Recovery for the Twenty First Century

Through SAT Program        

Testimonial from a physician.

When after 20 years of successful neurosurgery practice in a major metropolitan area I moved my practice to a small town 90 minutes away, I had no expectation that I was trading the headaches of managed care and third party payers, minor issues in retrospect, for ruthless small town politics. To be sure, both the wholesome family oriented atmosphere and the professional opportunity promised were gross misrepresentations. Aware that I had made a very bad choice, disrupting my career and the lives of my entire family, I soon noticed progressive physical discomforts and began self treatment to bolster my endurance. Over a year, tolerance led to increasing medication use, which at some point I realized and discontinued what I preferred to call, at the time, a bad and unnecessary habit of medication use for minor physical symptoms.

Still, this was too late to avoid consequences. A few weeks later a routine review of prescriptions by a narcotics investigator led to a complaint to my State Medical Board alleging falsification of prescriptions and abuse. A few months later my license was suspended, regardless of the fact that I had discontinued medication months before, and despite testimony from office and hospital staff that no impairment ever resulted.

 My Medical Board insisted that I would have to attend “treatment” to reassure them that, in fact, any substance dependence was entirely resolved. I agreed, believing that I would effortlessly pass this “test,” and expecting I would be reinstated soon thereafter. I had no concept of what lay ahead for me or my family.

 My Medical Board ordered this “treatment” at a very well known, traditional Twelve Step facility even though expert testimony at my suspension hearing and afterwards advised that this type of intervention was not necessary and even inappropriate. My experience at this facility proved to be a nightmare. I learned that “treatment” was synonymous with isolation and indoctrination, being held hostage until I professed acceptance of its dogma. Both I and my wife were threatened that failure to profess “recovery” would, and did, result in the recommendation back to my Board that I could not be trusted to resume the practice of medicine.

 What was this “recovery?” I was told that it meant the profession that I was powerless to make intelligent decisions regarding medication use, abandoning years of education and critical thought. I was told that it meant that I would have to use a ritual of meetings and recitations to control cravings. I was told that it meant that I would have to accept new concepts about a relationship with God and the “nature of things” which I found strange and foreign and could not accept.

 I was told that I must accept that addiction is life long, necessarily chronic and incurable, a character defect inept at handling the never-ending spiritual conflict between good and evil. The disease of addiction was viewed as being a “disease of the

soul and the will” caused by an inadequate relationship to God, but one the “counselors” were quite willing to define for me. And if I couldn’t accept that definition, there was ample opportunity for my participation in gang-mentality oriented group meetings engaged in the enforcement of the “party line.”

 There was, of course, no scientific or medical support offered for this view. Never was there a psychiatric medical evaluation performed on an individual basis. Twelve Step tenets, their version of this disease, were applied universally to everyone and all aspects of living, not just substance dependence and self medication.

 Not only was I turned off by their brand of religion, I knew intuitively that their approach was unprofessional, unscientific, bad medicine, and outright amateurish. I would soon learn, too, that their tactics included secret phone communication to my Medical Board, in retaliation, in addition to their fabricated and exaggerated official report, urging that I not be returned to the practice of medicine because I would not comply with their recovery dogma.

 I returned and petitioned and pleaded with my Medical Board, for more than a year, for an alternative to this religious “evaluation or treatment;” but, unaware of the secret communications, found a deaf ear. Finally, I filed lawsuit in State District Court and, after nearly another year of administrative stalls and delay, won a decision from a Judge that enforced my First Amendment privilege to have non religious, professional evaluation and treatment.

 After thorough research, I resubmitted the SAT Center for approval a year after its approval had first been rejected.  SAT offered a multi-disciplinary treatment for substance misuse or addiction; a comprehensive medical-psychiatric evaluation done by physicians. At SAT, I found first a focus on education based removal of the stigma of psychiatric intervention; then treatment with dignity, respect, confidentiality, and avoiding the inappropriate use of group participation to “enforce compliance.”

 Most importantly, SAT treatment was individualized for my specialized needs that required psychiatric intervention. I was given individual psycho-education. My personal life was discussed only in daily sessions with psychiatrists, not in group settings. However, SAT also offered a structured and “professionally administered” group therapy to discuss the nature of psychiatric disorders as well as psycho-educational seminars to address the reasons for drug use.

 I learned that addiction, or more correctly, substance dependence as defined by the DSM IV, was in fact self medication to bolster against profound, identity-threatening stress and consequent depression. I learned that this concept of self-medication had actually been introduced by Freud first, reintroduced in 1985 by Dr. Khanzian; but due to lack of understanding of the dynamics of the problem it was  

mistakenly believed to be character defect. I learned that, in reality, people use drugs to reduce emotional pain, not as a result of a “spiritual defect.” I achieved enlightened understanding of the underlying psychiatric conflicts which had led to my personal self medication; and with this came complete freedom from any need or desire to use again.

I left SAT with positive, productive defense mechanisms to replace negative and self-harming defenses. I learned about the mind, its function and neuro-biology and psycho-pharmacology from a psychiatric perspective. I learned why I had behaved as I had. I acquired new psychological tools to use psychological energy in positive, productive ways. There was no attempt to enforce a ritual or dogma to control the behavior of addiction, but rather a personal understanding of the my individual need to use drugs for altering emotional states and insight into the underlying dynamics of my defense mechanisms.

On Recovering from Cocaine:

Testimonial from a psychiatrist.                               

Throughout the past decade, my craving for cocaine has been constant and powerful. They would diminish immediately after a binge, but always came back quickly with great force and frequency.

Thoughts of using steadily entered my mind. Through three recovery programs in three years (1993-1996), they never let up.

At best, they receded to the background when I became busy, forced out by my thinking of other things-job, family, friends, my own health and well being--or my "surrendering" as AA states it, to the twelve-step program, one day, one hour, one moment at a time.

I cannot remember a single day over the past ten years when the urge to use, the memory of the sweet high, did not well up within me and beckon me to come. It was a piercing siren's call ever ringing in my ears.

I came to believe that I would be spending the rest of my life fighting off the distraction. I wondered if I'd ever break free from the obsession.

I learned early in recovery to recognize the signs of relapse and take steps to counteract them-call my sponsor, get to a meeting, read the Big Book---but cravings followed me everywhere.

I felt them always lurking in the back of my mind, waiting patiently, ever present.

Prayer, meditation, jogging, attending a meeting, working, doing service and talking to other recovering addicts gave me temporary relief and a sense of hope, but at the next and inevitable slip--the relapse into the hell that left me and my family shaken to the core-hope faded quickly. In an instant of " weakness," a moment of " insanity," a “lowering of my guard," I would scratch the itch and be off to the other side of town and another two-day run at chasing the high--not eating, not sleeping, not thinking of anyone or anything for 48 hours or more. I lost track of all my reference points-time, space, location, family, purpose, duty, work, responsibility, and money-until, exhausted, demoralized, shamed, depressed and denied.

I wound my way home. I wrote of this utter sense of failure, futility and numbness in the following poem during my first recovery program in 1994, but no words can convey the total agony and despair I felt following every relapse-the sense of having completely let down my children, brothers, sisters, girlfriend, friends, profession and self.

I chase you under neon lights,
Down alleys darkened black,
In vacant lots, soulless bare,
On streets that double back.
I sit in old metal rooms, curtains drawn,
And whisper soft your name:
"Come, sweet lady of the night,
join me in the game.
Ease my lonely hurting heart,
Help me numb the pain."
What I seek I cannot find,
Or find, find counterfeit.
Friends, love, peace of mind-
White lady is the hit.
Each time, with lowly bankrupt look,
I wind my way back home, broken in the morning haze,
Exhausted flesh and bone.
I slip into an aching sleep,
And dream in tears of stone.

Today my life is different. Within a few days of beginning my treatment, the craving diminished. The thoughts and memories of using became but tiny and faded forms in a rearview mirror--in the distance, but not close enough to harm me anymore.

They have no pull, no attraction, no power. They are like poison ivy on an arm covered in calamine lotion: there but not itchy. I do not have to fight them off, be on guard, and feel like a failure, a weakling who is no match for this " cunning, powerful, and baffling" enemy.

These characterizations--indeed, cocaine itself--seem irrelevant to me now. I do not feel I must stay on guard lest I get ambushed by my own impulses and weakness. My energy is not tied up in struggling to prevent myself from falling.

The old fascination isn't there anymore, Doesn't force its way into my mind. Smoking crack is just another thought, entering and leaving my mind like all other thoughts. It's lost its edge, released its grip.

I feel "normal" in the way I imagined "normies" felt when they took a drink of wine at an evening meal, enjoyed it, then set it down and continued on with their conversation. Not that I am interested in doing this with crack (I know better), but I do not obsess with the substance or even with the idea that I am an addict, not like regular people, but an abnormality prone toward relapses into insanity and "character defects."

In short, today I feel relaxed, focused, productive, patient, and happy--more so than I have felt in many years. I have my life back and no desire to seek out the effects of my old and deadly self-medication. Equally important, I feel capable of exploring the underlying issues that drove me in the first place to numb myself from the pain of past sadness, loneliness and guilt.

M.L., Ph.D.

Freedom at last S

Dear Mrs. Nikakhtar, M.D.,

I am writing as the sister of one of your patients, R.C.A, of NY.

Around 1972, my brother showed the first signs of mania. Since then, he had a long history of functioning on medicine and not properly functioning when not on proper medicine. As an observer of my brother, who is 5 years younger than me, he started using street drugs, mostly cocaine, during the times he was rejecting medication.

I declare and believe that as a result of what you did for him, he started a new life. You patiently educated him about his bipolar illness. You explained to him that he was using drugs to self-medicate. You stabilized his mood. He states that he no longer has any desire to use cocaine. He feels good about himself and accepts that he has a form of "mental illness," and as you say "psychiatric disorder," which required professional help.

For the past few years, there were occasions that he lowered his medication and soon noticed signs of mania returning. The education and treatment you provided him helped him understand his illness and return to the recommended medication.

Thank you for treating and teaching him.

On behalf of our whole family,
God bless you!

Freedom at last SAT Program

Eight years ago, my husband was diagnosed as having anxiety and panic attacks. He started drinking. For sure, each time he consumed beer, his anxiety was reduced significantly. After the effect of alcohol was gone, his anxiety was even worse, causing him to increase his drinking.

He reached the point that he could not live without it. Of course, me and my two children could not live with it. We consulted too many doctors. He went to too many rehab programs. Each time, he could not stay sober for more than 4-5 weeks.

My husband, who is a good man and a good father, felt that he was at the end of his rope. He was thinking of suicide. He started searching for street drugs while drinking 3-4 shots of whiskey each time. His doctor finally admitted that this was out of his expertise and referred us to Dr. Nikakhtar, and that was where my husband truly received the help he needed.

As I look back, I cringe at thoughts of where my husband may have turned up if we had not received the help we did from Dr. Nikakhtar.

My husband was on a very destructive path using alcohol, heroin and prescription medicines. He was self-medicating to cope with his emotions.

I hope the medical field realizes that if people cannot get the proper help, they will be driven to self-medication and/or self destruction.

Thank you thank you, Dr. Nikakhtar, for truly helping us.
I cannot imagine where my husband, my kids and I would be without your help.