Benzodiazepines such as Xanax are GABA-A agonists. This means that they stimulate the GABA-A receptor. Stimulation of the GABA-A receptor results in relief of anxiety. With external stimulation of this receptor, by taking Xanax, there is a resultant increase in glutamate. Glutamate can be thought of as an excitatory neurotransmitter. When the relaxing properties of GABA-A are taken away, meaning as the Klonopin or Valium decreases in dose as the
Outpatient Medical Detox Part I: Xanax – Klonopin – Valium – Ativan
Xanax, Klonopin, Valium, and Ativan belong to the class of medications known as benzodiazepines or “benzos”. They are frequently prescribed for anxiety. I will discuss Xanax here as it is the most addictive because of it’s short half-life. The effect of the drug wears off quickly. As a result, patients start taking it more frequently. With more frequent administration, tolerance (need more of the drug to have the same effect)
Stuart Kloda, MD on Suboxone Outpatient Detox for Opiates and Opioids
This is Dr. Stuart Kloda. I am an addiction medicine physician in New York City, and I have a solo private practice located at Columbus Circle. Today I’m going to talk about the outpatient detoxification from opiates such as heroin, and opioids such as Oxycontin, oxycodone, Percocet, Vicodin and Lortab. Drug and alcohol detoxification is medically supervised withdrawal. A medication that is the same or similar to the drug being
Stuart Kloda, MD – Addiction Medicine and Suboxone Doctor in New York City
Hello, my name is Dr. Stuart Kloda, and I opened a unique solo private practice specializing in Addiction Medicine in New York City. I completed a two-year fellowship in Addiction Medicine at the Addiction Institute of New York at St. Lukes & Roosevelt hospitals. I am board certified by the American Board of Addiction Medicine. I offer discreet and confidential one-on-one treatment in a beautiful office at Columbus Circle.
How Long Should Patients Stay on Suboxone Maintenance for Opiate Addiction?
The answer to this question will depend on which physician you ask. The “party line” is to tell patients to stay on Suboxone maintenance from six months to two years. However, my approach is to always tailor the answer to the individual patient. The studies show that opiate addiction has a high rate of relapse. However, this statement does not take patient individuality into account. There are different biologic, psychiatric,
CBT for Substance Use Disorders – Part III
One of the key components of CBT is the “functional analysis”. In a functional analysis, the following are identified before and after each episode of drug and alcohol use: Triggers Thoughts Feelings Behaviors Positive consequences Negative consequences A functional analysis is done together in sessions, as well as individually by the patient outside of sessions. The idea behind the functional analysis is that if patients understand their behavior, and remember
CBT for Substance Use Disorders – Part II
I teach patients that the time period in between substance craving and substance use is critical. Cravings will progress to relapse unless an intervention is made. There are a few specific CBT interventions that are used: 1.Going with the craving Many patients are surprised to learn that cravings are actually time limited. Cravings start, intensify, reach a peak intensity, decrease, then finally resolve. Understanding that cravings are time limited gives
Cognitive-Behavioral Therapy (CBT) for Substance Use Disorders – Part I
Cognitive-behavioral therapy, or CBT, can be a very effective treatment for drug and alcohol dependence. CBT is based on social learning theory. The assumption is that patients learn how to use drugs and alcohol. Because this is a learned behavior, it can eventually be “unlearned”. CBT is called cognitive therapy because that is exactly what it is – patients think their way out of cravings and potential substance use with
Opioid Agonist Therapy
My opinion is that the ultimate is to be able to stay abstinent without any medication. However, this is not always possible. In general, by the time patients come to see me, they have been unable to maintain any consistent sobriety, if any, on their own. Fortunately, there are now more medications than ever to help patients stay abstinent. Patients who abuse opioids eventually develop tolerance (need more of the
Inpatient Opioid Detoxification – Part II
Some patients elect to do what is called a “non-opioid” detoxification. This can be accomplished as an outpatient as well as via inpatient opioid detoxification. Just like it sounds, with this type of treatment, opioids are not used to taper the patient off of their opioid of abuse. Instead, the patient stops “cold turkey”, and the withdrawal symptoms are managed with symptomatic medications (as discussed in the “Outpatient Opioid Detoxification”