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Treating Anorexia: Is Cannabis A Cure?

A recent issue of Cosmopolitan magazine included a lengthy article on the use of medical marijuana for those who struggle with anorexia. By and large, the article was positive regarding such usage and it provided several salient and supportive facts. These included such statistics as; medical marijuana is now legal in 23 states as well as the District of Columbia and a record 53 percent of Americans now favor the legalization of marijuana.

Through case examples, the article revealed that cannabis helped reduce anxiety and irrational thinking while facilitating food acceptance and consumption in those who used the drug. In other words, it helped women eat.

Here’s the problem. Anyone who has spent any appreciable time treating women with anorexia knows one simple truth: anorexia is not about eating. If it was, then effective treatment would be as easy as forcing a person to ingest X amount of calories each day. There would be no need to understand the “whys” behind the disorder, what purpose it serves in the individual’s life, how the family is involved, etc.

The truth is, anorexia is a highly complex psychiatric disorder, and as such, certain therapeutic interventions are necessary to help a person truly heal. If we do not examine and alter the underlying emotional and cognitive issues, the person is quite likely to eventually succumb to relapse or develop another self-destructive coping mechanism, very possibly addiction. We know that up to 50 percent of those with eating disorders also have substance use disorders.

Another issue that was frequently alluded to in the article related to perception. Several of those interviewed spoke of their dislike of pharmaceutical medication—they rebelled against taking pills. However, this antipathy did not extend to marijuana. The usual expressions, “it’s from the earth,” and “weed is natural,” were heavily relied on. The problem is, marijuana, even if it comes from the earth, is a drug; and in many markets today, it is not a well-regulated drug.

Are psychotropic drugs often used in the treatment of anorexia? Yes, but every physician knows, when using medications, certain general principles apply, such as choosing the drug that provides the greatest benefit with the least harmful side effects. When used chronically, marijuana has been shown to increase risk of depression; also it is neurotoxic, which means it kills brain cells. This makes it a less than ideal “medicine.”

One of the more disturbing aspects of this article was the reference to marijuana as a “cure” for anorexia; this reference was made by a physician. The only cure for anorexia is recovery. In fact, that is the ultimate goal of treatment. Recovery is synonymous with freedom. Freedom from being bound to a substance or a behavior to make your way through life. Being able to find and remain connected to the wisdom within, the Higher Power within that provides a sustainable power source to live abundantly.

This is true freedom. This is recovery.

Up Close and Personal with Suicide

The CDC reported that 38,000 people died in the U.S. by suicide. It now surpasses motor vehicle accidents as a cause of death and is listed as 10th most common cause of all deaths in our country. It probably ranks 1st for the most stigmatized and least talked about form of death in our country.

As a psychiatrist, many of my patients struggle with suicidal thoughts, sometimes as part of major depression, PTSD, bipolar disorder, addiction, eating disorders or personality disorders. In my own recovery from an eating disorder, substance abuse and trauma, it is a mind state that I am familiar with.

But, I’ve never known it quite as intimately as I have since being informed of my nephew’s death by suicide in January of this year.

To experience the pain first hand that rips through a family after suicide was altogether a different experience than helping people professionally with suicidal thoughts, suicide attempts or loss of a loved one after suicide.

I was on vacation with my new family in Mexico, returning from an activity-packed, day-long trip to an adventure park. We returned to our hotel well after the sun went down. I reflexively checked my cell phone upon getting back to our room, expecting nothing more than maybe a few emails. To my surprise and then panic, there were missed calls from my mother, sister, brother and a few ominous texts. “Call me as soon as you can. Something bad has happened.”

I felt it in my body and knew it my heart it was something serious. Stepping outside to the balcony, I tried my sister. Voicemail. Then my mother. I could tell she had been crying. “Are you sitting down?” she asked. “

Yes,” I said, even though I wasn’t.

“Are you really sitting down?”

“Yes, I’m sitting.” I was annoyed that she knows me well enough to know I was not seated. Impatiently, and riddled with anxiety, I sat.

“Tommy killed himself.”

Floodgates opened. Pain, sadness, hurt, anger, guilt, shock, confusion — all at once. I asked for details. She shared what she knew.

I’m an addiction psychiatrist, CEO and Medical Director of a large residential treatment center for women with suicidal thoughts and addiction. With my nephew, drugs were involved. He was sick, in pain (but not obviously so), and clearly alone. He was adamantly against any attempts to intervene on his decided way of life and his life philosophy, part of which included the use of what he considered life-enhancing drugs—namely marijuana, ecstasy, and LSD. He was a talented dancer and street performer — into the rave scene in Chicago. And like so many in that world, he embraced drugs as a meaningful and important part of life. Not the so-called “hard” drugs like crack or heroin, but all the drugs people in that scene say should be legal because…”they’re not addictive, it enhances my life, opens me up, blah blah blah.”

I wonder if he ever considered that these drugs might play a role in making him think his time had come at the age of 32, and it was the plan of the universe for him to take his own life on the 2nd day of 2014.

I saw his life, which included early developmental trauma. In my experience as a psychiatrist, unhealed early life trauma is integrally linked to suicide attempts, suicidal thoughts, mood disorders and addictive disorders.

Like so many who have experienced suicide in their family, I have been plagued by the usual questions: How could this happen in my own family? How could I have prevented it? What could I have done differently? Although the questions are seemingly unavoidable, at the end of the day, they lead nowhere. So now I focus on how fortunate I am for all the love and support I have in my life, especially the support I received from my therapist, family, and hundreds of people in the 12 step recovery community who not only kept me alive, but taught me (teach me!) how to thrive. Every single day of my life in recovery I am blessed with the brave women at Timberline Knolls, who have the courage to ask for help and give me the gift of bearing witness to their miraculous journeys.

Addiction…A Choice?

Addiction to drugs or alcohol is a medical illness, a disease of the brain. And yet, there are those who continue to insist that substance addiction is a choice.

Several weeks ago, Matthew Perry, who portrayed Chandler Bing on the highly successful Friends sitcom, traveled to the UK to lend assistance to a new drug program involving the courts. While there, he appeared on a television show alongside journalist and anti-drug campaigner Peter Hitchens. A heated debate ensued.

Regarding his own addiction, Perry said, “I’m a drug addict and if I have a drink I can’t stop… if I think about alcohol, I cannot stop.”

Hitchens responded: “People have problems with drugs and drink. People like taking them and don’t want to stop. It doesn’t mean they have a disease.”

“Don’t want to stop?” How about the truth: so many addicts desperately want to never use again, but they can’t stop. Why? Because they are addicted, physiologically as well as psychologically.

Saying that a person addicted to drugs can “just stop” is like telling a diabetic they can simply toss out that insulin and be fine. That person will not be fine – that person will die.

Addicts don’t have a choice about whether or not they have an addiction, their choice is not in whether or not they have the disease but in whether or not they are willing to get the help they need on a daily basis to recover.

From the Eyes of Babes…A Fresh Perspective

I had the opportunity to bring my step-kids with me to work on Dec. 26th. They spent the day watching movies, playing games and such on their I-things in my office. They got to hear the 2 code greens called over the intercom on Willow that day, and have now identified Willow as the problem lodge. Occasionally after work they will ask me how Willow is doing.

They were also perceptive enough to notice an ambulance coming to one of the lodges. “Kimber, why is there an ambulance here?”

“Well, someone needs to go to the hospital.”

“Why are you so calm about it?”

“Well, it happens every now and again.”

“For what?”

“Various things, medical problems, to stay safe, etc.”

“Oh. Ok.”

Later, one of my patients who was leaving that day from our PHP stopped by my office to say goodbye, and she introduced herself to them. Both they and she enjoyed that very much.

As we drove off campus later in the afternoon, they noticed two PHP residents smoking outside of the sober living condos and waving goodbye to us—one of whom was the woman leaving that day.

My step son asked with shock, “Kimber, why are they leaving if they are still smoking? Don’t they need to stay until they get better???”

It made me take a step back and consider what we get used to.

Recovery is a process, and many people let go of the things that are killing them in the order of most actively/quickly killing to least.

Can you imagine if nicotine addiction was covered under medical necessity guidelines? If people were treated until they were that well in a controlled setting?

I hope someday the women we treat see themselves and what they are willing to put up with in the way of self destruction like my step-kids do.

I hope that for all of us.

Recovery and Spirituality

What happens to our relationship with God (Jesus, G-d, Higher Power, Universal Spirit, etc.) when we are caught in the grips of an addiction or mental illness? If you want to know what you believe in, what god you really worship, look at your actions. Everyone has a higher power…it is what they turn to when they are in need, in pain, suffering, bored or lonely.

I can’t insist that I believe in a loving Higher Power, personal to me, and simultaneously self-destruct by drinking, smoking, purging, starving, compulsively overeating, contemplating suicide or any number of other behaviors that a loving Higher Power would not want for me.

On a daily basis in recovery, we get to lead an examined life. I get to look at my day and see the places that I cut God out — places where I connect with fear instead of faith, anger instead of forgiveness, self-neglect instead of paying attention to what my soul needs and feeding it abundantly. And thankfully, God is merciful. We get to make amends, and the ones we make to ourselves with small acts of kindness, many times are the hardest.

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