful population. To me it sounds like we are part of the problem, gratitude would be proper care and help to be functional in a world that is vastly different than military combat. Country western anthems and throwing out the first pitch is nice and all but it’s not helping the 22 suicides per day.

Rebound Brooklyn is deeply committed to pro bono work. We understand that most people can not hire us. We would sincerely like to deliver quality, medically supervised addiction treatment to all who need it. That isn’t realistic. What we can do is take a combat vet into our program and help them and their family. Currently we are looking for someone who could benefit from this help. Please contact rebound by email if you or someone you know would be a candidate.

Joe Schrank

Scott Bienenfeld, M.D.

Late Night At Rebound Brooklyn

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Top 10 reasons to live sober:

1) Most sober people urinate into something

2) Come for the bad coffee stay for the stale cookies.

3) Church basement perfect setting for start of next failed relationship

4) Treatment cheaper than legal fees

5) Meeting Lindsey at your next rehab is over rated.

6) Almost impossible to overdose on caffeine.

7) Chances of meeting Dr. Drew greatly increase

8) Stay sober for a year and open a rehab in Malibu

9) Rationalize any behavior by saying “but that was when I was in my disease”

10) Feel justified in giving vague advice for any situation.