David A.N. Siegel, M.D. 23 W. 73rd St. Ste. 101 New York, NY 10023 (646) 418-7077

ADDICTION PSYCHOPHARMACOLOGY (MEDICATIONS)

Dr. Siegel is highly experienced in using various medications that are usually taken on a daily basis to help maintain abstinence. He will see you in consultation to discuss medications for addiction that might be helpful to you. Dr. Siegel uses medications as a part of medication assisted treatment (MAT).

The definition of “recovery” is when a person changes a dysfunctional life, that is a result of drug and alcohol use, to a life that is functional and healthy. This occurs with either medication alone, or with medication plus addiction psychotherapy. There are now a number of different medications that can be used as a part of medication assisted recovery.

BENZODIAZEPINE ADDICTION

Benzodiazepines (“benzos”) are the class of medications that includes Xanax, Klonopin, Valium, and Ativan. These medications are usually prescribed to treat anxiety. Most patients who have become physically dependent on these medications started with legitimate prescriptions that were being taken as directed. Unfortunately, tolerance developes. Previously effective doses of their medication become ineffective, with withdrawal symptoms either on or in between doses.  Detoxification from benzodiazepines can absolutely be the most difficult detox for patients to accomplish. The anxiety and withdrawal symptoms that develop can be protracted and severe. I follow the Ashton Method for benzo detoxification. In addition, I prescribe medications to not only treat the primary anxiety disorder, but also to treat the other symptoms associated with tapering benzodiazepines. Various antidepressants and anticonvulsants are primarily used for the treatment, but there are other classes of medications that can be very helpful for specific symptoms like beta blockers for palpitations.

SUBOXONE FOR OPIATE AND OPIOID ADDICTIONS

For opioid (oxycodone, Oxycontin, Percocet) and opiate (Heroin, Morphine) addictions, Suboxone (buprenorphine) can be a lifesaving medication. It is a “partial opioid” and has a safer profile than that of a full opioid. It exhibits a ceiling effect, which means that once a certain dosage level has been achieved, additional dosing does not produce additional effects, reducing the possibility of an overdose. It also binds very tightly to its receptor site, blocking the effects of full opioids. Additionally, the withdrawal syndrome seen with it is also much milder than that of full opioids.

A common misconception associated with Suboxone (buprenorphine) is that it substitutes one drug for another. Instead, it relieves the chemical imbalances in the body that cause withdrawal symptoms and psychological cravings. Suboxone (buprenorphine) provides a safe and controlled level of medication to overcome the abused substance. It can be prescribed in a doctor’s office, and filled at a pharmacy just like any other prescription. And research has shown that when provided at the proper dose, these medications have no adverse effects on a person’s intelligence, mental capability, physical functioning, or employability. Suboxone is also used for outpatient detoxification, or medically supervised withdrawal, to wean patients off from opioids and opiates.

ALCOHOL ADDICTION

There are now a number of different medications that are available to help people reduce or stop their drinking. They work in a variety ways to modulate the neurobiological adaptations that come from chronic alcohol use and help with the transition back to a more normal state when alcohol use is stopped or reduced. Each medication works in a different way on the brain’s reward system and the release of dopamine. Some decrease the promotion of dopamine release and some increase the inhibition of dopamine release. Medications that decrease the promotion of dopamine release make drinking less attractive and easier to stop. Medications that increase the inhibition of dopamine release help with the negative feelings that are associated with stopping drinking like anxiety, irritability and agitation, making it easier to stay sober. Different people are helped by one type of medication more than the other. Sometimes, people find both types helpful.

KETAMINE

Ketamine, an NMDA receptor antagonist, modulates glutamate and promotes neuroplasticity. It can help reverse the long-lasting changes in neural circuits that occur from substance use. Ketamine's rapid-acting antidepressant and anxiolytic effects can alleviate the mood disturbances commonly associated with chemical dependency, such as depression, anxiety, and irritability. Additionally, ketamine has been observed to reduce drug cravings, which can decrease the risk of relapse. Ketamine-assisted psychotherapy (KAP) combines ketamine administration with psychotherapy and can facilitate emotional breakthroughs, enhance introspection, and deepen therapeutic insights, aiding individuals in addressing the underlying psychological issues contributing to their dependence on a substance.

Call Dr. Siegel for a free phone consultation at (646) 418-7077