3-8-2008

Brian: Good afternoon

Atlanta and welcome the Breakthrough Addition Recovery Hour.  My name is Brian Fujii and my co-host is Jill Mattingly and we have again as our guest Dr. Neil Johnston, an addiction psychiatrist and our Director of Psychiatric Services at Breakthrough Addition Recovery and we’re going to be continuing our discussion about mental illness and substance addiction and how addiction is related many times to this issue of mental illness and I think we have kind of a sub-category called “de-mystified medications.”  Is that right Jill?

Jill: That’s exactly right,  You know when you look at psychiatric care a lot of people don’t feel very comfortable with it and there’s a lot of stigma around it, and what we’d like to do today is talk about some of the medication that actually can help with addictions to substances, like alcohol and other types of substances.  So Dr. Neil, which is what I call you at the office – I don’t want to confuse people though, it is Dr. Neil Johnston.  But how are you doing today?

Dr. Neil: I’m fine, thank you.

Jill: Dr. Johnston, tell me a little bit about the psychiatric problems people have on the spring-forward day.  Is there any diagnosis you’d like to talk about?

Dr. Neil: There aren’t any diagnoses, but interestingly enough traffic accidents go up and that sort of thing has been found both in the spring forward and fall back.

Brian: I think it’s because people’s schedules are all out of whack, and they are all trying to get to work sooner or to church.

Jill: That’s exactly right.  So you know tomorrow we’ll have a lot of people showing up . . . what is it . . . late or early for church tomorrow?  It that . . .

Brian and Dr. Neil: Late, I guess.

Jill: Yeah, it’ll be late.  Okay, so pastors out there don’t be too hard on your parishioners.

Anyways, Dr. Johnston, I came in today wanting to talk a little bit about the medications that are used in psychiatric diagnosis such as anxiety, depression, bipolar, ADD, and how treating efficiently with the medications can actually help someone with a substance dependency.  And the first thing I was going to bring up with you, so just get ready because I am going to start throwing questions at you, is about anxiety medications.  We did a couple of shows last month that covered like the Heath Ledger death and we were talking at length about benzodiazapines, Xanax, Clonopine, Valium, Atavan, we were talking about the benzodiazapines and how many people come in to Breakthrough Addition Recovery with dependencies on these substances or these medications and it’s very difficult to get them off of the medications but then again we have to turn around and say in some cases this medications is a perfect fit for you because of your problems.  Can you tell us a little bit about the medications themselves . . . about the anxiety first?

Dr. Neil: Well certainly, you mentioned most of them. There is Valium or diazepam, and that is something that sometimes confuses people because we have the trade names and generics.  Valium, Diazepam, Xanax, Alprazolam, Serax, Oxazopam,  Ativan, Lorazopam . . .

Jill:  So these are the “pams”, right?

Dr. Neil: Yeah, they’re all the “pams” and some of the “ills” like Restorill, there’s Midazolam, there’s “lams” and “ills”, but the benzos are a large class of medications. They basically work on the gaba-amino-butyric acid receptors.  They are excellent medications, they’ve been around for a long time and work exceptionally well.  What in psychiatry we usually try to do is if someone has an anxiety disorder and that is broad of spectrum of the disorders that includes panic, generalized anxieties, social phobias, etc. What we often times try to do is get patients on a non-addictive medication for that such as one of the serotonergic agent, such as Prozac, Paxil, Zoloft, etc., at the same time we want to put them on a benzodiazapine because often the anti-depressant can worsen the anxiety before it makes it better.

Jill: So, I see.

Dr. Neil: So the benzodiazapine helps modulate that, helps even people out if they get started, and once they’ve gotten on a full dose or an appropriate amount of time, if their symptoms are under control we begin a slow taper off the benzodiazapine and can hopefully manage them with just that.  Now with the substance addictionr, the problem is they are often self-medicating.  It just so happens that alcohol also works on the gaba-receptor in the same area and so someone with anxiety disorders may have become addicted to alcohol because they are trying to treat their anxiety and that kind of situation we would drug or alcohol detox them on benzos and also try to start them on SSRI or SNRI  which is a serotonin norepinephrine reuptake inhibitor and those are drugs like Effexor or Cymbalta and then go from there with the addiction treatment as far as first drug or alcohol detoxing and then trying to address the anxiety.

Jill: A lot of these people are first seen in an internal medicine or family practice and they are describing to their physician or nurse practitioner or PA that, “I’m having a lot of anxiety . . . a whole lot of anxiety and I am depressed and I’ve just had certain things happen with my job,” and they may choose put them on something like Lexapro. “Let’s just see how the Lexapro does.” So what you are saying is that many times the anxiety can worsen after they start the Lexapro or Prozac before it actually gets better.

Dr. Neil: Absolutely, especially with panic disorder.

Jill: Wow, and what about the fact that some of these physicians and health practitioners are putting them on these benzodiazapines but they are not really watching how these people are using these benzodiazapines . . . they’re not making it a short course.  It’s each month they come back and get their 30 pills?

Dr. Neil: Well, I’m not criticizing anyone of a particular specialties group, but often times under the pressure of seeing many patients someone may have been put on a benzodiazapine after the death of a loved one, or work stress, and it works . . . the doctor has the patient coming back feeling well, feeling good. They don’t want to mess that up . . . they just go ahead and refill that.  And unfortunately the reality is if you’re having a baby you are probably not going to go to a primary care doctor, you are probably going to go to your OB-GYN to have that done.  If you are having a mental health problem you should probably see a psychiatrist at least for the initial visit and then appropriate follow-up with your primary care doctor.  Unfortunately, as a psychiatrist many of you may not know after medical school, a psychiatrist spends 4 years in training for psychiatry whereas a primary care doctor spends 3 years of training to try to cover a little bit of everything.  So obviously there’s a big difference there.  Specialists are specialists.  Generalists deal with all sorts of problems.

Brian:  That’s great.  You know this is a very interesting topic and I know many of you listening out there are saying, “How can I get involved?”  Give us a call here at 770-226-0920 or if you’re outside the area you can call us at 1-888-920-2665.

You know Dr, Johnston, one of the things that we hear about people first of all getting onto the medications, but then they ask the question, “How can I get off the medications and how soon?”

Dr. Neil: Well, first let me address getting onto the medications because a lot of people don’t understand that getting onto the medications takes some time itself.  It can take anywhere from 2-8 weeks of being on the full, appropriate dose of the medication for it work . . . for it to be effective.

Brian: 8 weeks?  Wow.  That’s really good because many times we see clients not understanding that and they get very frustrated with themselves and saying, “I’m taking this medicine.  Why isn’t it working?”  And that’s a wonderful piece of information to have.

Dr. Neil: And the other piece is the appropriate dosage part.  I see a lot of times that non-psychiatric practitioners will prescribe medications at too low of a dose, especially medications like Effexor that really work best at higher doses.  So that’s the first issue is getting onto the medication.  Getting off the medications, there are several, specifically all of the SSRI’s, Prozac, Paxil, Zoloft, etc. that can cause withdrawal symptoms. And they can be uncomfortable at times, they are not life-threatening.  And I think we’re coming down to the break, so we’ll go into that a little more after the break.

Jill:  Okay, that will be a good thing to come back and start talking about.

Jill: Welcome back to Breakthrough Addiction Recovery hour.  My name is Jill Mattingly, I’m the physician assistant at Breakthrough Addiction Recovery.

So one question, Dr. Neil, tell me the difference between an addiction psychiatrist and just a regular, general psychiatrist.

Dr. Neil: Well an addiction psychiatrist specializes in addiction and has also gone through specialized training or has had specialized experience, and then take a test given by the American Board of Psychiatry and Neurology to be certified as having the sub-specialty of addiction psychiatry.

Jill:  Oh, I see.  And it looks like we have a caller.

Brian: Yes, we have Debbie from

Atlanta.  Debbie, welcome to the Breakthrough Addition Recovery hour.  How can we help you?

Debbie:  Hello!  I just want to make a comment more than asking a question.  My ex-husband began taking Atavan in about 1982 plus he started drinking and he’s still in denial all these years later.  We had the normal confrontations with him and it’s just so sad, and we can’t help him because he won’t admit he has a problem.  I guess that’s a common thing.

Dr. Neil: It is.  It’s a very common thing and most of the time you get into that denial because it’s usually because they really don’t want to stop and therefore if someone brings it to their attention they just get really irritated, annoyed and they really think you don’t know what you’re talking about.  What have y’all tried to do as far as helping him break through that denial?

Debbie:  Well, I’ve been divorced from him a long time and he lives in another city and he’s living with his elderly parents.  In fact his mother passed away and his father is really old and now his siblings are saying, “What are we going to do with him because he’s not able to keep any job?”

My children have already been through therapy trying to get through being adult children of alcoholics and they’ve all offered to give him help, not with money, but will help him find a job, help with this, that or the other.  But they don’t want to take him in because they don’t want to ruin their own little families.  But he says no, he doesn’t need help.

Brian:  Well, you know, that situation there, I believe the family members are doing what they need to do.  They are getting the help that they need and they’re trying to stay healthy.  Because many times when an individual is in that much denial, the family is also in a lot of crisis and so therefore the family members are doing the right thing.  They’re actually getting the help that they need to stay healthy,  and many times, Debbie, we find out that unless there’s enough negative consequences that really gets their attention, there’s not much else you can really do.  You can just continue to take care of yourself, be aware of the struggle that he’s going through and attempt to intervene at some point to bring it to his awareness.  But at this point, the family members, friends and so forth are the ones that really have to make sure that their emotional situation is being cared for at this time and it looks like they’re going through therapy and they’re talking to others and they are still not allowing their own self-esteem to diminish as a result of this addiction, then I think they are doing the best they can.

Dr. Neil:  I have one question for you Debbie, you mentioned that you all have children.

Debbie: Yeah, they’re adults.

Dr. Neil:  Adult children, okay.  It doesn’t apply then but what I was going to say that protecting the children from being around him when he’s using is something that’s very important and courts don’t like custody or visitation with intoxicated parents, so that also can be sometimes a pressure point.  But as adult children that wouldn’t apply.

Debbie:  We’re just wondering when he’s going to actually reach his rock bottom.

Jill:  Debbie, I was going to pose this question of Dr. Johnston.  Would an intervention be appropriate?

Dr. Neil: Absolutely.  If you and his family and friends could all come together in a non-threatening way . . . .

Debbie:  Well. that’s what they just did recently.  His brother and his son-in-law came together with him, offering him as much help as they could because they could see as soon as his father is unable to stay at home or passes away, what’s he going to do.  Because he doesn’t have a job right now and they said we’ll offer you any help we can give you and you have a problem with alcohol.  And he takes Atavan and he just said. “No, I don’t need your help.”

Brian: Well that is a real challenge and as long as he’s in that strong denial . . . he might be in what is called the pre-contemplative stage of addiction treatment where he just doesn’t believe he has the problem.  In fact most of the things I’m hearing is he feels it’s your problem and not his.

Debbie:  We’ve been divorced 15 years, so 20-25 years ago he was saying to me, “You know I drink 2 beers and you eat 2 hamburgers.  What’s the difference?” 

Dr. Neil:  You don’t get into wrecks on the highway from hamburgers, you don’t usually addiction your wife over a hamburger, lots of things.

Debbie: Right, his denial has been going on for years.

Brian:  Seems to be working for him, but not for you all.

Debbie: Yeah . . . right.

Brian: Well, take care of yourself, Debbie.

Jill:  Yeah, take care of yourself Debbie, thanks for the call.

Debbie: Okay, thanks so much.

Jill: Wow, very interesting.

Brian: It is.  And we see so much of this going on before people come in to addiction treatment, and even when we do our consultations, there at the office, it’s sometimes a mini-intervention that’s being done where sometimes a person will be bringing in their loved one, whether it be a husband, a son, or a daughter, and that individual just doesn’t want to be there until somewhere along the way we try to emphasize and help them get some clarification about some of the negative impact it’s making on themselves or their jobs or they’re having a problem with the law – that’s always the long-term consequence.

Dr. Neil: Another thing that can help with intervention is sometimes is to have a professional who’s an objective third party who’s not involved.  You can’t accuse me of having eaten 2 hamburgers, so I can go after you in a different way that’s more logical.  I don’t have any emotions built up, that you can accuse me of trying to vent on you.

Brian:  That’s right.  Well, again, if this type of discussion is striking a chord with you, we encourage you to give us a call at 770-226-0920 or at 1-888-920-2665.  And you know too, we have a fantastic website you can visit and look at all the various programs that Breakthrough Addition Recovery offers and that’s at www.Breakthrough Addition Recovery.com and there’s ways that you might get in touch with us via email.  So be in touch with us and continue to look at this opportunity or getting either addiction treatment for yourself or for a loved one. 

Dr. Neil: And I’ll throw in to check the blog, there’s always something interesting.

Jill:  Oh, there is very interesting things on the blog. But Dr. Johnston, I want to try to get to the protocol that you advocate for pulling someone off of a benzodiazapine.  We have so many clients that struggle with high doses of benzodiazapines and have tried to stop and the withdrawal symptoms are absolutely atrocious and they have so much difficulty.  Let me know what you advocate in terms of coming off of things like Xanax, Valium, and the others.

Dr Neil:  Basically what we do when somebody is on any of those prescription drugs in that class or alcohol or barbiturates – they’re all lumped in together.  What we try to do is figure out first of all how much of the medications they’re taking and how often and then what I call is sort of a ’switch and taper’.  We switch them to a different drug from their drug of choice, and usually it’s one that does not bring about as much psychic pleasure as the drug they were on, and then secondly we slowly taper them off of that.  By doing so, that prevents the medical complications such as seizures, delirium tremens and both of these things can cause death so it’s very important that you be medically supervised when you are coming off either these prescriptions drugs or alcohol and that’s something that we can help out with at Breakthrough and are happy to talk with people when they need to.

Brian:  Well this is fantastic as we take a look at people coming off of these and you’re saying that many times it’s so difficult because they’re struggling first of all with the withdrawal they’re having from the alcohol itself and that even raises up their anxieties even more and then we start trying to take them off of their anti-anxiety mediation, benzodiazapine.  I’ve heard that people say that it is just so painful.  And with that pain it makes it more difficult to try to come off and yet we do know that unless they do then the probability of them stopping the drinking is not going to work either. 

Dr. Neil: In some of those cases there may be an underlying disorder that needs to be treated and in those cases we like to taper them more slowly off the medication while instituting another psychiatric medication such as the SSRI’s, etc., and that way address both issues.

Brian: I like the way you said that, “addressing both the issues.”  And that’s

the key in dealing with people with co-occurring disorders, is dealing with both the psychiatric and chemical dependency simultaneously.

Jill: Well, like Dr,

Johnston was saying, we do address this at Breakthrough Addition Recovery and if you’d like to go to our website and look at the information on benzodiazapines, please do BreakthroughAdditionRecovery.com and also we will do free consultations for those of you that might have questions about the medications you’re on.  So Dr. Johnston, when we come back I’d really like to start hitting depression as another co-occurring disorder.  So stay with us.

Jill:  Welcome back.  We’d love to get you in on the conversation.  We had an earlier call that was fantastic.  If you have a question, comment, or want to kind of get in just talking about or asking Dr. Johnston a question . . . 770-226-0920.  Give us a call and Brian, you were really wanting to ask Dr. Johnston a question.  He is jumping out of his seat right now.

Brian: For those just joining in with us, this is a very important topic about the combination of psychiatric illness in relationship also to addiction, and one of the most common things that we come across, Dr. Johnston, at our clinic is the relationship of depression as it relates to substance addiction especially in the area of alcoholism and depression.  So how do we handle that most effectively with medications?

Dr. Neil:  Generally we like to find out what’s going on with them.  The first step, generally we like to again treat those problems at the same time.  In many cases it could be that alcoholism has led to depression or vice-versa, the depression has led to the alcoholism.  Finding that out for certain is a near impossibility in a lot of cases, so we treat both at the same time, start somebody on drug or alcohol detox to get them off the substance addiction and it could be any of the substances.  Then we would also have them treated with an antidepressant as well and depending upon their exact symptoms, that is how we would choose the anti-depressant.

Brian: That’s great.  Many times people think, ‘Well all I got to do is take my medicine and I’ll be fine,’ and they almost kind of see that as the magic bullet, and yet one of the things that I have found especially as the clinical director in working directly with so many of these clients is that they struggle with so many different interpersonal issues that seems to bring about the depression, the desire to use either alcohol or other drugs and it just seems to indicate, and studies have shown that unless you combine both the medications along with good psycho-social support that it really is not as effective.  We know that medications do a wonderful job, but in my work, I just see individuals struggling with issues of self-esteem or feelings of worthlessness or they understand that maybe because they had problems with addiction in their past even as young children, and until we actually deal with these issues, so many times, many of the clients just try to self-medicate or numb that feeling with their drugs of choice.

Dr. Neil:  Well there’s no question with regards to depression that all the studies have shown that both together, meaning psychotherapy and medication, work better than either one alone.  It used to be a big fighting war between psychiatrists and therapists over which one was better, but that was pretty definitively settled by studies that show that ‘a pox on both your houses’, the combination together work better than either one by itself.

Brian: Well, as I was saying earlier, let’s take a look at the way the medications work as we look at depression.  What other areas do you feel like . . . one of the things I’ve heard so many time is, when does this medicine kick in?  Because they’re on the medicine, they’re in addiction treatment with us in day addiction treatment, and they are still trying to figure out why am I still feeling so bad.  So many times it’s the idea of when does the medication reach some form of therapeutic level and what can we answer to them?

Dr. Neil:  Again, once you’re on the correct dosage of the medication, it can be anywhere from 2-8 weeks.  Some people will start feeling better after a few days, but generally give it 3 weeks or 4 weeks on average, but up to 8 weeks. We used to say up to 6 weeks, but recent studies have shown more likely up to 8 weeks for the full benefit of the medication.  But again, I can’t emphasize enough that so many practitioners do not prescribe a full dosage of medication, and that has to be done in order for it to work for any of the medications for any of the disorders.  This doesn’t just apply to depression but also to bipolar, anxiety disorders, etc.

Brian:  You know, many folks, when they come in to our program and they’re in day addiction treatment and they are trying to get some support and they get ready to leave, and . . . how does the idea of medications, well sometimes ALCOHOLICS ANONYMOUS says you shouldn’t take medications while you’re trying to come off your addiction.  How do we answer that?

Dr. Neil: Well, I consider that to be almost archaic in their philosophy.  If they are saying something of that nature, ALCOHOLICS ANONYMOUS was begun in the 1930’s, about 1935, 70-something years ago.  This is just absurd to tell someone they shouldn’t be on their psychiatric medication.  ALCOHOLICS ANONYMOUS is also run by non-professionals, so having a professional opinion on that is very necessary. 

Jill:  Wow, I have some things to say about that.  When we come back we are going to talk about that – medicating for the problems versus non-medication and using other resources, so get ready Dr. Johnston.

Jill:  Welcome back.  We’re discussing medications, use and co-occurring disorders with substance addiction and Brian, you were just discussing at the break the position of ALCOHOLICS ANONYMOUS and you seem to have a really good comment on that. 

Brian:  Yeah, I do.  I want the listening audience not to be thinking that we’re against all these issues with ALCOHOLICS ANONYMOUS.  There is some concern that we do know that many times in this situation where individuals may attend such a group as ALCOHOLICS ANONYMOUS or NA and the individual could have depression so they may be on an anti-depressant and in many groups they say that’s fine, you could be on an antidepressant and still be considered clean and sober.  And the reason for that is that number one, it doesn’t make you high.  And secondly, it’s non-addictive.  However, we do know that many people also suffer from anxiety and we know that some of the best medications that deal with anxiety is benzodiazapines, and we do know that also has an addictive property.  And so many times my clients get into a conflict – how can I stay on the benzodiazapine and yet I’m trying to come off the drug to which I’m addicted?  So what I’d like to ask Dr. Johnston is, so how can I as a therapist answer that question effectively to help the person know that this is a medicine, it’s not something they’re using as a drug in order for them to become even more addicted or for them to become poly-substance abusing.

Dr. Neil:  First off, I’ll address what I would do in that situation, which would be to certainly attempt to address their co-occurring anxiety disorder with a non-addicting medication in the anti-depressant realm.  Unfortunately there are even some medications in the anti-depressant realm that are addictiond by patients – they can get a little buzz off them although it’s dangerous.  However, in resistant cases where the anti-depressants are not working or causing some other sort of problem, will I consider using them?  Absolutely.  Now generally I would not consider using them with someone who is addicted to a substance similar to them, meaning someone who is an alcohol addictionr, I’m probably not going to put them on a long-term course of benzodiazapine, but many years ago I had a patient who was a heroine addictionr and bottom line was she was having panic disorder – it was very severe – and we got her off the heroine, the panic persisted, the antidepressants weren’t working.  We put her on low-dose benzodiazapine and it worked wonders. She got a job, was able to take care of her kids, never called in early for medication, never lost a prescription . . . the things that people who are addicted to benzodiazapine show, and she did fantastically.  So there are no absolutes, and whenever anyone says that, I take umbrage.

Jill:  Do you think the fear of some of these medication has hampered treating addiction? 

Dr. Neil: Absolutely. 

Jill:  I know of many people that are afraid of something they think will change their brain, and they’re never going to be off of it and they have a lot fear about that.

Dr. Neil:  What’s wrong with changing your brain if there’s something wrong with it to begin with?

Jill:  Exactly, and you know I am kind of in the vein of, why don’t we try something different before we go to medication?  Why not try something like prayer and meditation, or exercise or getting their nutritional deficits corrected before we start to add a medication?  I understand why a lot of people are kind of shy about just jumping right into a medicine and maybe that’s why these other organizations discourage the medication.

Dr. Neil:  Well, I am all for a holistic approach to addiction, there’s no question.  But there haven’t been any placebo-controlled studies that have shown that prayer, for instance, is going to improve addictions, or that a specific nutritional supplement will.  While these are all going to be helpful, there’s just no proof that that’s going to work. 

Jill:  So it doesn’t mean that it doesn’t work, it just means there’s no study?

Dr. Neil:  There’s no proof. ALCOHOLICS ANONYMOUS was developed before we had any modern psychotropics, and it has become the standard of care and they have been sometimes reluctant to incorporate the newer medications.  I will say with regard to exercise, there are studies that have shown that exercise, in depression at least, that exercise can be as effective as Zoloft at 6 months.  They weren’t very well controlled studies, but they’re out there and there’s something probably to do with the endorphins released during heavy exercise that’s useful.  Now don’t get me wrong . . . all of the above are useful.  If somebody has cancer, prayer is a tremendous support for them.  Good nutrition is going to be important for their strength in general – all of these are important.  But to depend on them solely without the scientifically proven medications that we have just seems . . .

Brian:  That’s a scientific approach.  We’ve got a call here from Ruth in Avondale.  Good afternoon, Ruth.  Welcome to the Breakthrough Addiction Recovery hour.  How can we help you today?

Ruth:  My son is in his 50’s and he has suffered from anxiety attacks and he is taking Paxil and has for a number of years and he is also using nicotine gum that he started using when he gave up smoking.  However, right now he is experiencing very frightful dreams and he wakes up screaming and asking for help and it’s a little difficult for his wife to wake him up.  And I was wondering if that had anything to with the use of Paxil.

Dr. Neil:  It is possible it is due to Paxil.  Paxil has a very short half-life, and one of the things he could explore with his doctor is going onto an SSRI that has a longer half-life such as Zoloft or Prozac because these tend to have fewer side effects, but Paxil definitely has more than the other ones do.  Also the nicotine, as he’s coming off of that, that can cause abnormal dreams quite frequently.  I’ve been off cigarettes now for 3 months and I can assure you I’ve had some unusual dreams. So just that as well can be causing problems. There are so many other addiction treatments out there for depression and anxiety, Ruth, that if it’s even thought that the Paxil is causing side effects that it would be worth to try switching to something else.

Ruth:  Okay, now he’s been taking this nicotine gum for a couple of years.

Dr. Neil:  Then it could very well be the Paxil.

Jill:  We have to take a break, but hey Ruth, could you hang on?  And let’s address nicotine when we come back from this break.

Jill:  Welcome back, and we’ve got Ruth on the line.  We’ve got about 50 seconds and Dr. Johnston wanted to address the nicotine issue for the last two years.

Ruth:  Okay.

Dr. Neil:  Ruth, the nicotine gum . . . and if he’s still smoking as well,

Ruth:  Oh no, he’s not still smoking.

Dr. Neil:  He’s just using the gum . . . okay.  Nicotine can have effects on the central nervous system of course, it’s a very, very addicting substance, and the dreams could be from that, they could be from the Paxil, again with regards to that I would definitely suggest that you have him see someone, there are new drugs out to help with nicotine withdrawal, one called Chantix, and it works very well, much better than anything we’ve had before to help someone get off of nicotine and we can help you at Breakthrough, our number there is 770-734-8091 and we would be happy to do a free evaluation with you there.

Ruth: Okay, well I’ll pass this information on to him.  And thank you so much.

Jill:  Thanks for calling, Ruth.

Brian:  Alright, sounds like we’re getting close to the end of our show, and Dr. Johnston, we’d like to have you back again.  I heard you have some time and we look forward to it.

Jill:  I’d like to go one better on that.  Dr. Johnston, we’d like to have you in as much as possible.  Would you commit to coming back at least once or twice a month?

Dr. Neil:  Sure.  You’ll have to pay me something, Jill. 

Jill:  Ha-ha . . . I’ll take you out to Starbuck’s afterwards,.  You are a fantastic addition to the show and if we could have you on once or twice a month I know our listeners probably would appreciate it too.  And one thing, Dr. Johnston may sound young on the radio, however in college he did follow the group Police and went to a concert, so just do the math on that one.  And Brian, what were you saying we are going to do next week?

Brian:  Next week we’re hoping to look at bipolar disorder and also the area of ADD, attention deficit disorder, and a lot of times we think people only who are adolescents have this, but we see this happening all across the adult spectrum too.  And so I’m really excited about this opportunity where we’ll be able to talk about how bipolar disorder which is probably one of the most misdiagnosed, and most hard to identify disorder, and how that gets impacted when a person is trying to deal with addictions because so many times they’re trying to use the alcohol to calm the feeling and reduce the anxieties and we do know those mood swings are really, really, devastating to so many people so it’s a great thing and we really appreciate Dr. Johnston being with us here today and we look forward to having you coming  back and discussing these two particular areas.

Dr. Neil:  I’ll look forward to it.

Jill:  And if you want to come up with any information that you want to share or a topic, please let us know Dr. Johnston, we will be happy to go over a topic that’s near and dear to your heart.

Dr. Neil:  I’d love to get the audience involved in more discussion about ALCOHOLICS ANONYMOUS.

Jill:  I do want to say we do have a great website.  It is chock full of information, and that is BreakthroughAddictionRecovery.com.  Our office right up in Norcross, and our office number is 770-734-8091.  We’ve had some great calls today and please plan on being with us next week.  Please call into the show, that’s part of the bread and butter of this show – just reaching out to the listening community and if you’re interested in ADD, that’s attention deficit disorder, or bipolar disorder – a very misunderstood illness, please listen next week and be ready with your questions and call your friends and family to listen too.

Brian:  Alright Jill, thanks a lot.  And again, this is a talk show and we’re just so excited about those that called in today.  And again, we do offer free consultations.  So if you and family members are struggling with the issues of addiction and/or issues dealing with mental disorders, give us a call at 770-734-8091.  And again, thank you for listening.