Tuesday, December 22, 2015

After 5 Years of Recovery Are Patients Cured?

by Peter R. Coleman, MD

Recently, we have been hearing more and more about the idea that if people can sustain recovery for 5 years, they are (almost) cured. The concept is, just like a cancer diagnosis, if people can be free of their disease for five years, then the chance of the disease coming back is very unlikely - we can almost say they are cured. It is very unlikely that relapse will occur.

This idea appears to go beyond traditional thinking. We all know the saying - "once an alcoholic, always an alcoholic". We also refer to people in recovery as being "in recovery" and not "recovered", because we don't want to forget the fact that relapse is always possible, and recovering people need to protect their recovery. So, this new thinking is very bold, but maybe it is not so different after all.

I attended the American Society of Addiction Medicine (ASAM) annual conference earlier this year and some preliminary research was published that sheds some light on this situation.

A large study is looking at what happens to people if they are able to maintain 5 years of drug and alcohol free recovery. The results of the study so far indicate that if the patients were able to maintain 5 years of drug free recovery, then the relapse rate over the next five years was an amazingly low rate of only 3%. Fully 97% of people did not fall off the wagon. 

These are amazing results and very encouraging. When you think about it, the results are not as surprising as they first seem. If we think of nicotine dependence, another chemical addiction, then we would probably see very similar results. If people are able to stay off cigarettes for five years, they are very unlikely to pick up smoking again. Of course, they can relapse back to cigarette use if they make silly mistakes, but they are unlikely to do so. After 5 years of abstinence, people see themselves as non-smokers. They are no longer affected by triggers and they have learned how to deal with their emotions rather than just smoking cigarettes when they are bored, lonely, or frustrated. 

So, it makes sense that if people can achieve 5 years of abstinence from drugs and alcohol, they will also be unlikely to return to their former addictions.

Is five years the magic number? We do know that it takes a long time for the brain to heal after the drug use stops. I used to say that 12 months was a reasonable amount of time to assume the brain had returned to normal, but when it comes to opiates like prescription painkillers or heroin, I believe it takes a lot longer for all of the brain to heal. 

There is no other explanation for the fact that relapse is so common, even after very long periods of abstinence. The truth is most people who go to jail and are then released, will relapse virtually as soon as they get out. This seems to be true even when people are incarcerated for long periods of time. Clearly, the memory circuits in the brain and the systems responsible for cravings and impulse control have not fully healed.

We are now recommending treatment and follow up for five years. Using Naltrexone implants and injections for this first part of recovery is crucial. Transitioning to lesser levels of support can then be done when clinically indicated. If we treat this disease just like other medical conditions, we are much more likely to have favorable outcomes.

Tuesday, December 8, 2015


by Gabriella Pinto-Coelho

For some, the holiday season can be a time of year filled with love, family, and joy. And for others, it can be a total you-know-what-show. A lot of it depends on your family, and that’s no surprise. Family is the one place where you can regress 10, 20, 30 years without even realizing it. Family is the one place where you can feel simultaneously loved, loathed, hurt, rejected, and accepted. Everything that comes with reuniting with your family - from memories of bad haircuts to reminders that yes, your aunt is still crazy - can create a perfect storm to exacerbate both mental illness and the risks for substance abuse. Sometimes we get so caught up in the dread of returning home and the pressure of buying the best holiday gifts that we forget what the season is really about - love, gratitude, and peace.

Gratitude isn’t just something that’s good for Thanksgiving, Christmas, or New Year’s. Gratitude should be an everyday kind of thing. And if you don’t buy into that because it sounds too kumbaya, then consider the fact that science has proven gratitude might just be really effective medicine (and it just might help protect you from your crazy aunt and your desire to pick up the bottle). Here are seven reasons why gratitude is the best medicine:

1.   Gratitude creates more opportunities for new relationships. Showing your appreciation for someone isn’t just a pleasantry, it can actually lead to new friendships, according to a 2014 study published in Emotion. And it makes sense: if you are kind to someone and they thank you for your generosity, you’re a lot more likely to want to interact with them again. Especially if you have had to prune your group of friends after starting on the road to recovery, making new friends can be a really good thing.
2.   Gratitude improves your physical health. A 2012 study published in Personality and Individual Differences revealed that grateful people report feeling healthier than their less-grateful counterparts. Grateful people are also more likely to take care of their health, exercise more often, and have regular physicals with their doctor.
3.   Gratitude improves your psychological health. Do you want to be happier and less depressed? Practice gratitude! Gratitude is proven to reduce a number of negative emotions like envy, frustration, regret, and resentment.
4.   Gratitude heightens empathy and decreases aggression. A 2012 study out of the University of Kentucky proves that grateful people are more likely to exhibit pro social behavior even when others are unkind. I’m pretty sure that all of us could use a dose of that when it comes to dealing with family members that drive us up the wall.
5.   Grateful people sleep better. Most people know and appreciate the fact that getting adequate, deep sleep is an essential part of being healthy. A 2011 study published in Applied Psychology demonstrated that writing in a gratitude journal before bed can lead to better quality (and longer) sleep.
6.   Gratitude improves self-esteem. A 2014 study in the Journal of Applied Sports Psychology found that gratitude increased the self-esteem of athletes, which is an essential factor in their performance. Although this study focused specifically on athletes, I would argue that most of us do better at whatever we do when are confident in our abilities and have a healthy self-esteem. Gratitude is also shown to reduce social comparisons, like becoming resentful of others for having a bigger house or better job. That sounds like a pretty valuable skill during the gift-buying and gift-receiving of the holidays.
7.   Gratitude enhances mental strength & resilience. Research has demonstrated the power of gratitude in overcoming trauma. A 2006 study in Behavior Research and Therapy found that Vietnam War veterans with higher levels of gratitude were less likely to develop Post Traumatic Stress Disorder. A 2003 study in the Journal of Personality and Social Psychology found that gratitude contributed heavily to resilience after the September 11th terrorist attacks. Practicing gratitude even in the face of grave circumstances can help promote resilience. Those are some really encouraging results given the all that it takes to be in recovery.

The moral of the story? Gratitude is good for everyone, but it might be even more beneficial for those of you on the road to or already in recovery. So when you’re sitting next to your crazy aunt at the Christmas table, do your best to think about all you have to be grateful for (even if it’s just good food at the table).

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: http://www.cdc.gov/alcohol.
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.

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.

Friday, August 21, 2015

How to Start Breaking Your Worst Habit Today

Ideas and Actions for Kicking Bad Habits
Problem habits are high on the list of things that most people want to overcome. For example, do you worry too much? Do your friends joke about you showing up late? Do you shop and spend too much? Are you caught up in too many lies? Do you eat calorie-rich food when you want to lose weight? Do you live your life through Facebook? Do you bite your nails?  Do you procrastinate? 
What makes a habit a problem habit? Some of these automatic activities are both the causes and consequences of stress or anxiety.  Some you acquire or learn accidently or by imitating others.  Some, like nose picking, can cause you to look unappealing. Some can result in serious physical harm: smoking raises your risk for lung cancer. In short, problem habits normally have negative consequences.
You can learn to lessen or extinguish these and other undesirable habits. Let’s look at more than 12 options for getting them out of your life.

Habits of the Mind, Consumption, and Behavior

I divided problem habits into three categories: (1) habits of mind, such as worrying excessively, (2) habits of consumption, such as eating excessively, and (3) habits of behavior, such as nail biting. The categories suggest different remedies.  I’ll give brief tips for each type of problem habit (tips for one group of problems may also apply to another). Then I’ll share a general habit-breaking tip.
Before we go any further, what’s your worst problem habit?

Habits of the Mind

A habit of the mind is where you automatically repeat beliefs and thoughts that lead to the same emotional and behavioral troubles. For example, some anxieties are based on fictions where you exaggerate risks and threats that most would consider non-dangerous events. Here’s an example. You believe that strangers you meet will see your faults and reject you. You dread going to social gatherings where you may meet strangers and you habitually avoid them whenever you can. You often feel lonely and spend a lot of time feeling sorry for yourself.
Like most negative habits of the mind, fictional anxieties are correctable. They are based on situations that, when you are in them, evoke fears that are also based on fictions.  For example, face up to what you foolishly fear often enough, and you are likely to stop feeling afraid. You are less likely to feel anxious about something that you no longer fear1.  So, if you are afraid of rejection in social situations, daily expose yourself to a social situation. If, after a few weeks, you no longer feel so anxious, what changed? (Exposure is a gold standard for combating fear situations that arouse anxiety.)
You may do more than exaggerate or fictionalize threats.  You may also feel anxious about feeling and looking anxious. This is a double trouble situation. You feel anxious about a situation and anxious about feeling anxious2. By accepting anxiety over anxiety as inconvenient (not terrible), you may feel considerably calmer.

Habits of Consumption

It is tough to resist consumptive urges. You want to lose weight. You see a bowl of potato chips. You tell yourself you’ll eat only one potato chip. Then, almost as if you were in a trance, you gobble down one chip after another.  You smoke and want to quit.  You tell yourself you’ll stop someday. You drink too much. You know you have to quit.  But, the bottle is your buddy.
You don’t have to smoke or drink. Indeed, by the age of 30, most people kick their addictive habits without professional help3. However, you have to eat to live. But, you don’t have to eat fattening snacks. In a sense, they are like nicotine and alcohol.
You don’t have to devour potato chips as if you had no other choice. Nevertheless, when tempting snacks are before your eyes (or you have a craving for a particular fattening food) you have a first line of defense: do something constructive to take your mind off consuming the snack. If you don’t start eating chips, you avoid having your mind go on automatic pilot where you start consuming like a ravenous reptile.  Can you do better than what your reptilian brain dictates?
If you have a craving-urge problem to address, and have a hard time dealing with it, what's next? Perhaps you have a pink elephant problem. Here’s the situation. For the next minute, try not to think of a pink elephant. If you are like most the harder you try to suppress the elephant the bigger it grows4. In a sense, that is why some habit urges and cravings linger longer. Accept them without a felt need to act on them, and they tend to lose their power.
Here’s another option to the pink elephant problem.  Actively substitute a coping tactic. When you start to have a snack attack, before you do anything else, do something other than take the first morsel.
Here is a time interval experiment. When you have an urge to consume find out how long the urge lasts. Check your watch. Keep your eyes squarely on the time, Does the urge last two minutes? Twelve minutes? Watch for changes in your emotions. Do you get impatient watching your watch? Do you get bored? Do you feel intrigued by what is happening?  What do you make of your emotions?
Here is a hypothesis for you to test: Once the urge subsides, are you less likely to consume the snack?  If the timing technique works for you, keep practicing until you make this into a competitive, positive, habit to pit against the problem variety.
Here’s another. Try a combination technique and see if you can procrastinate on executing your worst problem habit.  Redo the time interval experiment. This time do the experiment with a different twist. Instead of watching your watch, fill the time with an activity. Here’s how. Between the start and end of an urge, use my procrastinationrewards technique. Intentionally do what you might do if you were procrastinating.
When you procrastinate, you always substitute something less relevant for what you are putting off.  You dust instead of read. You fiddle instead of doing a pressing report. You shuffle papers instead of making an important phone call. These habitual behavioral diversions extend delaying when you are probably better off not delaying.
You can turn procrastination distractions to your advantage. As you are doing your time interval measure, do things that might ordinarily reward a procrastination habit. You dust your desk. You text. You plan next year’s vacation.  You may find that distractions, that ordinarily reward procrastination, also reward delaying the habit that you want to delay, then end. Test it out. See what results from this combination experiment. If this doesn't work for you, try another way.
By the way, did you feel any different between when you watched your watch as time flowed on  and when you filled that time void with activity? Did you discover anything interesting that you can use to quiet your problem habit urges?

Habits of Behavior                      

Problem habits of behavior can be self-defeating, especially when you make a negative impression on people that you want to impress. Chewing your pencil is an example. Here are a few others: lip smacking, finger tapping, and vocalizations such as "Ya know,” “Umm."  
Awareness is an antiseptic for habits of behavior. Developing competing actions is a second. Let’s start with awareness.
“Seeing is believing.” Video feedback can be a great source of information.  Observe yourself on tape. You may notice mannerisms and habits that merit eliminating. Self-monitoring is another great method.  Watch what you do and when. Target high-risk timeswhere your habit is likely to surface. Plan, and then practice  a competitive habit.
To deal with a habit of behavior start building a competing habit. For example, if you tap your fingers when you feel impatient, practice a different response. Fold your fingers together instead.  If you want to make this competing response automatic, try anovercorrection experiment.  When you are by yourself, move your finger as if you were ready to start tapping. Then, immediately fold your fingers together. 
How long does it take to find out if overcorrection can work for you?  It takes as long as it takes. Here’s an experiment. For the next week, for four  times a day, for three-minutes per time, practice your overcorrection technique.  See what happens.

Your General Habit Breaking Tip

Here is a technique that you can use with different problem habits, including your worst habit. It involves taking an easy attitude toward the problem habit.
Here is how the easy attitude technique works. You allow yourself to experience the urge.  You study your urge and habit in live time. You accept the urge as transitory: it is like a cloud flowing with a passing breeze.
From the time interval experiment, you know that urges have a relatively short lifespan. By accepting the urge, as part of what is going on now, that shift in perspective can transform the urge into feelings you can tolerate.  If you can better tolerate a feeling or urge, you’ll have less of a struggle5.  
Here is something else.  Habit urges and substance craving are not the only thing that are going on in your life. What else is taking place that is of greater importance? This shift in the locus of your focus puts your habit urge into a broader perspective. The habit urge or substance craving may not seem so compelling or important in the broader context of your life.
To learn more about procrastination, click on End Procrastination Now(link is external)


Here’s the American Psychological Association style for citing the procrastination reward technique, or other information, from this blog:
Knaus, W. (August 12, 2015). How to Start Breaking Your Worst Habit Today [Blog Post]  Retrieved from https://www.psychologytoday.com/blog/science-and-sensibility/201508/how-...
1. Knaus, W. (2014). The Cognitive Behavioral Workbook for Anxiety (Second Edition). Oakland CA: New Harbinger.
2. Ellis, A. and Knaus, W. (1979). Overcoming Procrastination. NY: New American Library
3. Heyman, G. M.  (2013). Addiction and Choice: Theory and New Data. Frontiers in Psychiatry. 64: 31 Retrieved from  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3644798/(link is external)
4.  Knaus, W. (1982). How to Get Out of a Rut. Englewood Cliffs NJ: Prentice Hall.
5. Knaus, W. (1994). Change Your Life Now. NY: John Wiley.
© Dr. Bill Knaus