Hello and welcome to Sage.
We chose the name Sage for two reasons. First, it's the color of nature, and second because a sage
is someone who speaks to the peoples' welfare from the wisdom of experience.
The world is in upheaval. The conversation around mental health and wellness is evolving. Now, more than ever, taking care of yourself and your mind, is no longer considered a luxury commodity, it's considered essential for survival. That's good in a way, because it gets people, business, government and society to take it more seriously.
Our mission is to speak to the welfare of people from our experience of their suffering. We specialize in ADHD and addiction (of all kinds) because we think that's where we can make the biggest difference. We serve anyone 13+. We are unique. Our services combine the best of wellness, clinical medicine and the mind-body connection.
Since COVID-19, we are a virtual clinic. You can book, schedule and pay for your appointment on-line. Your care will be directed by a physician. Our validated assessments are comprehensive and include a review of all mental health issues. You will be given a diagnosis, treatment, monitoring and coaching, for as long as you need it.
We look forward to serving you. On behalf of all of us at Sage, welcome.
Dr. Antonio Ocana MSc, MD, CCFP, ABAM, founder
Sage ADHD and Addiction Clinic
The overlapping neurobiology of ADHD, addiction and compulsion
ADHD is the most common neuro-developmental disorder in children. It is more heritable than hair or eye color and more common than anxiety and bipolar combined. It's real and it is the root a lot of unnecessary suffering.
People who have ADHD are more likely to drop out of school, become parents in their teens, have their electricity cut off, get fired, go bankrupt, fail in relationships and get injured or die in car accidents. But the greatest injury of all, is the steady decline in self esteem that accompanies repeated failure, despite best effort.
ADHD is not a religion that you have to "believe" in. A physician saying they don't believe in ADHD is like a cardiologist saying they don't believe in diabetes.
ADHD is as real as cancer. You can see it on a brain scan. It's that dark part in the frontal lobe... Where it looks like a spider-web, it should be solid blue.
What is even more real is the aforementioned suffering. We can do more to help people with this affliction. Understanding their plight is a good start.
Addiction and Dopamine
Decreased frontal cortex blood flow in ADHD
When it comes to treatment, integration is the key
Addiction, like ADHD is marked by decreased dopamine neurotransmission, particularly in the circuits that govern impulsivity and reward. As mentioned, this trait is inherited, but that's just the start. Other things lower dopamine, like the lack of attachment people develop as a result of trauma. Not just childhood trauma, any trauma.
Not only is dopamine low to begin with in people with addictions, but when stimulated by drugs or alcohol, dopamine rises higher and faster, and then falls lower than in non-addicted people. That pattern is also inherited.
It is this instability in dopamine transmission that remains, even in recovery. That is why people with one addiction often move on to another addiction when in recovery. That's why abstinence is only the beginning.
.Addressing the trauma is essential, but it won't stick unless, you also address the genetically under-functioning dopamine circuit and integrate that into your plan.
It's not persistent post-withdrawal syndrome. It's ADHD and if you've missed the diagnosis, your chance of long-term success is maybe 20%. I think we can do better.
Addiction and Compulsion
Addiction to substances like cocaine and heroin, is governed by the same neurobiology as compulsive gaming, shopping or sex.
The feelings and emotions associated with dopamine neurotransmission, became through natural selection, the signal that a behaviour was associated with survival. And it's hard to ignore a feeling that is associated with survival.
That's why severe addictions come with severe compulsions. Some people would do anything, even sell their kid's food, to increase their dopamine.
Therefore you can't treat ADHD or Addiction or Compulsive behaviours until you stabilize dopamine circuits.
This helps decrease the up-and-down of withdrawal, craving and relapse. And as the roller-coaster stabilizes, people can better regulate their thoughts, emotions and themselves.
That is why treating people to be mindful of their thoughts and feelings works.
That's why finding some other less jarring way of boosting your dopamine works. Whether that's meditation, trauma therapy, getting into nature, hugs, group support, riding your bike or medication. Do whatever works for you. Stabilizing the dopamine circuit is the key, and we are here and ready to help you do that.
Dr. Antonio Ocana MD