Sleep Wake

The following transcript and audio (below) is from an interview originally aired in July 07.

Also visit LeslieLundt.com and Turntohelp.com.

Michael Schiesser: Good morning, this is Dr. Michael Schiesser. I have with me today, Dr. Leslie Lundt from Boise, Idaho. Dr. Lundt is a psychiatrist and addiction specialist. And if you haven't heard of her, she has a website, LeslieLundt.com. Her most famous book is "Think Like a Psychiatrist". It's a book for the general public to understand how a psychiatrist views various mental disorders, as well as, the treatments that are available.

If you're working with the family members of persons who are exhibiting odd behaviors, how can you give the family some sense of a disease model?

Leslie Lundt: Again, you can't expect that somebody in the throws of addiction is going to think rationally. So for example, I have an older sister and she is a life-long cigarette smoker. It's just beyond me why an intelligent, rational human being would continue to smoke cigarettes given the overwhelming data that this is a really bad thing for you.

So my instinct is to say, "Gosh Linda, you are an idiot. What is wrong with you? Don't you know about the risk factors?" But not only would she be mad at me, which probably wouldn't be very effective anyway; but I also have to consider that her brain is hijacked by nicotine.

That strategy of me yelling at her is not going to work. Clearly, any rational person would not smoke cigarettes. But she has a chemical problem, a significant disorder that we call cigarette or nicotine addiction. And until that is addressed - both from a biochemical perspective and a stress reduction or coping mechanism viewpoint - she's not going to quit smoking.

Schiesser: So it sounds like there are two ways of approaching it. One is to help stabilize their brains so that it can change from the way it currently works. And the other is to find a way for them to examine their own behavior, and give them some tools to make effective choices about how they want to alter that.

Lundt: Absolutely, it's got to be at least a two-pronged approach where you address both issues. If you do one or the other, often, you're really doomed to failure.

Schiesser: I'd like to encourage you to visit TurnToHelp.com, where you will find a physician locater for local treatment of opiate dependence, patient testimonials, and access to patient resource kits, which can also be obtained by calling 1-866-455-TURN.

And I'm describing the TurnToHelp.com website, where you can get fast and easy access to physicians who treat opioid dependence, as well as, resources for family members of someone who is having trouble with addiction to prescription pain medications or street drugs, like heroin.

This is Dr. Michael Schiesser with Dr. Leslie Lundt. What are some of the promising medical treatments that you've seen come along, in the last decade, for treating various addictions?

Lundt: Let's talk about three of the most common addictions. Since I brought up cigarette smoking, let's do that first. There have been several medicines that have been out for a long time. One is the nicotine replacement patch, gums and inhalers, which just give people nicotine so that they don't have the intense craving and withdrawal from stopping nicotine abruptly from stopping smoking. So that one's pretty simple.

More recently, in treating tobacco addiction, there is a medicine called Buproprion, or Zyban. This works a little differently. It's not a nicotine substitute, but it actually works on dopamine.

Schiesser: Right.

Lundt: It helps you to restore your normal dopamine pathways, which even cigarettes can destroy. That's been out for years and we've had really good luck with that.

But there's a new medicine that's been out less than a year now, called Chantex, which we are really happy with. If there are any smokers out there listening, who really are serious about stopping, go to your doctor and ask them about Chantex. Again, it works on dopamine, but in a totally different way than Zyban, and we've had incredible luck with that.

It's actually a really interesting story. For decades, in Bulgaria, there's been an herb that has been quite successful in helping cigarette smokers stop. And Pfizer, a huge drug company here in the United States, heard about this Bulgarian herb, and thought that this was really amazing stuff. Of course, drug companies, like all companies, would like to make money, and there's no way to patent an herb. So they got their scientists working on trying to come up with a substance that's similar in chemical structure to this Bulgarian herb and they were able to do it and that's what Chantix is, so it's a wonderful medicine.

Schiesser: Sort of just mimicked from a natural substance.

Lundt: Exactly. But again, it's not nicotine at all, and we've had tremendous success with that, so there's a lot happening in the world of nicotine and it's one of my soapbox issues, so let me just remind everybody: the most important thing, the most important thing, that you can do for your health, is if you're a smoker, stop! That, by far, is the most important thing. So, if one person listening to this quits smoking because of what I have to say, I'll be pleased.

Schiesser: I agree, I think smoking is something that really has a lot of negative health consequences.

Lundt: Absolutely, and kills more people than anything else and everything else combined. So it's hugely important.

Then if we think about alcoholism which, of course, is also a big problem in this country, and causes so much pain, heartache and medical problems as well, there have been many medicines over the years. Probably the one that everybody knows is the oldest one, and that is Antibuse. And that's a different approach. That's making people sick, physically ill...

Schiesser: Right.

Lundt:... if they take the substance of their choice, which is alcohol. So a lot of people don't like Antibuse with good reason and we don't prescribe it much any more. But there are some other medicines that can now be helpful for treating alcoholism. The generic name for one is called Naltrexone, and that's available either in a pill or in a shot. That works, not on dopamine, but on another part of the brain which is also commonly involved in addiction issues, and that is the opiate system. So Naltrexone, whether the shot or the pill, can be helpful.

And then there's yet another one, called Camprol or acamprosate, that works on yet another brain chemical system called the glutamate system. So we're looking at all sorts of ways to help these people, not just dopamine.

Schiesser: Now, as I recall, your book is really taking a very similar turn as this conversation, which is to outline some of the brain chemistry behind a lot of common problems, and some of the scientific approaches to managing that. Your book is 'Think Like A Psychiatrist' and available on LeslieLundt.com. Am I describing it appropriately?

Lundt: Yes, that's an excellent description, Michael, and what I have found in my practice over the last 20 years, is that when people really understand these issues in a detailed way, understanding how your brain chemicals work, how these medicines work, they're much more likely to get help and to continue taking their medications appropriately, and hopefully not take other medicines inappropriately.

You know it's not hard, but the language sometimes... it's like learning Portuguese or something, you just have to know the lingo. So in my book, I try to talk in common-sense everyday words with simple pictures and get these points across to people that may not have any science background at all.

Schiesser: If you're just tuning in, I'm talking to Dr. Leslie Lundt, a psychiatrist from Boise, Idaho, and we're talking about addiction today and the biology of self-control. Leslie, are there any closing thoughts that you have for today's conversation?

Lundt: Yes, there are a couple of things, Michael. Number one, I think we all need to take a long hard look at ourselves and our behaviors before we start maybe getting on the bandwagon for our friends and family and loved ones, and their behaviors.

And think about pleasure! Think about what you do every day that gives you pleasure, and what may have positive consequences and what may have negative consequences.

So, for example, let's say that you go to the gym four times a week and you work out for an hour. You know, most of us would think: "That's great, it's helpful for your brain, it's helpful for your body", stress reduction, all of that. But then think of somebody who may go the gym every day for four hours, and has a stress fracture, and whose relationships are in jeopardy because they're never home, because they're always at the gym. So think about what you do that is fun and pleasurable and how it may be appropriate and helpful, but how it might be destructive as well.

Schiesser: This is Dr. Michael Schiesser with Dr. Leslie Lundt, Be sure to visit LeslieLundt.com for more information on her books and seminars. Thank you, Dr. Lundt.

Lundt: Thank you, my pleasure. Have a great weekend!

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Schiesser: Visit TurnToHelp.com where you can get fast and easy access to physicians who treat opioid dependence.

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