Upper East Health Psychiatry specializes in the comprehensive treatment of behavioral disorders and addictive behaviors with medical and multidisciplinary treatments in New York.
Upper East Health Psychiatry provides outpatient care for disorders of different types and at varying levels of severity. The practice treats patients with addictions, sexual disorders, mood disorders, anxiety disorders, attention deficit disorders, obsessive compulsive disorders, cognitive impairments and psychotic disorders. For those patients who require it, Upper East Health Psychiatry refers practice patients to the top medical specialists in the New York area.
When rehab and residential care are required, we admit patients to the leading medical and residential centers in the United States. Dr. Rosenberg maintains admitting privileges at New York Presbyterian Hospital and the Cornell Medical College. During hospitalization or inpatient rehab, the Upper East Health Psychiatry team remains in close contact with the inpatient facilities.
Our holistic approach is based on the idea that addiction is a brain disease which must be attacked from many vantage points, with different treatments.
Dr. Rosenberg
The drive to stimulate the pleasure centers trumps reason and common sense, steamrolling past regret, dismissing yesterday’s bad experiences and overriding the very instinct to survive. Surgically implant an electrode in a rat’s brain that stimulates these pleasure centers, and you’ll have a rat that will do anything and everything possible to get more and more brain stimulation. Give the rat a choice between hitting a lever to stimulate the pleasure centers or hitting a lever to feed itself and its pups and it will choose pleasure over survival nearly every time. Only death permanently separates the rat from its fix. Each of us has our poison. A personal poison that makes us feel better in a jiffy, soothes us, ignites the reward center of the brain, transforms us and offers peace of mind and a false sense of balance. It’s a poison so delectable that we erroneously convince ourselves that the benefits outweigh the risks. For some of us, it’s alcohol, drugs or cigarettes. For others, it’s compulsive sex. For many, it’s fatty foods. Few of us live without some irrational and destructive desires.
Alcohol addiction, well studied for years, is a prototype for the addictive cycle. Alcohol turns on and off major neurotransmitters in the brain and has anxiety-reducing effects. Body weight, age, and genetic metabolism all play a role in determining whether alcohol makes you sick or makes you feel great. For most of us, taking two or three drinks relaxes us -- much more makes us sick. Yet, there are some people who take their first drink and a light goes off -- an ease, a feeling of wellbeing previously unknown overtakes them.
It’s no surprise that these people tend have a predisposition to become alcoholics, people for whom the consumption of four, six, even twelve drinks, means that the party is just getting started. In the scientific literature, on average, biological (not adopted) children of alcoholics are able to consume much more alcohol than non-relatives from the moment of their very first drink, supporting the theory that biological predispositions play a major role in the development of alcoholism. To understand the biological susceptibility that some people have to alcohol, researchers break down alcoholics into Type 1 and Type 2 subgroups. Those who learn to drink in response to environmental pressures are Type 1 alcoholics. Those who drink because of an inborn, biological urge are categorized as the more severe Type 2 alcoholics.
This classification system is based on research done during the 1980’s in Stockholm on children of alcoholics who were adopted and thereby, grew up without the influence of their biological parents. According to this system, Type 1 Alcoholics are essentially made, not born. They develop their disease after the age of 25, they don’t have many alcoholic relatives and therefore don’t seem to have a strong genetic predisposition. Their ‘need” for alcohol has influenced by stressor and environmental influences. They tend to have passive personalities and succumb to peer pressure. They tend to be anxious and use alcohol to calm down. In sum, Type 1 Alcoholics get that way as a result of their environment and a temperament that makes them susceptible. They have a less serious, less entrenched and more treatable form of alcoholism.
Type 2 Alcoholics, on the other hand, have strong family histories, their problems tend to develop earlier in life (before age 25,) they tend to be antisocial (criminal and anti-authority types) and their alcoholism is far more serious (but still treatable.)
This division has its merit and most alcoholics can be placed somewhere on the continuum between those who are “made” and those who are “born.” But few alcoholics can be classified as purely Type 1 or Type 2. Increasingly, we see every behavior as the result of the complex interplay between our psychology, biology and environment. There are probably dozens of types of alcoholics, not to mention that each of the 18 million alcoholics living in America is different. (More poignantly said by Tolstoy who wrote, “every unhappy family is unhappy in its own way.”)
Metabolism and basic brain interactions are only part of the story. With sufficient months or years of addictive behaviors, anyone can build up a “tolerance” and develop desperate psychological cravings. Familiarity and access are critical to developing an addiction. Poverty, stress, poor education, and overburdened parents only add to their vulnerability. Even without the stresses of the inner city, addictions can be infectious.
Many of us are at risk, including doctors! Nearly all doctors are in the habit of writing their own prescriptions. And most have an arrogance and overconfidence that unfortunately are common corollaries to a medical education. And they have easy access to “left-over” pain-killers while they rotate through their hospital training.
Case-in-point is my experience with doctors abusing a drug that is a cousin of heroin called Fentanyl, an injectable and patch-like form of opium. Hospital anesthesiologists commonly use Fentanyl to put surgical patients into an opium haze during surgery. Anesthesiologists have familiarity with the drug and they’ve got access. Thus, it’s no coincidence that 78% percent of anesthesiologists with addiction problems are opiate junkies, and most use Fentanyl.
Another factor in determining whether you’ll become an addict is the psychological “fit” of the drug or the behavior. Case-in-point is a group of doctors-in-recovery who met in a therapy group in my office. They ranged from stimulant abusers (‘upper drugs’) to alcoholics (‘’downer drugs’). Despite their educations, the upper-doctor-junkies could never understand why the downer-doctor-junkies do what they do, and vice versa. “Why would anyone want to come down?” asked the upper junkies who gravitated towards cocaine. “I would never want to be more jittery than I am,” say downer-doctor-junkies who gravitated towards alcohol and Valium. The upper-junkies are people who crave extra stimulation. They tend to be people who tend to have attention deficit disorders; they have an inability to pay attention unless the stimulation is very intense and the volume is cranked up. Upper junkies also tend to be people with depression who want to wake up from their lethargic existences. Most often, they are people with a biological and psychological temperament that demands high-risk, high-energy behavior — gambling, skydiving, speeding, that sort of thing. Geneticists have even isolated genes that may identify this subgroup of abusers. If upper-junkies want it turned up, downer-junkies want it all turned down. Downer-junkies tend to be people who are already too ramped up, too over-stimulated, too sensitive, too tuned-in and turned-on. They “fit” better with alcohol, opiates or other downer drugs like Valium. They tend to be people with anxiety disorders, insomnia and post-traumatic stress disorder. They tend to be artistic, romantic and sensitive. Now I can go on and on, but the most important thing I can say about addiction concerns Denial and Shame.
Shame is the enemy. Caught up in the maelstrom of substance abuse or behavioral addictions, addicts feel immune to the disasters. Despite how easy it is to become an addict or patient, and how commonly it occurs, addicts are so ashamed — and their denial becomes the most formidable obstacle to recovery. Rather than ruin their lives with impunity, our patients have decided to confront their addictions and make monumental positive changes. And being a part of that comprehensive solution is what Upper East Health Psychiatry is all about.
Kenneth Paul Rosenberg, MD
Kenneth Paul Rosenberg, MD
Kenneth Paul Rosenberg, MD is a Clinical Associate Professor of Psychiatry at the Weill Cornell Medical College and New York Presbyterian Hospital, a member of the American Academy of Addiction Psychiatry, the Society for Sex Therapy and Research and a Distinguished Fellow of the American Psychiatric Association.
Since 2001, he has been listed every year as a Top Addiction Psychiatrist in New York Magazine's "Best Doctors" issue, and is listed as a U.S. News Top Doctor in U.S. News and World Report. He has produced films for PBS and HBO to educate the public about medicine and psychiatry, for which he is the recipient of a George Foster Peabody Award and has been recognized by both the Academy of Motion Picture Arts and Sciences and the Academy of Television Arts & Sciences.
Karen Robbins, LCSW-R, MS
Karen Robbins is a licensed psychotherapist She has worked with Carnegie Hill Institute, The Renfrew Center and The Center for Anorexia and Bulimia. In addition to working with individuals with anxiety, substance abuse and Eating Disorders, relationship and work issues, she works extensively with couples and has a background in group work as well.
She graduated from Columbia University School of Social Work and Northeastern University Graduate School of Education. She completed her Post Masters work in Psychodynamic Psychotherapy at the American Institute of Psychoanalysis. Prior to her clinical work, Karen worked more than ten years in consulting and managerial positions in Citicorp and Dreyfus.
Margaret Klein, LCSW
Margaret Klein is a Licensed Clinical Social worker, providing psychotherapy services to individuals, couples, and families in a comfortable and confidential setting. Working within a frame of cultural sensitivity, Margaret understands the client as part of a greater system of family, working relationships, romantic relationships, friends, and community.
While serving a varied population with a wide range of challenges and life stage transitions, Margaret brings a particular expertise working in the following areas:
Individuals and family members struggling with addiction and substance abuse
Families where chronic, acute or end of life issues present
Infertility issues and guidance around acceptance and assisted reproduction
Transitioning back to workplace after maternity or medical leave
Margaret received a BS in Psychology from Ithaca College and a MSW degree from New York University.
She has had a diverse body of work experience in the fields of business and psychology. In her clinical work, Margaret has held positions at three different outpatient substance abuse treatment facilities treating individuals and family members. Margaret was Program Director at AbleTo, a pioneer in the field of behavioral telehealth, delivering manualized CBT programs to clients who have had a medical or life event. At the Ackerman Institute for the family, she completed the dual program in the core curriculum of Foundations in Family Therapy and Live Clinical Supervision. Margaret continues her education and experience through comprehensive trainings across treatment modalities.
Laura Curtiss Feder, PsyD
Laura Curtiss Feder, PsyD is a licensed clinical psychologist at Upper East Health Psychiatry. Dr. Feder co-edited Upper East Health Psychiatry's textbook Behavioral Addictions: Criteria, Evidence, and Treatment for Elsevier Academic Press. Her psychotherapy practice is geared toward working with adolescents and adults, particularly those who struggle with behavioral addictions and compulsions. Dr. Feder received an undergraduate degree in psychology from Princeton University and then went on for her doctorate in clinical psychology from the Graduate School of Applied and Professional Psychology at Rutgers, The State University of New Jersey. Her doctoral training included working at several New York City hospitals, including Bellevue, Beth Israel and St. Luke’s Roosevelt as well as multiple local university counseling centers.
Dr. Feder completed a postdoctoral fellowship at the William Alanson White Institute where she also continues to receive specialized training in working with eating disorders, compulsions and addictions. She has written and presented at professional conferences on the topics of substance abuse, psychological symptoms related to dermatological conditions, camp-based leadership programs and psychotherapy with artists.
Sam Decker
Sam's role as office manager for Upper East Health Psychiatry involves taking care of everything necessary to make sure that patients are able to get the care that they need in an efficient, stress-free, and professional manner.
He is also a professional musician and educator, with a number of records released over the last five years and a private teaching practice in Brooklyn. You can hear his latest album on Spotify.
UEH experts are licensed and recognized. Dr. Rosenberg was named a 2020 Exemplary Psychiatrist by the National Alliance on Mental Illness (NAMI).
