Upper East Health specializes in the comprehensive treatment of behavioral disorders, and addictive behaviors with medical and multidisciplinary treatments. Upper East Health provides outpatient care for disorders of different types and at varying levels of severity. The practice treats patients with addictions, sexual disorders, mood disorders, anxiety disorders, attention deficit disorders, obsessive compulsive disorders, cognitive impairments and psychotic disorders. For those patients who require it, Upper East Health refers practice patients to the top medical specialists in the New York area.

When rehab and residential care are required, we admit patients to the leading medical and residential centers in the United States. Dr. Rosenberg maintains admitting privileges at New York Presbyterian Hospital and the Cornell Medical College. During hospitalization or inpatient rehab, the Upper East Health team remains in close contact with the inpatient facilities.

Our holistic approach is based on the idea that addiction is a brain disease which must be attacked from many vantage points, with different treatments.

The drive to stimulate the pleasure centers trumps reason and common sense, steamrolling past regret, dismissing yesterday’s bad experiences and overriding the very instinct to survive. Surgically implant an electrode in a rat’s brain that stimulates these pleasure centers, and you’ll have a rat that will do anything and everything possible to get more and more brain stimulation. Give the rat a choice between hitting a lever to stimulate the pleasure centers or hitting a lever to feed itself and its pups and it will choose pleasure over survival nearly every time. Only death permanently separates the rat from its fix. Each of us has our poison. A personal poison that makes us feel better in a jiffy, soothes us, ignites the reward center of the brain, transforms us and offers peace of mind and a false sense of balance. It’s a poison so delectable that we erroneously convince ourselves that the benefits outweigh the risks. For some of us, it’s alcohol, drugs or cigarettes. For others, it’s compulsive sex. For many, it’s fatty foods. Few of us live without some irrational and destructive desires.

Alcohol addiction, well studied for years, is a prototype for the addictive cycle. Alcohol turns on and off major neurotransmitters in the brain and has anxiety-reducing effects. Body weight, age, and genetic metabolism all play a role in determining whether alcohol makes you sick or makes you feel great. For most of us, taking two or three drinks relaxes us -- much more makes us sick. Yet, there are some people who take their first drink and a light goes off -- an ease, a feeling of wellbeing previously unknown overtakes them.

It’s no surprise that these people tend have a predisposition to become alcoholics, people for whom the consumption of four, six, even twelve drinks, means that the party is just getting started. In the scientific literature, on average, biological (not adopted) children of alcoholics are able to consume much more alcohol than non-relatives from the moment of their very first drink, supporting the theory that biological predispositions play a major role in the development of alcoholism. To understand the biological susceptibility that some people have to alcohol, researchers break down alcoholics into Type 1 and Type 2 subgroups. Those who learn to drink in response to environmental pressures are Type 1 alcoholics. Those who drink because of an inborn, biological urge are categorized as the more severe Type 2 alcoholics.

This classification system is based on research done during the 1980’s in Stockholm on children of alcoholics who were adopted and thereby, grew up without the influence of their biological parents. According to this system, Type 1 Alcoholics are essentially made, not born. They develop their disease after the age of 25, they don’t have many alcoholic relatives and therefore don’t seem to have a strong genetic predisposition. Their ‘need” for alcohol has influenced by stressor and environmental influences. They tend to have passive personalities and succumb to peer pressure. They tend to be anxious and use alcohol to calm down. In sum, Type 1 Alcoholics get that way as a result of their environment and a temperament that makes them susceptible. They have a less serious, less entrenched and more treatable form of alcoholism.

Type 2 Alcoholics, on the other hand, have strong family histories, their problems tend to develop earlier in life (before age 25,) they tend to be antisocial (criminal and anti-authority types) and their alcoholism is far more serious (but still treatable.)

This division has its merit and most alcoholics can be placed somewhere on the continuum between those who are “made” and those who are “born.” But few alcoholics can be classified as purely Type 1 or Type 2. Increasingly, we see every behavior as the result of the complex interplay between our psychology, biology and environment. There are probably dozens of types of alcoholics, not to mention that each of the 18 million alcoholics living in America is different. (More poignantly said by Tolstoy who wrote, “every unhappy family is unhappy in its own way.”)

Metabolism and basic brain interactions are only part of the story. With sufficient months or years of addictive behaviors, anyone can build up a “tolerance” and develop desperate psychological cravings. Familiarity and access are critical to developing an addiction. Poverty, stress, poor education, and overburdened parents only add to their vulnerability. Even without the stresses of the inner city, addictions can be infectious.

Many of us are at risk, including doctors! Nearly all doctors are in the habit of writing their own prescriptions. And most have an arrogance and overconfidence that unfortunately are common corollaries to a medical education. And they have easy access to “left-over” pain-killers while they rotate through their hospital training.

Case-in-point is my experience with doctors abusing a drug that is a cousin of heroin called Fentanyl, an injectable and patch-like form of opium. Hospital anesthesiologists commonly use Fentanyl to put surgical patients into an opium haze during surgery. Anesthesiologists have familiarity with the drug and they’ve got access. Thus, it’s no coincidence that 78% percent of anesthesiologists with addiction problems are opiate junkies, and most use Fentanyl.

Another factor in determining whether you’ll become an addict is the psychological “fit” of the drug or the behavior. Case-in-point is a group of doctors-in-recovery who met in a therapy group in my office. They ranged from stimulant abusers (‘upper drugs’) to alcoholics (‘’downer drugs’). Despite their educations, the upper-doctor-junkies could never understand why the downer-doctor-junkies do what they do, and vice versa. “Why would anyone want to come down?” asked the upper junkies who gravitated towards cocaine. “I would never want to be more jittery than I am,” say downer-doctor-junkies who gravitated towards alcohol and Valium. The upper-junkies are people who crave extra stimulation. They tend to be people who tend to have attention deficit disorders; they have an inability to pay attention unless the stimulation is very intense and the volume is cranked up. Upper junkies also tend to be people with depression who want to wake up from their lethargic existences. Most often, they are people with a biological and psychological temperament that demands high-risk, high-energy behavior — gambling, skydiving, speeding, that sort of thing. Geneticists have even isolated genes that may identify this subgroup of abusers. If upper-junkies want it turned up, downer-junkies want it all turned down. Downer-junkies tend to be people who are already too ramped up, too over-stimulated, too sensitive, too tuned-in and turned-on. They “fit” better with alcohol, opiates or other downer drugs like Valium. They tend to be people with anxiety disorders, insomnia and post-traumatic stress disorder. They tend to be artistic, romantic and sensitive. Now I can go on and on, but the most important thing I can say about addiction concerns Denial and Shame.

Shame is the enemy. Caught up in the maelstrom of substance abuse or behavioral addictions, addicts feel immune to the disasters. Despite how easy it is to become an addict or patient, and how commonly it occurs, addicts are so ashamed — and their denial becomes the most formidable obstacle to recovery. Rather than ruin their lives with impunity, our patients have decided to confront their addictions and make monumental positive changes. And being a part of that comprehensive solution is what Upper East Health is all about.

Kenneth Paul Rosenberg, MD

June 7, 2012