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October 26th, 2016 - Posted By Jonathan Horey, MD

Recently, a rash of videos and images showing adults unconscious from opioid overdoses while their children look on helplessly have been making the rounds online. The response to these images has been predictable in that most of the comments were critical of the parents for their irresponsible actions.  This reaction is understandable to some extent given that these situations put the young children in danger. That said, I wonder what the reaction would have been if these parents were found unconscious because of other chronic illnesses. For example, what if a parent passed out because of a complication...Read More
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August 19th, 2016 - Posted By Jonathan Horey, MD

In 1963, President John F. Kennedy presented Congress with a proposal to launch a national program to address the needs of patients suffering from mental illness in their communities rather than in large state institutions[1]. His program aimed to reduce the number of patients “warehoused” in state psychiatric facilities so that they could be treated in their local communities, get jobs and receive support from their families. The advent of modern antipsychotic medications made this feasible: These medications  treated many of the symptoms of illnesses that had otherwise condemned patients to...Read More
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June 21st, 2016 - Posted By Jonathan Horey, MD

The tragic fentanyl overdose death of Prince has thrust this synthetic opioid into the headlines. As we learn about the prevalence of this extremely potent opioid, it becomes more likely that it is a main contributor to the dramatic increase in opioid overdoses. Some states are now finding that deaths that were thought to be due to heroin overdoses were actually fentanyl overdoses. Some of these individuals deliberately took fentanyl but many did not because what they thought was heroin (or any other number of drugs) was cut with fentanyl. The use of fentanyl is a cynical way for drug dealers to make their...Read More
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May 27th, 2016 - Posted By Jonathan Horey, MD

Last month, I wrote in this column about the legalization of marijuana and how some of the draconian policies of the past have hindered a more nuanced understanding of the risks and benefits of marijuana. There is much to be learned about the potential benefits of marijuana for adults; however, adults should also recognize the significant danger that marijuana poses for adolescents.   The simple reason for the need to restrict adolescent access to cannabis is that research on brain development clearly shows that adolescence is a critical period in which cannabis is likely to have more profoundly negative...Read More
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May 2nd, 2016 - Posted By Jonathan Horey, MD

The legalization of marijuana is an extremely popular topic in the media and public opinion is clearly swinging toward medical and recreational legalization of marijuana. There are understandable reasons for this change in public opinion, most of which are the result of ill-informed policies about marijuana that were established in the 20th century. Foremost among these is the criminalization of even the possession of small amounts of marijuana which has played a role in the United States having the highest rate of incarceration in the world[1]. The effects of this mass incarceration have been especially...Read More
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April 1st, 2016 - Posted By Jonathan Horey, MD

A recent article in the Boston Globe reminded me of a topic that I’ve been meaning to write about in this column for some time: How the language of addiction reflects the moral judgements of addictive illnesses. We all have heard the pejorative phrases that are used to describe those with substance use disorders. Words like “junkie”, “strung out” or “meth/coke/crack head”. I actually looked on one of the online slang dictionaries and there were 41 different words to describe someone with a substance use disorder, all of them not flattering terms. I then compared...Read More
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February 29th, 2016 - Posted By Jonathan Horey, MD

I am currently co-teaching a class at the Oregon Psychoanalytic Institute entitled “When More Isn’t Enough: Addiction Through a Psychoanalytic Lens.” In this class, we have explored various theories about addiction including 12-step philosophies, the “self-regulation” theory of Edward Khantzian, as well as Lance Dodes’ ideas about addiction as a way of controlling powerlessness. I took on this class with some trepidation because of my view of addiction as a biological illness. However, I also find many of these different psychological theories helpful when working with...Read More
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January 31st, 2016 - Posted By Jonathan Horey, MD

Recently, the Centers for Medicare and Medicaid announced a proposal that would pay for up to 15 days of inpatient drug and alcohol rehabilitation per month for patients with a managed Medicaid plan. This represents a huge change in policy and a tragically late one given the increase in overdose deaths over the past 15 years. Even with all of the attention being paid to overdoses, the death rates from opioid overdose rose 16% last year. Before this proposal, patients whose only insurance was Medicaid were forced to use limited state or other local money to pay for their treatment. In practice, this means that...Read More
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December 23rd, 2015 - Posted By Jonathan Horey, MD

You may have seen Michael Botticelli, the head of the Office of National Drug Control Policy, on "60 Minutes" this month discussing addiction as an illness that deserves treatment, not stigma and jail time. His arguments were sound and meaningful, especially because he discusses his own experiences in recovery. Not surprisingly, his article was criticized by those who say that by claiming addiction is a brain disease, Mr. Botticelli is saying they have no ability to change the course of their addiction. Sally Satel's article in Forbes about "What Drug Czar Botticelli Got Wrong on "60 Minutes"", writes, "the...Read More
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November 30th, 2015 - Posted By Jonathan Horey, MD

A few years ago, a colleague sent me a link to a You Tube video from the sketch comedy TV show "Mad TV". The skit features Bob Newhart as a psychiatrist who has a patient come in asking for help with anxiety. Before I ruin the punch line for you, go ahead and Google the phrase "Stop It Mad TV" and watch the skit. The joke is that the psychiatrist whose patient is simple: He says, "Stop it," in a loud and commanding voice. The patient sits stunned for a few seconds and then, puzzled, asks, "So I should just stop it?" Mr. Newhart responds, "Yes, just stop it." There are variations on this theme until the patient...Read More
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October 14th, 2015 - Posted By Jonathan Horey, MD

Patrick Kennedy appeared on 60 minutes and discussed some Kennedy family secrets that he has revealed in his new book, A Common Struggle. His appearance was courageous because of his family's legacy and because of the backlash he has received from some family members. However, beyond his famous family name, his story is not otherwise unique. Rather, it is instead an example of the "common struggle" of addiction and mental illness and how these illnesses affect the physical and mental health of the entire family. At the root of the effects on the family is the shame that the entire family feels when one (or...Read More
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October 7th, 2015 - Posted By Jonathan Horey, MD

When I read this week that C.C. Sabathia was "checking into rehab", I began to steel myself for the reactions of the media and the public. I assumed that most of it would be negative, as it has been for many other famous people who attempt to get treatment for their addictive illnesses. Surprisingly, reading the various articles (and even the notorious comment boards on well-known sports pages), I have been impressed with the expressions of support. Having lived for a good number of years in New York City, I expected Yankee fans to be especially harsh since C.C. was to figure prominently in their post-season...Read More
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May 2nd, 2015 - Posted By Jonathan Horey, MD

I get this question from patients often though it's usually stated more affirmatively: "I just have an addictive personality." Usually patients have been told this by physicians, therapists and family members, not to mention numerous media outlets that perpetuate the idea of an addictive personality. Even people who have not had serious problems with addiction wonder if they have an addictive personality. My usual question after someone asks me if they have an addictive personality is to say, "What do you mean when you say 'addictive personality'." The answers are usually pretty...Read More
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April 2nd, 2015 - Posted By Jonathan Horey, MD

Alcohol use disorder, more commonly called alcoholism, has been around likely as long as man has been making alcohol with historical estimates noting 10,000 B.C. as the earliest discovered containers of alcohol. Most cultures have had an ambivalent relationship with alcohol with some cultures worshipping wine gods but also warning against excessive consumption and others strictly forbidding it except for religious purposes (where it was often consumed in excess). Bill W and Dr. Bob brought alcoholism further into the public awareness in the early 1930s, by describing alcoholism as a disease, and AA has been...Read More
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March 2nd, 2015 - Posted By Jonathan Horey, MD

How would you respond if I asked you which addictions are "legal"? Most people would respond by citing cigarettes and alcohol. Some might identify prescription medications, such as prescription opioids or benzodiazepines like Valium (when legally prescribed). Others might insist that food, sex, sports, shopping and social media are also "legal" addictions. However, few people would spontaneously identify "gambling" unless they or a loved one have been affected by what is referred to in the latest edition of the Diagnostic and Statistical Manual as "Gambling Disorder". While the science behind social...Read More
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February 2nd, 2015 - Posted By Jonathan Horey, MD

Substance use disorders and eating disorders are two of the deadliest illnesses that psychiatrists treat. The complicated nature of these illnesses means that doctors and treatment facilities tend to specialize in one of these disorders, but not both. As a result, the illnesses are usually treated individually rather than concurrently. The main problem with sequential treatment, however, is the "whack-a-mole" phenomenon. Remember that game you played as a kid where you used a mallet to "whack" down some sort of plastic animal that would pop up from the surface of the game? As soon as you...Read More
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