NOVEMBER 15, 2008

BRIAN: Welcome Atlanta to the Breakthroiugh Addiction Recovery Hour, my name is Brian Fujii and my cohost Jill Mattingly with our special guest Dr. Neil Johnston.

Jill: Hey Brian.

Brian: Today we are talking about managing stress and identify what stress produces especially we will review how the brain deals with stress.

Jill: What I want to say before the scientific stuff, you asked the psychiatrist and I take that personally because we were acting up last week? Hope that is not the case,

Brian: I will not say over the air

Neil: I don’t know what she did,

Jill: Just some off the wall comments which have no bearing on my psychological health. Ok, Dr. Johnston thanks so much for coming today and this is down your alley, the swell of stories in the media about stress, it is like Brian and I have a understanding what is going on and we talk about this and six weeks ago with the market and the upcoming election we began to recognize in our clients the stress related problems connected to the alcoholism and we started talking about it and now just last night I think you said that NBC is doing a special on stress and how to handle it.

Neil: I briefly watched and they comment on working hard and stressful jobs are not nearly as stressful as waiting to lose a job, it was a brief segment on the nightly news not an ongoing series, but it is all over the place. You can’t listen to the news or read a paper without the stress of a financial crisis. It is stressful for everyone.

Jill: This is one of the first times that across the board everyone is effected and some manifestation in their lives that result from this problem in the financial markets and even in the post election and there is a let down for some and elation for others. Those working hard for their candidate now have nothing to do once it is over. I read an article about this because so many were invested on both sides and the energy is gone.

Neil: After the party syndrome

Jill: What I want to talk about with you and our listeners, who can call us 770-226-0920 we are talking about stress and how it is effecting you and if you want to call in and tell us how you are working through this and what you have found to work for you that would be beneficial and we are a show about addiction so if you are finding a way to hold on to your sobriety by doing something beneficial when you have stressful moments and we have had some call with job loss and financial difficulty and they are holding on and walking through this, so 770-226-0920. Brian did you have something?

Brian: The idea of stress and those in our programs and I know that when we do the free consults we hear folks saying that they are coming for the first time because of the impending doom of their finances and stress of trying to keep their jobs. Many think of it for a long time and what motivated them was something interesting. The article I read of characteristics of functioning alcoholics and those seeking rehab it goes right in line with those coming in seeking that free consultation and that is when they come in they don’t think they need help and that they aren’t a bum or skid row so I don’t think that alcohol or drugs have impacted them significantly and what we found in ths article is that alcohol and drugs help them to feel worthless and undeserving and low self esteem it begins to make them understand that it isn’t the economy it is because of the abuse of a substance. The feelings of worthlessness come out of trauma and also what we are talking about and that is the economy.

Neil: If you have lost your job you almost have concrete proof and it feels like proof that you are worthless and not as good as someone else. That feeds the feeling

Jill: So many layers there if they are already struggling and then you add job loss and economy and

Brian: Think about this when individuals identify themselves they say what they do. That is their identity, so many times as Dr. Johnston said, when they lose a job and they lose themselves and that is a very traumatic event.

Neil: The trama for me is that when I say I am a psychiatrist they scatter

Jill: I think that is interesting, why are people coming in? How does that apply to what is going on in the economy and how is that effecting the people that we treat? The alcoholics and the drug addicts and if you want to make a comment please give us a call at 770-226-0920 and I just want to say that I looked at the Wall Street Journal and found the picture on the front to be disconcerting showing “Market Mayhem” south Korean investors angry with a huge mob fighting in front of a bank, they were protesting and I find that interesting in what we are talking about that a lot of stress in someone’s life especially over finance and the loss of who they are can lead to a lot of anger and I guess that could lead to violence, right Dr. Johnston?

Neil: It almost makes me violent when I look at my 401K

Jill: My question is what would you do if a patient comes in and it is pretty generic, they have job problems finances and they may not say right away that they are overdoing the drinking and pills but how would you walk through getting to what to do with them. If they just said I am stressed, what would be the next question?

Neil: You get a full exam a full history and generally in treatment we would use psychotherapy and to try and help them with these feelings and often once the anxiety and depression set in, breaking that will work against helping them get out there and find a new job and I am dealing with a patient currently who is in this situation and may have to have suicidal thoughts and may need the hospital or cognitive restructuring trying to change the thinking without naming names and this individual loves the job and now has been put on probation and trying to restructure it could be a good thing because at least you still have your job and also with him his is severe enough that he needed medication.

Jill: Not only who comes in with the addiction but the medications that can be used to help someone through this. We are coming down to our first break so 770-226-0920 is the number to call,. 770-226-0920. We will be right back

Commercial Break

Brian: 770-226-0920 is the number to call

Jill: Talking about stress today and if you are experiencing stress you can call us here today at 770-226-0920 or at our office for a free consult at 770-734-8091. Neil, you know we were bantering about political commercials and Georgia was not spared from the political commercials which make you scared so that you will vote a certain way. Unfortunately we are in a run off on December 2, 2008 so we still have to listen to the commercials and the element of stress is still in the air. I wanted to know more about what would happen if I came to you and said I am stressed out and you just said you would get a history and exam but you also said that you know you would look at meds or other things to help me?

Neil: I would want to know if you had had problems before or if you were doing something on your own to deal with the stress like exercise or meditation or are you doing something unhyealthy like drinking or using meds or something that was not originally prescribed for but I see we have a caller

Jerry: Thanks for taking my call, I have a comment and you were talking about stress, I had something happen with my doctor, he decided that I should go to a stress management class and so I went to the counselor and after telling her what was happening she said it sounded like it would be more stressful to come to the stress management class. So anyhow I thought I would pass that on.

Brian: What are you doing for your stress

Jerry: I am just dealing with it, a lot going on but you know the Lord is able and that is basically how I deal with it.

Neil: Did she give you an alternative?

Jerry: No, she didin’t, I had job stress and I just you know told her what was happening and she said what she did and so….

Neil: I don’t want to say anything bad but you needed more options. Individual counseling or medications, so that is funny and often times I will say to a patient that anyone would be stressed in their situation but that doesn’t mean we can’t help.

Jerry: Well it was a long time ago

Jill: Well it sounds like you made it. Sometimes stress can be handled naturally so what else would you do for someone Neil?

Neil: Well therapy I always consider to be important and it is proven to be better than meds by itself and by the way meds and therapy are better than either one alone. One way to go I would also look at their history if they have had previous alcohol or substance abuse and then would probably start them on a medication in the category of seratonin reuptake inhibitors such as Zoloft, Paxil, Lexapro, etc., I am not pushing or selling any one of them but

Jill: Those help with stress?

Neil: The serotonin when regulated can calm anxiety and panic disorders. They are equally good at depression and stress. Most people there is cross over between depression and anxiety and vice versa so a lot of people will be under stress for some time then develop hopeless feelings and

Jill: I want to give our number out because I know some have questions and if you want to call 770-226-0920, 770-226-0920 if you have a comment please call. Brining this up Neil, an antidepressant to help through stress, this might have perked up the ears out there.

Neil: The first thing these were approved for by FDA they are chemically similar and have been approved for anxiety, in addition if the patient has no history of substance abuse, I would prescribe a low dose benzodiazepine and that would start immediately and the antidepressant takes some time to work.

Jill: What if I finally as you start to ask questions I tell you that I am already taking Xanax and I take half of a milligram if I need it because of work stress but I have been taking a liitle bit more…

Neil: How much more?

Jill: Two or three doses a day because of getting on line and looking at my 401K and my boss is making job cuts and I have to have the extra, so I have a feeling there are those out there that are going through that type of problem and so how do you back them off or do you take them completely off of that drug.

Neil: I would have them start something else and if they increase their dose is not a good idea and we will continue on the dose that has been effective until the other kicks in and we will taper them off and they can not with me as their doctor continue to escalate without permission.

Brian: What about drinking?

Neil: That is completely different and is more dangerous. They need to be off the alcohol and we would use something else.

Jill: We will go back to that as we come back from the break. Some may not be telling the truth when it comes to just how much they are drinking.

Commercial Break

Brian: Welcome back to the Breakthrough Addiction Recovery Hour, our guest Dr. Neil Johnston is with us today and again if you want to be a part of this discussion on stress and addiction call us at 770-226-0920 that number is 770-266-0920. At the break we were asking the question about people under stress is now increasing the intake of alcohol and as a result moving into alcoholism and so how do we address that issue?

Neil: You need to know quantity, one glass I am not worried about it

Jill: Do they tell the truth?

Neil: No, studies show that people generally minimize the amount that they tell us and clinicians will say take whatever a patient says and double it but I try to trust what they say. If they are at 4 to 6 a day they are in the danger range so they should decrease or detox, or then put them on an ssri for the anxiety. I find it repulsive that I saw a stock broker’s set of tips to get through hard times and put your money into alcohol and tobacco stocks because addicts will keekp using no matter how bad the economy is. I was revolted by that and this captive audience if you will is going to keep using no matter what and so if you are out there and you have a problem, get angry at the fact that someone is making money off of the fact that you have a problem,

Brian: Victimization at it’s prime

Jill: Stock tip of the day is that addiction will make you money, well, that is you know one of the reasons we are doing this and you have to know that there are ways to get help and resources and you do not have to spiral into a place where you are doing what they want you to do in order to make them money and there is a way to get help and get help as easy as seeing Dr. Johnston and he will clarify that you have crossed a line and let’s do this and get you back on course and instead of going all the way down into a severe addiction and you know it could cost your family job and everything else.

Neil: We would want to treat the anxiety as well as an emerging addiction that is the idea, people are self medicating and get them to something safer and more effective and alcohol is not good for anxiety. It makes you feel high but after a few hours you are miserable and when that is over you are back where you started from.

Jill: What I want to know is that if they are taking Xanax or Clonopin or someone has increased their wine from one to six glasses, what about the person that has been laid off and the spouse is upset and I saw my Vicodin and I just you know without thinking found that after those I could cope for the next hour or two or even that night. How would you address that.

Neil: That worries me even more because they do not have an anxiety indication they are simply altering their mood getting high and they use the word stoned wasted etc., for a reason at those times they don’t care about what is going on and that is concerning, at least with anxiety there is an indication they would be confronted on their difficult path and corrected to the right treatment.

Jill: What if they go from two to six pills every day.

Neil: Detox with suboxone and then find the correct best medical treatment as well as psycho therapeutic treatment.

Jill: The benzodiazepines and now vicodin, lortab, oxycontin, all of those can be misused for this time in the world with the economy and personal items going on and stressful things. Let’s leave everyone with hope so after the break we need to talk about how to get treated. If you know you have crossed a line call us. 770-226-0920 if you would like to call in.

Commercial Break

Jill: Welcome back, we are talking with Dr. Neil Johnston, call us today here at the station 770-226-0920 Georgia just one so that should eliminate someone’s stress right? We were talking about the economy and financial news and how the world in general causes stress and were using hypothetical situations and if they are under stress and take too much xanax and are drinking more wine at night because of the boss or they have found an old prescription of vicodin or lortab that takes the edge off at night. There is three substances and obviously Dr. Johnston has a way to treat a person when they are self medicating with those items, what about Breakthrough? What do we do there for those that have crossed the line and need to talk about the abuse of medications or alcohol. Let’s take one at a time and see what we would do.

Brian: This is progressive relaxation, this is simple. Let’s start off with the bottom of their feet they tense the muscle then the calf then the thigh the hands shoulders and then hold that a minute and release and the opposite direction in such a way that when this happens the tension is released and the pressure is released. There are very simple techniques like quiet music relaxation and serenity and they begin realizing that they have control.

Neil: I throw in that I have anxiety problems myself and I have been through this

Jill: Since working with me?

Neil: It did worsen a bit though. The automatic response to contracting a muscle is relaxation and whether you want it to or not it will and so doing it all over the body it can be followed with progressive breathing and then you will find self hypnosis almost. I have heard acupuncture works for some and I am not opposed to that pets, aquarium, these are known to relax. In these times you may not afford a pet but you could always

Jill: I go with crying, that tends to be a stress reliever for me and the good thing is and in fashion are the huge sun glasses so put those on as you drive a cry. At least for women and they know what I am talking about. We are coming to another break. If you have another way of relieving stress call us at 770-226-0920, we are finding alternatives from alcohol and drugs and we will be right back. 770-226-0920.

Commercial Break

Jill: Welcome back to the Breakthrough Addiction Recovery Hour, we are talking about relief from stress in these times and we have a caller, Sidney in Atlanta, Hi there.

Sidney: I am a chiropractor I have a patient involved in a car wreck and a lot of pain but she also has an ongoing condition and I feel like um, based on things she has told me that she is probably addicted to the pain relievers she has been taking and you know when she does come into the office it is because she is taking the meds and she shouldn’t be driving and when she is off of them she is feeling awful, I need to refer her to pain management to work with her with addiction but listening to you I am thinking you are the referral and I will be talking her into doing something and getting her husband involved and give me advice.

Neil: Sidney I agree with you completely and I deal with chronic pain management and I don’t do steroids but if someone does have a chronic pain problem and needs pain medication I will do that for clinicians who are feeling they don’t feel comfortable prescribing in an ongoing fashion, I am very firm about that. If she is using for non pain reasons, then you need to get off of that.

Sidney: She is in chronic pain but from experience I have had patients who I thought they were in pain because they were addicted to the pain meds and I think that is the case with this woman and she has been so injured and at that point you

Neil: I am sure you are aware of non addictive agents like cymbalta etc., I have chronic back pain and I use cymbalta with great success for mine and we try to approach it from the myriad of perspectives and if we feel pain management is needed as well we will work with you to refer.

Brian: Our office number is 770-734-8091 and we would like to help with alternatives.

Jill: Thank God she has someone like you that is thinking outside the box for her. She is in a use abuse cycle and has increased the pain because of the abuse of the opioid. Unfortunately we see this and it is work to get them out of the cycle and it can be done.

Neil: One other suggestion but in trying to talk about it to her you might want to mention that it is hard for you to tell if your treatment is being effective with her opiate use.

Sidney: I thank you very much.

Jill: Have a stress free day, we will see you next week.