Benzodiazepines Addiction and Abuse

Benzodiazepines are a class of drugs that are commonly prescribed as a short-term treatment for anxiety disorders, panic attacks, and insomnia.

Although safe and effective when taken as prescribed, benzodiazepine drugs like Xanax or Ativan can be misused for their effects.

Over time, benzodiazepine abuse can lead to severe physical dependendence, addiction, withdrawal symptoms, and other negative health consequences without treatment.

Benzodiazepines are what’s known as central nervous system depressants (CNS). When taken, they depress central nervous system activity, which can affect breathing and physical movement.

Benzodiazepines are known to enhance the effects of the brain chemical GABA. When taken, this can cause calmness, sedation, and reduce anxiety.

Benzodiazepines, also known as “benzos,” can be abused in several ways. What benzo abuse looks like can vary from person to person, and some signs may be less obvious than others.

What benzodiazepine abuse might look like:

  • taking higher doses than prescribed
  • taking doses more often
  • crushing and snorting benzodiazepines
  • injecting benzodiazepines
  • drinking alcohol to enhance drug effects
  • mixing benzos with other drugs to get high
  • taking someone else’s prescription

Chronic benzodiazepine abuse, characterized as a pattern of frequent benzodiazepine misuse, can be dangerous and may harm both physical and mental health.

Misusing benzodiazepines can be dangerous. Both acute and long-term dangers can occur by taking this type of drug in any way other than prescribed by a doctor.

Primary dangers of benzo abuse include:

  • severe dependency
  • drug addiction
  • drug overdose
  • increased risk of polysubstance abuse
  • worsened mental health conditions
  • potential brain damage

Benzodiazepines are rarely dangerous when taken as prescribed. But misusing benzodiazepines carries a risk of serious dangers, including drug overdose.

Benzodiazepine overdose can occur by taking excessively high doses of a benzodiazepine, or by combining the use of benzodiazepines with other drugs, such as opioids, alcohol, or heroin.

People who overdose on benzodiazepines may experience difficulty breathing, breathe very slowly, become unresponsive, or collapse. If this happens, call 911 right away.

Mixing benzodiazepines with other substances such as cocaine, heroin, methadone and alcohol can have serious effects on both short-term and long-term health, with the potential to affect vital organ function and increase the risk of drug overdose.

Common short-acting benzodiazepines include:

  • alprazolam (Xanax)
  • lorazepam (Ativan)
  • triazolam (Halcion)
  • midazolam (Versed)
  • temazepam (Restoril)
  • oxazepam (Serax)

Common long-acting benzodiazepines include:

  • Klonopin (clonazepam)
  • Valium (diazepam)
  • Librium (chlordiazepoxide)
  • flurazepam
  • clorazepate (Tranxene)

Exercise Addiction

Obviously, there are many health benefits to working out regularly. It’s good for our cardiovascular system, can relieve stress, and it releases feel good chemicals like endorphins. But just like anything, it’s best in moderation, and when exercise is done excessively, it can come with some dangerous health complications of its own.

So let’s jump into what exercise addiction is: simply put, it’s an unhealthy obsession with physical fitness and working out and we feel helpless to stop even if we know it’s not good for us or is out of control. It’s that second portion, the part about not being able to stop, that differentiates this from professional athletes, olympians, and marathon runners. Sure those people could have exercise addiction, but it’s not just the amount of exercise we do that’s an indicator of this, it’s much more than that.

If we think about it, we can imagine a lot of reasons why someone would become addicted to exercise: it’s a distraction, it makes us feel good, and it’s something our society supports. And it’s not a big jump from that for us to understand why those of us with eating disorders can struggle with it as well. Since eating disorders are coping skills, and exercise can reduce stress and make us feel good. Not to mention that it still feeds into that ED voice by giving us a false sense of control and makes us think that we are achieving something worthwhile.

Reducing Use of Mood-Altering Substances

Drugs and alcohol are called mood-altering substances for a reason: They alter a person’s mood, and the person has no control over how his mood is altered. People commonly report that they use alcohol to help them relax, but the disinhibiting effects of alcohol often turn into physical aggression, yelling and screaming, tears, and so on. If a person already has difficulties managing his emotions, is it wise to add the unpredictable effects of drugs or alcohol?

Some people use alcohol to help them sleep. It’s important to understand that alcohol actually has a negative effect on sleep due to a rebound effect. Four to five hours after consuming alcohol, the rebound effect kicks in and people usually find themselves awake. In addition, researchers have found that consuming alcohol within an hour of bedtime seems to disrupt the second half of the sleep period, so people don’t get the same deep sleep they otherwise would.

Then there are people who use drugs or alcohol to help numb their emotions so they don’t have to deal with them. This makes sense, and we therefore need to validate it, indicating that we understand it, and at the same time encourage them to see this as a goal to work on, as it’s unhealthy and possibly even self-destructive.

Your first challenge may be to just get a person to see that drugs and alcohol are a problem. But even when people can see that a behavior is problematic, they still might not want to change it. In this case, the next challenge is getting them to set small goals around reducing their use—keeping in mind that if a person isn’t willing to set something as a goal yet, you need to accept this and gently continue to push for change over time.

Sources: DBT Made Simple

Drug and Drinking Cultures

Drug culture is a subculture of popular culture, it represents the principles, patterns, physicality, hierarchy and behavior within a group of individuals with substance use disorders. We see drug culture in various movies, television shows, music, etc. Drug culture has a hierarchy, dependent on your role in the community of drug users; you can be a drug synthesizer, supplier, dealer, and user. Drug culture is made up of socialization, values, rules, gender roles and relationships, symbols and images, dress, language and communication, and attitudes. In addition to drug cultures, there are also drinking cultures. Think college sororities and fraternities, where it is a part of their culture to drink in massive quantities, supports binge drinking, reinforces denial, develops rituals and customary behaviors around drinking (Center for Substance Abuse Treatment).

Many people turn to subcultures like drug and drinking cultures as a source of social support and cultural activities that make these people feel like they belong somewhere, or “fit in.” The danger of subcultures like these is the toleration and promotion of harmful activities like using drugs and alcohol to socialize. Socializing no longer becomes the objective, but using drugs and alcohol together becomes the objective— with socialization being an after effect. A lot of anti-social behavior is supported, which includes: opposition to authority, rule-breaking, defiance, and destructive acts, among other behaviors. Many further specified subcultures can stem from the broader drug or alcohol culture.

“The need for social acceptance is a major reason many young people begin to use drugs, as social acceptance can be found with less effort within the drug culture” (Center for Substance Abuse Treatment).

Drug culture also holds its own style of communication and language. Common phrases within drug culture include:

• “picking up”- meaning that you are getting more drugs

• “shoot it”- referring to using a drug intravenously

• “chasing the dragon”- trying to get to a certain level of high that is reminiscent of the first high

• “light up”- smoking a drug

• “rail it”- refers to snorting a drug

• “re-up”- getting more of a drug

• “dope sick”- meaning you are experiencing withdrawal symptoms

• “snap crackle pop”- reference to the drug crack

• “bundle”- a 10 bag supply of heroin

• “rig” or “works”- meaning a needle

• “nodding out”- refers to a state of going in and out of consciousness

Other phrases in drug culture are slang terms for different drugs, slang terms for the dollar amount of a drug, and other language. The communication style in drug culture is dependent on who you are talking to, it is common to be short and to-the-point when communicating with a dealer and more social with other friends within the same drug culture.

Sources: Royal Life Centers

Heroin by The Velvet Underground

Heroin by the Velvet Underground is a prime example of pop culture, in this case music, glorifying illegal drugs and addiction:

I don’t know just where I’m going,

But I’m gonna try for the kingdom if I can,

‘Cause it makes me feel like I’m a man

When I put a spike into my vein,

And I’ll tell ‘ya, things aren’t quite the same,

When I’m rushin’ on my run,

And I feel just like Jesus’ son,

And I guess that I just don’t know,

And I guess that I just don’t know.

I have made the big decision:

I’m gonna try to nullify my life.

‘Cause when the blood begins to flow,

When it shoots up the dropper’s neck,

When I’m closing in on death,

And you can’t help me now, you guys,

And all you sweet girls with all your sweet talk,

You can all go take a walk.

And I guess that I just don’t know,

And I guess that I just don’t know.

I wish that I was born a thousand years ago

I wish that I’d sail the darkened seas,

On a great big clipper ship,

Going from this land here to that,

In a sailor’s suit and cap,

Away from the big city

Where a man can not be free

Of all of the evils of this town,

And of himself, and those around.

Oh, and I guess that I just don’t know.

Oh, and I guess that I just don’t know.

Heroin, be the death of me.

Heroin, it’s my wife and it’s my life,

Because a mainer to my vein

Leads to a center in my head,

And then I’m better off than dead

Because when the smack begins to flow,

I really don’t care anymore

About all the Jim-Jim’s in this town,

And all the politicians makin’ busy sounds,

And everybody puttin’ everybody else down,

And all the dead bodies piled up in mounds,

‘Cause when the smack begins to flow,

Then I really don’t care anymore.

Ah, when the heroin is in my blood,

And that blood is in my head,

Then thank God that I’m as good as dead,

Then thank your God that I’m not aware,

And thank God that I just don’t care,

And I guess I just don’t know,

And I guess I just don’t know.

Slang for Illegal Drug Combinations

  • 3M—Mescaline, mushrooms (psilocybin) and Molly (crystal Ecstasy)
  • A-bomb or atom bomb—Marijuana mixed with heroin
  • Amp joint—Marijuana cigarette laced with some form of narcotic
  • B-40—Cigar laced with marijuana and dipped in malt liquor
  • Back to back—Abuse of heroin followed by crack cocaine or vice versa
  • Banana split—Combination of the synthetic 2C-B with other illegal drugs,
    especially LSD
  • Banano—Marijuana or tobacco cigarettes doctored with cocaine
  • Bars—Heroin mixed with alprazolam/Xanax
  • Basuco—Incompletely refined cocaine paste sprinkled on a marijuana cigarette
  • Bazooka—Combination of crack cocaine or unrefined cocaine and marijuana
  • Beam me up, Scottie—Cocaine combined with PCP
  • Bipping—Snorting heroin and cocaine, either simultaneously or close together
  • Black Russian—Hashish and opium
  • Buda—High-grade marijuana with crack cocaine added
  • Bumping up—Combining Ecstasy with powder cocaine
  • C & M—Cocaine and morphine
  • Canade—Heroin and marijuana used together
  • Candy blunt—Marijuana-filled cigar (blunt) dipped in cough syrup
  • Candy flipping—Using LSD and Ecstasy together
  • Candy flipping on a string—Combining LSD and Ecstasy or LSD, Ecstasy and cocaine either all at once or in sequence
  • Capsizing—PCP and MDMA
  • Caviar—Cocaine and marijuana
  • Cheese—A mix of black tar heroin and diphenhydramine (most commonly found in Tylenol PM)
  • Chasing the dragon—Crack cocaine and heroin
  • Chips—Tobacco or marijuana cigarettes treated with PCP
  • Chronic—Marijuana mixed with crack
  • Clicker—Crack mixed with PCP or a marijuana cigarette treated with dipped in formaldehyde before smoking
  • Cocktail—Combination of crack and marijuana
  • Cocoa Puffs—Cocaine and Marijuana smoked together
  • Crackers—Talwin (narcotic painkiller) and Ritalin
  • Crescent roll—Marijuana laced with cocaine
  • Crisscrossing—Snorting a line of cocaine along with a line of heroin
  • Crunk—Getting high and drunk at the same time.
  • Diablito—Crack cocaine and marijuana in a joint
  • Dipped joints—Marijuana combined with PCP and formaldehyde
  • Dirties/Dirty joints—Marijuana mixed with powder cocaine
  • Donk—Marijuana and PCP
  • Draf—Ecstasy with cocaine
  • Dragon rock—Heroin and crack mixed together
  • Dust—Marijuana mixed with various other drugs such as cocaine, heroin or PCP
  • Dynamite—Cocaine mixed with heroin
  • Eightball—Crack cocaine and heroin
  • El diablito—Cocaine, marijuana, heroin and PCP
  • El diablo—Cocaine, marijuana and heroin
  • Elephant flipping—Use of PCP and Ecstasy with animal anesthetic ketamine
  • Ethan—LSD and cocaine
  • Fire—Crack and methamphetamine
  • Five-way—Snorting heroin, cocaine, methamphetamine, and Rohypnol while also drinking alcohol
  • Flamethrowers—Regular cigarettes treated with cocaine and heroin
  • Flower flipping—Ecstasy and mushrooms used together
  • Frisco special/Frisco speedball—Cocaine, heroin, and LSD
  • Fry/Fry sticks—Marijuana cigarettes dipped in embalming fluid or PCP
  • Fry daddy—Crack and marijuana mixed and smoked
  • Geek-joints—A marijuana cigarette with crack or powdered cocaine added
  • Gimmie—Crack and marijuana mixed together
  • Goofball—Cocaine and heroin
  • Greek—Marijuana and powder cocaine
  • H & C—Heroin and cocaine
  • H-bomb—Ecstasy and heroin
  • Handlebars—Combination of crack cocaine and alprazolam (Xanax)
  • Happy stick—Marijuana and PCP in a cigarette
  • He-she—Heroin mixed with cocaine
  • Herb and al—Marijuana and alcohol
  • Hippie flip—Use of mushrooms (psilocybin) and Ecstasy
  • Houston cocktail—Hydrocodone, a benzodiazepine like Valium or Xanax, and Soma/carisoprodol
  • Hugs and kisses—Combination of methamphetamine and Ecstasy
  • Illie/illy—Marijuana dipped in liquid PCP or embalming fluid and then dried
  • Jedi flip—Mushrooms, LSD, and Ecstasy
  • Jet fuel—PCP use combined with methamphetamine
  • Jim Jones—Marijuana treated with cocaine and PCP
  • Joy stick—Marijuana treated with PCP
  • Juice joint—Marijuana cigarette sprinkled with crack
  • Karachi—Heroin, phenobarbital (a sleeping drug), and methaqualone (depressant)
  • Killer weed—Marijuana and PCP
  • Kitty Bending—Ketamine and benzodiazepines (Xanax, Valium)
  • Kitty Boosting—Amphetamine and ketamine
  • Kitty Flipping—Ketamine and Ecstasy
  • Kitty Tripping—Ketamine and LSD
  • Lace—Cocaine and marijuana
  • Las Vegas cocktail—Hydrocodone and a benzodiazepine like Valium or Xanax
  • LBJ—Heroin plus LSD and PCP
  • Liprimo—Marijuana and crack mixed and formed into a cigarette
  • Love boat—Marijuana dipped in formaldehyde; a cigar refilled with marijuana
    and then dipped in liquid PCP; cigar refilled with marijuana that has heroin added
  • Love flipping—Mescaline and Ecstasy
  • Lucky flip—Ecstasy and synthetic 2C-T-7
  • Love trip—Mescaline and Ecstasy
  • Lovelies—Marijuana treated with PCP
  • Methball—methamphetamine and heroin mixed in one syringe
  • Missile basing—Crack and PCP
  • Moonrock—Crack and heroin
  • Murder one—Heroin and cocaine
  • Neon Nod—LSD and heroin
  • Nexus flipping—Nexus (the synthetic 2-CB) and MDMA
  • Nox—Nitrous oxide and MDMA
  • Octane—PCP laced with gasoline
  • On the ball—Ecstasy particles added to a bag of heroin
  • One and ones—Talwin (narcotic painkiller) and Ritalin
  • Oolies—Marijuana cigarettes laced with crack
  • Ozone—Cigarette containing marijuana, PCP and crack cigarette
  • P-dogs—Cocaine and marijuana
  • P-funk—Crack plus PCP
  • Pancakes and syrup—Glutethimide (hypnotic drug) and codeine cough syrup
  • Parachute—Smoking crack and PCP; smoking crack and heroin
  • Parachute down—Using Ecstasy when coming down off heroin
  • Party and play—Methamphetamine together with Ecstasy and Viagra
  • Party pack—The synthetic 2C-B plus other illicit drugs, particularly Ecstasy
  • Pharming—Mixing prescription drugs
  • Piggybacking—Simultaneous injecting two drugs; using Ecstasy sequentially to maintain the high
  • Pikachu—Pills containing PCP and Ecstasy
  • Polo—Heroin and dimenhydrinate (Dramamine)
  • Poor man’s heroin—Narcotic painkiller Talwin and Ritalin, injected
  • Poro—Heroin plus PCP
  • Primos—Marijuana joints treated with crack cocaine
  • Quiktrip—Methamphetamine and psilocybin
  • Red rock opium/Red rum—Heroin, sleeping pills, strychnine and caffeine
  • Ritz and Ts—Ritalin and Talwin, injected
  • Robo flipping—Ecstasy and dextromethorphan (cough medication)
  • Rompums—Marijuana with Xylazine or other horse tranquilizers
  • Sandwich—Two layers of cocaine with a layer of heroin in the middle
  • Scramble—Low purity heroin plus crack cocaine
  • Screwball—Heroin and methamphetamine
  • Serial speedballing—Sequencing cocaine, cough syrup, and heroin over period of days
  • Shabu—Powder cocaine and methamphetamine
  • Sherman stick—Crack cocaine with marijuana in a blunt (refilled cigar)
  • Smoking gun—Heroin and cocaine
  • Snowcone—Amphetamine and weed smoked together
  • Snow seals—Cocaine and amphetamine
  • Space base/Space blunt—Crack dipped in PCP; refilled cigar with PCP and crack
  • Space cadet/Space dust—Crack dipped in PCP
  • Speedball—Cocaine and heroin; may also refer to methylphenidate (Ritalin) mixed with heroin
  • Speedboat—Methamphetamine, PCP, heroin and cocaine or marijuana, PCP and crack smoked together
  • Speedkitten—Methamphetamine and ketamine
  • Speedies—Ecstasy adulterated with amphetamine
  • Spill—Speed and an ecstasy pill in the same line to be snorted
  • Splitting—Rolling marijuana and cocaine into a single joint
  • Spoke—Speed, crushed Ecstasy pill and coke in the same line to be snorted
  • Squirrel—PCP and marijuana that is laced with cocaine and smoked
  • Stupor stoning—Drinking alcohol while smoking marijuana
  • Sugar flipping—Ecstasy and cocaine
  • Super grass—Marijuana treated with PCP
  • Super X—Methamphetamine and Ecstasy
  • Tar—Smoking crack and heroin
  • Tipsy flipping—Alcohol and Ecstasy
  • Torpedo—Marijuana and crack
  • Troll—LSD and MDMA
  • Twisters—Crack and methamphetamine
  • Waffle dust—Ecstasy and amphetamine
  • Wet/Wet sticks—Marijuana cigarettes soaked in PCP or formaldehyde and dried
  • Whack—Heroin and PCP; Crack and PCP
  • Wicky—Powder cocaine, PCP and marijuana
  • Wild cat—Methcathinone (synthetic similar to methamphetamine) mixed with cocaine
  • Wollie/Woo—Adding crack rocks to a marijuana cigarette
  • Woola blunt/Woolah- Marijuana and heroin in a refilled cigar
  • Woolas—Crack sprinkled on marijuana cigarette
  • Woolie—Marijuana and heroin; marijuana and crack cocaine; marijuana and PCP
  • Woolies—Marijuana and crack or PCP
  • Yerba mala—PCP and marijuana

Antidepressant Withdrawal: Is It Real?

Antidepressant withdrawal is possible if you abruptly stop taking an antidepressant, particularly if you’ve been taking it longer than four to six weeks. Symptoms of antidepressant withdrawal are sometimes called antidepressant discontinuation syndrome and typically last for a few weeks. Certain antidepressants are more likely to cause withdrawal symptoms than others.

Quitting an antidepressant suddenly may cause symptoms within a day or two, such as:

• Anxiety

• Insomnia or vivid dreams

• Headaches

• Dizziness

• Tiredness

• Irritability

• Flu-like symptoms, including achy muscles and chills

• Nausea

• Electric shock sensations

• Return of depression symptoms

Having antidepressant withdrawal symptoms doesn’t mean you’re addicted to an antidepressant. Addiction represents harmful, long-term chemical changes in the brain. It’s characterized by intense cravings, the inability to control your use of a substance and negative consequences from that substance use. Antidepressants don’t cause these issues.

To minimize the risk of antidepressant withdrawal, talk with your doctor before you stop taking an antidepressant. Your doctor may recommend that you gradually reduce the dose of your antidepressant for several weeks or more to allow your body to adapt to the absence of the medication.

In some cases, your doctor may prescribe another antidepressant or another type of medication on a short-term basis to help ease symptoms as your body adjusts. If you’re switching from one type of antidepressant to another, your doctor may have you start taking the new one before you completely stop taking the original medication.

It’s sometimes difficult to tell the difference between withdrawal symptoms and returning depression symptoms after you stop taking an antidepressant. Keep your doctor informed of your signs and symptoms. If your depression symptoms return, your doctor may recommend that you start taking an antidepressant again or that you get other treatment.

Sources: The Mayo Clinic, NAMI, NIMH

McLean Psychiatric Hospital: Belmont, Massachusetts

Founded in 1811: McLean Hospital is a leader in psychiatric care, research, and education and is the largest psychiatric teaching hospital of Harvard Medical School.

Mission Statement

McLean Hospital is dedicated to improving the lives of people and families affected by psychiatric illness.

McLean pursues this mission by:

• Providing the highest quality compassionate, specialized and effective clinical care, in partnership with those whom we serve

• Conducting state-of-the-art scientific investigation to maximize discovery and accelerate translation of findings towards achieving prevention and cures

• Training the next generation of leaders in psychiatry, mental health and neuroscience

• Providing public education to facilitate enlightened policy and eliminate stigma

Core Values

We dedicate ourselves each and every day to McLean’s mission of clinical care, scientific discovery, professional training and public education in order to improve the lives of people with psychiatric illness and their families.

In all of our work, we strive to:

• Conduct ourselves with unwavering integrity

• Demonstrate compassion and respect for our patients, their families and our colleagues

• Foster an environment that embraces diversity and promotes teamwork

• Achieve excellence and ever-better effectiveness and efficiency through innovation

• McLean Hospital’s clinical and research activities are organized into seven Centers of Excellence and Innovation

These centers integrate the hospital’s three mission elements—clinical care, research, and education—with a focus on the rapid translation of science in order to establish, deliver, and disseminate ever-better, evidence-based approaches to care.

• Led by world-class clinicians and researchers, each of the seven centers have a primary diagnostic, research, or demographic focus and are laying the groundwork for further innovation as McLean continues to set a high bar in psychiatric care, research, and education.

Center of Excellence in Alcohol, Drugs, and Addiction

• McLean’s Center of Excellence in Alcohol, Drugs, and Addiction, led by Chief Roger D. Weiss, MD, is designed to foster integrated, evidence-based approaches to prevention, early detection, and treatment of substance use disorders.

• Addiction has become one of the most prevalent health issues of our time. From the current opioid crisis to the treatment of those dually diagnosed with addiction and other mental health illnesses, McLean offers a continuum of addiction care, including brief hospitalization for detoxification and stabilization, four residential programs, a partial hospital program, outpatient treatment, specialized programs, and a consultation service.

• The center also includes robust training and research initiatives through the Co-Occurring Disorders Institute, the Alcohol and Drug Addiction Clinical Research Program, and the Addiction Psychiatry Fellowship.

Nancy and Richard Simches Center of Excellence in Child and Adolescent Psychiatry

• Mental health issues are appearing ever-more widespread among young people. Joseph Gold, MD, is McLean’s chief medical officer and chief of the Simches Center of Excellence in Child and Adolescent Psychiatry. Children and teens are more prone than adults to depression, anxiety, obsessive compulsive disorder, attention-deficit/hyperactivity disorder, autism, bipolar disorder, addiction, and personality disorders.

• Led by Dr. Gold, McLean treats children ages 3 to 19 years who are struggling with these and other issues. Two fully accredited schools provide educational opportunities for children needing specialized academic programming. The center also reaches into the community to support children and adolescents in every possible setting, including public and private schools and pediatrician’s offices.

Center of Excellence in Depression and Anxiety Disorders

• Anxiety disorders are the most commonly diagnosed psychiatric disorders in the United States today, and individuals with anxiety also frequently suffer from clinical depression. Led by McLean’s Chief Scientific Officer Kerry J. Ressler, MD, PhD, along with its Director of Research Diego A. Pizzagalli, PhD, and Clinical Director Jane Eisen, MD, the Center of Excellence in Depression and Anxiety Disorders works to understand the biological underpinnings of these illnesses.

• The center conducts both clinical and basic science research into the relationship between stress, fear, trauma, and the prevalence of depression and anxiety disorders. Because these disorders occur in all demographics and often appear in conjunction with other psychiatric diagnoses, the center works collaboratively with McLean’s six other centers of excellence to speed the translation of science from bench to bedside to develop ever-better clinical and medication treatments.

• The center incorporates all levels of care, from outpatient to residential to multiple specialty inpatient programs and outpatient services like ECT, TMS, and ketamine.

Center of Excellence in Geriatric Psychiatry

• Providing psychiatric care for older adults can include managing the normal effects of mental and physical changes of aging while also concentrating on the psychological and neurological changes that can worsen as the body and brain get older.

• Led by Chief Brent P. Forester, MD, MSc, McLean’s Center of Excellence in Geriatric Psychiatry works to make the later stages of life healthy, fulfilling, and joyful. Clinical care and research at the center focus on older adults with depression, bipolar disorder, and behavioral complications of Alzheimer’s disease and related dementias.

Center of Excellence in Psychotic Disorders

• Led by Chief Dost Öngür, MD, PhD, the Center of Excellence in Psychotic Disorders includes inpatient programs, a residential facility, specialty outpatient clinics, and community-based services for individuals diagnosed with psychotic disorders, primarily schizophrenia or bipolar disorder.

• Dr. Öngür and his team have built clinical and research collaborations to advance our understanding of the neurobiology of psychosis and develop new insights into treatment and prevention. Researchers and clinicians in the center are changing the landscape of recovery and helping to restore lives and offer hope to those diagnosed with these debilitating disorders.

Center of Excellence in Women’s Mental Health

• The mission of McLean’s Center of Excellence in Women’s Mental Health is to innovate and improve mental health care for all women and girls throughout their life span. Led by center Chief Shelly F. Greenfield, MD, MPH, and Clinical Director Amy Gagliardi, MD, the center provides a uniting infrastructure to advance clinical care, training, and education.

• The center is a national leader in this emerging field and is conducting and sharing research across McLean and around the globe.

Center of Excellence in Basic Neuroscience

• One of McLean’s primary mission elements is to conduct state-of-the-art scientific investigation to maximize discovery and speed translation of findings toward prevention and cures for major psychiatric disorders.

• Chief Bill Carlezon, PhD, leads McLean’s Center of Excellence in Basic Neuroscience which is dedicated to studying the role of biological factors in mental illness. Under his direction, more than 130 principal investigators in more than 40 research labs conduct research into the “why” and “how” of mental illness.

• Scientists study the brain at the cellular and molecular levels to push the frontiers of knowledge and move their findings from “benchtop to bedside.”

McLean Values are at the core of everything we do. As clinicians, researchers, educators, administrators, and support staff, we conduct ourselves in ways that reflect our deep commitment to integrity, compassion and respect, diversity and teamwork, excellence, and innovation. These Values are the essence of McLean; they are at once emblematic of who we are and what we aspire to be.

~ McLean Hospital President and Psychiatrist in Chief Scott L. Rauch, MD

Will Tonight Be The Night

July 22nd, 2009

It had been one of those weeks. I was on a bender. I was always on a bender averaging around eight drinks a day, but this one was significant, was impressive even by my standards. I was drinking more than usual during the day and then when I got off work I headed direct to the Bar. I wasn’t eating, hardly sleeping, just drinking heavily. It was a mere two and a half blocks to the Bar, I could stumble to and from there in my sleep.

I slapped my copy of Anna Karenina on the bar. I read it once every year and it was that time of year again. The days of me actually ordering a drink here had long since passed. A moment later I had my well vodka tonic and a rocks glass of Jameson. The perks of being a regular. Work had been slow and I was eager to put it behind me. Tomorrow would be better, it could hardly be worse. I glanced around the oval shaped bar, most of the usual regulars were there. The professor was talking with his latest girl. He wasn’t a full fledged professor, but a lecturer at Montana State University. He read genre fiction in his spare time. He would bring in about five books a month to trade in at my used bookstore. I almost always sold his books online within a day or two. We’d talk a bit of philosophy and the current events at the university.

P was sitting across from me drinking her coke. N her boyfriend and father of their unborn child was bartending. She had her laptop in front of her going through possible baby names. She was a photography student with a penchant for going to the strip club outside of town. N would stop by her every few minutes and they’d exchange a glance or a joke. She was talking to the girl next to her I didn’t know. We would probably talk later as we usually did. She stopped in the store from time to time, but just to say hello and see if I’d be at the Bar later.

The Jameson and vodka was going to my head quickly tonight. It could be the alcohol I’d already consumed today or the blood I’d been passing lately. This was going to be an early night even if it was my thirty-seventh birthday. J walked in, a girl who had taken interest in me a couple of months ago as the guy who was always quiet and reading. She wishes me a happy birthday ordering us each a shot of scotch, Johnnie Walker Blue. We had polished off most of a bottle back on her birthday. It had cost a fortune. She sits down and we begin to chat. She runs a construction crew and has been by my store a few times.

I’ll miss my drinking buddies I casually think to myself when I’m gone. I wonder if it will be tonight or maybe tomorrow. This is what I’ve lovingly begun to refer to as my passive suicide attempt. I’m not leaving a note, just goodbye. The world will be better off without me. I’m sure it will hurt my family, but one large hurt is better than the endless small hurts I’ve been causing them these past few years. I wonder if I’ll have many people attend my funeral. I’d like a decent size crowd. I push my empty glass forward for a refill and return to my book. “If you look for perfection, you’ll never be content,” I mumble.

“What’s that,” J asks.

“Just something from the book,” I pat it tenderly, “if you look for perfection, you’ll never be content.”

“Do you believe that?”


“I think we need another shot.” Moments later I have my well vodka tonic, a rocks glass of Jameson, and a shot of Johnnie Walker Blue all in front of me. The shot goes down a little rough. I can feel the heat of it in my belly and my stomach churns in response. I take a large swallow of my vodka tonic to calm it down. “You alright tonight?”

“Just tired,” I reply.

“Well you’ve got a long night ahead of you the two of us,” she giggles.

“I’m in,” I lie.

“Be right back,” she gets up heading in the direction of the bathroom. I take it as a sign for me to escape. I quickly stand the alcohol hitting me. Grabbing the barstool I steady myself. This could be an interesting trip home. I can feel the heat of the shots in my belly as my nausea is returning. I have to get out of here quick before I’m ill. I’ve thrown up already twice today, all liquid. I haven’t eaten anything in a few days and the cheap vodka diet is playing havoc on my system.

“Will tonight be the night the sweet comfort of death closes my eyes forever and ends the unrelenting pain,” I mumble leaving the bar for home before J returns.