Spotlight On Our Medical Leader: Chris Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers

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One thing we want everyone to know about Pinnacle Treatment is that we put people first.

We put our patients first.

We put their families first.

But we also put our team members first: they’re people, too.

They are people committed to helping our patients heal and grow. They lead and facilitate group and individual therapy sessions. They lead educational classes and practical skill-building workshops. They do new patient assessments, create treatment plans, review patient progress, create aftercare plans, and spend their days doing everything related to the clinical side of recovery.

Many of our clinical team members have direct, experiential knowledge of addiction and recovery, because they’re in recovery, too. That’s how they can empathize, offer compassionate care, and truly relate to what our patients are going through: many have literally been there themselves. We’re not just talking about our front-line clinicians. This is true all the way up the leadership continuum, and includes key individuals who make decisions about who we are as an organization, how we treat our patients, and how we operate on a day-to-day basis.

Our licensed physicians – many of whom are also in recovery – oversee medical detoxification and determine when a new patient is medically safe, physically stable, and ready to begin treatment. They assess medication needs, initiate medication-assisted treatment, write prescriptions for medication-assisted treatment, and monitor dosage and timing throughout treatment. If medical complications arise, they can help quickly. If a dosage or a prescription needs changing, they make or oversee any changes.

Our physicians communicate medical needs with nurses, nurse practitioners, pharmacists, and anyone involved in the treatment process. They participate in creating the overall treatment plan, monitor patient progress, and weigh in on any critical decisions, such as whether to step up or down a level of care, or discharge a patient from treatment. If we discharge a patient, our physicians will contribute to the aftercare plan, and work to ensure a seamless transition from one level of care to the next, including a proactive effort to provide any new providers or therapists everything they need – records, histories, notes – to help the new provider help our patient on the next phase of their recovery journey.

One of these physicians is Dr. Chris Johnston, our chief medical officer, known by many at Pinnacle by staff and patients alike as “Dr. J.”  Dr. J sat down with us recently for a candid question and answer session covering a broad range of topics. We want to share that conversation with you so you can read his story, learn about his approach to addiction treatment, and hear his take on everything from internet addiction (is it really a thing?) to the benefits of mutual-aid groups like AA, to the benefits of psychotherapy, to the warning signs you should watch for if you think you or someone you love has an addiction problem – and important things to consider if you think you need to get them help, or get help yourself.

Q&A With Dr. J: “Treatment Works in All Formats”

It’s our privilege to introduce Dr. J, a core member of the Pinnacle Treatment Centers leadership team, and a person who goes above and beyond every day to help people with addiction create a sustainable life in recovery.

  1. Tell us a little about yourself and your own recovery process. What treatment(s) have you sought? How has it helped? What was your first step in seeking help/treatment? What advice would you give to others about addiction?

I’m a recovering physician who, over 30 years ago, was married to a woman who was very anxious and not affectionate. I spent many years in unproductive marriage counseling until I heard a message of hope at a hospital staff meeting from a physician who benefited from ALANON. I decided to focus on my part of the dysfunction in the marriage. The message I heard was of very high success rates for people who abstained from alcohol completely, attended AA meetings regularly, and got an AA sponsor. I thought that I wouldn’t be able to do the “God stuff” in AA, so I asked for help from the counselor who specialized in addiction treatment in my marriage counselor’s office. I have not had a drink since. I saw several other therapists in my early years of recovery, but the majority of the healing has come from the kind and loving power generated by fellowship with people in all walks of life, varying stages of recovery, and in several different 12 step mutual support organizations. I’m grateful now to be counted among the more than 20 million people in the U.S. in stable, long-term recovery.

  1. What kinds of people are particularly vulnerable to an unhealthy addiction of some kind? Are there particular personality traits, genetic predispositions, or other factors that can make a person more likely to suffer from an addiction?

At least 50 percent of the risk of addiction is genetic and the rest is environment. The biggest environmental risk factor is early age of exposure to tobacco, alcohol, or marijuana when the immature, developing brain is most sensitive to being rewired, causing addiction-related behavior. Adverse childhood events and trauma have a role to play as well, but it’s important to understand that addiction also happens to people with no apparent risk factors.

  1. What is your definition of an unhealthy addiction? Why are humans prone to addiction?

The term “addiction” is generally applied to problematic behaviors and is always unhealthy. We have very strong evidence of addiction occurring in animals. This is not just a human problem. This is a problem that can impact any organism with a brain. Lab studies show that even crayfish show what’s called conditioned place preference for cocaine, which is considered analogous to aspects of addictive behavior in humans.

  1. What are some of the most difficult types of addiction to treat/overcome and why (e.g., opioid addiction, alcohol addiction, cigarette/nicotine addiction, sex addiction, etc.)?

Addiction treatment is complicated by the changes in brain chemistry and wiring that make it hard for the person with the atypical brain to make sensible, healthy choices. The potency of current opioids creates profound changes seen in brain scans that persist for more than six months after stopping using. Healing of these parts of the brain happens faster when anti-craving medications are taken, such as methadone or buprenorphine. Large scientific studies show that people are less likely to die, more likely to stay in counseling, and more likely to get back to work and stay out of trouble if medication is taken for enough time.

  1. Are there any newer types of addiction that we’re seeing in society that we perhaps didn’t recognize or label before (e.g., social media addiction, etc.)? Why are these problematic and challenging?

The DSM-5, which is our go-to diagnostic reference for mental disorders including addiction, defines diagnostic criteria for something new called internet gaming disorder. However, the DSM-5 has not defined any other discrete internet related addictions. But there are many scholarly articles proposing criteria for diagnosis and the associated characteristics of people who have problems created by overuse, misuse, or unhealthy use of technology. Before we’re able to scientifically decide how to treat these things, we need to agree how to accurately – i.e. scientifically – define and diagnose them.

On another note, technology and addiction aren’t necessarily related in only negative ways. I’ve seen some smartphone apps that show promise in improving outcomes for people with addiction. This is a case where these devices – that do have the potential to be addictive, or at least lead to behavior that appears addiction-related – can be used for improving behavior and detecting a tendency towards relapse before any substances are used.

  1. How can someone know if they have an addiction problem? What are the telltale signs? Are there any particular criteria they can/should meet that you can suggest?

Seeking professional evaluation from an addiction specialist is wise if someone has trouble controlling how frequently and how much time they spend using drugs or alcohol. The rule of thumb is “if alcohol or drugs causes problems in their life they should consider a professional evaluation administered by an addiction specialist.” Mental obsession to use when not using, even if there is the sense that “I can stop anytime I want” is another warning that addiction has changed the brain function. Constant worsening use is not a requirement to ask for help. In other words, a person doesn’t have to have a crisis like getting fired for showing up at work impaired, get a DUI, or “reach the bottom” – to use an AA term – before they seek help. Many people appear to improve a little after making some changes in their lifestyle, but usually the addicted mind causes problems even when “dry” for a period of time. What I mean here is that if a person thinks they need to quit, they should consider quitting, but the best way to do that is with professional help. An addiction treatment professional, or even a community support group, can help a person stay in recovery long enough for the addicted mind to start to heal and return to balance.

  1. What are the first steps, in order, you’d recommend to someone if they feel they have an addiction problem?

If a person uses sedatives daily like alcohol or Xanax, and tremors occur on days when they try to stop, then that person needs medically supervised withdrawal management. Most other people can do very well in outpatient programs. People with opioid use will frequently benefit from anti-craving medication in the first year or so. I have met some people who have been very successful going the talk therapy only route, but because of the growing potency of opioids on the street, this has become much more challenging.

  1. Any other thoughts, tips, or suggestions on this topic?

Yes. We should understand it’s rare for someone to be addicted to only one thing. Also, if there are co-occurring psychiatric problems [a mental health disorder in addition to an addiction disorder], these must be addressed at the same time as the addiction disorder. Evidence shows that when co-occurring psychiatric problems are present, treating both the addiction and the psychiatric disorder improves outcomes for both.

Also, people who don’t know anything about addiction treatment, or know very little about addiction treatment, should know this: treatment works in all formats. If one type of treatment doesn’t work, try another until you find success. Combining mutual help programs with scientifically proven therapy like cognitive behavioral therapy and group therapy improves the odds of success. Finding ways to avoid or deal with triggers for relapse are crucial.

Final Thoughts: Treatment Works

After we spoke with Dr. J, it occurred to us that his early experience mirrored that of many of our patients. He was unsure about entering recovery via the AA route – he didn’t think certain parts would work for him – but he sought a different way in, which worked. Which eventually brought him around to understanding the power of mutual aid groups like AA, where he benefited from “the kind and loving power generated by fellowship with people in all walks of life” who, like him, are on their respective recovery journeys.

This is the embodiment of his philosophy, and ours: any door is the right door.

If you need help, it doesn’t matter to us which door you come to. If you knock, we’ll answer. We’ll help you to the best of our knowledge and ability. And with people like Dr. J on our team, the help, the knowledge, and the ability we have to offer is considerable.

The materials provided on the Pinnacle Blog are for information and educational purposes only. No behavioral health or any other professional services are provided through the Blog and the information obtained through the Blog is not a substitute for consultation with a qualified health professional. If you are in need of medical or behavioral health treatment, please contact a qualified health professional directly, and if you are in need of emergency help, please go to your nearest emergency room or dial 911.