Dr. James Laurent Gagne, MD

I would STRONGLY suggest you see a physician to see if there's an underlying illness. The most common reason for "polyphagia" (eating constantly) is diabetes. A bunch of other illnesses can cause this. Don't wait. Go get checked out.

Not that I'm aware of. But the larger issue is believing it's okay to diagnose your friend with a psychiatric disorder. Unless you're a trained mental health professional, this is hard to do accurately. Instead, you might tell your friend you've noticed a change in behavior and ask if he's okay. Does he think there's a problem? If not, you're maybe best off dropping the whole thing.

I'm not sure what you mean by "behavioral therapy," but two types of therapy have good scientific evidence of benefit: cognitive behavioral therapy and dialectical behavioral therapy. You can look them up online. That said, remaining sober from opiate addiction is difficult without "Medication Assisted Treatment" (MAT): ongoing, long-term treatment with Suboxone or other brands of buprenorphine/naloxone, Vivitrol (injected naltrexone), or methadone maintenance that's only available at a federally licensed methadone clinic. Many addiction treatment centers resist MAT.

We used to tell everyone wearing the patch never to smoke while using it. Turns out that's not true; nothing much happens. But if you get too much nicotine in your blood, it will make you sick at your stomach. The better choice is to use nicotine lozenges like Commit, also over-the-counter, for when the desire to smoke arises.

ABSOLUTELY. But genetics aren't destiny. If one parent is alcoholic, each child has about a 25% chance of inheriting the RISK of alcoholism, and about HALF of that group go on to problem drinking. The more affected relatives, the higher the risk. One way to tell you have the risk might be your response to alcohol. If each drink makes you feel more WONDERFUL and euphoric than the previous drink, you have the risk of losing control and should avoid alcohol. Childhood emotional trauma (e.g., abuse or neglect) can also put someone at risk. Similarly, if you take one opiate painkiller and become euphoric, you have a potential problem. The normal response to painkillers is they relieve your pain, that's it.

Patients have told me that they're not alcoholic but recognize that it would be possible if they weren't careful. That's because after one drink, they lose control and almost immediately have six drinks or more. So they avoid alcohol like the plague. That's smart.

Given what you say, avoiding potentially addicting substances is probably a good idea.

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The answer is, it depends. Usually, entering a rehab that emphasizes group and individual therapy is the best bet. Treatment is more comprehensive, and they can detox your son easily. The problem with many rehabs is their quality varies enormously. Some rehabs are scams, especially a large group in south Florida. Moreover, if the rehab is full of 20-something heroin addicts, your son would be at risk of learning how to shoot up and coming home with a worse addiction - HEROIN - and a much greater danger of overdose. Individual therapy also varies enormously in quality. A good therapist can be very helpful, and a bad one can harm their patients.

But, one of the most important considerations is finding a treatment that includes Medication Assisted Treatment (MAT). Look this up online, emphasizing reputable sources like SAMHSA (e.g., https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview <https://www.integration.samhsa.gov/clinical-practice/mat/mat-overview>). Unfortunately, the majority of treatment programs emphasize a strict abstinence approach: just stop using all drugs. This approach works for alcohol and many drug addictions, but not opiates/painkillers, where the success rate is only about 5%. Because opiate addiction is so lethal, insisting on a treatment approach proven to fail 95% of the time means many of your patients won't survive. They say Suboxone is "just another addicting drug." But used properly, it PREVENTS further opiate use. Suboxone does NOT foster addiction. It has no significant harmful effects on the body. Yes, addicts can abuse cocaine or marijuana or meth while on MAT. Most of us believe those drugs aren't nearly as dangerous as opioids.

INSIST on MAT unless there are compelling reasons your son shouldn't take it. You'll need to find a physician addiction specialist who can prescribe it. The most commonly prescribed MAT medication is Suboxone, also known by other names/brands like Zubsolv, Bunavail, and generic buprenorphine/naloxone. It is now widely covered by health insurance. The alternatives are methadone maintenance at a federally licensed methadone clinic, and Vivitrol, a monthly injection of an opioid blocker/antagonist. Most people choose Suboxone.

If you research Suboxone online, you'll encounter enormous opposition to its use, purely for ideological reasons. Buprenorphine is the active ingredient in Suboxone. It IS an opiate AND an opiate blocker. Properly used, it prevents further opiate use. Buprenorphine doesn't get you high, but it fills the "hole" left if you've been addicted to opiates and quit. Even after the acute withdrawal has resolved, most people enter "post-acute withdrawal," consisting of months of fatigue, depression, and extreme craving for opioids. That's why it's so hard to stop with abstinence alone. Buprenorphine prevents these symptoms. If successful, people feel NORMAL, and their families notice the difference. "I have my son back!"

The major downside of Suboxone is you have to take it for AT LEAST 5-10 years. I've had many male opiate addicts start a career, get married, buy a house, and have children while on this medication. Stopping Suboxone sooner is almost a guaranteed relapse. While taking it, most people feel a lot better, have more energy, and return to normal function.

There's more to be said about MAT and treatment for opioid addiction, but this will at least get you started.

Suboxone has some real pluses and minuses. Let's start with the minuses: if you're an opiate addict, you basically have to take it forever, at least several years. Shorter courses usually lead to relapse. Many addicts get tired of being sober and go on and off Suboxone, keeping it around so when they run out of their preferred opiate, they can prevent withdrawal. Suboxone has value on the street, so some addicts who are close to the streets wind up selling it and buying dope.

The benefits are clear. If you take Suboxone as directed (usually 8-24 mg/day), the success rate of maintaining sobriety rises from 5% with abstinence (not taking any medication at all) to over 50%. It dramatically lowers the risk of death from overdose. Many people who simply stop opiates without medication go through months of "post-acute withdrawal" they feel exhausted, depressed, unable to enjoy anything, and crave drugs intensely. Suboxone almost always prevents all these symptoms. It's pretty good at treating depression. Family members are often thrilled to find their son/daughter/spouse/sibling is back to their old, pre-addiction self. Used properly, the outcome is amazing. There are some minor exceptions, but basically Suboxone is incredibly safe and won't hurt your liver, kidneys, or other organs.

But the biggest problem with Suboxone is toxic ideology. You=E2=80=99ll run into hundreds of people who consider Suboxone =E2=80=9Cjust another drug. You can do it without taking anything.=E2=80=9D That=E2=80=99s like saying you don=E2=80=99t ever need to use seatbelts in your car, which is a terrible idea. Many doctors won=E2=80=99t prescribe Suboxone because they don=E2=80=99t want to treat =E2=80=A6 ADDICTS! It=E2=80=99s frequently hard to find physicians who will prescribe it, and many of the prescribing MDs run mills where you=E2=80=99re in and out in five minutes and pay $100 just for the prescription.=20

The scientific evidence supporting Suboxone is overwhelming. Taken as directed, it promotes sobriety and saves lives. But you=E2=80=99ve got to overcome all the naysayers.


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Finding that your young adult child is using drugs is truly heartbreaking. As you know, abusing many kinds of drugs can kill him or cause serious illness or put him in prison. But you have no direct control over his use and probably can't "convince him" to do anything. Often, the more you nag him, the more he uses.

First question is, are you part of the problem? Do you give him money that he can use to buy drugs? Do you give him free rent and overlook transgressions like stealing family possessions? Do you rescue him from the consequences of his actions? That's almost always unwise. If he's arrested, do you bail him out? In short, are you good at setting limits?

Second, do you have insurance that covers rehab? If so, CAREFULLY research drug rehab facilities and find one that accepts your insurance and has a good reputation. Be really picky because the rehab business has attracted more than its share of scammers. Once you find a place, consider giving your son an ultimatum: get help or get out. Tell him, "If you're going to kill yourself with drugs, I'm not going to let you do it under my roof."

Third, and probably most important, get help for yourself. Therapy with a good psychotherapist can be incredibly helpful. You may find Al Anon meetings in your community that can help. Again, BE PICKY and keep looking until you find honest to goodness support.

The answer depends somewhat on your son's specific circumstances. For almost everyone, abstinence alone ("just stop using" and go to rehab or Alcoholics Anonymous meetings) fails 95% of the time. Opiates rewire the brain to the extent that it's not possible to experience pleasure with anything except using, and this effect often lasts for months after you stop. The craving is overwhelming, and it's just too hard to quit. Yet 75% of rehabs are ideologically committed to abstinence and won't support Medication Assisted Treatment with Suboxone or Vivitrol. They refuse to treat anyone on Suboxone because "It's just another mind-altering drug." It can be hard to find physicians who will prescribe Suboxone. But the science is clear: Suboxone saves lives and dramatically improves the likelihood of success.

Alas, no, there are no magical answers in treating alcoholism. One thing that might help is if YOU get treatment and support. Consider going to Al-Anon or seeing a therapist yourself. One trick: be PICKY about which Al-Anon meetings you attend; some will be a much better fit than others. Ditto with psychotherapists, be picky.

You can't. Enough alcohol causes general anesthesia. IF you were a surgeon, you could probably remove their appendix without waking them up. The thing to watch out for is if their breathing slows or they start to turn blue. Then this could become a fatal overdose. Call 911!

Here are some of the factors to consider: 1) Opioids often make headaches WORSE, so often stopping them completely will lessen your pain once you're through the pain flare-up that typically lasts 1-2 weeks after stopping these drugs. 2) It does sound as if you're taking the pain medication for euphoria (to feel good) and not just for pain. Most opioid addicts can't stop without Medication Assisted Treatment. This involves long-term maintenance treatment with methadone (at a federally licensed methadone clinic), Suboxone, or Vivitrol. 3) Most rehabs emphasize abstinence: just stopping and going to 12-step meetings. That works for alcohol or cocaine but only very rarely for opioids. Google "Medication Assisted Treatment" and look for links to SAMHSA (samhsa.gov <http://samhsa.gov/>) or the FDA (fda.gov <http://fda.gov/>) on this topic. 4) Often, emotional factors like depression or post-traumatic stress disorder help drive opioid addiction. Get therapy if you've had trauma in the past.


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There's no medication that consistently helps people with alcohol dependence. Some people who drink for the euphoria they get do well with naltrexone, but many of my alcoholic patients drink to numb emotions. If you're a "euphoria drinker," naltrexone may help, but if you're an "oblivion drinker" (drink simply to get numb), it probably won't. Overall, naltrexone is helpful in a minority of patients. Acamprosate also has scientific evidence of benefit, but I've not found it useful. Antabuse is commonly prescribed for alcoholism, but almost never helps. Science shows conclusively it's of little or no benefit.

So, basically, drugs don't do much for most alcoholics. The treatment is rehab, either inpatient or outpatient. There are also good internet-based programs. Some people can get sober going to Alcoholics Anonymous, which requires 90 meetings in 90 days to have any effect. The trick with Alcoholics Anonymous is you have to find a meeting where you feel comfortable; typically, 9 out of 10 aren't a good fit and you have to keep looking.

Absolutely! Three medications can help heroin addicts stay sober, and most heroin addicts should be using one of them. The sobriety rate with abstinence alone (i.e., not using long-term medications) is terrible. The three drugs with solid scientific support are buprenorphine (Suboxone and others), naltrexone (best used as a Vivitrol shot), and methadone maintenance at a licensed methadone clinic. These drugs save lives. This whole approach is called Medication Assisted Treatment.

Here's a brief overview of Medication Assisted Treatment: https://drugfree.org/article/medication-assisted-treatment/
And you can Google this term to learn a lot more.

I'm afraid your question contains mistaken assumptions. First, the vast majority of medications have no risk of "addiction." Are certain medications essential to health if you have a condition like hypertension or diabetes? Absolutely. Are they addicting? Well, are you addicted to food or oxygen? If you stop eating or breathing, you will die, but no one considers that an addiction. These medications are like gas in your car. No matter how tired you become of filling up your tank, you have to keep refilling it or your car will stop running. Not an addiction.

Second, only a couple of medications for hypertension pose a risk of withdrawal if you stop them suddenly. So, if you're taking a beta blocker like Inderal (propranolol), carvedilol, or metoprolol and stop suddenly, that could cause chest pain or even a heart attack in a susceptible person. Taper and stop them over about two weeks, no problem. Clonidine has a similar problem. Otherwise, you can stop an antihypertensive drug and all that happens is your blood pressure goes up. Diabetes is similar; I know of no drug with a withdrawal risk, but if you stop them, your blood sugar shoots up.

It's certainly true that hypertension and diabetes may get worse over time, so that you require more medication. It's a little like an old car that gradually gets less gas mileage over time, so you need to fill up the tank more frequently. The problem here is the car, not the gas. Similarly, when they need more medication to control their illness, people often refuse to believe the problem is their hypertension or diabetes itself. They blame their need for more medication on the drug, not the illness.

Finally, "addiction" is when you take a drug like alcohol, Xanax, or Norco that causes euphoria, and you wind up using more and more. You lose control and the drug takes over. The drug then starts causing problems, but you don't stop. No drug for hypertension or diabetes has this risk.

How old is your daughter? Child? Teen? Adult? If younger than a teen YOU=E2=80=99RE in charge and need to be the parent in the house. If over age 11, you might work with your daughter to find HEALTHY treats she likes, like fruit. Fill up the house with healthy food. Cook together to create luscious, healthy treats.

There are other possibilities. Occasionally craving sweets can be due to a medication, so you might review the prescriptions she=E2=80=99s taking. Rarely, an illness like diabetes can cause sweet craving. There are no medications that help sweet craving, so usually this is a parenting/lifestyle issue.

Drug addiction is more than one thing; it's several things depending upon which drug we're talking about. And are you asking about detox (safely stopping ongoing use of a drug) or maintenance, preventing relapse?

Detox is a complicated subject. The drugs that typically require a detox treatment protocol are alcohol, sedatives like Xanax, and opioids like pain killers and heroin. Marijuana, cocaine, and meth don't require a medical detox, although you'll feel lousy for the first week or two after stopping them.

Medications to help prevent relapse are useful in patients who abuse alcohol or opioids. For alcohol, naltrexone is often used, both pills and the once-a-month injection Vivitrol. For opioids, there are three choices called "Medication Assisted Treatment." They are Suboxone, Vivitrol, and methadone maintenance in a federally licensed methadone clinic. Suboxone and Vivitrol can be prescribed by a primary care physician. Campral (generic name acamprosate) has some evidence of effectiveness in alcoholics, but I'm not convinced it's useful. Antabuse for alcohol is proven useless and should not be prescribed except in very rare cases.

"Antidepressants" is a large category of different drugs, so your mileage may vary depending on which one. But I'm not aware that ANY antidepressant would interfere with your quitting. In fact, most antidepressants would HELP, because feeling punk is a lot of what drives smoking behavior. Moreover, one antidepressant, Wellbutrin (generic bupropion), is FDA-approved to HELP you quit smoking, under the brand name Revia, and is often quite effective. (It's the same drug whatever it's called.) Whichever antidepressant you take, you should see the prescribing physician about 1-2 weeks after you start to be sure the medication is working properly, and every few weeks thereafter.

It depends what's in the cough syrup. Several cough syrups contain diphenhydramine or other sedating antihistamines. One brand name of diphenhydramine is Benadryl, and it's also sold as an over-the-counter sleeping aid. This can definitely help sleep and is not habit forming or addicting, but it can cause drowsiness and impaired function the following day.

Other cough syrups contain opioids like codeine or hydrocodone (the same drug as Norco). A common hydrocodone-containing cough syrup has the brand name Hycodan. These are commonly abused by opiate addicts. You may want to investigate the ingredients and discuss what's in the cough syrup with a pharmacist.

You should probably have your brother see a physician. A sudden craving for eating ice cubes is often a symptom of iron deficiency. He may be anemic.