An Interview with Psychiatrist Lantie Jorandby
Dr. Lantie Jorandby is a board-certified psychiatrist with certification in addiction psychiatry and addiction medicine. She is currently the chief medical officer of Lakeview Health Addiction Treatment and Recovery in Jacksonville, Florida.
Theresa Nair: Thank you for joining us today for this installment of the Seattle Psychiatrist Interview Series. I'm Theresa Nair, a research intern at Seattle Anxiety Specialists. I'd like to welcome with us psychiatrist Lantie Jorandby. Dr. Jorandby is a board-certified psychiatrist with certification in addiction psychiatry and addiction medicine. She is currently the chief medical officer of Lakeview Health Addiction Treatment and Recovery in Jacksonville, Florida. Dr. Jorandby also has a blog on Psychology Today's website, where she regularly writes articles on topics related to addiction and addiction therapy. Before we get started, Dr. Jorandby, could you please tell us a little more about yourself and what made you interested in studying addiction?
Lantie Jorandby: Thanks, Theresa, for having me. Yeah, I would love to share that. It's a personal journey of sorts. I had gone to medical school, thinking I wanted to do obstetrics and gynecology, and ended up just falling in love with mental health. And part of it is that I have family members, my father specifically, who really struggled with anxiety, depression, and then addiction. So, it was really a tug for me to go into. And another feature around it was that I was working with veterans early on in my career. Veterans coming back from the wars, Afghanistan and Iraq, and a lot of them were struggling with not just PTSD, which seems somewhat obvious, but they also had addictions that they developed on the battlefield, and they were also dealing with these co-occurring kind of disorders that you see. So, this all came together for me, and really spurred me to go ahead and do a little bit more training. And that's why I went into addiction. And being in addiction really just feels like exactly where I need to be. It's a field that I love. It's very challenging, and it's an addiction that affects everybody in that person's life. So the family members, loved ones, partners. It really is wide-ranging. So when you help that one person, you're helping several more people that are in their lives as well.
Theresa Nair: That's wonderful. It sounds like you've really found your calling. You mentioned how you can tell that it's what you should be doing, right. It feels right. So.
Lantie Jorandby: It really does. It feels like just where I should be, especially during the pandemic. That obviously is something I'm sure we'll talk about a little bit later too. But we have seen such a side with people struggling with relapses, and overdose rate is high, higher than we've ever seen. And so knowing that here I am in this treatment center, not having any clue that we're going to be facing something unprecedented and then being at the forefront, being able to, where a time that of the world really haven't seen at this level before. It's very rewarding.
Theresa Nair: I'm glad that you found that way to make a difference and have a positive impact. Since we are a psychotherapy practice specializing in treating anxiety, I'm wondering if you could talk a little bit about the relationship between anxiety and addiction, and if individuals who suffer from anxiety are at a higher risk of taking on addictive behavior.
Lantie Jorandby: I think that's a great question. So, one of the things that we see a very high rate of here is what I mentioned earlier, co-occurring disorders. And those are disorders like anxiety disorders or depressive disorders that go hand in hand with addiction. So a lot of our patients, I'd say at least 50%, sometimes higher, have something else in common. So they're coming in primarily with, let's say, alcohol problems, or addiction to heroin or something else. But they also have these underlying conditions that really, if you are not aware you can treat, they will have a lot harder time into recovery, being able to prevent relapses. And so that definitely is a big issue. What I know is that for instance, our female population, we see about 75% of them have trauma. And trauma, I know the DSM waffles about this diagnosis being an anxiety disorder specifically, but for me, it is an anxiety disorder.
It's an anxiety of, or disorder of heightened awareness. Difficulty with their environment, difficulty with relaxing and being able to connect with others. And so, when we have the high level of trauma in our female population, being able to be aware of that and address it while they're also getting treated for their alcohol use disorder or their opiate use disorders is just super-critical. And then if we look at, for instance, panic disorder, social anxiety disorder, we see high correlations with, for instance, alcohol and sedatives. And if you look at the data, for instance, social anxiety disorder has a high hand-in-hand with alcohol. There's popular TV shows and movies about people that have such social or crippling social anxiety that they have to have a drink in their hand to be able to go to a party or meet somebody new. And that becomes a behavior, often, that can lead to addiction. And so we are very aware here when I work that we really need to look for and be aware of other conditions like social anxiety, like panic disorder, PTSD, to really get to the root of issues.
Theresa Nair: That's interesting. I have seen that on shows before. It's almost kind of modeling that that's how you deal with anxiety, is have a drink in your hand, or-
Lantie Jorandby: One of my favorite shows is The Big Bang Theory. It's off now, but they have that main character. And that's the only way he can talk to women is he has to have some alcohol in his system. And it's kind of a running joke, but towards the end of the show, they do show that he starts to get in trouble with alcohol. And it isn't, I don't think, anywhere to the level of addiction, but he is progressively becoming a pattern for him, that kind of behavior. And it's no longer the effective coping tool. It's become a behavior that's really causing him some trouble. And so that, when I think about addiction, and I feel like this is a message that gets lost, it's a progressive disease. And so, for the patient, a lot of them may have started out with something like alcohol or marijuana. That it wasn't initially problematic, but you add in stressors or bad coping skills, or even co-occurring disorders that might develop, and it eventually becomes a problem you can't ignore. So, I just feel like that's a very important message to share.
Something else, speaking about anxiety disorders, especially with addiction, is the idea of perfectionism. There is an interesting term I read in The Atlantic. This was actually pre-COVID. They talked about women specifically who get caught up in maybe alcohol addiction. And one of the things that's still out there, this myth of the superwoman, she can do everything. She can have a full-time, high-powered career. She can have a family at home, take care of the children, be at the soccer game, go to the board meeting. And then this article connected all of that, those demands on women now, with the idea that, okay, when they get home the end of the day, and they're making dinner for the entire family and still multitasking, they're going to have a glass of wine. And then maybe that leads to another glass. There is this connection of these demands that we put on people in society, women specifically, that if you go down that road, seem to be connected with patterns with alcohol, for instance. And I'm not saying every successful woman that's trying to do everything is going to end up with substance use problems. But more and more through the pandemic, we've seen women coming in, seeking treatment with those kind of behaviors and environment in their lives. And I think just following that context, I think we're going to see this more and more as we get past COVID.
Theresa Nair: Speaking of that, and you mentioned a little bit about relationship between trauma and addiction, and you've talked a little bit about COVID and addiction. We've gone through such major historic events lately. It's been referred to in some articles as a cascade of collective trauma between COVID-19 and increasing political tension, racial tension, economic instability. Are you seeing in general an increase or any type of relationship between what's currently happening and addiction in your office?
Lantie Jorandby: I would say yes, but it's interesting. What we saw in the midst of COVID, we go back to 2020 and even last year, people were still coming into treatment. But I think there was a delayed response. Like they were still in survival mode, and they weren't really recognizing all of what you just listed. You're right. Unprecedented global pandemic, all this political and this violent tension. And so now that we are, and I'm certainly not saying we're even past COVID, but it has shifted our priorities a bit. And now what I'm seeing here in the treatment facility and now, and I do talk to other colleagues in other areas of the country. They're seeing the same. Now there's this big rush to get into treatment. People are starting to recognize that two years later, their behaviors or their addictive patterns are no longer working.
It's like that progressive disease I mentioned earlier. In the thick of it, I feel like people weren't quite recognizing it. And now that we're getting a little perspective, a little bit of distance from COVID, people are recognizing now, "Wow, this has just been tremendously hard on myself and my family, and on my network. And I need help." And so that is good to see, that recognition. It's hard, though, because I mentioned earlier around 75% of the women we see seeking help are traumatized. And now we're seeing a higher uptick with our male population, younger adults in their early 20s or late teens are also struggling. And I do think the social isolation that came with COVID, the heightened use of substances to manage all of our collective stress and trauma is starting to show. It's really starting to manifest now.
Theresa Nair: That's really interesting. So is that because people thought they were just doing these things temporarily to cope? They're stuck at home, there's a lockdown. And then they find when all of that's over, they're trying to return to normal life, that it's maybe harder to quit than they thought it was.
Lantie Jorandby: It is. One of the things that I've talked a lot about over the last year is that you have people that have been working from home, those Zoomers. And one of the things about Zooming and working from home is that it sometimes is easier to hide your substance use. Say someone's going to drink at work. You can put your camera off, which I think in this time and age is a sign that either you didn't get up early enough to put on makeup, or maybe there is something more serious going on. And so initially, I think that a lot of us ended up just thinking, "Okay, this isn't going to stay forever."
And then it kind of did. And now, we're looking back on it, and we're coming back in the office. And I read all the time about companies that are struggling to get employees back, and some of the bumps in the road. And I think that is what we're seeing now, is that people hunker down for two years, develop some habits that weren't healthy. And now they're realizing that those don't work, now that you're back in more of a normal time or a normal environment. And so that's where they end up seeking for help.
Theresa Nair: That's really interesting. Yeah, I think we're definitely in unprecedented times. Right? And so everyone's trying to figure out and cope, and figure out how to return to some semblance of normalcy. Right?
Lantie Jorandby: I agree. And I think this is my own opinion, not basing on it on research, but I think we need to take stock of these last two years and understand that life is precious. There are a lot of good things in life. We've lost a lot of people that we love. And so to take each moment that we have here and just make it meaningful. Engage in something that you find enjoyable, whether it be art or nature, just take that moment because we're not really promised what's next week or even tomorrow. And so really understanding that, because COVID, I feel like, all of the terrible things have happened that shed a light on our national kind of work. Our work balance in life and understanding what's important.
Theresa Nair: That's a good point. Yeah. I think there's a lot of people reevaluating. What is most important, right? It might as well face what matters most in life and reconsider our priorities. Switching gears a little bit, you had written an article recently about the benefits of ketamine with alcohol addiction. I was wondering if you could talk a little bit about recent research with that, and why you think that's a beneficial treatment method?
Lantie Jorandby: Well, I would say we haven't necessarily gotten to the point where you're absolutely proving beneficial results to treat alcohol addiction. So you look at the history of ketamine. It evolved from the beginning as an anesthetic drug on the battlefield in Vietnam to a club drug that was abused in the 80s and 90s, to a therapeutic drug now in the psychiatry scene. And the therapeutics of it are pretty well-studied for depression, and in fact the FDA has approved it for people that have depression that's refractory, meaning they've been tried on an anti-depressant, and haven’t improved or even those people that have --
Theresa Nair: It's cutting out a little bit. I'm sorry. Could you repeat that?
Lantie Jorandby: What I was saying is that the FDA has looked at and approved an inhaled form of ketamine, that looks to be beneficial for people with refractory depression. Meaning that they've been on a lot of other medications that haven't worked, and it's also where it appears to be pretty effective for people that have chronic suicidality. So we have seen ketamine go from one type of therapeutic use in anesthesia, to an abused drug and now to a therapeutic. So, some of the more recent research shows that there may be some benefit for addiction. And a lot of the research right now, most of it in the area of alcohol. What we are finding out is that ketamine can show good results if you pair it with therapy. It can be, show some really interesting data. People in the studies are able to interact better with their therapies to address the addictions or to address the appropriate resource, and so it's really interesting.
One of the things about ketamine, of course, is what I mentioned earlier. Usable. People can get addicted. It's not as common other drugs, but there is kind of this fine balance. So if we're going to use it to treat people that have an addiction, we really have to be very careful about who we're choosing to use ketamine on. You have to be aware of things like trauma in that person's past or in their current issues. You have to be aware of how they cope with their coping strategies, their support system. Because if you introduce something that is addictive, and they don't have some of those other things in place, it can cause more problems than you're looking for. And then the other thing I think really that I came away with looking at the research is, therapy is really key to this. You can't do anything in isolation. Ketamine is not that quick fix that we're all, I think, looking for. Just like an antidepressant isn't a quick fix, either. I firmly believe that medicines can be very helpful, but if you're not pairing them with change. Whether that change is being navigated with a therapist or with someone else that's helping person, someone support them or change their coping styles, you're not going to get as far as you need to. And so that's where I think the real message is, that ketamine looks exciting for this population, but there's more data to learn. And I think ultimately we're going to use it in conjunction with a lot of other tools in the toolbox.
Theresa Nair: That gets to another topic I wanted to discuss. Where in a recent article, “The ‘Aha’ Moment in Addiction Treatment,” an article that you had written, you talk about how once individuals get through the detox phase, the real work can begin. But people are often terrified at that point. So how do you work with individuals to get past that point when they have detoxed? And then they're just terrified, how do you get them to move forward?
Lantie Jorandby: What I really love to do with people who do absolutely have their fingernails, just clinging to the side of the pit, and it’s just scary. Especially when they have with no history of treatment. So, this is brand new. What we really find helpful is peers. People that have been in the facility a little bit longer, been in treatment a little longer, can help them navigate. Who can really speak to them with credibility, knowing that they've been down that thing there.
We also engage family. I think family is so important. They are often the reason people come to treatment. The family members giving them an ultimatum, whether it's a husband or a partner or a parent. And so they're here, somewhat unwilling to be here or against their will. And when you engage family, it can be very impactful. And in fact, a lot of times, to get people past that terror moment, we will ask family to send us impact statements, things that tell that loved one that's in treatment. "I'm so proud of you. I'm so glad you're in treatment. This is why. Because in the past we have struggled with seeing you hurt yourself. We have struggled with seeing your health go down. You have not been present with us, and we love you." And so having family within can be very, very powerful because they're a big reason these groups come into treatment. And then just having them understand. And I do this a lot with our medical team, is just walking them through the medical piece of it. Because a lot of times, they may not be aware that their liver function is not doing as well. Or they may not be aware they've developed a pneumonia because of their alcoholism. And so going through the clear basics about that. And then finally, I always like to encourage folks. This is a fine balance, but really encourage them to understand, being in treatment and having the addiction doesn't mean that they're bad people. It doesn't mean they have a character flaw or something wrong with their personality. But they've really developed it, unfortunately, a progressive disease. And it's disease of brain activity. And so destigmatizing it some can help them, our language.
Theresa Nair: You were just mentioning the importance of involving family. And often, if a family member or a loved one has someone in their life with addiction, they're told to take them to detox or to take them to rehab, and to get treatment. Do you find that if a person is coerced into going and seeking treatment, and they're just going for a family member that it's beneficial, is that the best approach for family members to take if they have loved ones with addiction?
Lantie Jorandby: I think it's a fine line. Honestly, people that come in with family coercion, they do very well, as much as the folks that are coming in on their own. But I think it's really a surrender moment. If those folks are being coerced or somewhat encouraged strongly to come into treatment, often they kind of get fixated on, "Okay, I'm only here because my husband said that he's going to file for divorce." Getting them to go beyond that and just render and see all the other things that are happening in their lives, beyond just feeling like someone's turned on them, is really important. I speak with the experience of having a loved one who had an addiction. And it's hard to sit down with that person, especially as a parent and just say, "I'm so worried about you."
"This is what I'm seeing. X, Y, and Z. Please go to treatment." Because it feels in some ways, a lot of times, that person's going to take it as a betrayal. And so, you have to separate yourself from that feeling and just do the best that you know from that person. And getting them into treatment is the best thing. If you think about, this is the way I see addiction is often that person's been taken hostage by the drug or the alcohol. And you have to be that hostage negotiator of sorts, to try and get them freed. And sometimes the only way to do that is to get them into some form of treatment inpatient. Doesn't always have to be inpatient, but often it does. And that's where the real work starts. It's tough. I mean, it's really an individual case by case, but I think both sides can be very successful. The person that comes in separately, and then the person that comes with family.
Theresa Nair: Okay. So that's interesting. So you don't necessarily have to wait for that person to realize on their own that they have a problem.
Lantie Jorandby: We have a young woman here now who I'm so proud of. She came on her own. And what she shared with me a few days ago was that her family just took a collective sigh of relief when she told them that she was going in, because they were ready to agree. And they were just so worried about her. She was doing some really interesting stuff. So it's great when they have the insight like that, when someone can see, "Okay, this is really unhealthy. I'm starting to understand." But you don't always get there. And so that's where you kind of have to take that initiative.
Theresa Nair: Okay. Well, I think that's good for people to know that it can still be beneficial, even if you're pushing somebody to go in for treatment.
Lantie Jorandby: Absolutely.
Theresa Nair: Another thing you've written about are the changes in the brain that take place during addiction. I'm wondering if, when somebody goes through recovery, if you see those changes reversed, or if there are any other changes within the brain that occur when somebody has gone through treatment. Do you see a reversal in the trends that had occurred during addiction?
Lantie Jorandby: Yes, we actually do. Usually, those changes start to show up around 30. Really, I want to say 30, but up to 90 days is really where the beginning stages of change start to happen. We see it with their behaviors, kind of that "Aha" moment I mentioned earlier in the blog I wrote. You just see everything click for them. They start to engage in the groups. They're starting to show positive peer relationships. They're often voted by their peers to lead for the week. And so those are really positive things to see. And it's so rewarding, but it can take some time. And the reason is, if you get into some of the science behind it, the brain, it's part of that reward center of the brain that can be taken over by drugs and alcohol. So that individual thinks they need a chemical to survive.
They need heroin, or they need alcohol, or they need a Xanax to just survive day to day. So, it's going to take some time to take that part of the brain back, and to also rewire it. Not to get too technically, but we know that neurotransmitters are unbalanced. We know that particular pathways are affected and injured during addiction. And so, to really rewire all of those pathways and rebalance the chemicals, we see that it even takes up to a year to 18 months. But in that first 90 days is really where you start to see the behaviors manifest. And I think that's what keeps all of us in this field is that when we see people change and their lives the better, and then their families come in for the family workshops, and they see the changes, they just can be so transformative for the whole system.
Theresa Nair: That's wonderful. I'm sure that's just a great experience to be able to see somebody come back, right. Come back to who they are and-
Lantie Jorandby: Absolutely. Yeah, it really is.
Theresa Nair: Great. Did you have any other parting words or advice, or anything you would like to share with our audience?
Lantie Jorandby: You know what, I feel like education is so important for addiction in the field. And for so many years, even 20, 30, more years or longer, it's been a field that has a lot of stigma to it. People are ashamed to tell someone that they have an alcohol problem, or they're ashamed to tell someone that their family members have a problem with addiction. And so really getting education out there about what addiction is, how it affects the brain, destigmatizes it. And when you destigmatize treatment, more people go.
I'm going to call out some celebrities, people like Demi Lovato, or some popular stars that have a lot of recovery, like Eminem or Pink. And they've been very vocal about all of their struggles and how they went to treatment and how they got healthy. Really helps in some ways, it obviously very alluring to see stars getting help, because we're all fixated on gossip and stars. But it's also really rewarding for me to see this, because the general population sees them and think that they're so successful, but they don't understand that these people have also fallen prey to addiction or to mental health issues. And so they see them getting help, that destigmatizes it so they can work and get help too.
Theresa Nair: I think that's a great point. I think there are a lot of people who still want to keep these things as a family secret, not discuss-
Lantie Jorandby: Yeah definitely, it happened in my family. Yeah. And it goes on and on. So you have to break that pattern in your own family, and just be very willing to break down those barriers. Because people, this is a treatment with these. If I was to say one more thing, and I could say many more things,
Theresa Nair: That's OK.
Lantie Jorandby: If I could say one more thing, this is an issue that's treatable. People can get healthy and then can lead healthy lives and be happy. It's not the end of the world, but they have to get into treatment first to do it.
Theresa Nair: I think that's an important point. That it can, I don't know about cured, if that's the correct word, but you can get past that. You can move on from it and-
Lantie Jorandby: You can, but I love to see, yeah, we have a very strong alumni group that they have their own private Facebook page, but periodically some of our staff will share just some positive stories that come out of the alumni group. But it's so nice to hear, because people will say, "I've had five years sober, I've had 10 years sober." And they will even have little clocks on their phone, and it'll show that the days that they've been in recovery. It's great, because they have transformed their lives.
Theresa Nair: That is great. It just has me thinking one more thing I'd like to ask you here, last minute. Do you have advice if somebody is seeking for a program as to what types of programs they should look for? I know you hear sometimes that maybe some treatment programs might just be scams. What should a person look for if they're looking for a successful treatment program?
Lantie Jorandby: I think you want to make sure that it's accredited by JCO, or Joint Commission, I think that's very important, because that is an organization that goes around the country and looks at these to make sure they have the basic elements of treatment. So that means nursing care, physician or provider medical care, therapy. That they're meeting standards. So, I think that's very important. I also think it's important to have a strong medical presence at the facility. Because people that are coming into treatment with addiction often have medical issues that need to be addressed, whether it be liver disease or infections, or problems with heart disease. There's a lot of different things that go hand in hand with addiction, and so you want to be able to treat those medical conditions. And then being a psychiatrist myself, I feel like having a very strong mental health presence in that facility. And so having someone that's going to treat co-occurring disorders and evaluate for more serious conditions, and be able to treat them is also very critical.
Theresa Nair: Thank you. That's wonderful advice. I appreciate you speaking with us today, and thank you for participating in our interview series.
Lantie Jorandby: Well, thank you for having me. I appreciate it.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.