Dr. Ryan Myles Wallace, MD

Those suffering with a substance abuse addiction are often unable to cease their behavior without some form of medical intervention. Studies have found that repeat use of certain drugs can figuratively rewire the brain, resulting in alterations to neural pathways associated with dopamine. This means that repeat drug users may become reliant on consuming the substance in order to function. For example, those with alcohol addiction ("alcoholism") become physically dependent on alcohol and may experience extreme withdrawal symptoms when avoiding alcohol entirely; in rare cases, medically unsupervised withdrawal can lead to death.

Behavioral addictions are similar to substance abuse addictions; however, people with behavioral addictions are addicted to a behavior or emotion associated with certain behaviors, as opposed to drugs. In addition to gambling, common behavioral addictions include food, video games, social media, shopping, and pornography addictions. When performing the activity, people experience euphoria (a rush of dopamine) that slowly lessens over time, meaning they build a tolerance and dependency on a behavior. For example, people who are addicted to shopping may need to purchase more items or spend more money to feel the same rush that once fueled their addiction.

Addictions can be assessed through a variety of means such as diagnostic screening, abuse assessment, or psychiatric evaluation. Treatment can help patients recover from their addictions and manage mental and physical health conditions related to their addiction. People with addictions may be treated in rehabilitative treatment facilities, hospitals, and other clinical settings.

Addiction treatment for substance abuse may include:

• Detoxification (withdrawal from an addictive substance)
• Pharmacotherapy (prescription medications), such as buprenorphine-naloxone (Suboxone), disulfiram, and naltrexone to ease withdrawal symptoms
• Overdose treatment, such as the administration of naloxone (also known as Narcan)

Addiction treatments for both substance abuse and behavioral addictions may include:

• Addiction therapy and psychiatric care, such as cognitive behavioral therapy (CBT)
• Prescription medicine for co-occurring psychiatric disorders
• Twelve-step programs and support groups, such as Alcoholics Anonymous (AA) or Food Addicts Anonymous (FA)

Addiction treatment has expanded to include care for patient substance abuse in non-clinical settings. A number of community programs now provide at-risk substance users a safe place or means to use drugs and mobile doctor's services for drug-associated illnesses and injuries. Behavioral addictions are also gaining increased attention as researchers and mental health professionals seek to better understand and treat them. For example, some researchers are assessing the connections between video game addiction and childhood risk factors. More and more, mental health experts are recognizing the importance of meeting people with addictions where they are at, using more advanced treatments. Addiction treatment is intended to care for people with addictions with compassion and respect.

The use of therapy is extremely common, with millions of people going through therapy each year in the United States alone. It can be useful for patients who want to learn coping skills when they are facing difficult issues or need to heal from past trauma. Therapy can also be a support tool when patients are facing stressful periods in their life. Essentially, therapy is helpful any time life events require more mental or emotional resources than a patient currently has. Change is a major theme of therapy, offering a supportive environment for patients to make changes to their life or themselves so that past problems stop recurring in the future.

There are several different types of psychotherapy, with the most common being cognitive behavioral therapy or CBT. This type of therapy focuses on the connection between thoughts, feelings, and behavior. Dialectical behavior therapy, or DBT, is a form of CBT that encourages acceptance and validation as well as change. Interpersonal therapy focuses on relationships and communication as a pathway to feeling better. Psychoanalysis, an older form of therapy invented by Sigmund Freud, teaches that all problems stem from the unconscious.

Although many people see therapists by themselves, not all psychotherapy is one-on-one. For example, in family therapy, the therapist treats a family as a unit. Patients can also participate in group therapy, where they meet as a group to work on issues.

Psychotherapy is a safe, powerful healing tool that can help patients lead happier and healthier lives. However, therapy is a joint effort between the patient and the therapist. Both need to work together in order for therapy to be effective.

Young adults ages 18 to 30 are most commonly diagnosed with SAD. For unknown reasons, more women have SAD than men. Those who have a preexisting mood disorder, mental illness, or live in a region with cloudy and dark weather are also more likely to have SAD. People with SAD may experience:

• Feelings of hopelessness
• Fatigue
• Daytime exhaustion
• Loss of interest in activities
• Weight gain
• Social withdrawal
• Oversleeping
• Headaches
• Increased desire for carbohydrates
• Difficulty focusing

The causes of seasonal depression are uncertain. It is suggested that the reduced daylight and sunshine of winter and fall can alter the chemistry of the brain. Sunlight may assist in the production of serotonin, a hormone that regulates mood and happiness. Less exposure to sunlight may result in decreased serotonin, leading to SAD. Other potential causes include disrupted circadian rhythms, vitamin D deficiency, and increased melatonin (sleep hormone).

A variety of treatments are used to alleviate SAD. Patients usually benefit from more than one treatment. Light therapy is a special lamp that lets off intense light. The therapy is performed at home with patients keeping the lamp a few feet away from them as they complete their regular activities. Two types of light therapy include the light box (consistently bright lamp) and the dawn simulator (lamp that gradually becomes brighter and brighter). Light therapy may be partnered with other treatments for SAD, such as:

• Antidepressant medication
• Increased sunlight exposure
• Vitamin D supplements
• Psychotherapy

SAD is more than feeling disappointed by shorter winter nights or rainy days; it is months of depression that can drastically influence mood and behavior. Fortunately, people with SAD typically respond quickly to consistent light therapy and other treatments. Self-care and relaxation are also vital to the SAD recovery process. For those with SAD, treatment can be the first step to making four or five months of the year enjoyable once again.