HBO Addiction: An Interview with Dr. Kathleen Brady

"Dr. Kathleen Brady is a professor of psychiatry at the Medical School of the University South Carolina, and an expert in addiction and co-occurring psychiatric disorders. Here she discusses how underlying disorders like anxiety, depression or trauma can lead to addiction or relapse, stressing the necessity of treating these mental disorders and addiction simultaneously."

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You can see the whole interview on the HBO: Addiction website by clicking here. Next to the video, you will see three chapters that are clickable links and these will give you access to the whole interview in roughly 10 minute segments.

As in the case with Dr. Volkow, I am impressed not only by the obvious grasp of the subject matter that Dr. Brady has attained but also by the way her interview is filmed. Her topics are presented in short, to-the-point segments introduced with a black and white text that is all wrapped up in a similar summary at the end.

She begins by giving her definition of addiction; a compulsive use of drugs and/or alcohol. She goes on to explain the steps of experimentation, casual use, and then abuse that lead up to an addiction and the genetic predisposition and environmental factors that also can play a role. Most of this information I have heard from other sources, but the way it is delivered here is quite effective.

Definitely more interesting was the topic of anehedonia, which is a condition that impairs one’s ability for emotional gratification and is caused by the reduced dopamine (the brain’s neurotransmitter and natural reward system) production of an addicted brain. Actually I have heard this term mentioned, even in conjunction with the fact that alcoholics and addicts have reduced dopamine production because of their reliance on drugs and alcohol to serve as a proxy service for an emotional reward system. However, I had never caught on to the fact that this is not only a major cause of continued drug and alcohol abuse, but also a major cause of relapse.

An example: When a mother sees her child, dopamine is produced and the result is a positive emotional reward. A mother gripped by addiction will not have a similar bond with their child because the same emotional reward can only be gained from drugs and alcohol. So in the first stages of recovery, many become depressed because it can take several months of abstinence from their drug of choice before their brain begins producing dopamine normally. The mother who is now in her first weeks of recovery still may not get a normal emotional award from her family interaction and can easily fall right back into using again.

This is kind of the neurochemical explanation of the “high” that many get from becoming clean and sober that is all too often transformed into a depressive state after just a few weeks of sobriety. The “high” comes from the stress relief and physical rejuvenation one usually experiences when they switch from 24/7 abuse to taking care of themselves. However, without the dopamine reward systems functioning properly they very soon find them self in a depressed state and searching for something to give them “meaning” once again.

Now you can see why as a psychiatrist she is very interested in the co-occuring problems of depression and anxiety. She stresses the simultaneous treatment of the addiction and the other problems, but does not really delve too far into the issue that one may just be a symptom of the other. I think the reason for this is that there is only so much you can try to explain in a twenty minute interview, but the introduction does stress that this is her specialty. But to be fair I do not think I would want to touch that topic if I had a full semester either, much less with just a few minutes to get my point across.

I’ll let her slide on this one, but submit for discussion the fact that I and almost every addict and alcoholic I know that had access to the head doctors also convinced them that we were manic depressive, bi-polar, and suicidal. We did this in a manipulative manner not in the search for solace, but in the hunt for drugs and reinforcement that our problems were unique and not “just and addiction”! Once we got what we needed, it was time for another doctor, another script, and a life that was already destroyed by the drug of our choice was now muddled further by those prescribed to us by (usually) well meaning professionals.

I will cover the other points that I disagree with Dr. Brady in another segment because this is getting rather long winded. I will leave you with my topics of contention for those of you that may want to blog on the subject. 1) I disagree in principle with Dr. Brady that one need not hit “rock bottom” before they can begin recovery. 2) I also disagree in principle that non-voluntary treatment is effective. I say in principle not because I think she is wrong in the clinical sense, just that reality and the support resources an average person can command almost always bear truth to these rules.

Good show, I am looking forward to watching and reviewing more of this well done documentary series.