Friday, November 20, 2015

The Surprising Prevalence of Drug Abuse in America

by Gabriella Pinto-Coelho

A new study out of the National Institute on Alcohol Abuse and Alcoholism paints a bleak picture of drug addiction in the United States. Certain social factors like unemployment (which has a strong correlation to drug abuse) and the rise in prescription opioid use have contributed to the current state of drug use and abuse in our country.

The study from the NIAA analyzed data taken from a 2012-2013 national epidemiological survey. The research team focused on discovering the prevalence of drug use disorders (DUDs) as defined by the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The DSM-5 serves as an encyclopedia and diagnostic tool for mental and behavioral health disorders.

The findings revealed that roughly 9.1 million, or 3.9%, of Americans had a DUD diagnosis based on their reported use in a 12-month period. Even more concerning is that 9.1% of Americans had a DUD diagnoses based on their reported lifetime use. The statistics on treatment for those with DUDS are more disheartening; only 24.6% of those with lifetime DUDs received treatment, and just 13.5% of those with 12-month DUDs received treatment.

The researchers identified demographic characteristics that put individuals at a higher risk of developing a DUD, including:
  • ·         Men
  • ·         Caucasians and Native Americans
  • ·         Young, and previously married or never married adults
  • ·         Individuals with lower levels of income and education
  • ·         Individuals who reside in the Western states

The results also linked a set of psychological factors related to the 12-month DUD diagnoses:
  • ·         Major depressive disorder
  • ·         Persistent mild depression
  • ·         Bipolar disorder
  • ·         Post-traumatic stress disorder
  • ·         Personality disorders

Finally, psychological risk factors for lifetime DUDs include:
  • ·         Generalized anxiety disorders
  • ·         Panic disorders
  • ·         Social phobias

This study didn’t even include information on drug abuse for institutionalized individuals like prisoners and active duty military personnel. Given the fact that the risk factors above are prevalent in the prison population (e.g. young, men, low income and education) and in the active military population (e.g. PTSD, young, men), I think that the statistics quoted by the researchers are lower than they actually are.

While these findings are a little bit depressing, we have to face the facts. As the researchers said, we are facing an urgent need to destigmatize drug abuse and focus on education, prevention, treatment, and support.

Friday, November 13, 2015

The Changing Demographics of Opioid Addictions

by Gabriella Pinto-Coelho

There’s no doubt that the population of individuals seeking treatment for opioid addictions now is vastly different than the same group profile in the 1990's or even early 2000's. A new study out of Canada has shed more light on this reality: the changing demographics in Canada, the U.S., and abroad highlights the importance of treatment programs to evolve to meet the needs of a new and unique group.

The study focused on a large group of both men and women at 13 methadone clinics in Canada. All study participants were seeking treatment for an opioid dependence disorder and were attending methadone clinics for their treatment. Researchers found that the majority (52%) of women and 38% of men had their first contact with opioids from a doctor’s legitimate prescription. Researchers aren’t entirely sure why women were so vulnerable to opioid dependence originating from a doctor’s prescription. One hypothesis is that women are more likely to seek medical care in general. Furthermore, the women in the study were more likely to have both physical and mental health issues, a family history of psychiatric illness, and childcare responsibilities. Meanwhile, the men were more likely to hold jobs and smoke cigarettes. Interestingly, the average age of patients seeking treatment is 38, though they began using opioids at an average age of 25.

This profile is very different than the profile of patients seeking treatment in the 1990's; the average age at treatment was 25, while age at first use fell to 21. Patients seeking treatment in the 90's were predominantly male, injecting heroin, and without childcare or employment responsibilities. The unfortunate fact is that many current treatment methodologies are still based on this outdated model that has shifted in recent years. More and more women are seeking treatment for opioid addiction in Canada, the U.S., and other countries, and many treatment programs do not consider the impact of childcare and employment responsibilities on the lives of both women and men seeking help.

Given this shortage of patient-centered treatment programs, it comes as no surprise that programs like The Coleman Institute’s accelerated, outpatient detox are growing in popularity; it's private, compassionate, comfortable, and relatively quick detox programs seem to be appealing to people who are eager to get back to work, family, and other life responsibilities.

Thursday, November 5, 2015

A "Wild" Transformation

by Peter R. Coleman, M.D.

I recently watched the movie “Wild” starring Reese Witherspoon as Cheryl Strayed - a young woman who was having serious problems and felt like the best solution was to go hike on the Pacific Crest Trail. I was expecting a fairly boring movie showing some struggles and perseverance and then she would finally make it to the end and live happily ever after. What I saw instead was the story of an amazing transformation in a young woman’s’s life.

Cheryl grew up with some significant dysfunction – an alcoholic, abusive father, who was so abusive the family was bundled up and had to escape late at night. Her mother then seemed to run away from all of life and not deal with things in healthy way. It was very painful for Cheryl and her brother. Cheryl escaped with a young boyfriend, then drugs, and ultimately became horribly addicted to heroin. When she was at the end of her rope, she happened to notice a beautiful photograph of a landscape hanging on the wall of an office.

It was a photograph of a section of the Pacific Crest Trail (PCT). A little voice inside her told her that if she could just tune into this beauty and follow a different path, things would turn out alright. She surrendered to this voice without quite knowing why or what lay ahead. With only the minimum of preparation, she set out. The early days were very difficult but she persevered. In the end, she hiked over 1,000 miles. 

She conquered enormous obstacles and put up with what, at the time, seemed unbearable pain. Along the way, she was able to evaluate her past experiences and how she had handled them. Cheryl was able to feel and experience her pain – both physical pain and emotional pain. Ultimately, she was able to accept her past and forgive herself and others. She came out a transformed woman.

What struck me about this true story is that the journey Cheryl embarked on is so similar to the journey of substance abuse recovery. She just did it in an unconventional way. She first gave up the drugs and alcohol and then, she was able to think and feel clearly. She nurtured her body and soul with good exercise, good food, and beautiful surroundings. She overcame challenges. She sat through pain without giving up. She started to look at her patterns of thinking and behavior that got her into trouble. Cheryl looked back at the influences of her past and was able to get past judgement and blame. She became able to see her parents as real people who did the best they could – even if that wasn’t very good. She was able to forgive herself and them. Over time, she found a new passion for living – writing, sharing her stories, and helping others.

Finally, as she neared the end of the trail, she found a way she could reintegrate and live in the real world in a safe way that would not trigger her to return to drug use.

Since the “Wild” walk, Cheryl Strayed married and raised a family. She has written books, shared her stories, and inspired others. Last week, I saw a reference to a talk that Cheryl will be giving soon. Over 15 years later, she is still growing in her recovery, still following her passion, and still helping others.

Tuesday, November 3, 2015

Risks: Prescribing Opioids to Teens

by Gabriella Pinto-Coelho

A new study out of the University of Michigan has shed light on some disturbing facts around teenagers and opioid abuse: high school students who are prescribed opioid painkillers are 33% more likely to abuse these drugs by age 23 when compared to their counterparts who did not have a prescription for opioids during their high school years.

Surprisingly, the study found that teens with the highest risk of prescription drug abuse were those with little or no history of illegal drug use and who felt strongly against drug use. Researchers hypothesized that, given their disapproval of drugs, prescription painkillers might be these teens’ first exposure to an addictive substance. 

Their initial experience of pain relief is pleasurable and perceived as safe; this experience of safety and euphoria in first exposure to a drug are believed to be factors that contribute to drug misuse and abuse. On the other end of the spectrum, teens with a history of drug use were less affected by their prescriptions for opioids; although they might go on to abuse prescription pain relievers later in life, there appears to be little association with their introduction to the drugs in their adolescence through a legitimate prescription.

These results emerge amid the FDA’s new approval of OxyContin for children as young as 11. The drug has been approved for use in pediatric patients who have not benefitted enough from other pain management alternatives and who can already tolerate a minimum dose of 20 mg of oxycodone, OxyContin’s active drug ingredient, for five consecutive days. 

Although OxyContin was reformulated in 2010 to make it more difficult to abuse, there is no doubt that long-term use of the drug can lead to dependence. It appears that the FDA approved the use of this drug for younger patients in cases of extreme pain, such as those undergoing cancer treatment. 

Another opioid approved for use for patients as young as 11 is the Duragesic patch, which releases fentanyl. Given research on the effects of opioids on both adults and adolescents, we can only hope that providers are using these drugs as a last resort for the pediatric population. 

Monday, October 19, 2015

Excessive alcohol use continues to be drain on American economy

Medical News Today

Excessive alcohol use continues to be a drain on the American economy, according to a study released by the Centers for Disease Control and Prevention (CDC). Excessive drinking cost the U.S. $249 billion in 2010, or $2.05 per drink, a significant increase from $223.5 billion, or $1.90 per drink, in 2006. Most of these costs were due to reduced workplace productivity, crime, and the cost of treating people for health problems caused by excessive drinking.
Binge drinking, defined as drinking five or more drinks on one occasion for men or four or more drinks on one occasion for women, was responsible for most of these costs (77 percent). Two of every 5 dollars of costs - over $100 billion - were paid by governments.
"The increase in the costs of excessive drinking from 2006 to 2010 is concerning, particularly given the severe economic recession that occurred during these years," said Robert Brewer, M.D., M.S.P.H., head of CDC's Alcohol Program and one of the study's authors. "Effective prevention strategies can reduce excessive drinking and related costs in states and communities, but they are under used."
Excessive alcohol consumption is responsible for an average of 88,000 deaths each year, including 1 in 10 deaths among working-age Americans ages 20-64.
Excessive alcohol use cost states and the District of Columbia a median of $3.5 billion in 2010, ranging from $488 million in North Dakota to $35 billion in California. Washington D.C. had the highest cost per person ($1,526, compared to the $807 national average), and New Mexico had the highest cost per drink ($2.77, compared to the $2.05 national average).
The 2010 cost estimates were based on changes in the occurrence of alcohol-related problems and the cost of paying for them since 2006. Even so, the researchers believe that the study underestimates the cost of excessive drinking because information on alcohol is often underreported or unavailable, and the study did not include other costs, such as pain and suffering due to alcohol-attributable harms.
The study, "2010 National and State Costs of Excessive Alcohol Consumption," is published in the American Journal of Preventive Medicine. For more information on alcohol and public health see:
Adapted by MNT from original media release

Tuesday, October 6, 2015

CC Sabathia Entering Rehab

by Gabriella Pinto-Coelho

While it is always sad to hear that anyone is heading to rehab, publicly announcing your decision is also a demonstration of bravery and vulnerability. It is hard enough to realize that you need help, let alone sharing it with the public. That is exactly what CC Sabathia of the New York Yankees did on Monday, October 5th.

CC released the following statement:

"Today I am checking myself into an alcohol rehabilitation center to receive the professional care and assistance needed to treat my disease.

I love baseball and I love my teammates like brothers, and I am also fully aware that I am leaving at a time when we should all be coming together for one last push toward the World Series. It hurts me deeply to do this now, but I owe it to myself and to my family to get myself right. I want to take control of my disease, and I want to be a better man, father, and player. I want to thank the New York Yankees organization for their encouragement and understanding. Their support gives me great strength and has allowed me to move forward with this decision with a clear mind.

As difficult as this decision is to share publicly, I don’t want to run and hide. But for now respect my family’s need for privacy as we work through this challenge together.

Being an adult means being accountable. Being a baseball player means that others look up to you. I want my kids -- and others who may have become fans of mine over the years -- to know that I am not too big of a man to ask for help. I want to hold my head up high, have a full heart and be the type of person again that I can be proud of. And that’s exactly what I am going to do. I am looking forward to being out on the field with my team next season playing the game that brings me so much happiness."

Regardless of your opinion of the Yankees, CC’s statement regarding his addiction and entrance into rehab is admirable. His decision to go public certainly helps the movement to destign tize addiction and recovery. Even more encouraging is the fact that the Yankees organization has expressed their total support for Mr. Sabathia, applauding his courage and promising to offer “everything in [their] power” to help in his recovery.

As more people go public with their addictions, we can hope that the stigma surrounding this disease will begin to dissipate so that we can truly bring this conversation out in the open. Addictions often develop and fester behind closed doors, so lifting the veil off part of the problem bodes well for our societal attitudes towards the disease and the available treatments leading to lasting recovery.

Friday, October 2, 2015

By Joan Shepherd, FNP

I was so inspired this week by my patients…(not their real names)

First, Lacey.

She is 23 years old, and since age 15, she lived in a blitzed out world of drinking. As of this month, she’s been clean for a year. I asked her what was different. She got really quiet and I started thinking I’d overstepped some bounds by asking her. 

Then, she looked at me and said, “Everything.”

She has watched her little niece grow this year, while during the first two years of her life was mostly a forgotten blur. She has conversations with her family now. She realizes she quite likes her family. She is enrolling in classes again. 

Life isn’t perfect, but she realizes there are solutions. Talking can help.

Then, Jimmy.

He has not used opiates for 2 months. I know that’s a really short time, but he came back for another 2 month naltrexone implant. 

He can’t believe how good it feels to not have to chase the drug; to wake up and wonder where the money will come from, who he’s going to take advantage of to get his dope. He admits things are a little boring but the way he interprets that is, “Now I have time to do everything I need to do. I am so grateful my family stuck with me.”

His family is taking him to counseling, taking him to meetings. They are kind of watching him like hawks and he is way OK with that for now.

And, Teddy.

I didn’t even recognize the handsome young man sitting in front of me. He’s gone from 125 pound to 140 and looks amazing. He’s working again, off heroin for 5 months. 

He is struggling a lot in his sobriety with the (his words) "horrible things he did to his friends and co-workers" while actively using. Working on the shame and the guilt. I read somewhere that guilt can be handy; it helps guide us toward the next right thing. 

Shame however, isn’t so useful. It tends to keep us stuck in thoughts that don’t do us any good.

This is but a small sampling of what I get to hear treating patients at TCI. These folks have all experienced the misery of addiction and are tasting the sweet fruits of recovery. Talk to most people in long term recovery and you will hear that it keeps getting better. 

It’s my privilege to be a little part of it.