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.

Wednesday, September 23, 2015

CDC Program to Help States Fight Prescription Drug Overdose Epidemic

The Centers for Disease Control and Prevention (CDC) will be launching a new program, Prescription Drug Overdose: Prevention, for a pilot group of 16 states: Arizona, California, Illinois, Kentucky, Nebraska, New Mexico, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, and Wisconsin. These specific states were chosen after a competitive application process, and will be the recipients of millions in funding toward programming to enhance education, awareness, prevention, and tracking of prescription drug overdoses.

The CDC has committed $20 million for this fiscal year in order to get the program up and running in the select group of states. Over the next few years, each of the 16 states will receive between $750,000 and $1 million annually. With this funding, states will begin to:
  •     Enhance their existing prescription drug monitoring programs (PDMPs).
  •     Implement community prevention and education programs.
  •     Collaborate with and educate health systems, insurance companies, and clinicians to  help them make more informed prescribing decisions.
  •     Lead innovative projects on the full spectrum of awareness, prevention, and  intervention.

The CDC is also allowing states to use the funds to do more research around the use and abuse of heroin in response to the ever-growing epidemic: just between 2010 and 2013 there has been a threefold increase in the number of deaths involving heroin. 

At the same time, the amount of opioids prescribed and sold in the U.S. has increased fourfold since 1999 even though there is no overall change in the amount of pain reported by Americans. States will be able research the relationship between opioid abuse and heroin use and better respond to the increase in heroin overdose deaths.

The potential benefit from this program is tremendous, and we can only hope that the Department of Health and Human Services extends these funding grants to more states over time.

Thursday, September 17, 2015

How Stroke Research is Advancing the Science of Addiction

by Gabriella Pinto-Coelho

A pair of studies suggests that the insular cortex, a specific region of the brain, may play a central role in addiction. Scientists discovered this groundbreaking connection after studying smokers who suffered a stroke in this region. After the stroke, individuals were far more likely to quit smoking (70% vs. 27%) and experienced fewer and less intense withdrawal symptoms as compared to smokers who suffered strokes in other areas of the brain.

Studies also suggest that the insular cortex may play a role in the emotional process that facilitates drug and tobacco use, including conscious desires and cravings. The insular cortex is understood to play a variety of diverse functions linked to emotion and maintaining the body’s equilibrium. Functional MRIs have demonstrated the insular cortex’s role in experiences of pain, anger, fear, disgust, happiness, and sadness.

Most research on the role of the brain in addiction has shown that the brain’s “reward pathway” plays the primary role in addiction. This reward pathway involves several parts of the brain and is responsible for flooding the brain with dopamine, a neurotransmitter, when activated by stimuli such as drugs. 

While it is certain that this pathway plays a major role in addiction, this new research on stroke patients is illuminating the possibility that there are other brain structures also at play in the complex and devastating process of addiction. 

A more robust understanding of the mechanisms of addiction should give hope to both patients and clinicians - it offers promise toward creating more effective treatments and therefore a clearer road to recovery.

Friday, September 11, 2015

One in two adolescents misuse their prescription drugs, study shows

Although prescription drug misuse is on the decline among adolescents, one in two patients tested between the ages of 10 and 17 years are not using their medications appropriately, potentially putting their health at risk, according to an analysis by Quest Diagnostics, the world's leading provider of diagnostic information services.
However, patients in the 10-17 years age group also showed the greatest improvement in appropriate prescription drug use compared to all other age groups over a four-year period. In 2011, 70% of adolescents tested by Quest Diagnostics showed evidence of prescription drug misuse compared to 52% in 2014. These findings align with research from the National Institute of Drug Abuse, which revealed a decline in high school students' misuse of prescription drugs over the past two years.
The Quest Diagnostics Health Trends™ study, Prescription Drug Misuse in America: Diagnostic Insights in the Continuing Drug Epidemic Battle, is based on an analysis of approximately 2.5 million test results on patients of all ages in 48 states and the District of Columbia. According to the analysis, the overall rate of prescription drug misuse for all ages was 53% in 2014, a decline of 16% relative to the rate of 63% in 2011. Drug misuse is defined as evidence, based on lab test results, that a patient is using or combining non-prescribed drugs or skipping doses in a manner that is inconsistent with the ordering physician's directions. Quest's prescription drug monitoring test services help to identify evidence of use of up to 26 prescription and illicit drugs, such as opioids and marijuana.
"The Quest analysis shows that while our nation is making great strides to curb drug abuse and misuse, we have a long road ahead before we can declare victory on the prescription drug epidemic," said Leland F. McClure, PhD, director, medical science liaison, Quest Diagnostics. "By every means of slicing the Quest test data - age, gender, geography, and payer type - we observed significant patterns of misuse in our nationally representative database. This is troubling because it strongly suggests, using objective lab data, that there truly is no good way to predict which patient may abuse a prescribed therapy - everyone is potentially at risk."
The findings of high misuse rates among adolescents follows the U.S. Food and Drug Administration approval in August 2015 of the opioid pain reliever OxyContin (oxycodone) for children 11-16 years old whose pain is severe enough to require daily around-the-clock long-term treatment and for which alternative options are inadequate. "Having more options for pain relief is a great potential benefit for children experiencing significant pain," said Dr. McClure. "But our data is also a stark reminder that diligent monitoring of prescription drug regimens in young patients is absolutely critical."
Other key findings from the study:
  • All patients are at risk of prescription misuse. The high rate of prescription medication misuse (53%) was observed across all age groups and in both genders, as well as across patients enrolled in different types of health plans (MedicaidMedicare and private payer).
  • The type of drugs misused varies by age. In adults 30 years of age and older, the two drug groups most likely to be misused, based on test results, were oxycodone and opiates. In children less than 10 years of age, amphetamines and opiates were most likely to be implicated in misuse. In patients 10-29 years of age, the leading drug groups associated with evidence of misuse were marijuana and opiates.
  • Some states and regions are curbing prescription drug misuse better than others. California, Florida, Georgia, Kentucky, New York, Pennsylvania, and Tennessee all showed marked improvement in their inconsistency rates from 2011-2014. On a regional basis, the Mountain States and Great Plains states (Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming) had the highest inconsistency rate, at 61%, while New York and New Jersey together had the lowest inconsistency rate, at 41%.
  • Patterns of drug misuse shift over the past four years. The percentage of patients who did not take their medications consistently, suggesting they are skipping doses, increased from 40% in 2011 to 44% in 2014. Additionally, 35% of patients tested in 2014 showed evidence of combining drugs without a clinician's oversight, compared to 32% in 2011, indicating heightened potential for dangerous drug combinations.
The analysis was based on clinical lab testing performed by Quest Diagnostics' laboratories as part of the company's prescription drug monitoring services.
Study Strengths and Limitations: The study's strengths are its size and national scope; use of an objective laboratory method, versus surveys or polls, which may be subject to user misrepresentation or error; confirmation of all positive drug screens by mass spectrometry, the most advanced drug testing method; and for consistency rate analysis the inclusion of patients under care by clinicians in a primary care or pain-management setting, but exclusion of those in drug rehabilitation or addiction treatment settings, where unusually high rates of drug misuse may be expected.
Study limitations include geographic disparities; inability to confirm drug misuse through access to medical records or clinical evaluation; and technical factors and patient variations, such as drug metabolism and hydration state, that may affect the reliability of a minority of results. Quest Diagnostics does not provide services to all clinicians in the U.S., so results are not broadly representative of all patients taking prescription medications in the U.S. It is also possible some clinicians tested patients due to appropriate suspicions of drug misuse, and that some clinicians omitted to specify all drugs prescribed for the patient on a test order, skewing some results.
The report can be downloaded here.

Adapted by MNT from original media release

Thursday, September 10, 2015

9 Habits of Authentically Happy People

by Gabriella Pinto-Coelho

Historically, the study of the human psyche is plagued with a lot of “don’ts” and “shouldn’ts.” Psychology and Psychiatry are primarily focused on how to treat negative mood states and disorders rather than fostering positive ones. Of course, this is entirely necessary and appropriate. Without treatments for depression, anxiety, bipolar disorder, schizophrenia, and other potentially debilitating mental illnesses, millions of people would suffer. However, it means that, until recently, science didn’t offer us much information on how to foster genuine happiness and joy.

Luckily, a new wave of research and thinking has begun to change this trend. Positive psychology has helped us understand, from a scientific perspective, what really makes us happy. Here are just a few of the tidbits that positive psychology offers us on how to live an authentically and sustainably happy life:

    • Build on your strengths. Happy people don’t spend too much time correcting their weaknesses. Some of the highest successes are derived from developing your own unique strengths.
    • Practice optimism. Dispute your own pessimistic thoughts when they arise! When the going gets tough, recognize that this too shall pass. Realize that your setbacks are surmountable. Success is largely the result of your own outlook.
    • Build your social resources. Having a support network of friends and family is crucial to your own emotional wellbeing, especially when the going gets tough.
    • Volunteer. Not only does your altruism help your community, but it also improves your own emotional reserves and capacity for genuine happiness.
    • Don’t focus on the almighty dollar. While a certain amount of income is necessary to live a comfortable life, materialism is proven to be counterproductive to happiness. At all levels of income, people who value money over other goals are less satisfied with their income and with their lives in general.
    • Practice gratitude. Consider keeping a daily “gratitude journal.” Write at least 10 things you are grateful for and see if you can write just one more thing down each passing day.
    • Forgive people that have wronged you. Perhaps one of the most difficult things to do, forgiveness is not a “free pass” for the offender, but a gift to yourself.
    • Start a mindfulness-based practice. Mindfulness is the practice of present-moment awareness with a compassionate and nonjudgmental attitude. Take a few moments each day (consider: during your lunch break, before starting you car to go home) to pause and observe your breathing. Each time your mind wanders, bring your attention back to the breath. You can also consider starting a formal meditation, yoga, or tai chi practice.
    • Find a hobby or even a job that allows you to find your “flow.” In positive psychology, “flow” is defined as finding true engagement with something - the task is challenging, you are focused, there are clear goals, you get immediate feedback, you have deep almost effortless involvement, there is a sense of control, your sense of self vanishes, and time stops. Some people find these qualities in painting, others when mowing the lawn, and some people in their jobs. Find what gives you that sense of “flow,” and do it more often!

Monday, August 31, 2015

Do Cravings Ever Go Away?

Do Cravings Ever Go Away?

 by Peter R. Coleman, MD

Recently, I have been asked by a few people if I still have cravings for drugs or alcohol.  The questions took me a little by surprise because I have not had any cravings for such a long time. Frankly, I had not e3ven thought about it for many years.  The question made me remember just how powerful the cravings were n the early days, and it got me feeling very grateful for the fact that the cravings have been completely lifted.  I have a lot of compassion for people in early recovery because, when I think about it, I can remember just how pervasive and painful those cravings were.  I remember sitting in group therapy unable to think about anything other than using.  I remember having dreams so vivid that I woke up in a sweat, positive that I had relapsed and lost my sobriety.

How do cravings go away?  Mostly, it is purely a function of time.  But there are also things we can do to help ourselves avoid cravings.  Please also read the "Ask the Doctor' article in this newsletter on what causes cravings.

Recovery is mostly a practice thing - the more we do it, the better we get at it.  I have often used the analogy of riding a bike to represent recovery.  When we start out we are wobbly and we can fall off if we go too fast or take too many risks.  It is best if we have a teacher to show us the ropes and its best if we ride in a group with other people.  It is more fun to ride with a group of friends.  Eventually, we can learn some things from them and we can teach some things to the newer riders in the group.  As we get better at riding, we can begin to look around and appreciate more and more what a great thing it is to be a rider.

After we have become skilled at riding a bicycle, we almost never fall off.  Unless, of course, we do stupid things - like take our hands off the handle bars, or not look where we are going.  We may have to negotiate difficult terrain at times, but we can even do that if we take it easy and if we are careful.  When riding in difficult terrain, it is usually best if we have some friends with us, especially those who have been on this trail before.

Recovery can become as easy as riding a bike.  After some time, it is easier, fun, and most people never fall off.  Of course, we do need to keep our wits about us and look our for tricky situations - loss if a job, conflict with spouse, death of loved ones, etc.  But even these don't need to trip us up if we are careful.  In difficult times, it is especially important to ask for help and get support.  As we learn to navigate difficulty in life, our confidence improves, our happiness expands, and our appreciation of just how fabulous this life continues to grow.