Guest: Dr. Indra Cidambi
Presenter: Neal Howard
Guest Bio: Indra Cidambi, M.D. is recognized as a leading expert and pioneer in the field of Addiction Medicine. She founded the Center for Network Therapy (CNT), New Jersey’s first state licensed Ambulatory (Outpatient) Detoxification care and treatment facility, and currently serves as its Medical Director working to to help patients addicted to substances such as alcohol, anesthetics, benzodiazepines, opiates and suboxone.
Dr. Cidambi received her medical degree from Tashkent State Medical Institute in the former U.S.S.R and completed her residency at Maimonides Medical Center in Brooklyn, New York. She was then selected for the prestigious Fellowship in Addiction Medicine at New York University/Bellevue Hospital in New York City. Dr. Cidambi is Board Certified in General Psychiatry and double Board Certified in Addiction Medicine (ABAM, ABPN). She is fluent in five languages, including Russian.
Segment overview: Dr. Indra Cidambi, MD, talks about the types of medications that treat addiction.
Health Professional Radio – Addiction Treatment & Medications
Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. Our guest in studio today is Dr. Indra Cidambi, leading addiction expert and Medical Director at New Jersey’s first licensed out-patient substance abuse detox facility, The Center for Network Therapy. And she’s in studio today with us to gives us some insight into some of the science of addiction, how we can help and especially when it comes to our teenagers who seem to becoming hooked on drugs in an epidemic rate. How are you doing today Dr. Cidambi?
Dr. Indra Cidambi Thank you Neal.
N: Thank you. When it comes to drug abuse, what is it about this new so called well “Good-Grade Pill” that seems to have teenagers becoming hooked at an alarming rate?
C: This is the stimulant, Adderall mostly. Students think that they want to … out and then they go for these Adderall and they want to abuse them because they think that they’re going to have success, get good grades but that’s not what it’s supposed to be doing. It only works on your working memory, that’s not really give you the rote memory where it helps and the working memory is working need to get good academic performance. So it doesn’t help you with that at all.
N: So there’s a misunderstanding about the way that the drug works in the first place, yeah?
C: Correct. They think with that alone “I’m going to score now” because it’s not supposed to be doing that. It’s only rote memory you’re going to do, memorize stuff and you know you need a working memory to do well that get, to get high score, to obtain a good increase in concentration. But then this Adderall really does help you increase concentration, make you focus and helps you stay out longer to study but then the next day, one is going to crash from the Adderall. And so they are not performing well in the test. So it’s a myth that it’s an academic achievement steroid.
N: So once you become addicted then you’re not able to take advantage of what the drug was supposed, was intended for as far as your concentration and your rote memory. Now you’re just addicted to the drug and I guess struggling to maintain the addiction?
C: Correct. The research had shown them that over 25% of teenagers believe prescription drugs can be used as a study aid. And they use it, non-medically use during college, they used for them to achieve more in school.
N: Let’s talk about some of the science that maybe a student or a loved one is hooked on some type of substance whether it be an Opiate or a stimulant such as Adderall. What are some of the signs to look for?
C: What you see is like first of all the behavior changes, the pattern like they become very irritable and you see the symptoms of like anger and they are not sleeping and they’re quite anxious, they have mood swings. When you see that in general they’re talking about any addiction. And so that’s should raise concern from the family members that there is something that’s going on. And then they become like absent minded, they are not engaging with us and they’re isolating themselves, and they have some psychological dependency when they become quite anxious and they kind of forego anything to obtain the drugs. And then you see that they have been lying, they have been stealing, and they’re preoccupied within themselves and they’ve fallen off from all their activities like they don’t go to school, their grades are coming down and they are not keeping up with the relationship and a lot of debts, financial constraints. So once a person starts seeing that we should pay attention that something is going on. And so there is a disruption to the daily routine, that’s most important stand up. You also see somebody’s scolding, you see that leave them, they have runny nose and they have problem with their diet and stuff like that, that’s really important for us and you should also be looking or paying attention to the paraphernalia’s like there you would see in their room like cut-off straws, a dollar bill rolled and powder, and contraceptives and stuff like that. So that should kind of alert you and also if you see spoon in the car and if you see some aluminum foil on their drawer, and also rubber bands, it kind of alerts you and you should say “Okay, I should first talk to my loved one and confront them with that thing and ask them”…first of all ask them, don’t jump to conclusion. Just ask them and understand their stresses and tell them that you’re here to help them, obviously expecting to lie you first then, that’s the nature of the beast. That they are going to deny, they’re going to like lie to you. But then once they understand that you didn’t know … they have to come clean and they’ll tell you one fourth of the story and that’s good enough to take them to the next step of taking a proper treatment.
N: Do you find in your experience that one age group or another is more receptive to your type of Ambulatory Detox as opposed to another?
C: Not at all. I’ve been seeing young kids too. I mean kids, who is like anyone above 19, 19 and above and those some from that aged to, age 80 they had all open minded and come to have little detox. As I said it is most friendly for them, it’s not the fear of going away. So there is a struggle of the addicted population, they always think “That my family doesn’t want me, they want to kick me out.” That’s the fear that they have.
N: Do you at The Center for Network Therapy treat patients differently depending on how their addiction came to be? Whether they were trying to escape the stresses of their life and became addicted or whether or not they had an injury and became addicted to some type of pain killer? Are there differences in your approach to therapy based on how their addiction came to be?
C: Not at all, because it doesn’t matter. The brain doesn’t understand how you obtain the opiate. It could be a doctor’s prescription and you took it for pain and eventually you became addicted to it. Or it could be a Heroin that you bought from the street or the prescription pill that you bought from the street. That the ward system in the brain it’s all the same, you’re getting this … outside and having said that, it’s all about stigma and shame associated with the drug use. So what I focus on with the patient is anybody who comes in with the addiction problem to us, I do not judge them. Number one, I take away the shame and stigma of the situation. I tell them “Your addiction is an illness, it’s the same as Diabetes.” So there is no difference between Diabetes and your substance abused. It kinds of makes them so surprised and they say “Oh, isn’t that my behavior, I got it upon myself and I should struggle to come off of this drug” and I tell them that’s not your fault, you should take accountability, you should work towards sobriety but that doesn’t mean that it’s just all your behavior. Part of it is your behavior but it is an illness, it’s a brain disease. So that kind of takes away their shame and stigma, and that is the truth of the matter, addiction is a brain disease. And once you do that, when I tell them there’s no need to lie. You have to be brutally honest with their trigger, and that kind of gives them first step to the task and they understand by someone admitting to us that I relapsed, that’s not a threat and we come to sit down with them and ask them “why did you have a relapse? What you could have done differently to avoid having a relapse?” So that kind of makes them understand the next time around they will not have a relapse, because you walk through the cycle of addiction.
N: Now one final question Dr. Cidambi, before founding CNT or The Center for Network Therapy, you were the Director of Detoxification and Rehab at Summit Oaks Hospital in Summit New Jersey, have you found that you are able to help patients more hands on or in a more comprehensive way now that you are a Medical Director at CNT as opposed to Summit Oaks?
C: I always was able to help patients … they work with but then Center for Network Therapy is a model that I put together by working in-patients, I did understand what the patients were missing out. It was rewarding though for them that’s because when someone got detoxed they didn’t have enough support to address a full secure withdrawal symptoms. So what I did with Center for Network Therapy is to have detox and bring down to partial hospital program that should be two weeks after the detox. Detox goes from 9am to 7pm during which time we also incorporate the family part to it, which was the missing piece in majority of the patient in-patient, because they wouldn’t give you the release or the family is not coming in. They don’t have so many family meetings and in real life what is going on with the patient and the family so I get that piece at The Center for Network Therapy, so it kind of gives you a family with the patient, the whole picture. And also we work with the…they come in on daily basis and they run the group. So we should have ask the patient “you should go to a 12-step program” we incorporate that in our program, so it kind of comes of one big umbrella. You see the family part, the daily addiction treatment for detox and then the partial hospital program under the post-acute withdrawal because post-acute withdrawal can really make a patient come off of the detox level of care, go home and immediately before they step down to intensive out-patient which will be like 2-3 days later their discharge time from the in-patient setting. They go on use because they don’t have enough support, they don’t understand, they’ve been back to the same stress of the daily life only from before going in-patient. So I kind of took everything that was not working in in-patient and coined all those things to make my ambulatory level of detox. So I kind of get the satisfaction that when a patient comes in, I’m able to give them everything that they needed, so both myself and the patient enjoy this level of care.
N: Excellent. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio talking with Dr. Indra Cidambi, recognized as a leading expert and pioneer in the field of Addiction Medicine. And she’s been in studio this afternoon with us talking about some of the signs to look for in substance abuse, some of the ways that you can help and also some of the ways that you can manage the stress and avoid some of the triggers. It’s been great having you here with us today Dr. Cidambi.
C: Thank you.
N: Thank you. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to our podcast on iTunes.