specializing in addiction recovery
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QUALITY HEALTHCARE – MAKING THE RIGHT CHOICE! Dr. Weinstock graduated from Tulane Medical School in New Orleans. He then went on to complete his residency training in psychiatry at Tulane University Medical Center. Dr. Weinstock is Board Certified in Adult Psychiatry by the American Board of Psychiatry and Neurology. He has been in full-time clinical practice since 2005.He has been appointed an Affiliate Clinical Professor of Psychiatry at the University of South Florida Medical School, Psychiatry Department. He also performs psychiatric evaluations for the Hillsborough and Pinellas County Courts, serving as an active member of the Hillsborough County and Pinellas County Guardianship Examining Committees. He currently holds admitting staff privileges at both Tampa General Hospital and St. Joseph’s Hospital. SERVICES PROVIDED: Dr. Weinstock treats all patients aged 17 and older. He treats all psychiatric disorders but he specializes in treating: Mood and Anxiety Disorders, including Depression, Bipolar, Generalized Anxiety Disorder, Panic Disorder, Obsessive-Compulsive Disorder, and Eating Disorders. Additionally, Dr. Weinstock is licensed to prescribe Suboxone for the treatment of Opiate Dependence / Addiction. Treating those in need of psychiatric help in the greater Tampa area
MEET THE DOCTOR Eric L Weinstock
Eric Weinstock, MD, is a Florida licensed, Board-Certified Adult Psychiatrist. He now offers the ground breaking new Ketamine therapy for Depression and Anxiety. He completed both his medical school and residency training at Tulane University in New Orleans, Louisiana.
What is Ketamine?
What are the side effects? Ketamine is a “fast-in, fast- out” drug that can be given as an injection in the arm or hip muscle with 90% absorption and elimination in 4-6 hours, or by monitored IV infusion, 100% absorption and elimination in minutes. The side effects are rare but include allergic reaction, elevation of blood pressure, and a weird “spaced out” dreamy state that quickly wears off. These risks require a companion to drive the patient home after the first treatment (Uber is okay too). Normal activities can be resumed after 2 hours. For follow-up treatments, patients are usually able to drive themselves home once they have been cleared by Dr. Weinstock.
What are the benefits?
Multiple studies over the last decade have shown that ketamine can rapidly alleviate symptoms of treatment resistant depression, within hours of treatment. (References below) This “off-label” psychiatric use appears to offer several advantages over traditional anti-depressant therapy. Rapid response is the primary benefit. Depression can improve within minutes or depressants. And unlike most anti-depressants, ketamine does not cause sexual side effects or weight gain. The medication is so promising (70% rapid response rate in most studies) and it is so different from existing anti-depressants, that it can now be offered to carefully selected patients in an office setting. Ketamine was first synthesized in 1962 and received FDA approval in 1970 for use as an anesthetic for general anesthesia induction and maintenance. It is classified by the DEA as a schedule 3 controlled substance. It is also used off-label for the treatment of chronic pain conditions such as fibromyalgia and complex regional pain syndrome (CRPS). hours, compared to 4-6 weeks for a trial of anti-
Ultra-rapid relief of depression and anxiety symptoms. Symptoms can improve within minutes or hours, compared to 4-6 weeks for a trial of anti- depressants. And unlike most anti-depressants, ketamine does not cause sexual side effects or weight gain. When starting ketamine, it is not necessary to stop your current medication, however; after demonstrating a positive response, patients may be able to gradually wean off of their other depression medication under the careful guidance and supervision of Dr. Weinstock. Patients commonly describe the treatment experience as a feeling of complete calmness, peaceful, light, tranquil, relaxed, and mildly euphoric. The residual after-effects which can last several days to several weeks after your treatment include a general sense of well being and a much greater ability to cope with the daily stresses in your life. Recent research has also discovered that ketamine increases the production and release of BDNF (brain derived neurotrophic factor) in the brain. BDNF acts as a kind of “fertilizer” for neurons and other brain cells, leading to increased synaptic connections between neurons and the formation of new neuronal pathways.
Patients commonly describe the treatment experience as a feeling of complete calmness, peaceful, light, tranquil, relaxed, and mildly euphoric
Talkin’ ‘Bout My Generation
NIDA Researchers Develop Screening Tool for Teen Substance Use This article is a condensed version of a piece that originally appeared on the National Institute on Drug Abuse (NIDA) website.
Teens’ use of addictive substances often goes undetected by health care providers. But NIDA-supported researchers have developed a Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD), to help spot teens’ problematic habits. In a recent study, BSTAD developers Dr. Sharon Kelly and colleagues at the Friends Research Institute in Baltimore examined the frequencies of use likely to qualify a teen for a diagnosis of an alcohol use disorder (AUD), nicotine use disorder (NUD), or cannabis use disorder (CUD). The frequencies proved to be surprisingly low, according to the researchers.
Teen drug substance use revealed For the study, the BSTAD survey employed a few, simple questions about teens’ use of alcohol, tobacco or drugs within the past year.The teens’ BSTAD responses revealed that 22 percent had used alcohol in the past year, 16 percent had used marijuana, 10 percent had used tobacco, and 3 percent had used at least one illicit substance other
than marijuana. (Original article by Eric Sarlin, M.Ed., M.A., NIDA Notes Contributing Writer) 28
“ Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention. “
-Dr. Sharon Kelly, Friends Research Institute
Analysis of the data showed that almost all teens who reported on the BSTAD that they had consumed an alcoholic beverage on two or more days during the past year had an AUD. Conversely, teens who reported drinking on fewer than two days were unlikely to have this disorder.The corresponding BSTAD cut point for an NUD was nicotine use on two or more days during the past year and for a CUD was marijuana use on two or more days. BSTAD enables early detection Using these cut points, the researchers found that the BSTAD was highly sensitive. Ninety-six percent of teens with an AUD, 95 percent with an NUD, and 80 percent with a CUD would be flagged as likely in need of further assessment for a brief intervention or referral to treatment. BSTAD’s specificity was also high: 85 percent of teens without an AUD, 97 percent without an NUD, and 93 percent without a CUD reported use below the cut points, and so would be correctly classified. “Very low substance use frequencies were found to be optimal in identifying these disorders,” Dr. Kelly comments. The BSTAD does not distinguish
Researchers encourage regular screening Both the World Health Organization and the American Academy of Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Still, many providers do not regularly screen their patients for substance abuse. “Providers are extremely busy and need a quick and valid screening measure for identifying teens who use substances,” says Dr. Kelly. She and colleagues developed the BSTAD in response to a NIDA call for new tools to fill this need. To create the BSTAD, Dr. Kelly and colleagues added the questions about tobacco and marijuana to the widely disseminated National Institute on Alcohol Abuse and Alcoholism screen for youth alcohol use. In the validation study, the FRI research team administered the BSTAD in person to half of the participants, and the rest of the participants self-administered the instrument on an iPad. The teens reported a strong preference for the iPad. The iPad version offers the potential extra convenience that results can be automatically transferred into a teen’s electronic medical record.
the severities of the disorders, she notes, so when it flags a teen, providers need to follow up with questions to determine appropriate interventions or referrals to treatment. Furthermore, Dr. Kelly says, “Health care providers should have a one-on-one discussion with teens who indicate any substance use to assess level of risk, provide brief advice, and, if necessary, recommend further assessment for a treatment intervention.” Providers also should rescreen teens regularly, because onset of substance use can occur abruptly during adolescence. Pediatrics recommend screening all adolescent patients for substance use since problems later in life often originate in adolescence. Both the World Health Organization and the American Academy of
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THE FLORIDA PSYCHIATRIC CENTER IS ABOUT CHANGING PEOPLE’S LIVES
1300 NWEST SHORE BLVD STE 240 • TAMPA, FL 33607 813.636.8300 EWEINSTOCKMD.COM CONTACT US TODAY
SAMHSA PUBLISHES BEST PRACTICES ON MEDICATION-ASSISTED TREATMENT FOR OPIOID USE DISORDER Best Practices
Treatment Improvement Protocol 63, “Medications for Opioid Use Disorder,”
reviews the use of methadone, naltrexone, and
buprenorphine, the three FDA-approved medications to treat opioid use disorders.
Data indicate that OUD-treating medications are both cost effective and cost beneficial
The Substance Abuse and Mental Health Services Administration has published new guidance to help health care professionals better understand medications that can be used to treat Americans with opioid use disorder (OUD). Treatment Improvement Protocol (TIP) 63, “Medications for Opioid Use Disorder,” reviews the use of methadone, naltrexone, and buprenorphine, the three FDA-approved medications to treat opioid use disorders. TIP 63 provides guidance for health care professionals and addiction treatment providers on how to appropriately prescribe these medications and effectively support patients using these medications for OUD treatment. “We know that people can and do recover from opioid use disorders when they receive appropriate treatment, and medication-assisted treatment’s success in treating opioid use disorders is well documented,” said Dr. Elinore F. McCance-Katz, assistant secretary for Mental Health and Substance Use. “TIP 63 emphasizes that increasing access to medications to treat opioid use disorder will help more people recover, enabling them to improve their health, living full and productive lives.” TIP 63 is part of SAMHSA’s larger response to the opioid crisis. More access to treatment with OUD medications is critical to closing the gap between treatment need and treatment availability and an important public health strategy. Data indicate that OUD-treating medications are both cost effective and cost beneficial.
CALL US TODAY! 813.636.8300
Dr. Weinstock treats all patients aged 17 and older.
1300 N WEST SHORE BLVD STE 240 • TAMPA, FL 33607 | EWEINSTOCKMD.COM
CONTACT US 813.636.8300
Dr. Weinstock is Board Certified in Adult Psychiatry by the American Board of Psychiatry and Neurology. CONTACT US TODAY 1300 N WEST SHORE BLVD STE 240 • TAMPA, FL 33607 | WWW.EWEINSTOCKMD.COM
Dead people don’t get into recovery
D. Waters Is Suboxone a Reasonable Treatment Option for Opioid Addicts? After twenty years of providing substance abuse treatment I can tell you that the ultimate goal of anyone battling an addiction is total abstinence. Every addict and alcoholic eventually figures out they can not control their usage, and moderation is unrealistic. Learning to live life on life’s terms is part of the process of learning to live abstinent. Self-help programs like Alcoholics Anonymous(AA) and Narcotics Anonymous(NA) do a great job of helping people understand their addiction, themselves, and effective solutions for coping with their disease. Dead people don’t get into recovery Opioid addicts are not terribly different from any other addict or alcoholic, except the risk of death by accidental overdose is huge. People are dying in droves from opioid overdose. The current heroin epidemic is even more dangerous than the pain killer epidemic it replaced. Relapse rates are tremendous. Unfortunately, it may take years before an individual addict is ready to give the 12-Step AA/NA
I’ve truly never seen anything work better, and when it works it’s a beautiful thing.
process the thorough try it requires to be effective. Therefore, Suboxone is a terrific option for chronic relapsers. You can’t generally get high from it, unless you haven’t used in awhile, or never used in the first place. You can’t overdose on it from use or abuse, and any other opioid you take while it’s in your system will be nullified and wasted.
Not the solution, but maybe a good step forward Suboxone is not the solution, but in many cases it’s better than nothing, and a good response for chronic relapsers who are risking death from overdose. At least the addict is getting some exposure to treatment which is more likely to lead to recovery in the long run. Suboxone buys people time and keeps them alive. There are quite a few people who’s funerals I’ve attended that I wish had gotten on Suboxone. You can’t treat the dead.
The Subs knock down the monster cravings almost completely, and people don’t go through the nasty withdrawal that’s so painful. Once dysfunctional people who couldn’t hold a job, or were constantly on the obsessive hunt for the next fix suddenly become much more functional, and the addiction looks like it’s in remission. They can work consistently, they stop chasing the drugs, they have more money and can care for themselves and their families, and their addiction doesn’t seem to be ruling their lives. It seems like magic! Very few people actually wean off Suboxone successfully Suboxone users often wrongly think they’re cured because they look and feel more functional. Then they think all they have to do now is wean down, or taper off the medication, which is what the clinic doctors help them manage over a number of months to years. The problem is they’ve done nothing about the underlying addiction and all the addictive thinking and coping that go along with it that drive the addiction from within. They haven’t developed any social support, or learned anything about themselves and their disease. We like to say that using, or putting some chemical into the body, is only a symptom of the underlying disease. Abusing substances is not the actual disease—just a symptom. As soon as they stop using the Subs the addiction is still there and ready to start expressing itself all over again through the many painful ways it does. Chemically addicted people cope with life stressors with chemicals—that is, unless they make some fairly significant changes. Suboxone changes nothing in the end. Suboxone changes nothing A combination of Suboxone treatment coupled with AA/NA (with Sponsor and Step work) is a great thing. At Crossroads Counseling we require anyone with a substance abuse issue
to attend AA/NA, obtain a Sponsor, and work the 12-steps. If they don’t we won’t sign-off on their program. Most Suboxone clinics require their participants to attend at least one counseling meeting a month. Unfortunately, this is almost completely useless unless the individual engages in a personal program of recovery that addresses not only the biological issues, but the social, psychological, and spiritual issues related to the disease, as well.
GET HELP TODAY 813.636.8300 1300 N West Shore Blvd Ste 240 Tampa, FL 33607
The Centers for Disease Control and Prevention reports that overdoses from prescription opioids drive the 15-year increase in opioid overdose deaths. Opioids are drugs that are extremely powerful and lead to uncontrollable addiction, even in good, honest people. If you’re a resident of Alpharetta, Roswell, John’s Creek, Milton, or located anywhere in the metropolitan Atlanta, Georgia area, who’s ready to be free of your addiction, contact the trusted staff at Detox with Dignity, an affiliate of W.I.S.E. Medical Centers. Call the office to make an appointment, or use the online booking agent.
SUBSTANCE ABUSE Q & A
How do I know if I have an unhealthy addiction? Not all addicts are recreational abusers. You may question your use of the drugs if you’re unable to stop using the drug after the cause of the pain has resolved. If you have a past or a family history of substance abuse, your risk of addiction to opioids is great, even when a doctor prescribes pain medications for a valid condition. Do you use medications to help with withdrawal symptoms while detoxing from opioids? There is no single correct way to detox off of opioids. Sometimes sedatives, anti- nausea, anti-depressants, and blood pressure medications are helpful in different stages of the rehabilitation process. Some patients must taper off the opioids gradually before starting any detox medications. One of the most successful medications for detox is called Suboxone—containing the active ingredient buprenorphine. You start on Suboxone® once withdrawal has begun. Dr. Locke may also recommend naltrexone, sold under the brand name Vivitrol®, after all opioids are out of your system. Vivitrol discourages the resumption of opioid use.
What are the differences between tolerance, physical dependence, and addiction? Tolerance refers to a drug’s becoming less effective over time. Physical dependence describes a situation in which a person develops symptoms and signs of withdrawal, including sweating, nausea, diarrhea, anxiety, and rapid heart rate, when they cease taking the drug or lower the dosage. Addiction is a condition in which a person has lost control over the use of the drug. They continue to use it even when the drug harms themselves and their relationships with others. People who are addicted may obtain pain medications from non-medical sources, alter oral formulations of prescription medications, or snort or inject medications.
What are opioids? Opioids are drugs that affect the body in the same way that opium does. Examples of opioids include:
Oxycodone Hydrocodone
Fetanyl Heroin
They’re often prescribed for chronic pain or to help you recover from surgery. You may know them from their brand names, such as Vicodin®, Percocet®, and OxyContin®. For people with pain, opioids are very effective, and most patients don’t become addicted to them. However, in some people, opioid dependence becomes an unexpected side effect of well-intentioned pain treatment.
FOR DETAILS CONTACT US TODAY! 813.636.8300
1300 N West Shore Blvd Ste 240 • Tampa, FL 33607 | www.eweinstockmd.com
PSYCHIATRIC CENTER THE FLORIDA
VISIT OUR WEBSITE www.eweinstockmd.com
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To keep the billing process of our practice smooth and hassle free, we use medical billing and practice management services of MTBC. Our office works closely with MTBC to ensure that your health insurance company is billed accurately and promptly.
1300 N West Shore Blvd Ste 240 • Tampa, FL 33607
not just a bad habit It’s NOT JUSTA BAD HABIT
Recent research and dialogue in the political sphere have brought long-simmering questions about addiction to the forefront: Is addiction truly a disease? Do addicts deserve to be treated like people who have a Recent res arch and ialogue in the political spher have brought long-sim ering questions about ad iction to the fore: Is addiction truly a disease? Do addicts deserve to b tr ated like people who hav a dise s that’s outside their control? disease that’s outside their control? While most researchers agree with the so-called disease model of addiction, stereotypes and cultural bias continue to stigmatize those with addiction because they made an initial choice to consume substances. However, Columbia University researchers point out that “choice does not determine whether 34 While most res archers agre with the so-called isease model of ad iction, ster otypes and cultural bias continue to stigmatize those with ad iction because they made an initial choice to consume substances. However, Columbia University res archers point out that “choice does not det rmine whether
something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices.” Experts say that applying the distinction of choice to addiction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked during a 2015 town hall meeting in New Hampshire. When Christie’s mother was diagnosed something is a disease. Heart disease, diabet s and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what hap ens in the body as a result of those choices.” Experts ay that ap lying the distinction of choice to ad iction creates biases that justify inadequate treatment. It begs the question New Jersey Gov. Chris Christie asked uring a 2015 town hall me ting in New Hampshire. When Christie’s mother was diagnosed with lung cancer at 71 as a result of addiction to tobacco, he noted that with lung cancer at 71 as a result of ad iction to tobacco, he noted that
no one suggested that she should not be treated because she was “getting what she deserved,” he said. “Yet somehow, if it’s heroin or cocaine or alcohol, we say, ‘Ahh, they decided that, they’re getting what they deserve,’” Christie remarked. HOW ADDICTION WORKS After satisfying basic human needs like food, water, sleep and safety, people feel pleasure. That pleasure is brought by chemical releases in the brain. This is according to Columbia researchers, who note that the disease of addiction causes the brain to release high levels of those pleasure chemicals. Over time, brain functions of reward, motivation and memory are altered. After these brain systems are compromised, those with addiction can experience intense cravings for substance use, even in the face of harmful consequences. These changes can stay in the brain long after substance use desists. The changes may leave those struggling with addiction to be vulnerable to “physical and environmental cues they associate with substance use, also known as triggers, which can increase their risk of relapse,” write Columbia researchers.
not just a bad habit treatment and continued monitoring and support or recovery.
THE COLUMBIA RESEARCHERS DO HAVE SOME GOOD NEWS: Even the most severe, chronic form of the disorder can be manageable and reversible, usually with long term
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1300 N West Shore Blvd Ste 240 • Tampa, FL 33607
GET WELL WITH US TODAY 813.636.8300
OPIATE PROGRAM BREAKING THE CYCLE
Why are we non-12-step? We’d like to state at the outset that this does not mean that we are Anti-AA. (See “An Open Letter to Our Friends at AA.”) We believe in anything that works, and we believe that individuals should have a variety of choices from which to choose.
Since 1995, here at Assisted Recovery, we have seen our
approach work even when the 12- step approach had previously failed.
Most people are already familiar with AA’s primarily spiritual program of recovery (turning your will and your life over to a Higher Power). AA offers many social support resources, in the form of self-help group meetings that are available nearly everywhere… plus dances, pot-luck suppers, retreats and conventions where members can meet other sober people. AA also offers some limited psychological tools, mostly in the form of simple slogans such as “One Day at a Time,” which are easy to understand and remember. Finally Evidence- Based Treatment for Opiates that will empower you to quit using and make positive changes in your life. As a recognized leader in the non-12-Step recovery movement, Assisted Recovery’s founder and Director Lloyd Vacovsky was interviewed for the Penn and Teller Show on the Showtime Cable TV network. The episode about AA, entitled “12 Stepping”, which began airing in September 2004. In this episode, Penn and Teller were particularly critical of AA, and of government-mandated attendance to what is essentially a religious program. (Note: Suggested only for mature audiences and those who are not offended by foul language.)
Assisted Recovery is a leader in providing state of the art treatment for opiate dependence. ARCA addresses the biological, psychological and social components of the recovery process. This program fully integrates medications with psychosocial support. This type of integrated program is an example of the Pennsylvania Model of Recovery. The model is so named in recognition of the work of the University of Pennsylvania and in particular Dr. Joseph Volpicelli, MD, PhD (author of Recovery Options) Assisted Recovery is a fully licensed behavioral health agency, Arizona BH 2620. We recognize that most individuals whom become dependent upon drugs and or alcohol have core psychological issues which they self-medicate for. Stopping drug use does not stop the cravings and the thought processes that lead an individual to relapse. ARCA provides effective individual and group cognitive behavioral therapy. Treatment is provided in an Out Patient professional setting. With Suboxone®, we can safely and effectively detox an individual from opiate dependence comfortably in an Out Patient environment. Cognitive Behavioral Therapy is provided and is an integral component of the Assisted Recovery Pennsylvania Model program. It fully meets the counseling requirement that is mandated by the Food & Drug Administration for individuals taking Suboxone®. ARCA recognizes the anxiety and depression associated with detoxing from opiates. Further that benzodiazapine’s are not an appropriate response. ARCA utilizes ondansetron as a safe and effective alternative to a benzodiazapine. As soon as a client is detoxed, ARCA strongly reccomends the use of Vivitrol(r) which is injectible naltrexone. Vivitrol(r) blocks the ability to use any type of opiate for 30 days. Vivitrol(r) is an escential tool that clearly is often the differance between success and failure. ARCA works closely with Vivitrol’s manufacturer Alkermes Pharmaceuticals to facilitate the delivery of Vivitrol(r) to the client. Vivitrol(r) provides the assurance that an individual cannot use an opiate for 30 days. The Assisted Recovery Program fully integrates medications with psychosocial support. This type of integrated program is an example of the Pennsylvania Model of Recovery. The model is so named in recognition of the work of the University of Pennsylvania and in particular Dr. Joseph Volpicelli, MD, PhD (author of Recovery Options) The Psychological component is addressed primarily with the use of Cognitive Behavioral Therapy as developed by Dr. Albert Ellis, PhD of the Albert Ellis Institute of New York City. Suboxone® protocols offer opiate dependent individuals a safe, effective and reasonable path to abstinance and recovery.
Since 1995, here at Assisted Recovery, we have seen our approach work even when the 12-step approach had previously failed
Dr. Weinstock is licensed to prescribe Suboxone for the treatment of Opiate Dependence / Addiction.
CONTACT US 813.636.8300 1300 N West Shore Blvd Ste 240 Tampa, FL 33607 eweinstockmd.com
For more information please contact us at (813)636-8300 1300 N West Shore Blvd Ste 240 Tampa, FL 33607 EWEINSTOCKMD.COM
Call or email our office to schedule a new patient visit to determine if ketamine is right for you.
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