Psychiatric Therapy for Addiction Treatment

Few things rival the public stigma of addiction, but mental illness is one of them.

For some reason, we tend to believe we can ignore the maladies of the brain and think our way into living well. At Cornerstone of Recovery, we recognize that the opposite is true: Those who suffer from addiction and mood disorders have to live their way into thinking well, which is why we offer a host of psychiatric services as part of our treatment regimen.

How prevalent are co-occurring disorders, i.e. addiction and mental illness such as depression, bipolar disorder, etc.?

According to the 2014 Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health, more than a third of the 20.2 million Americans with a substance use disorder also suffered from a mental disorder. It’s been estimated that roughly 65 percent of bipolar patients have a substance use disorder at some point, as well as a third of those who suffer from Attention Deficit Hyperactivity Disorder (ADHD). Sufferers of anxiety, depression, trauma … we often find that many individuals who suffer from mental illness turn to drugs and alcohol in an attempt to self-medicate, and over time, those substances present as an entirely separate disease.

At Cornerstone of Recovery, we treat the addiction, but we also make a concerted effort to address underlying and coincidental issues as well. A medical detox regimen is necessary to safely and slowly withdraw patients from drugs and alcohol, because only then can other mental health issues be addressed. That’s where Dr. Lane Cook, Cornerstone’s chief of psychiatric services, enters the treatment process.

Dr. Cook has been a board-certified private practice psychiatrist for almost four decades, and his involvement in addiction medicine dates back to his work at East Tennessee’s Peninsula Hospital in the 1980s, where he was a colleague of some of Cornerstone’s founders, including William J. “Bill” Hood, Bob McColl and Dan Caldwell. He’s served as both a physician and an educator in the field of psychiatry, and at Cornerstone of Recovery, he oversees the services that helps patients with co-occurring disorders address the issues that may have precipitated their addiction. What he finds is that many patients are often unaware of these underlying issues, and helping them to identify them and treat them is another tool that helps them to sustain long-term sobriety from the substances that have brought them to our facility.

Sometimes, those mental health issues are pre-existing conditions; other times, those substances bring about secondary conditions that are alleviated once the substance abuse is addressed. Example: Is a patient’s depression caused by abuse of opioids, or were opioids used to self-medicate the depression? Cornerstone’s psychiatric services helps patients discover the answer to that and similar questions, so that moving forward, they can pursue the best treatment plan that offers a solution to both issues. Patients with psychiatric issues can request appointments with Dr. Cook, or they can be assigned appointments by counseling staff during the treatment process.

Either way, mental illness doesn’t have to be a stigma that’s ignored or dismissed any longer. Patients who suffer from these disorders aren’t weak or mentally deficient; they’re sick, and their illnesses must be addressed in order to move beyond the curtain of pain and misery that impedes them from living a life that’s joyful and fulfilling. The drugs they take are often a symptom of deeper problems, but there’s no reason a patient can’t receive treatment for both while in our care.

Medication Therapy

Medicine can a wonderful tool for anyone who suffers from a physical or mental malady, but sometimes it isn’t the answer. We address each patient’s needs individually, and the decision to use medication is part of the therapeutic process. We work collaboratively with each patient to make these medication decisions.

One of the more helpful medications we’ve found useful to the treatment process is Vivitrol, also known as long-acting naltrexone, which has proven successful in early recovery for both addicts and alcoholics. Trading one drug for another is often frowned upon in the treatment process, but Vivitrol is a different type of medication. For one thing, it’s not a full agonist like methadone, or even a partial agonist like buprenorphine (Suboxone); it’s a total antagonist, meaning it binds to opioid receptors in the brain and prevents those who ingest opiates from achieving the “high” that is so addictive. It has zero use liability and no street value.

Vivitrol was approved in 2006 for the treatment of alcohol abuse to prevent relapse. It is a monthly injection form of naltrexone, a pill which was first approved in 1984 to treat opioid addiction and 10 years later to treat alcohol abuse; as the injectable version, Vivitrol was approved in 2006 for alcohol abuse and in 2010 for the prevention of opioid relapse, and numerous studies have demonstrated that opioid users who accept Vivitrol as part of a multi-layered plan of care are 50 percent more likely to maintain long-term sobriety. Since Vivitrol blocks opioid effects and euphoria, a six-month study of heroin users showed that the typical Vivitrol patient was opioid-free up to 93 percent of the weeks in the study. Since alcohol promotes the release of endorphins, the body’s own opioid chemical, naltrexone/Vivitrol combats alcohol abuse and decreases the binge behavior. For patients who were detoxed and able to abstain from alcohol for one week, 40 percent were able to remain completely abstinent on Vivitrol versus 19 percent of placebo participants.  

At Cornerstone, the use of Vivitrol is discussed with many patients who come to treatment addicted to opiates and/or alcohol. It’s important to understand that it’s certainly not a “cure,” by any means; if anything, it works most effectively when administered as part of a comprehensive, ongoing treatment plan that involves group therapy, 12 Step recovery and peer support. As with most approaches to addiction treatment, there is no “magic bullet” that kills the disease of addiction, but when used under the guidance of trained professionals, it can give patients another tool that helps them maintain successful post-treatment recovery unhindered by the specter of a return to addiction.

At Cornerstone, the use of Vivitrol is discussed with many patients who come to treatment addicted to opioids and/or alcohol. It’s important to understand that it’s certainly not a “cure,” by any means; if anything, it works most effectively when administered as part of a comprehensive, ongoing treatment plan that involves group therapy, 12 Step recovery and peer support. As with most approaches to addiction treatment, there is no “magic bullet” that kills the disease of addiction, but when used under the guidance of trained professionals, it can give patients another tool that helps them maintain successful post-treatment recovery unhindered by the specter of a return to addiction.