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Do you actually understand what addiction or substance abuse disorder means?

I just had a long term former substance disorder patient turned warrior and full fledged citizen of llife and family and work. She spent years on crack cocaine and it destroyed her life, her job options, her home, her family, and her health. Her once bright appearance became unrecognizable. The good news is that three years ago now, with prompting by her parents who had not yet given up on her, offered her a place to live in exchange for getting help. You know what, she got that help and three years later she is independent, has her own apartment, and her own job and comes into my office smiling with make up on. It is amazing to witness.

it really got me to thinking a lot about addiction and substance abuse disorder. I thought about all the misconceptions that I have heard about it and all the judgement that I have heard about it. Let me take a minute to explain what it really is.

Sadly I have a lot of personal experience with this with patients and I make it a point to listen to their stories in detail, always hoping that I can grab something from one of them that could be used to inspire another patient in trouble.

Let’s first define addiction. The definition of addiction is the fact or conditions of being addicted to a particular substance, thing, or activity. I know, using a word to define itself right? An addiction can also be referred to as a dependence, craving, habit, weakness, compulsion, fixation, or enslavement to a particular substance, thing, or activity. You get the point though, correct? It implies an unhealthy deep attachment to anything.
Now let’s talk about substance abuse disorder. the definition of substance use disorder is the persistent use of drugs despite substantial harm and adverse consequences to oneself and or others. This often described in laymen’s terms as drug or alcohol abuse.

So, you see they both go together. They can’t really exist without each other, but yet they are not the same thing.

Theses are devious bad buddies people. When people often think of addiction, they get either judgy or uncomfortable. They tend to be afraid of or look down on those patients and people, either because they just don’t understand it or they have had some personal bad experience.

I get it, if you have been the victim of a crime perpetrated by someone under the influence of drugs or alcohol, it can be both terrifying and very serious and something that it hard to get. Short of that, most of the judging or condescending toward addiction patients is just a lack of understanding,

This is not me saying that there are basic codes of conduct that should be followed by any human being. No. Not at all. I am just trying to make sure that this particular disease is better understood.

Wait? Did I say disease? Yep I did. Addiction is truly a form of disease with multiple components not unlike diabetes or hypertension. You could tell yourself, there is no way that someone made a choice to be diabetic or hypertensive and an addicted person did! Well, actually, in a way, genetics aside, sometimes people have made choices to gain weight or make other unhealthy decisions that led them to those diagnoses in the first place and once the anatomical changes are in place, serious measures have to be taken to attempt to correct them and ensure a longer life.

Well, whaddya know. The same kind of principles apply to addiction. Addiction has multiple components. There may in fact be a genetic susctibility. There may be environmental factors. There may be stimulating traumas that lead people to try to find a mental way out and they pick the worst one. Last time I checked, no addicts that I have come to know just sat down one day and decided to shoot up heroin out of nowhere. That initial terrible decision came from a variety of different sources and triggers the majority of the time.

Like with any disease, once addiction has rooted itself in the brain, it literally changes the brain anatomy, It literally causes the formation of a whole new shortcut pathway of dopamine to the nucleus accumbens in the brain. This decreases and intensifies the perception of the pleasure response, while also shortening the duration at which it lasts. This is a terrible double-edged sword and even for those who maintain recovery status, there is a risk of that new path always being there, hence the forever fight against cravings and temptation.

Like with any disease, it requires a certain level of readiness before recovery can even become an entertainable option, just like hypertension and diabetes. I have patients every day that are not ready to actualize that they have these conditions and it is incredibly difficult to help them until they are ready. Unfortunately, addiction carries the extra weight of ruining all the patient’s relationships and job opportunities all around them so many people suffer, not just the patient. That is a way that addiction is definitely worse and potentially more powerful.

My whole point and the most important bottom line is to offer a least a slight pause of understanding for the addicted patient. They do need help and hopefully they are willing to receive it. They have to understand going in that it will require a lifetime of strength, resistance and fortitude. It is not a job or a task that is completed in a day. There are multiple steps every single day to keep the train on track so to speak. It is no easy task, but it can potentially save their lives.

Have a great day everyone. There are potential heros at heart everywhere.

Dr. Katz

So, I just had this huge anniversary

Guys, do you realize that just over a year ago I was unconscious, in a coma, filled with brain tumor and swelling. Like, literally, gone from the world, no verbal communication, gone. That was Dec 11th 2023.

Wow! How time has passed. I cannot really say flown because believe you me, nothing has been fast. It has been hard, grueling, painful, lonely, exhausting, but not really fast per se. But, look at me now. My business survived. I retained all of my employees and made sure that their incomes were not impacted. I managed not to lose any of my equipment or my home. I have even managed to write two more books in the meantime! And, I finally managed to start paying myself some after like four years of mostly not doing it.

Sounds like all wins so far, but not gifts. These are all hard-earned achievements that took a lot of blood, sweat, tears, grit, determination, and positivity. I was not really given anything, but I didn’t expect to be either. I knew the road ahead. I had been through it before. Here’s hoping for some more lengthy time off in the future.

I have friends that are amazing and want to make sure to praise me for how far I have come. That is awesome and they are awesome. At the exact same time, I want someone to recognize me and all that I have survived and been through and throw me a big party that doesn’t involve raising money for my survival and is just for fun, I want to forget the whole thing and pretend it never happened in the first place. When I actually sit and allow myself to reflect for a minute, I go right back to the moments of fear and not knowing and wondering if I was even going to be able to get to stay on this planet at all. Those memories turn on you fast before you know it. I am never going to be upset at my friends for congratulating me. They are just trying to be the amazing people that they are. I am just admitting that it scares me at the same time. Like, what if it happens again? You know, all the fearful dready thoughts that mix in with the happy celebrations. I guess that is just the way that it is at the moment. Thank goodness for therapy on a regular basis to keep your head on straight.

The bottom line is that I will never stop being grateful for still being here and getting just to be alive. I will never stop trying to use my now functional brain for good and to help women and girls and hairy men( ya know the ones I do laser hair removal for?) everywhere and every day. I just have to realize that is also ok to sit back and take a minute if I need to pause for some memories or anxiety. It’s a normal response. I don’t have to be constantly busy and productive. I am still of use to the world even if I am not doing twenty things at once in case it’s my last chance to do so. Take it easy there Katzie, you are going to continue to be ok. It’s your time to shine now.

Dr. Katz

I can’t believe I am doing this again.

Hi guys. Long time no write I realize. There has been a crap ton of stuff going on. I have cancer again, for the second time in three years. This time instead of Hodgkins, I have large b cell primary cns lymphoma. That means I have a monster brain tumor. Yuck. This means two different cell lines within three years. This means I have a stem cell issue and am probably looking at stem cell transplant on top of months of chemo. This mean months in the hospital away from my family and other people I Iove. To even say the words brain cancer out loud are terrifying. It’s the kind of thing that sends a little shudder of terror right to your heart. I can’t help it. it’s true. It’s a scary thing. I personally feel it shouldn’t happen to anybody…lol. It’s one of those things that I cannot spend a lot of time overthinking about. The fear could paralyze you if you let it. Life must go on somehow, no matter how much you have left. I realize that this one could finish me but I am not going to let it stop me from living now. I am going to do everything I can to stay for myself, my family, my friends and my patients. I am determined to make the most of my life. 

I am about to change direction and tell you what has been good about this diagnosis. I realize that that sounds ridiculous and counterintuitive, but just listen for a minute. The overflowing vast amount of support has been amazing and warms my heart. It reminds me of all the blessings I still have despite my diseased brain. My staff, friends, family and patients have been amazing and I could not be more grateful. It reminds me that I am a good person who has spread positivity and helpfulness into the world and now people are trying to give it back. No matter what happens, I will try never to forget that. Thank you. Thank you from the bottom of my heart. Stay positive and fierce people!

Dr. Katz

You can never be “too Allen.”

Image result for Friends

With the launch of HBOmax the other day, my world was rocked to discover that Friends had jumped ship to HBO after disappearing from Netflix. Life was whole again! I, like much of America, still hold on to my love for that bunch of 20 somethings who modulated flawlessly into 30 somethings while still looking fabulous and maintaining a lifetime of friendships. I started with episode 1 and just kept going…for the 100th time. I go to the episode when Monica finally was dating a guy named Allen that the whole group liked…a little too much for Monica’s comfort. They couldn’t get enough of him and even hung out with him when Monica was not around. This should have made Monica ecstatic right? She had been saying for years( as far as we know, because this was only 3 episodes in…lol), that she really wanted to find someone that her friends liked. Instead, she broke up with him right away, devastating her friends and then went on to her next series of unhealthy, unhappy relationships. It seemed like she was so intent to take complete ownership of her relationship decision that she was willing to sacrifice potential happiness rather than give her friends credit for perhaps seeing something that she wasn’t able to.

This brings up several questions. Do we really want the approval of our friends as much as we say that we do? Does that outweigh our own need to make our own decisions? Are we always able to make healthy decisions for ourselves without input? Do we sometimes make a bad decision intentionally just to say that we did it on our own? Do our friends know us better than we know ourselves? Do our emotions rule our decisions?

Ok, that is a lot of questions. Let’s break this down. All human beings have an innate inclination toward having some kind of control over our lives. We like to be in charge of our own decisions, no matter how trivial they may seem. We say we want our friends’ input, but really our natural impulse is to ultimately make the decision of our choice, not theirs, regardless of the consequences, just to say that we did it. That’s who we are. Even the most collegial of humans have a need to have the final say in the topic of choice.

Psychologists all over the world have studied human decision making. There are multiple theories about the decision making process. One theory says that the decision making process involves 7 steps: 1) Identify the decision to be made, 2) Gather relevant information, 3) Identify the alternatives, 4) Weigh the evidence, 5) Choose among alternatives, 6) Take action, and 7) Review your decision. Other theories do not break down decisions into steps. They say that there are only two types of decisions: Habit decisions and Goal-directed decisions. Habit decisions are made on a more impulse-based process. Goal-directed decisions are made based on information and logical thinking, but research shows that you can’t give a person more than four pieces of information to evaluate without actually slowing down the decision making process or stopping it all together.

We like to think that we are logical in our decisions and that we carefully weigh the alternatives, we gather info and look at our options. However, it is just not possible that we are logical in all of our decisions. Our brain actually makes hundreds of decisions per day without any kind of logical think through. Here I go bringing up research again, but, it shows that the bulk of our decisions are actually unconscious and actually involve emotion over logic. Researchers have studied brain activity during decision making. They were actually able to determine what choice the subjects were going to make on average of 7 to 10 seconds before they even realized that they made a decision or verbalized it. Let’s take a look at the emotional component of decision-making. The somatic marker hypothesis also suggests that decision making is a process that depends on emotion. We know that the ventromedial prefrontal cortex (vmPFC) of our brain is key in processing emotional signals that are essential for guiding our decisions to our advantage. The vmPFC helps regulate fear. and stops you from continuing to be afraid in certain situations. It modulates conditioned fear and helps you let go of it and be able to make a decision. Our amygdala is also a key component in processing emotional signals but it’s role differs slightly from our prefrontal cortex. The amygdala is where conditioned fear responses are created and continued. Damage to either of these areas affects decision- making. There you go: more evidence that decision making depends on emotion. I will take this a step further and add that emotion plays a role in helping others with their decisions. For example, you can’t effectively help someone change their mind about something unless you begin to truly understand how they feel about it in the first place. Otherwise, you cannot really make any arguments of influence. It makes sense, doesn’t it?

I am glad that we have established that we are not robots and that we do not make cold, calculating emotionless decisions every day. I personally view this as a positive but I am in the minority. It is interesting to me that the concept of emotionally -influenced decision making is still vastly greeted with skepticism and negativity. This is exemplified in phrases like “clouded by emotion.” Gender discrimination in the work place abounds based in large part by the misconception that women are more inclined to utilize emotionally based decision making more often than men. Therefore, women are often looked over for high powered management positions if a male candidate is available. This has a negative connotation implying that the weighing of emotional factors implies a sense of weakness or irrationality somehow. Based upon what I’ve told you this bias does not make any sense. All humans make decisions based on emotional input, regardless of chromosomes and regardless of whether they are aware of it or not. It is a scientific fact. Does emotional have to equal irrational? Absolutely not. Emotions are just part of what makes us human. Emotions and decisions are intertwined and not likely to become untangled anytime soon and that’s what makes life interesting and unpredictable. Have a fantastic day everyone!

Dr. Katz