Jill: A chicken doctor . . . I’m sorry . . . you know, Purdue Chicken. Got it? Okay, sorry about that – he’s not on the commercials.

Neil: But anyway, as I was saying, it’s mainly a morality play, not a health issue for whether or not to sell it on Sundays or not, if you’re really going to look at from a health perspective it would be going back to prohibition. And you know we’ve been down that road and had a constitutional amendment and a constitutional repeal of that. But he went though, and I think it’s important to notice that he extrapolated himself from the study from Robert Wood Johnson Foundation that there would be 371 alcohol-related crashes and 6 alcohol-related fatalities per year in Georgia should the blue laws be passed. That’s based on the study in New Mexico which is the first study of the time. The Robert Wood Johnson Foundation is a fantastic organization. Their only purpose is to improve the health and welfare of American citizens and that’s what they study. But if Governor Purdue had bothered to look at some of their other articles and some of the other things that they had to say, that they’ve studied, there are many other ways that are probably more effective at controlling alcohol-related accidents and deaths than stopping Sunday sales. I’ll run through a few of those in a minute when we talk about other ways of doing it, but he also stated that “the republican principle of individual freedom is just as important to me as my colleagues in the legislature, but so is the principle of protecting innocent Georgians.” Well, he’s not even letting us Georgians decide if we want that protection or not, he doesn’t want us to vote on that and he compared this to letting Georgians vote on prostitution or not, which I consider a straw man type of argument that creating something that is offensive to most people, that’s really unrelated, and then comparing it to alcohol use – so I think that’s a little bit of a bad argument.

Jill: Okay Dr. Johnston. You know how I like to look at all sides, and he really does talk very strongly in this article about safety issues, and I appreciate the fact that you’re looking at wide range of ways we can decrease drinking and driving, not just stopping a Sunday alcohol sales. And I kind of understand a little bit of the point he’s coming from . . . why even mess with this? If a study out there showed that the alcohol-related deaths went up, however the study was done, isn’t it just a good idea to leave this alone? I kind of hear his heart coming out while he’s writing this. So I don’t know, I kind of see his point but I also see the clinical point about alcohol dependency and how dangerous it is for someone who is alcohol dependent to go without their medication, meaning alcohol, for a full day if that happened, They would go somewhere and get it. Isn’t that right, Brian?

Brian: They’ll not only get it from that place, or they will be creative enough and probably get it from somebody who already has a stash. We find this happening a lot too. If they can’t purchase it, usually they will find somebody that either has it and they can get it, or they take it.

Neil: Or they can still go to their local bar, pub, and drink as much as they want to.

Brian: And then drive home. If this topic is stimulating your thought processes, give us a call here at 770-226-0920, or 1-888-920-2665. It’s a tremendous stimulating discussion because I’m sure there are different viewpoints, and like Jill you were saying, we’re looking here at individual who may have loved ones who have suffered from the results of drunken drivers and not the fact that because we have it on Sundays is it going to prevent people from buying alcohol during the week and still have accidents, but I do know that that is a real concern for many people about how drinking and driving at the same time is a very difficult, and obviously has caused a lot of damage to many families. So I think this is the reason why this is such a sensitive and volatile issue.

Jill: I was just going to say, we’re so ready to talk about this. I was also going to say this . . . that’s something I don’t understand though, when he talks about it so passionately and about keeping Georgians safe, I don’t understand why then Georgians can find alcohol at other locations, such as bars, restaurants, and to me this might smell a little bit like ‘who’s the stronger lobbyist – the grocery lobby or the restaurant lobby?’

Neil: Jill, I think when you said that you heard his heart coming out in the article, I’m sorry, I heard his wallet coming out. The taxes on many things help support the state and I’m sure that the taxes and the lobby for restaurants and whatnot are present here. And even going back to the Olympics, when Sunday morning at 1 AM or 2 AM etc., alcohol sales were prolonged, that was obviously an economic decision. If we’re going to save any lives, that wasn’t going to help anybody. And Brian doesn’t like it, but also compare it to cigarette smoking, that if you were really worried about protecting individuals in Georgia, why not stop selling cigarettes on Sunday as well? Why not do that? Probably because of all the tax money that’s brought in from cigarette sales.

Jill: But you know, you’re not impaired when you smoke cigarettes.

Brian: And I’ll come back with that one. And you’re right, Dr. Johnston, in that respect, cigarettes certainly kill more people than alcohol does annually. I believe you had some figure like 750,000 people annually that die because of nicotine. And for those that heard that number – yes, 750,000. So put those packs away, across the United States. But at the same time, I’ll contend with this, and that is when we look at alcohol sales, it does not relate to because someone smokes cigarettes, other than what you might call the indirect inhalation of smoke, that they really would cause the death of someone else. Whereas in alcohol-related deaths, it usually is the result of someone else driving under the influence, and because they’re impaired, end up killing one or more people.

Jill: Well, 770-226-0920. We’ve got a lot of opinions right at three different mikes today, so if you’d like to give your opinion or if you’d like to call, I would really like to hear what your ideas are about this legislation. And another thing that Dr. Johnston you were talking about is, what are some other ways that besides just saying nobody can buy a bottle of wine at their grocery store on Sunday, what are more better studies being done to look at how alcohol-related deaths from MVA’s could be decreased?

Neil: Well first of all, going back to the study, it was done by the Robert Wood Johnson Foundation, and they specifically have a substance addiction policy research program, and they have several different studies within that that I will talk to after the break.

Jill: Yeah, we’re going to take a break real quick. 770-226-0920. Dr. Johnston, we’ll be right back with your comment.

Jill: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Jill Mattingly, and this is my co-host, Brian Fujii, and we are sitting here with Dr. Neil Johnston. From now on we’re going to call him Neil because it’s easier than calling him Dr. Johnston, is that alright Neil?

Neil: I get no respect.

Jill: Oh right, right. Anyways, we’re talking about the Sunday alcohol sales and if you have a question, comment, please call us 770-226-0920, once again that’s 770-226-0920. And we’re noticing that people fall on all different points of this argument, especially legislature is falling on many different sides of this argument, and we know now where our governor, Sonny Purdue, falls because of the article he wrote in the AJC. What we came to at the end of the last segment is talking about DUI’s, and talking about driving under the influence of alcohol and are there other ways that we can try to reduce this other than just saying you can’t buy it at your grocery store on Sunday. Dr. Johnston, or Neil, what were you saying about that?

Neil: Well, the same foundation that Governor Purdue quoted have done some other studies that are more recent and one of them showed that immediate license suspension for a first offender DUI would save 800 lives per year. Now that’s not something that I think occurs in Georgia and I’m not a lawyer but I don’t believe that driving is a constitutional right, it’s a privilege and it’s one that the state can take away. So that’s one way that’s been proven to save a lot more lives than reducing or restricting Sunday package sales would be. Another one is for first time offenders, immediately requiring them to have a breathalyzer on their ignition switch so that they cannot get in their car unless they blow a negative alcohol level. That saves lives as well and was proven more recently than the article that he quoted.

Jill: Okay, but can’t you have a friend blow into it so you can start the car? Well that’s not a friend. What am I even saying? I don’t think that would be a friend that will allow a friend to drive drunk.

Neil: You could probably get a turkey baster and blow into it, but again, you got a much more devious mind than I realized, Jill.

Jill: Sorry.

Neil: And then another one that I find interesting was a study that they showed that local bars, not liquor stores, associated more with heavy drinking, and the study linked neighborhood alcohol addictions to minor-restricted establishments, meaning where minors could not get in – they’re going to be carded, etc. But that would seem to support more allowing package sales on Sunday but not allowing bars to be open. So the logic just doesn’t seem to be here to me. I can’t be convinced.

Brian: I think where we’re looking at here is all these controversies are there and that is very true and these are things that probably won’t be answered by the end of this show, but one thing we can answer is how we have probably a lot of people out there listening, Jill, that are having loved ones who are really suffering from alcoholism and we begin to realize that individuals who have problems with either just using alcohol, abusing alcohol, and actually becoming dependent on alcohol. And I think the area that we work with the most is those that are dependent on alcohol. And that dependence is really something that is fairly basic. If a person begins having tolerance that means they means they need more and more alcohol to get the same effect, or they start having withdrawal, when they stop using they really begin having some physiological reaction for not having the alcohol in their body and I think for me as a therapist is to realize that when they continue to drink in spite of no negative consequences, so if they keep on driving after multiple DUI’s, or they keep on drinking in spite of the fact that their boss says you’re going to lose you job if you keep coming to the job site drunk. I think this is probably the more critical. And I know that here at Breakthrough Addiction Recovery, we have a program for people who are suffering from alcohol dependence and they don’t necessarily have to go into a hospital or a closed unit for that, we actually have a ambulatory drug or alcohol detox program that can really help individuals drug or alcohol detoxify off of the alcohol and get them engaged in our addiction treatment program. And I’d like for people to give us a call at 770-226-0920 and I’d like to talk with them about some of the things we offer. Because not only do we offer the fact that we can help them drug or alcohol detoxify from alcohol, we can also let them do it safely and either in one of our private suites or maybe even in their own homes, comfortably.

Jill: There’s not many places out there that provide that type of service and I think that’s the obstacle to a lot of people going out and trying to look for addiction treatment for alcohol dependency, but if you’re someone that is in the back of their mind thinking all day Saturday, ‘Okay it’s Saturday, I need to get to the liquor store before midnight,’ and you’re rushing out in your house slippers at 10:30 Saturday night to make sure that you have your alcohol so you can get through the day on Sunday. And it is devastating, I mean those of you who are suffering with alcohol dependency, you know what we’re talking about in terms of those withdrawal symptoms. The withdrawal symptoms being the increased anxiety, the nausea, the sweating, the wondering about your family worried about because you just don’t look like you feel so well. It’s Sunday afternoon, Sunday evening, and you don’t have enough alcohol to sustain you because it has become a self-medication at this point.

Neil: And a chemical addiction that with more severe symptoms with increased or decreased heart rate, changes in blood pressure, arrhythmias that can occur, it can be fatal coming off alcohol without medical support and addiction treatment.

Brian: And a lot of people try to do that, where they feel they can just drug or alcohol detox themselves, but if they’ve ever had some issues with seizures, delirium tremens, I mean those are the individuals that are really at risk physically, and it can be a life-threatening situation, and they do need that medical support.

Neil: And by the way, for those of you who don’t know what delirium tremens is, or DT’s, it’s a state where people are confused, they become delirious, they don’t know where they are, they often times will hallucinate things . . . a pink elephant, seeing snakes, things of that nature often occur. There are lot more people out there who have that symptom and don’t realize that is a hallmark of someone who, if they’re going to come off of alcohol, they need medical supervision to do it.

Jill: And I think that’s where we’re coming from at this program, Breakthrough Addiction Recovery Hour, we’re coming from the understanding of the alcohol dependent person, and knowing that stopping sales at a grocery store, or a liquor store, is not going to stop that alcohol dependent person from finding their medication. And they will get in a car and they will travel to the nearest bar or restaurant and complete their medication regime and by the time they leave they will, if they don’t have the breathalyzer ignition, they will get in their car and drive home . . .

Brian: Intoxicated.

Jill: And that is what are concerned about, about limiting sales if you’re going to limit the sales, it just needs to be a little more logical. So I think the legislature is going to battle this out and people are going to take their sides in terms of morality and logic and studies, but what it comes down to, if you have a problem or have a loved one with a problem with alcohol dependency, it is necessary and it is very important for you to seek help.

Brian: And not only the fact that physically, but also from a psychological side too, we come to realize that as individuals become addicted to alcohol, the approach that we have at Breakthrough, we don’t see it as a character disorder, we don’t see it as they don’t have enough will-power as the reason they can’t stop drinking, that there really is a neurological reason and it’s a brain disease and that because of some lowering of the dopamine because they’re drinking so much alcohol, this is the reason why they can’t stop. I’ve heard it so many times in addiction treatment, ‘Why can’t my loved one just stop drinking?’

Jill: Or ‘Why won’t they go into addiction treatment?’ ‘Why are they so resistant?’ That’s what I hear a lot.

We are coming down to the end of the segment, Brian, and what I think we should do, we’re going to go into co-occurring disorders when we come back and talk about ADD, so please continue listening. I want to give you that number, 770-226-0920. Keep listening and we’re going to be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and with me is Jill Mattingly and Dr. Neil Johnston and we just got done talking about some of the issues about how people move into chemical dependency especially in the area of alcohol and we have been continuing this discussion on co-occurring disorders, and that means an individual who not only has an addiction to alcohol or some other drugs, but who also has a psychiatric condition. It’s a person who may have depression, or they may have anxiety, or posttraumatic stress disorder along with their problems with alcohol or the drugs. If you’d like to be part of the discussion, we’d like to encourage you to call us at 770-226-2690, or if you’re outside the area give us a call at 1-888-920-2665.

So at the break we were getting ready to talk about how attention deficit disorder is another one of those psychiatric conditions that many times people will use alcohol as a way to self-medicate themselves and as a result become more and more dependent upon alcohol. So Dr. Johnston, what are some of the characteristics, or what is it about ADD that usually causes individuals to want to use alcohol or other drugs more extensively.

Neil: First let me talk a little bit about attention deficit disorder and it’s subcategorized into with or without hyperactivity. So attention deficit disorder is characterized by inattentiveness, distractibility, and impulsivity. It usually begins in childhood, definitely can last into adulthood, so children who had it often will have it as adults. Many people are able to compensate and learn how to function without addiction treatment or without medication, so we don’t always see every child that has ADD or adolescent that has ADD, progress to being an adult with it, but often we do.

Jill: That was going to be my next question. Do most children progress into adult ADD?

Neil: I would say yes they do, but some of them have compensated with techniques to learn how to manage their problem. In fact, sometimes folks with ADD are especially good at certain jobs. I have interestingly enough seen people with very bad ADD be very fantastic computer operators and computer workers.

Brian: I think one of the statistics I looked at, they say about 60% of the people who are diagnosed with ADD in childhood usually carry that forward into adulthood.

Neil: That sounds about right to me. And as far as the substance addiction people will have, often times I see folks using stimulants or using cocaine to self-medicate. In fact if I have a patient who is an amphetamine or a cocaine addictionr, I will ask them, “How does it affect you? How does it make you feel?”

Because for a person without ADD, it usually hypes them up, gives them more energy, stimulates them, but paradoxically for someone with ADD, it calms them down. They can even feel sleepy or tired from using cocaine or amphetamines. That’s highly unusual, so that can cause some interesting situations.

The other complications with ADD include people who are very intelligent who cannot achieve in school, who are told that they are dumb, or unable or feel that way because they are not able to complete their tasks or projects. That often leads to co-occurring depression and that’s where I would see the alcohol coming in a lot, as far as to sort of numb that pain. And in addition, that impulsivity, sort of poor judgment piece, ADD kids are likely to do things without thinking about it. Anything from jumping off the roof to try to fly – I’m being very serious and literal there – to experimenting with drugs. They’re going to be more likely to be novelty-seeking, wanting to do something of that nature, so the likelihood that they would experiment with drugs at an earlier age would be higher than someone without ADD.

Brian: One of the areas, as we take a look at how that over-stimulation occurs, we know that because of that many people are very creative. I heard they also have a great capacity to take very complex concepts and be able to almost distill them down to something very simple. I’ve seen this with some of my clients where they continue to be very functional but at the same time, have a very difficult time in paying attention to what’s going on in addiction treatment, One of the things I look at too, the way that we treat individuals with alcohol dependency as well as ADD, is that it seems like from both addiction treatment experience and also from the studies is that the cognitive behavior therapeutic approach is far more effective because it is something that’s more focused, it is something that is active, rather than more the passive, more psychoanalytic approach or maybe a Rogerian approach, it probably causes more frustration for them, so the more we can help them to work on particular skills, or help them develop certain types of approaches and give them some homework, it seems that they focus and follow through with those assignments a lot better.

Jill: This seems to be one of the areas in addiction addiction treatment where it just makes sense to identify that underlying problem such as ADD or ADHD and get that taken care of either through a medication regime or as you know I like to do things a little more holistically at times, if we can use nutrition or exercise, but do something to get that under control and then bring in the cognitive behavioral therapy to help with the person’s thinking about life and walking through life – helping with the depression that may have come along with it. So an addiction addiction treatment for someone with this co-occurring disorder, the multi- approach is so important. I can’t see it working, just someone going in and sitting for 30 minutes listening to someone talk and then leaving, how that’s going to change if we don’t get the ADD under control somehow.

Neil: There are now non-addictive, non-abusable medications to treat ADD. So if there is someone who has both.

Jill: Red Bull?

Neil: I was thinking more of one called Stritera and something called Vyvanse. But it looks like we up to a break again.

Jill: Yeah, we’re coming down to a break. I’m going to give you the number again, 770-226-0920. Maybe you’re someone struggling with ADD and want to ask a question or have a comment, please call in. And we’re going to be right back after this break.

Jill: Welcome back to Breakthrough Addiction Recovery. We are talking a little bit about co-occurring disorders, we’re talking about ADD and we’re going to talk a little bit more about that this segment, and once again, if you’d like to call and get in on the conversation, question, comment, anything about addiction you might want to talk about, 770-226-0920.

Jill: The Starbuck’s, right?

Neil: Right. These patients, give them the stimulant and they calm down. And mentioning Starbuck’s, I’ve even seen patients who have tried, or have attempted to treat their attention deficit problems by drinking up to 3, 4 pots, not cups, pots of coffee a day. And that stimulant effect, while dangerous on certain other organ systems with all that caffeine, does tend to help them to focus.

Jill: You’re bringing up a little bit about medications and self-medicating, there’s a mother out there listening and she has an 8 year old, a 9 year old son, and he’s exhibiting the attention problems, he’s being talked to at school, and she’s about to take him to the pediatrician, but there’s a lot of things in the back of the mind. ‘If I get him on medication, will he be addicted to the medication?’ Because she understands that it will be possibly an amphetamine that he will be placed on in order to calm him down, and I can just see the wheels turning in her mind, ‘Am I going to addict my son to a stimulant for the rest of his life?’

Neil: I wouldn’t call it an addiction even if the child was on the stimulant for the rest of his life. Now will that child become chemically dependent upon the amphetamine? Yes. If they were to abruptly stop it, would they have withdrawal symptoms? Yes.

Now we do have other options right now for addiction treatment. One called Stritera that is a non-stimulant medication. The nice thing about that medication is that when it is effective, it works 24 hours a day – it works constantly. And ADD doesn’t just affect school performance or work performance, it also affects social interactions. A lot of the other kids don’t like the hyperactive kid and will avoid them, so that impedes their development socially as well. Another medication that’s recently out called Vyvanse, is a stimulant, but it one that is made to attach to amino acid, your body then cleaves off the amino acid at a specific rate so that you can’t snort it, shoot it up, and get a high off it . . .

Jill: Like from Ritilin, and . . .

Neil: Right, and other medications. There is a lot of concern and rightfully so of students giving their medications to somebody else or trading off medications. So I would encourage parents that if they do have a child with ADD to make sure that they control the medication supply or ask for one of the longer lasting, extended release formulations so that they can give a pill to the child and be done with it.

Jill: You were mentioning Stritera and Vyvanse and what are the other ones?

Neil: There are quite a few. There’s Adderall, Adderall XR, Ritilin, Dextroamphetamine, there’s a whole host, Concerta, Cylert, there are a number of different medications. All of those are stimulant, amphetamine-like.

Jill: Really what it sounds like then, if the parent decides I’m not going to treat or allow the medication to treat my son or my daughter, there can be that they’re putting them more at risk for self-medicating with things like other stimulants which may start out as innocently as a lot of caffeine like you were talking about, now that they can get Red Bull and hyper-hyper-caffeinated drinks at the drugstore and the grocery store, but also that’s going to put them at risk for picking up and experimenting with drugs and alcohol.

Brian: Actually inhalants are one of the things that we find people using.

Neil: Kids are using all sorts of things like that that are incredibly dangerous neurologically to their . . .

Brian: And damaging to the brain itself.

Neil: So I would say that the risks of not treating ADD overall, including substance addiction issues are far less than the risk of the medications they are treated with.

Jill: I think that’s the most important point to get out there. If you are looking at doing something for your son or daughter, it probably would be much better for them to be treated by the professionals, the psychiatrists, rather then going out on their own and trying to find something to help them calm down themselves. Unfortunately a lot of people that come in are the 20-something, 30-something untreated ADD adults and they ended up getting dependent on another substance and that’s what we see them for when they’re 25, 28.

Brian: And I think too what’s in the research is that many times the difference in trying to understand ADD or maybe even someone who may have a bipolar disorder, they’re very close in some ways . . .

Neil: Incredibly hard to distinguish bipolar and ADD.

Brian: Especially a mood disorder.

Jill: Well it sounds like we’re coming down to the end of this segment. Hope this has been informative to you, 770-226-0920. We’ll have time for another phone call or two when we come back from this break. Stay with us.

Neil: In some cases, yes, in that case they’re self-medicating. They found something that’s helping them symptoms and going for it. As I said, other substances can easily be addictiond with ADD due their impulsivity they get high on something else and the reality is that getting high feels good so they continue to do it. And because of their impulsivity from the ADD, they’re not as likely to have the judgment of thinking ahead – what are the consequences of this behavior? Should I really go down this course, etc.?

And with the other disorders, it’s hard to pin down any one substance that is addictiond exclusively or predominantly by this illness subtype. Alcohol probably is the number one overall, because of it’s availability, because it’s legal, etc., but in bipolar disorders – that’s the same as manic depression – people often times will use stimulants when they’re down and then something to bring them down when they’re up, and when you get into all of this with someone who is poly-substance abusing, they start becoming expert little pharmacologists themselves. They’ll take cocaine, other stimulants, and then they’ll need to even that off. They’ll take some benzodiazapine and some alcohol on top of that. That gets them too down and they want to come up a little, they’ll tweak themselves and they become excellent at knowing just how much of this, and knowing just what to do. So it’s sometimes amazing to see that.

Jill: And with anxiety, that’s mainly going to be something that’s going to calm that down as far as the different neurotransmitters in the brain.

Neil: Yeah, I haven’t seen too many people with true anxiety disorders abusing stimulants or cocaine. That’s a rarity, because that makes them much worse, so I’ve never seen that.

I’d like to mention about the website, I particularly enjoy reading the blogs section of the website. There’s area there for lots of different comments or articles and you can comment there and put your input in the website there, also there’s a section for client testimonials so you can read what other people’s experiences have been. I’ve been with Breakthrough for about 6 or 7 months now, and I’m finding it to be one of the most flexible, easy-going, comfortable addiction treatment settings that I’ve ever worked in. I’ve been in addictions for 15 years.

Jill: So that’s great to know. And just knowing that you’re not treated like – okay, here’s an alcohol person, this is where they go, through that door – I mean everyone is treated very individually when they come through the doors at Breakthrough. Isn’t that right, Brian?

Brian: Absolutely. And again, we get so many calls here dealing with the free consultation, In fact, even at the break we had several that were listening to our show and wanted to do some consultation. Again, we do provide this free help in helping you decide how to get your loved ones into addiction treatment and also finding ways that we can work with them.

Alright, we’re right back to our time. We’ve come to a close and we appreciate all of you listening to us and we hope that you will be back with us next week.

Neil: Take care, have a good week.