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HOUSE CALL WITH DR. SANJAY GUPTA

Interview of Dr. Drew Pinsky

Aired March 5, 2005 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


TONY HARRIS, CNN ANCHOR: Now in the news, Lebanese troops backed by armored vehicles have surrounded Syria's intelligence headquarters in Beirut. Lebanese opposition leaders, along with United States and several other countries, have been demanding that Syrian troops get out of Lebanon. Syria's President Bashar Assad addresses his parliament later today. And there is speculation he'll respond to those demands.
Italian journalist Giuliana Sgrena is back in Rome, being treated for wounds mistakenly inflicted by U.S. troops in Iraq. Sgrena had just been released by kidnappers when the car she was in fired on as it approached a roadblock.

I'm Tony Harris, HOUSECALL begins right now.

DR. SANJAY GUPTA, HOST: Good morning, welcome to HOUSECALL. Millions of Americans are struggling with addictions, from drugs and alcohol to food and gambling. But an exciting new development. A new drug that attacks the very biology of alcohol addiction is giving hope to millions struggling with the disease.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Pop a pill and stop the craving for alcohol. Sound too good to be true? Well, a pill approved by the FDA may do that for millions of people who can't shake the urge to over drink.

It's called Campral. Used in Europe and other countries for decades, Campral works differently than other alcoholism drugs like Antabuse (ph), which makes you violently ill if you have a drink.

DR. DREW PINSKY, ADDICTION SPECIALIST: It's the first drug that we're going to have in our armamentarium that actually attacks the biology of addiction itself, actually the drive mechanisms.

GUPTA: Campral targets chemicals located in the reward circuit in the brain, blocking those chemicals blocks the pleasurable effects of drinking. Simply put, alcoholics no longer have the cravings.

Despite the body of research to the contrary, many consider alcoholism to be a personal failure, not a disease. But that is starting to change.

PINSKY: Anyone that works with the disease will tell you that this is clearly a biological process and couldn't be anything further from the old notions of it being a moral weakness.

GUPTA: They will also tell you there are chemical changes in the brain associated with alcoholism, largely the result of genetics. And those changes can also be treated with drugs.

Campral, the newest on the U.S. scene, doesn't work if you're still drinking. You have to quit first, and then use the medication to stay dry.

(END VIDEOTAPE)

Nearly 18 million Americans struggling with alcoholism or alcohol abuse, but the problem of addiction is much larger, ranging from chemical addictions, to behavioral or compulsive disorders involving sex or food. Talking with us this morning about all the varied forms of this deadly disease is Dr. Drew Pinsky. You've seen him before. He's addiction specialist and co-author of the new book, "When Painkillers Become Dangerous."

Thanks for joining us, doctor.

PINSKY: My pleasure.

GUPTA: You've heard about this new alcoholism drug Campral. Is this a major breakthrough, in your opinion?

PINSKY: It's sort of about time. We've been waiting for it. It's been used in Europe for many, many years. And finally, it's here. It's been a mystery for me why it has not been approved long before this. It is, as we mentioned in the piece you ran a few moments ago, it's the first drug we're going to have that actually goes at the biology of the disease.

Everything we've had before sort of was ancillary to the disease process. But now we're beginning to attack the biological mechanisms of the disease itself.

GUPTA: Of addiction. So would it work for other sorts of addictions as well? Or just alcohol?

PINSKY: Well, it's been approved for alcohol. But actually, we expected it for stimulants. It's very effective. Maybe useful for nicotine as well. So absolutely, it will have a broader use than merely just it's approved for I'm sure.

GUPTA: Dr. Pinsky, we get lots of questions about this. Let's work through some of them. One from Tracy in New York who wants to know, "Are some people predisposed to becoming addicted to things while others are not? I always thought it was the chemical in the substance that created the addiction." What about that, doctor?

PINSKY: Absolutely. It's a complex disorder, but it clearly has a genetic basis. In fact, in the definition of the disease, we consider genetics absolutely a crucial piece of the definition. So the definition as stated in a consensus conference that was published in the early '90s, it's a genetic disorder with a biological basis. The hallmark is the progressive use in the face of adverse consequence, and then finally denial.

Now notice nowhere in there does it say dependency and withdrawal and liver disease or vomiting or any of those consequences that do develop from addiction. But people need to have a clear idea in their head of a different between dependency, which is the physical dependency upon the drug that creates withdrawal and tolerance, and addiction, which is compulsive behavioral disorder where people chronically go back in an escalating fashion to a substance in spite of consequences.

GUPTA: Are there people who have addictive personalities? You know, people who are just predisposed to that?

PINSKY: Well, it's a complex question. There clearly features of having this gene. But I don't believe it's specifically a personality.

Now people might argue otherwise, but in my patient population, every possible person I (UNINTELLIGIBLE) if you can imagine is represented there.

And yet, there are features they have, they're perfectionistic, their frustration intolerance, they have euphoric response to opiates essentially always. They're stimulated from alcohol as opposed to sedated. There are qualities about them that are distinctly different than the average person, but I wouldn't put it under the heading of a personality per se.

GUPTA: Well, let's try and work through this a little bit more. There are still some people who see addiction as a failure of willpower and not a disease.

Kate in Los Angeles writes, "I'm curious how you explain these skyrocketing cases of addiction in so many new arenas. To me," meaning her, "it just sounds like people are unwilling to take personal responsibility for their own hedonism. Isn't identifying any type of dependency or use of a vice as an addiction only facilitating this kind of behavior?"

So Dr. Pinsky, obviously this is the other side of the argument. How do you respond to Kate?

PINSKY: Well, Kate's discussing the sort of blanketing of multiple behaviors with the sort of moniker of addiction. And I'm not in favor of that, actually. I kind of agree with her that every time somebody has an unpleasant behavior, they sort of claim it's an addiction. They can't contain it.

It's simply not the case. Addiction clearly is a biological process. I'm sure in the course of the show we'll talk about many of these biological mechanisms.

It is a failure of volition, but it's a overwhelming drive that absolutely crushes volition. And so, volition can no longer be -- function, no longer works in the defense of these powerful drives that take over -- literally addiction is a hijacking of the survival drive mechanisms of the brain. That's fundamentally what it is. I yell this (UNINTELLIGIBLE) all the time.

You must understand. The motivational priorities of the brain, survival, reproduction, eating, those motivational priorities have been usurped and focused on the pursuit of a drug. So every thought, every feeling is colored by that motivational system and that motivational priority every day, even when they're not using the drugs. And so, it's an extremely, extremely powerful disease.

GUPTA: Well, we are talking with Dr. Drew Pinsky.

Coming up on HOUSECALL, avoiding the tremors of detox. Stay tuned.

(BEGIN VIDEO CLIP)

UNIDENTIFIED MALE: They're very excited when they wake up and not craving. They can't believe it.

(END VIDEO CLIP)

UNIDENTIFIED FEMALE: Magic cure for addiction or the beginning of a long battle? We'll bring you the latest treatments.

And later, is your eating out of control? We'll show you how to figure out if you're a food addict.

But first, take today's daily dose quiz. How many drinks per week could put you at risk of becoming dependent on alcohol? A, 10; B, 14; or C, 18. The answer when we come back.

(COMMERCIAL BREAK)

UNIDENTIFIED FEMALE: Checking the daily dose quiz, we asked how many drinks per week could put you at risk of becoming dependent on alcohol? The answer, 14 for men. Cut that in half to 7 for women.

GUPTA: More than 50 percent of the population drinks. That, of course, doesn't mean everyone has a problem. But millions do, from binge and heavy drinking to alcoholism or alcohol dependence.

Here are some signs to look for if you think someone you know is in trouble. If they drink alone or in secret, they have trouble remembering, experiencing blackouts. Also, becoming annoyed if they can't have a drink or seem to have built up a tolerance to alcohol so they need much more to get that euphoric feeling.

Other signs? Losing interest in hobbies or storing alcohol in unusual places, like the car.

Answering our questions on addiction this morning is Dr. Drew Pinsky. He's an addiction specialist and best selling author of the book, "Crack."

Doctor, let's just jump back into our questions. This one coming from our roving camera.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: How much of a high risk, if you have a family member that was an alcoholic, would you have towards becoming an alcoholic?

(END VIDEO CLIP)

GUPTA: And Dr. Drew, you've already talked about the complicated sort of interactions with alcohol predisposition, alcoholism predisposition. Is there a family link with addiction?

PINSKY: Oh, absolutely. And just in sort of gross terms, it's about 50 percent per child if one or both parents have alcoholism. 50 percent probability of inheriting the gene. The only exception to that I've seen interestingly is in North American Indians, particularly Cherokee heritage, where the penetration seems to be more on the order of 100 percent.

GUPTA: Interesting. And aside from your family history, other risk factors include steady drinking, as we mentioned in our quiz, and your age. The earlier you start drinking, the higher risk you have of developing a problem.

PINSKY: There's actually an interesting body of information out there on rats, that if you take adolescent rats and expose them before the age of the equivalent of 15 in the human, their increase of -- their risk of alcoholism goes up dramatically. And we see the exact same thing in humans.

GUPTA: That's really interesting. Your genetic make-up may also cause imbalances in brain chemicals, increasing your chances of dependence. Plus, you know this Dr. Drew, if you're a man, you're more likely to become an alcoholic as well.

PINSKY: Yes.

GUPTA: And lastly, having anxiety or depression puts you at risk.

There was also a recent study found 20 percent of those with an alcohol or drug problem also suffered from mood or anxiety disorders. No doubt a tough disease to beat once it's got a hold of you.

Let's get to another question on this topic, Dr. Drew.

PINSKY: OK.

GUPTA: This comes from Gene in Florida who asks, "What's available to help alcoholics get clean?" The whole process of trying to stop?

PINSKY: Detoxification, is that what they're asking?

GUPTA: Right.

PINSKY: Well, there's a difference between detoxing and treating. Detoxing is getting off the drug, breaking the cycle of dependency. And actually, can be a very serious medical problem.

Alcohol is one of the common drugs from -- for which withdrawal can be fatal. So it is something that needs to be very carefully medically monitored.

Typically, people will use -- doctors will use Benzoldiazapene (ph) medication, Valium like medication. Sometimes they'll use anti- epileptic medication or barbiturates.

GUPTA: There are a lot -- you talk a lot about the 12 step program. And there are those who argue against it. Can addicts get clean without them?

PINSKY: I've not seen it. There are certainly behavioral programs, cognitive -- something called cognitive behavioral interventions that have been shown to be quite effective.

But by far, the most effective is the 12 step program.

GUPTA: A new form of treatment for drug addiction may save people from the debilitating symptoms of withdrawal Dr. Pinsky was just talking about, that go along with beating this disease. Watch this.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): In "The Basketball Diaries," Leonardo Dicaprio is acting the pain of drug withdrawal. But 28-year old Valerie Coody wishes it was just an act for her.

VALERIE COODY, RAPID DETOX PATIENT: You're cold, you're hot, you're anxious, no sleeping. You're body just craves the drug.

GUPTA: In this case, the drug was an opiate called Percocet, a prescription pain medication. Her story is not uncommon. A federal study shows 1.5 million of the 30 million patients who use prescription pain relievers in 2002 became dependent. Years ago, after a knee operation, Valerie was prescribed Percocet for post- operative pain. Soon, she was popping 20 to 30 a day.

COODY: It's almost like you can function better when you're on them than having to go through withdrawals.

GUPTA: Scared of withdrawal, but knowing something had to be done and quickly, Valerie tried a relatively new technique called Rapid Detox.

Typically, a person is weaned from drugs slowly. With Rapid Detox, patients are given anesthesia and then given an opiate blocking drug called Maltrexone that causes nearly immediately withdrawal.

Now if Maltrexone were given without anesthesia, the heart rate would increase, breathing would become labored, and the patient would feel violently ill. But the anesthesia seems to block all those ill effects. And detox can be almost immediate. Just a few hours, instead of weeks. RICK SPONAUGLE, DR., FLORIDA DETOX CENTER: They're very excited when they wake up and they're not craving. They can't believe it.

GUPTA: Still, patients do require several days in the program for medications and further counseling. And some doctors worry about the risks of general anesthesia.

(END VIDEOTAPE)

GUPTA: And Dr. Pinsky, your new book is about these addictions to painkillers. You're not a big fan of this treatment. It seemed to work for Valerie. What's your take on it?

PINSKY: I'm delighted that there are options for people out there. It certainly is a very viable option for Methadone addicts, because Methadone withdrawal can be miserable for up to 30 to 60 days.

My concern is that people believe that somehow the detox is all they need to do. The fact is nothing can be further from the truth. The detox is just where you start your process of treatment. So to think that being -- going through Rapid Opiate Detox and you're done, you're sorely mistaken. And it's a lot of money to spend on the earliest piece of the treatment process and the part that is not the most important in my mind.

I can get anybody off -- we've sort of perfected withdrawal. We can get anybody reasonably comfortably off almost any medication in three to five days.

GUPTA: Let's get to another e-mail on topic here. Tracy from Texas wants to know, "How addictive is marijuana when compared to heroin? How about when compared to tobacco and alcohol?"

Dr. Pinsky, marijuana's the most commonly used illegal drug.

PINSKY: Yes.

GUPTA: And there's a perception that it's not dangerous and not really addictive.

PINSKY: Right.

GUPTA: What's the comparison?

PINSKY: Let me -- I'm -- it would take too long, I think, to compare to each of those drugs. The fact it is addictive. And it seems to be an opioid mechanism, very much like heroin, very much like the Percocet you just had in the previous piece.

GUPTA: Right.

PINSKY: And the marijuana, I should go through the syndrome, because it's the same in all people. It's someone with a family history of alcoholism about 85 percent of the time, who initially doesn't think much of pot, but somewhere on the third or fourth exposure, as though there's some priming effect on the brain, they suddenly get this intense euphoria. Oh my God, I love this stuff. And that is what they preoccupy about.

From that day forth, they will use every day for somewhere between one and 30 years. During that time, the effects will wear off. They'll start getting depressed. They'll smoke more to try to compensate. And they'll slip into a depression.

At that point, they either come to treatment or they switch to another drug. Typically, amphetamine.

GUPTA: That is remarkable.

PINSKY: And amphetamine reverses the depression. So most of my amphetamine addicts and nearly all are actually marijuana addicts for whom the marijuana stopped working.

GUPTA: Initially they were marijuana addicts and now amphetamine. Really interesting stuff. We're talking with Dr. Drew Pinsky.

Coming up, drugs and alcohol not a problem. What about food and gambling? Stay tuned to HOUSECALL for help.

UNIDENTIFIED FEMALE: Abstaining from drugs or alcohol is one thing, but if you're a food addict, you can't stop eating. We'll tell you how to beat the habit.

But first, this week's top medical news in the Pulse.

(BEGIN VIDEO CLIP)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): New legislation unveiled this week in the Senate would mandate drug companies to report all their clinical trial results in a public database, this after criticism that some companies hid unfavorable drug study results.

And Americans are living longer than ever before. 77.6 years to be exact. The report by the Centers for Disease Control also showed the life span gap between men and women is shrinking.

Christy Feig, CNN.

(END VIDEO CLIP)

(COMMERCIAL BREAK)

TIME STAMP: 0851:47

GUPTA: Welcome back to HOUSECALL. We're talking about battling addiction. Alcohol and drugs are what we usually think of when talking about this disease. But in recent years, other compulsive behaviors are starting to fall under this umbrella as well.

For example, food. A recent study found the mere display of food, smelling and tasting without actually eating, caused increased activity around the brain, similar to the desire that a cocaine addict experiences.

So can a person be addicted to food? Let's get the answer from addiction specialist Dr. Drew Pinsky.

So what do you say, doctor? Can food be addictive as well?

PINSKY: Well, it's a complicated issue. I don't actually believe it can without first there having been a pharmacological addiction, because food is a physiological process. Pharmacology alters physiology. It causes extra physiologic changes in the brain.

And once those extra physiological changes have been induced, then the drive systems can become out of control. And food can be one of those things people turn to, to try to satisfy those drives.

GUPTA: Is there a difference...

PINSKY: Though not typically.

GUPTA: Is there a difference between addiction and compulsion? What's the difference?

PINSKY: Absolutely. Compulsion is a troublesome behavior that continues -- as people have difficulty containing. An addiction is a progressive disorder with mounting consequences with a genetic, biological heritage. And often, denial in addiction, while compulsive behaviors, people usually will tell you, they're not in denial about it. They're troubled by it.

GUPTA: They know that they're overeating, for example.

Let's keep on topic here. We got lots of e-mails on this. Let's get to one from Tommy in North Carolina who asks, "What are some of the symptoms of food addiction?"

Well, first of all, Tommy, there are signs -- typical signs of any kind of addiction, like needing it on a regular basis and failing attempts to stop abusing the item. Also...

PINSKY: Right.

GUPTA: ...people with addictions will go to extreme lengths in order to maintain the addiction.

Are there symptoms specific, Dr. Pinsky, to someone addicted to food versus something else?

PINSKY: I think we think again in terms of medical consequences. If somebody is diabetic, somebody's having vascular disease, somebody's having medical problems from food and still can't contain it, that's when it really sort of meets the criteria of an addiction.

GUPTA: An estimated $2 million adults become compulsive gamblers at some point in their lives. They lose control of their betting and sometimes their lives as well. Will from Connecticut has a question on this topic. "Can you explain what causes compulsive gambling? Is this a genetic disorder? Also, how would you recognize this disorder in an individual?"

Lots of questions there, doctor. Let's start with the signs that you may have.

PINSKY: Yes. Well, the signs you may have that you can't contain your behavior in relation to gambling. You know, University of Nevada-Las Vegas has a gambling laboratory, where they're studying these gambling behaviors. And they are complicated.

The most people, again, that I deal with, have become gambling compulsives are people who are trying to deal with a chemical addiction. And the reward mechanisms from the thrill of gambling are very similar to that from chemical addictions.

GUPTA: Dr. Drew Pinsky, of course. Grab a pen, everybody. When we come back, we're going to give you some tools to overcome addiction.

UNIDENTIFIED FEMALE: Coming up on HOUSECALL, from finding treatment help, to learning about the disease itself, discovering where to surf for information.

First, our bod squad looks at rehab of a different sort.

(BEGIN VIDEOTAPE)

CHRISTY FEIG, CNN CORRESPONDENT (voice-over): Whether you're a conditioned athlete or a casual exerciser, being involved in physical activity makes you prone to injury. The most common types of sports injuries are sprains and strains. And while they sound similar, the only thing they have in common is being painful.

At the Sports Rehabilitation Center in Atlanta, physical therapists go through a variety of functional strengthening exercises to help patients get back on their feet. A good rehab program will include exercises that target joint stability, like balanced board ball toss, lateral biometrics, single limb spot jumping. And because of its buoyancy, water is also used in rehabilitation programs.

If you do suffer a sprain or strain, experts suggest the PRICE approach, protection, rest, ice, compression, and elevation. And be sure to see your doctor if pain or swelling persists.

Christy Feig, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

GUPTA: For more information on battling addiction, point your browser to the substance abuse section of the Department of Health and Human Services at findtreatment.samhsa.gov. You can also look up treatment centers in your neighborhood. Also, click on to www.nih.gov. Follow the health information link and look up addictions from alcohol and drugs to food.

And our guest, of course, Dr. Drew Pinksy. He has his own Web site. www.drdrew.com. It targets young adults with live chats and answers to questions on addictions, as well as relationships.

Dr. Drew Pinsky has been our guest. So he's been all over the place. He writes books. He's on television programs. And he takes care of patients as well. What's a final thought you'd like to leave with our viewers tonight, sir?

PINSKY: Well, what I'd like people to know is that this -- if they or someone they love, they believe might have a problem with these kinds of disorder, realize they probably do. These are not problems that get better on their own, please get treatment. It works. Talk to a professional.

GUPTA: That's all the time we have for today. Thank you, Dr. Drew Pinsky for taking time from you busy schedule. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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