Dr. Richard G. Soper, MD, JD, MS, FASAM

A few suggestions-
1- make sure U have objective proof your companion does not have any infectious medical problems ( HCV, HIV, HSV,yeast, bacteria or other. Intimate behavior and actions should be pleasureable and without negative consequences. and consensual
There are no known detrimental effects from ingesting male ejaculate. Basic guidelines can be found on several internet sources, National Coalition for Sexual Freedom is reputable, reliable and nonjudgmental.
Explore and be creative-

The hardest part you have accomplished, admitting you have a problem and seeking help. Stopping alcohol abuse is possible, rarely can it be achieved by sheer willpower. Even though, Nancy Reagan, bless her heart, said- just say no stopping alcohol abuse is best achieved like other chronic medical maladies with the guidance of a physician trained, experienced and qualified in substance use disorders ( aka addictions). You can find a list of such physicians at: American Society of Addiction medicine: (asam.org) website. Richard G Soper MD,JD, MS, ABAM, DFASAM

Very insightful of you. In the past twenty years the professional medical field has suddenly become aware of the age old practices of yoga and meditation. Both have been shown to be of significant benefit in treating medical maladies.
My belief is that like all of us, anyone with a medical condition prefers to NOT be told what to do. Offer a suggestion or invite brother to consider the option of one tool amongst many that helps treat many medical conditions. Let him explore and decide, usually better chance of his accepting.
Than-you for the empathy and concern you have for brother. Be patient and kind- he will need lots of love and support to change his life pattern.

Your question is one I am frequently asked.
Let’s start with terminology. “can you fix it” would suggest something is broken ergo someone broke it and there is blame. If you had asthma or high blood pressure,( other chronic medical conditions - like addiction is) we would not ask it it could be “fixed” rather can it be treated or brought into remission. Like diabetes, asthma or high blood pressure addiction causes bodily changes and all can be treated. There are several options for treatment and some are more effective than others. You are NOT broken and do NOT need fixing, you have a medical condition and need treatment. It shows strength of character and quality of person to be seeking help as you are. I suggest U consider going on the American Society of Addiction Medicine website and search for a physician member in your area. Make an appointment with that physician when ready and discuss treatment options. Serenity-Courage- Wisdom: Doc Soper

Yes, alcohol abuse/ addiction can be treated . Healthcare insurance covers treatment for alcohol abuse or dependence. There are several options for treatment. Many factors are involved in designing the treatment protocol. I suggest U discuss with your family doctor who should be able to refer you or treat you. If referred seek a medical doctor that is certified in addiction medicine or addiction psychiatry or both. Go on websites ASAM.org and/or AAAP.org and find a member physician of one of those and contact that doctor. Serenity-Courage- Wisdom: Doc Soper

Marijuana is fat soluble- meaning when used it rlands in/stores in our body fat. It takes 30 da to completely out of body. It can still be detected in hair samples for up to 6 mos. In sum, yes U will most likely test positive on urine drug screen for Thc, having used 16 da prior to test.

Contact the physician that took over the deceased doctors practice. If that is not possible urge you to get into a doctors office asap. U could be at risk for seizures. Provide same information to doctor, and take your last prescription bottle. Also, go to pharmacy whereU had script filled and get a copy of your past years prescription record to show the doctor.

That is a proper perspective - YOU should NOT wean off any psychotropic medications by yourself.

Generally, several years of therapy with an antidepressant should not have a negative impact. If there has been a sudden change in his behavior, you might want to notify the physician who could evaluate you son for a possible reason. Most likely, the physician would consider whether the symptoms are due to the antidepressant. If your son has expressed a concern or desire to stop taking the medication, again, discus that with the physician. A sudden stop in dosing of an antidepressant can have negative consequences.

Yes, they work about 66% of the time over a 3-4 month continuous use. The patch will assist in gradual tapering of nicotine. When paired with the gum the success rate for sustained abstinence goes up to nearly 80%. The patches deliver continuous nicotine while adhered to your skin, There are several brands and generic patches available. The patches come in 3 different strengths. I usually suggest the patient taper to a pack of cigarettes or less per day prior to using the patch or patch/gum combo. Do not get frustrated if the first time of use you feel the continued craving to smoke. There are two components to cigarette smoking- nicotine and the behavioral ritual. Early in treat teen with the patch being used, you may find you miss holding or touching the cigarette. There is no restriction to only using one patch, Try to find the dosage that allows you to manage the day without “needing” a cigarette. It might take two patches, The patch strength is 21, 14, and 7 micrograms. Suggest you start with the 21. Put on in the morning and take off before bed. I have had several patients tell me the generic is just as effective but can be more variable in regards to labeled strength and actual strength.

BE supportive, if you have internet access use your search engine (Safari, Google or other) there’re are abundant sites for support to unit smoking.
Suggest he consider seeing his physician to discuss the options, patch, pill, gum, lozenges or combination. Discuss gradually restricting the locations where smokes, (ie- NOT inside home, in the car, in the garage) DO not buy cartons, it discounts monitoring per day use. Discuss with him the significant health benefits to stopping nicotine use. Be patient and supportive- it takes time and is a progressive weaning/tapering.

Thank you for your bravery and empathy to reach out for help. You can stay non-judgmental and resolves to help him. Hopefully, he can acknowledge he has an alcohol problem.
One very good and simple screen tool is CAGE:

C- Have you tried to CONTROL your drinking and been unable to?
A- Have others been ANGRY with you about your drinking?
G- Have you felt GUILTY about your drinking?
E- Have you ever needed an EYEOPENER?

Score yes=1, no=0
If the total score is more than 1, there is a problem with alcohol drinking, and seeking help is appropriate. If he has a primary care physician, that doctor can help. If employed, many employers human resource department can assist. If he has healthcare insurance, that company can assist in seeking help, and many communities have Alcoholics Anonymous and Al-Anom group meetings which can be resources for help.

Serenity, Courage, Wisdom,

Doc S.

Congratulations for taking a very significant step towards reducing your risk for negative health. Nicotine cessation is difficult. Withdrawal symptoms are nearly always experienced. An abrupt quit is the method some individuals chose, but usually has more severe withdrawal symptoms. I would suggest (1)- discussing with your primary care physician, since there are medical options available. (2) you might consult the internet, several good websites are available for nicotine cessation, one being , stop smoking.com. (3) there are over the counter several aids to assist with reducing the withdrawal symptoms, including nicotine gum, nicotine lozenges, and nicotine skin patches.
Combining the patch and gum has nearly a 80% success rate for stable abstinence, when used in combination for several months.
(4) Avoid using a "vap" as the literature is continuing to develop that "vaping" causes significant lung damage, and last week the first death attributed to vaping was reported.
Be patient, it is not a failure if you slip and have a recurrent use, stay with the goal of nicotine abstinence. Continue with progress, and you will get there. Doc S

You can be of help by first discussing with him and determine if he acknowledges the problem. One of the Screening tools is "CAGE"- 1- "CUT" back: has he tried and not been able to; 2-are family and friends "ANGRY" with his drinking; 3- does he feel GUILTY for drinking 4- Does he need an EYEOPENER drink to start the day.
If one is positive his drinking is a problem. If more than one is positive- he needs help.
You might discuss with your primary care physician what the options are for helping him. Most communities now have an physician-addiction medicine specialist with whom you could seek help. Contact the local medical association to obtain information. Most communities also have recovery groups, or known as 12 step groups, such as Alcoholics Anonymous which can also be resourced. You might also consider a 12c step support group, Al-Anon, which is for partners and family of individuals suffering form the medical disorder of alcohol dependence. Be patient and realize it is a medical disorder, not a character defect.

Your initial concern is the first step, try to avoid anger and frustration.
I would strongly urge him to discuss with his primary care physician or a qualified addiction medicine specialist. Treatment options are available. One method of finding a specialist is to call your local or state medical association, or search websites like “find a top doc”
Also, I suggest you remember to do some self care. One of the available community resources for family members of an alcoholic dependent person is Al-Anon. You can find locations and time for Al-Anon meetings on the internet or check your local phone book.
Serenity- Courage- Wisdom; Doc S

Alcohol use disorder can be treated on out patient basis depending on the complexity of patients clinical presentation (how they are at the time of evaluation). To determine if treatment can be on an out patient basis, must be evaluated first to determine if hospitalization is necessary. The severity of the consequences of alcohol use usually require. Some blood testing for such things as vitamin B, folic acid, liver enzymes, and so forth. Substance use disorder is now covered by most all health care insurance and cannot be refused to be treated as a prior existing condition.

The current diagnostic manual for pscchiatry doesn’t have a diagnosis for sex addiction. The diagnosis currently accepted is, impulse control disorder.

It is a subjective assumption for any of us to label someone’s behavior as an addiction when they happen to have a frequency of participation different than ours.
If your wife is maintaining a monogamous relationship but simply has a desire for more frequent intimacy than yours, I’d suggest open candid and considerate dialogue between the two of you and/or with a qualified professional to assess whether there could be changes each of you consider to improve and enhance your continuing relationship

Anxiety, depression, and substance abuse commonly co-occur with impulse control disorders, which formally include kleptomania, pyromania, and intermittent explosive disorder. Impulse control disorders are closely tied to conduct and disruptive disorders, and considered in the same chapter in the newest DSM, the DSM-5.Oct 14, 2018

Yes, there can be withdrawal symptoms from tapering/weaning off buprenorphine (suboxone) I would suggest discussing with the prescribing physician your symptoms. There are other medications that can assist for the tapering period if you are experiencing insomnia, restless legs, diarrhea, muscle and bone aches, and mood changes.

Flakka is one of the synthetic stimulants and a cathinone (“bath salts”). Alpha-PVP produces a rush of dopamine in the brain, causing an intense high similar to that of cocaine and methamphetamine. Flakka enhances energy, alertness, and mood. But it can also cause agitated delirium and sometimes results in psychiatric hospitalization. Symptoms (effects) can occur within 5-15 min after use and last three to six hours. Effects include, but are not limited to:

-Profuse sweating
-Disorientation
-Paranoia
-Extreme agitation
-Delusions
-Panic attacks
-Severe hallucinations
-Slurred speech
-High body temperature

Thank you for your bravery and seeking advice. If you have constant thoughts (cravings) with continuing life consequences from the behavior, yet still seek the item or object and simply cannot get enough of it, that meets the criteria for addiction.

1- More and more of your time and daily routine is spent thinking, procuring, consuming them cycle back to thinking, procuring....
2- Despite negative life consequences you continue us to participate in the behavior
3- You simply cannot get enough, or are developing tolerance you most likely have an addiction.

I would suggest to you, it is not uncommon to become addicted to food (the category or type is secondary). Food addiction is very prevalent in our culture, frequently clustered with
other self harming behaviors such as too little food (anorexia) or purging after consuming (bulimia) all categorized as having an eating disorder. I would agree with your query and advise you to seek help from a health care professional qualified and experienced with eating disorders. There are also 12-step recovery groups for eating disorders you can access.