General Adult Psychiatry & Addiction Psychiatry
Med School/Year Graduated: St. Petersburg Pavlov Medical University, Russia, 1996
Years in Practice: 10
How do you treat addiction/substance abuse through psychiatry?
The treatment of any mental illness and substance use disorders is about strengthening the frontal lobes to inhibit and suppress the urges, impulses and cravings that are generated from the underlying parts of the brain. This ability to tolerate frustration and delay gratification is typically acquired by the age of 25-26, and by then the brain is more equipped to withstand the damage of various substances. We use medications to suppress cravings and treat the underlying issues… and group and individual psychotherapy, as well as meditation, education and skills training to boost the frontal lobes.
One of your areas of study is the gender difference in mental illness and substance use. What are your findings on the difference between men and women in these arenas?
The neuroimaging research shows that female brains tend to be more sensitive to various stimuli and release more dopamine in response to them. More dopamine means higher vulnerability and stronger cravings. There is a telescoping phenomenon proven in all animal and human studies for all substances of abuse that females develop addiction faster and in a more severe fashion if the level of exposure is equalized between the genders.
Mental health is so individualized and different from one patient to the next – unlike a broken arm, which is always just a broken arm. Does this ever feel overwhelming?
Life is difficult for everyone. We are all fellow travelers, and everyone is an expert in his or her own life more than anyone else. The best approach is empathizing, guiding and helping patients to believe in their own strength to figure things out in their unique life circumstances. It is gratifying and humbling, even though it may be at times overwhelming and painful.
What are the most common misconceptions of your field? How do you address them?
Anxiety is essential for survival. One is not anxious if dead or intoxicated – otherwise, humans are supposed to be anxious. Too little or too much anxiety is pathological. Getting rid of anxiety is not a goal of the treatment. Making it manageable is the goal. It is achieved by expanding the capacity to tolerate it or by shrinking the external level of stress, which may or may not be possible.
What are some indicators that people should seek mental health help? What is a good first step in doing so?
When life challenges us beyond our capacity to handle it, when the protective mechanisms are breached, mental illness starts to develop. This point of breaking is different for different people. At that point, every human being starts having predictable symptoms: disturbance of appetite and sleep, inability to enjoy things, difficulties with decision-making and concentration, things like that.
What’s the best “shrink” joke you’ve heard? Or are they all terrible?
I love “shrink” jokes. Many of them are really funny and reflect a certain level of professional deviation. Like this: “How do you tell a patient and a psychiatrist apart on a psych ward? You look for who has a key to the door.”
“If I wasn’t a doctor, I’d be…”
A musician. I love singing in a choir and making music with other people.