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Pressing Questions About Addiction and Mental Health: Part 2
July 15, 2020
Weill Cornell Medicine, in conjunction with the 92Y, presented a full-day summit about mental health for the public. Throughout the day, experts from Weill Cornell Medicine shared insights about mental health, mental illness, and other important topics, answering questions along the way.
During one session, Dr. Richard Friedman joined Dr. Mitchell Rosenthal to answer questions from attendants about addiction.
Dr. Richard Friedman is a Professor of Clinical Psychiatry and Director of the Psychopharmacology Clinic at Weill Cornell Medicine. His clinical and research specialties include anxiety and mood disorders, as well as psychopharmacology and refractory depression. In addition to treating patients and conducting research, Dr. Friedman also frequently contributes to The New York Times as an op-ed columnist.
Dr. Mitchell Rosenthal founded the Phoenix House in 1967 in New York City. Under his leadership, the organization grew to become the nation’s leading provider of alcohol and drug treatment. Currently, there are 52 locations across nine states that offer 97 programs for 3,530 patients. Dr. Rosenthal also founded the Rosenthal Center for Addiction Studies, an organization that provides information to individuals and families grappling with addiction, healthcare professionals, and policymakers.
Acknowledging that there is a strong interest in understanding addiction—as well as pervasive misinformation and misperceptions surrounding this difficult topic—Dr. Friedman and Dr. Richard invited attendants to ask their pressing questions.
Do we become addicted to alcohol and other substances in the same way?
Dr. Friedman explained that opiates, stimulants, and other drugs have different chemical makeups. “They have diverse targets in the brain,” he said, “but even though they start in different places, they all end up causing one common signal. They release dopamine in the reward pathway. And the reward pathway is a very ancient circuit in the brain that's very deep inside the brain.”
He continued, “And when you activate the reward pathway, you make people feel good, and it creates a sense of importance. It's a powerful signal in the brain that's very hard to control consciously—and all drugs will do this.”
What about “soft addictions” like overeating or dependence on caffeine?
“You don’t want to medicalize everyday behaviors that are undesirable. They’re not diseases,” asserted Dr. Friedman. “There's no question that eating foods—let's say, that are very dense in sugar and fat—have effects in the brain that are somewhat like drugs. They can cause repetitive eating that's hard to control and changes in the brain that are very similar to certain addictive drugs.”
“However, you run the risk of minimizing the seriousness of substance abuse if you start to equate an opiate addiction to a shopping addiction, even if the person who goes shopping experiences negative consequences. Yes, they both involve behaviors that are not great and might have harmful effects, but the ‘soft additions’ are not causing the same degree of harm to the brain or to a person's life as drug addiction.”
It seems like a full recovery requires multiple stays in treatment and may take years. Is this true?
Dr. Rosenthal has spent his career creating treatment centers that help patients recover successfully. “We've done the research on this,” he explained. “We have looked at our patients a year, three years, five years after treatment and said, okay, what's happened? How many are sober, and how many are in school? How many have not gotten back into trouble with the criminal justice system?”
“A successful outcome is predicted by time in the program,” he stated. “Somebody who's been there nine months is going to have a much better chance of being successful than somebody who was there for three weeks. So, it's not just talking the talk. It's walking the walk and really working at sobriety and behavior.”
He continued, “Somebody is not going to get a three-week cure. Now, does it happen? Yes. But, if you look at big numbers of people who've been in treatment, time in the program is going to be the predictor of success.”
Dr. Friedman added, “This question is critically important and is a research question. You can't answer this question with one number because it depends on what drug you're talking about, what kind of population you're talking about. If you took a group of people, let's say, who are having this problem for the first time, no history of prior addiction or dependence. That's going to have a very different outcome than a group of people who've already failed. Meaning they have had multiple relapses and recurrences. So, the answer to the question is, it depends on who you study, who you look at.”
What can I do for my loved one struggling with addiction?
Dr. Rosenthal reminded all attendees that addiction issues are extremely common, so it’s important for all of us to understand what we can do for a loved one struggling with addiction.
“Silence is not a great idea,” he asserted, “but how do you enlist somebody on their own behalf? How do you give back to them? How do you let them know that you're worried about them? That you're troubled about this behavior? That you wonder if they've considered this or that?”
“Engaging in the relationship with friendship and care over time is the most important action,” explained Dr. Rosenthal. “It may not be a single act. It may be a conversation that goes on for six months.”
Dr. Friedman agreed, “It can take a long time. With addiction, you're essentially dealing with a person who is using something—and they're using it for a reason. They think it makes them feel better. So, when you say to somebody, ‘You know, you have a problem, you should stop doing this,’ you're basically taking away something that's pleasurable. They don't see that it's linked to these other terrible consequences, like poor relationships and problems at work. They may not actually see it and have insight.”
He continued, “So, one of the things you can do is to start the conversation with, ‘I'm concerned about you. You know, you're not getting to work on time. I'm really worried that something bad is going to happen.’ And it must be done over a period of time. People take a while to develop insight. Sometimes it requires that the person suffer a bad consequence.”
It can be painful and frustrating to not be able to do more—or watch a dear friend or family member struggle for months or years. To make matters more difficult, many feel alone or that no one can understand what they are experiencing. Meditation and support groups provide immense help to many, as well as personalized cognitive behavioral therapy.
Dr. Rosenthal assured those who may be feeling hopeless, “I like to remind people that we have more than 20 million people in America who are in recovery.” He has seen many patients recover from addictions and go on to lead healthy, fulfilling lives.