Q & A with Dr. D

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I have been asked on multiple occasions if I could address reader questions on my blog, or blog about a particular topic. So, today’s blog post will address some these reader questions, and I invite additional questions in the comments.


Q: Is addiction a behavior problem, stemming from bad choices? Is it a biochemical brain difference? Is it something else?

A: Addiction starts with behavior (using a substance), but it definitely also involves difference in the biology of the brain and nervous system. A whole lot of research shows us that the biology of the brain is different in addicts. Sometimes that brain difference may be due to changes in brain biology after exposure to drugs and alcohol, or other times it may be those brain differences that lead a person to use substances in the first place. After the brain has adapted to addiction, the biology is a strong force and willpower is not enough to overcome it. It’s great advice to never try drugs or alcohol in the first place, but “just quitting” is impossible after addiction takes over the brain.  


Q: Are teenager’s mental health symptoms going to last for the rest of their lives?

A: During adolescence, a great many things are changing, including regulation of the emotions. When a teenager develops mental health symptoms, they are highly likely to change over time. Even though many teens will reach adulthood and still have symptoms, they may not be the same symptoms experienced in adolescence. Adult symptoms may be better, worse, or just different. Some problems resolve completely. What’s clear is this: getting mental health symptoms under control quickly (any kind of symptoms) leads to better outcomes later. So whether symptoms will morph over time or stay the same, early management is key.


Q: Is mindfulness a fad, or does it actually help with anxiety and depression?

A: Mindfulness seems to be a fad, AND it appears to be a good tool for coping with anxiety and depression. Mindfulness is all about “just noticing” thoughts, feelings, and experiences, and sometimes just noticing and observing symptoms is a good way to regroup. Fads in mental health and self-help are common, but some of them are more useful than others. Mindfulness is a positive trend.


Q: What is the difference between bipolar disorder and depression? What is the difference between bipolar disorder and a personality disorder, like Borderline?

A: Bipolar disorder is not a new mental health condition, but it has become a part of the public conversation. Still, many people are confused about what the illness entails, and to make matters more confusing, there is more than one type of bipolar disorder. Many times, bipolar is an illness of ups and downs. (That’s where the name comes from). The downs may include bouts of depression. People with depression and bipolar disorder may experience the exact same symptoms of depression, with the main difference being the ups in bipolar that don’t come in depression.

Borderline personality disorder can be hard to explain, but I often tell patients that it is like a problem of inner chaos. Bipolar disorder type II has a lot of features in common with Borderline personality disorder and in fact, it can be hard for even experience professionals to tell them apart.

Unfortunately, the term “bipolar” has been adopted in the popular usage to mean out-of-control emotionally. That is not an accurate use of the term, and using it this way is harmful to people who struggle with mental illness.


Q: How can I get my wife to stop drinking so much? She won’t listen to me.

A: Whether your loved one has a mental health condition, substance use problem, or general health condition, it can be hard to get them to follow their treatment plan. The people we love may refuse to take their medications. They may refuse to curb self-destructive behaviors. When this happens, the best thing a family member can do is refuse to participate in the problem, and urge the loved one toward health with healthy behaviors of your own, good communication, and a refusal to make the unhealthy behavior easy or convenient. Unfortunately, you may also have to wait and worry before things get better. If things get worse and the situation reaches a crisis, crisis intervention may become necessary to put your loved one in treatment.


Posted on April 9, 2018 .