NYC alternate therapy to alcoholism?

June 19, 2011 2:24 PM

I need a non-12-stepper psychiatrist in NYC.

I already have a therapist at the Albert Ellis Institute, whom I meet with weekly. He is wonderful. But he can't prescribe, and the psychiatrists he's recommended have been more along the line "you have to check in; go to AA; work the steps." I tried the naltrexone route (Sinclair method), but it didn't seem to reduce cravings even though I stuck with it for many months.

Even my GP has been willing to prescribe short-term xanax, and that's been very helpful in helping me get off alcohol--I take it for a few days, taper off fast, and then am fine for a month or a few. Staying quit is obviously the problem. I need a doctor I can go to over and over (say, every six months if necessary) and say, look, I need to detox again, can you help me?

I'm persuaded (from looking at stats) that this is actually the typical pattern for the vast majority of alcoholics. And also that there are no reliable statistics that show that AA or checking-in rehab produce better results.

So I'm looking for a psychiatrist in NYC who might be willing to work with me me on this--along with the addictions-specialist therapist I see weekly.

Thanks for any insights, though I'd really prefer for this not to turn into and AA/anti-AA thread.

posted by torticat to Health & Fitness (6 answers total)

I doubt if you will find very many physicians willing to do this protocol. It is down on the list of preferred or recommended protocols. Since you have done considerable reading I assume you know the upsides and down sides. Using benzo's in the TX of acute withdrawl and a history/presence of D Ts &/or seizures is appropriate but (from most physicians point of view) needs to be closely monitored including the possibility of 24/7 observation. Using benzo's to transition from alcohol dependence to short term sobriety is just not done that frequently as there is little or no evidence that it is any more (un)successful than other methods of managing dependence and has the risk of the person using the benzo's in addition to alcohol. Not a good scenario as you know. If I were you I would try and find a psychiatrist who is willing to work with you to try the "off label" use of some of the newer atypical anti-psychotics at dosages substantially less than those used with psychoses. They can have powerful anxiolytic properties with no dependence or tolerance. Seroquel (quetiapine) can be used with or without Remeron. You will no doubt see/hear that Seroquel is awful, terrible, dangerous, contraindicated with alcohol etc. It is a potent drug, however at lower dosages it can effectively manage the acute and chronic anxiety experienced with alcoholism. I wish you success--please find a psychiatrist who wants to work with you and is willing to experiment. You are really limiting your options by going in and requesting a specific treatment regime and further limiting your options without making an honest commitment to sobriety. It is asking a lot of any physician to prescribe a drug knowing there is a very real possibility that it might be coupled with alcohol. Imagine the progress note they have to make--pt. prescribed xxx, refused AA, no commitment to sobriety and btw the drug is contraindicated. Much different than pt prescribed xxx, referred to AA and made a commitment to go and to maintain sobriety for next 60 days.
posted by rmhsinc at 4:03 PM on June 19, 2011 [2 favorites]

Response by poster: Points well-taken, rmhsinc.

I understand the pressure on the psychiatrist; that's partly why I've been afraid to go talk to them (though i've talked to at least three).

The point is, even AA emphasizes "a day at a time." I don't thing any self-aware addict can swear not to fall off the wagon over the next 60 days. One of the things AA does is accept people back, over and over, hoping each time the outcome will be different, and really not applying pressure beyond, "A day at a time; and we'll always be here when you are desperate enough to quit, regardless of your history..."--plus, of course, a lot of positive affirmation of success.

Statistics show it takes many relapses before your typical smoker will quit. I don't know what the comparable stats are for alcoholics; I'm sure they're abysmal. But it is impossible to find a doctor who will work alongside you through all that, in the same way the fellow-travellers at AA do?
posted by torticat at 4:42 PM on June 19, 2011

Best answer: BTW, I was trained, and was a trainer in Ellis's RET now CBT--I don't think you could be going to a better place for therapy, of course I am biased. you are in a very difficult place--of course I would like to drag you off to find the "right" AA group--but I even more hope you can find the right psychiatrist who will encourage you to work with him/her and some alternative medication regimes. There are some fairly interesting alternatives that involve off label use of a wide variety of drugs--of course--that usually requires a psychiatrist who is foolish, extremely bright, very committed to their patients, innovative , irresponsible or some combination there of. Keep on doing research on the off label use of some of the other psychotropic drugs--of course most of the strategies are for continuing sobriety. Nothing works as well in the short term as benzo's. BTW, average number of relapses from sobriety is five (I have been told by a psychiatrist) who specializes in addiction medicine. Yes, that is a specialty with Board Certification so you might look for one of them.
posted by rmhsinc at 6:07 PM on June 19, 2011

Response by poster: Thank you, thank you, rmhsinc! But you don't have any old contacts to recommend in NYC?

On the relapses scale, I'm at about three, and don't really want to hit five. But I'd also like to have a doctor who wouldn't give up on me if that happened. Who wouldn't say, well at THIS point you have to check in. (My therapist is on board with finding a psychiatrist like this.)

(Apologies for babysitting thread; it just doesn't seem anyone else is chiming in, so I might as well respond.)
posted by torticat at 8:54 PM on June 19, 2011

Best answer: I am not in NYC and can't recommend anyone personally, but you want to use the phrase "addiction psychiatry" or "addiction psychiatrist" in your Google search. As you sift through the various websites, look for someone Board Certified in Addiction Medicine or Addiction Psychiatry. Then, if you can't find this info on their website, call and ask what their usual approach to treatment and outpatient detox is. You may also talk to the admissions department of a deco center and ask them if they have some recommendations of psychiatrists to call. When I worked admissions we'd often get those calls, and knew which of our doctors treated different situations. This may boil down to quite a few phone calls before finding the right one.
posted by MultiFaceted at 10:16 PM on June 19, 2011

I wish I had a recommendation but I'm afraid I don't. Multifaceted is right about many phone calls and looking for "Addiction Medicine. There may well be a listing of physicians in the NYC area who are Board Certified/Eligible-or are members of American Society of Addiction Medicine. I nchecked, there are member listing services for both groups. Keep in touch and let me know how things develop. email is in profile.
posted by rmhsinc at 7:18 AM on June 20, 2011