[Press release] SAMHSA’s new report tracks the behavioral health of America

From the press release, Monday, January 26, 2015

A new report from the Substance Abuse and Mental Health Services Administration (SAMHSA) illuminates important trends — many positive — in Americans’ behavioral health, both nationally and on a state-by-state basis.

SAMHSA’s new report, the “National Behavioral Health Barometer” (Barometer), provides data about key aspects of behavioral healthcare issues affecting American communities including rates of serious mental illness, suicidal thoughts, substance use, underage drinking, and the percentages of those who seek treatment for these disorders. The Barometer shows this data at the national level, and for each of the 50 states and the District of Columbia.

The Barometer indicates that the behavioral health of our nation is improving in some areas, particularly among adolescents. For example, past month use of both illicit drugs and cigarettes has fallen for youth ages 12-17 from 2009 to 2013 (from 10.1 percent to 8.8 percent for illicit drugs and 9.0 percent to 5.6 percent for cigarettes). Past month binge drinking among children ages 12-17 has also fallen from 2009 to 2013 (from 8.9 percent to 6.2 percent).

The Barometer also shows more people are getting the help they need in some crucial areas. The number of people receiving treatment for a substance use problem has increased six percent from 2009 to 2013. It also shows that the level of adults experiencing serious mental illness who received treatment rose from 62.9 percent in 2012 to 68.5 percent in 2013.

 

The data in the Barometer is drawn from various federal surveys and provides both a snapshot of the current status of behavioral health nationally and by state, and trend data on some of these key behavioral health issues over time. The findings will be enormously helpful to decision makers at all levels who are seeking to reduce the impact of substance abuse and mental illness on America’s communities.

“The Barometer provides new insight into what is happening on the ground in states across the country,” said SAMHSA’s Administrator, Pamela S. Hyde. “It provides vital information on the progress being made in each state as well as the challenges before them.  States and local communities use this data to determine the most effective ways of addressing their behavioral healthcare needs.”

The Barometer also provides analyses by gender, age group and race/ethnicity, where possible, to further help public health authorities more effectively identify and address behavioral health issues occurring within their communities, and to serve as a basis for tracking and addressing behavioral health disparities.

For the first time, the Barometer provides analyses broken down by poverty level (above or below) and health insurance status. This data can help provide researchers, policy makers, public health authorities and others a better understanding of how income and insurance coverage affect access and utilization of behavioral healthcare services.

To view and download copies of the national or any state Behavioral Health Barometer, please visit the SAMHSA web site at http://www.samhsa.gov/data/browse-report-document-type?tab=46.

For more information, contact the SAMHSA Press Office at 240-276-2130.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services (DHHS) that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

Last Updated: 01/26/2015

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think | Johann Hari

Last month I unfriended (FB) Huffington Post. The postings were increasingly not only sexual in nature, but outright base. Came across this one via a FB friend, and am grateful. While I believe the jury is still out, it does highlight a factor that probably has been overlooked.  Caring compassionate communities do make a difference. Reminds me of a story about an inmate. He was very angry with another inmate, so much so he was contemplating murder. He told this to other members of his prayer group. He also related that he did not murder because he didn’t want to let the prayer group members down.

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think | Johann Hari.

From the 20 January 2015 Huffington Post article

It is now one hundred years since drugs were first banned — and all through this long century of waging war on drugs, we have been told a story about addiction by our teachers and by our governments. This story is so deeply ingrained in our minds that we take it for granted. It seems obvious. It seems manifestly true. Until I set off three and a half years ago on a 30,000-mile journey for my new book, Chasing The Scream: The First And Last Days of the War on Drugs, to figure out what is really driving the drug war, I believed it too. But what I learned on the road is that almost everything we have been told about addiction is wrong — and there is a very different story waiting for us, if only we are ready to hear it.

If we truly absorb this new story, we will have to change a lot more than the drug war. We will have to change ourselves.

…

The rats with good lives didn’t like the drugged water. They mostly shunned it, consuming less than a quarter of the drugs the isolated rats used. None of them died. While all the rats who were alone and unhappy became heavy users, none of the rats who had a happy environment did.

At first, I thought this was merely a quirk of rats, until I discovered that there was — at the same time as the Rat Park experiment — a helpful human equivalent taking place. It was called the Vietnam War. Time magazine reported using heroin was “as common as chewing gum” among U.S. soldiers, and there is solid evidence to back this up: some 20 percent of U.S. soldiers had become addicted to heroin there, according to a study published in the Archives of General Psychiatry. Many people were understandably terrified; they believed a huge number of addicts were about to head home when the war ended.

But in fact some 95 percent of the addicted soldiers — according to the same study — simply stopped. Very few had rehab. They shifted from a terrifying cage back to a pleasant one, so didn’t want the drug any more.

Professor Alexander argues this discovery is a profound challenge both to the right-wing view that addiction is a moral failing caused by too much hedonistic partying, and the liberal view that addiction is a disease taking place in a chemically hijacked brain. In fact, he argues, addiction is an adaptation. It’s not you. It’s your cage.

….

There just might be something to this. Can only speak for myself. There’s a bottle in the house with about 10 oxycodone pills left over from my husband’s hospital admission. Been there from about a year. I’ve taken three when I thought they were needed. Could be argued I’m not physiologically wired for them. But I think I have a relatively stable life and good support…

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[Press release] US needs harm-reduction approach to drug use, researcher says

US needs harm-reduction approach to drug use, researcher says 

From the 14 January 2015 Rice University press release

Neill: Approach minimizes harm associated with drug use for the individual and society    

HOUSTON – (Jan. 14, 2015) – The United States’ law-and-order approach to reducing the supply of drugs and punishing sellers and users has impeded the development of a public health model that views drug addiction as a disease that is preventable and treatable. A new policy paper from Rice University’s Baker Institute for Public Policy advocates that a harm-reduction approach would more effectively reduce the negative individual and societal consequences of drug use.

According to the paper’s author, Katharine Neill, the rate of federal inmates incarcerated for drug offenses hovered at just under 50 percent in 2011, and in 2013 the Obama administration’s budget asked for $25.6 billion to fight the drug war, $15 billion of which was directed toward law enforcement. In addition, by some estimates, state and local governments spend a combined total of $51 billion per year on drug-related law enforcement efforts, which suggests they have a lot to gain by investing in treatment options, Neill said.

“That law enforcement efforts continue to dominate drug policy highlights the need to reframe the discourse on drug use and addiction,” said Neill, the Baker Institute’s Alfred C. Glassell III Postdoctoral Fellow in Drug Policy. “While emphasizing the cost-saving benefits of treatment is important, this should be coupled with more public conversations focusing on drug addiction as a disease requiring medical treatment, not politically based solutions. Reframing the issue in this way should increase the likelihood that a public health approach to drug policy will be adopted for the long term.”

The paper, “Tough on Drugs: Law and Order Dominance and the Neglect of Public Health in U.S. Drug Policy,” is published in the journal World Medical and Health Policy.

Emphasizing harm reduction is a popular public health approach to drugs, Neill said. “A harm-reduction approach recognizes the permanence of drugs in society and, instead of trying to eradicate drug use, focuses on minimizing harm associated with drug use for the individual and society,” she said. “This encompasses a variety of objectives, including preventing individuals from using drugs, treating individuals who want to stop using drugs, preventing drug use where it increases the chances of negative outcomes such as driving while on drugs, and helping individuals who want to continue using drugs do so in a way that does not further compromise their health or the health of others.” This last objective is often achieved through needle-exchange programs intended to prevent the spread of HIV and hepatitis C and is more controversial than other policies, Neill said.

Harm reduction is multidimensional and can include contradictory objectives, she said. For example, some proponents wish to decriminalize drug use and focus on helping drug users get the resources they need for treatment or to continue to use drugs safely, while others accept the illegality of drug use so long as treatment is more available. Others argue that distinctions should be made between drugs according to the risks they pose to the user and society and that policy should be based on these distinctions. “Still, most advocates of harm reduction agree on some basic tenets, including the view that addiction is a disease requiring medical assistance, the desire to minimize risky behavior without requiring abstinence and the need to protect the public from the consequences of drug use, which includes punishing individuals who commit acts that harm others,” Neill said.

– See more at: http://news.rice.edu/2015/01/14/us-needs-harm-reduction-approach-to-drug-use-baker-institute-researcher-says/#sthash.2OCJoKRU.dpuf

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[Press release] People with opioid dependence in recovery show ‘re-regulation’ of reward systems — ScienceDaily

People with opioid dependence in recovery show ‘re-regulation’ of reward systems

Newswise — December 9, 2014 – Within a few months after drug withdrawal, patients in recovery from dependence on prescription pain medications may show signs that the body’s natural reward systems are normalizing, reports a study in the Journal of Addiction Medicine, the official journal of the American Society of Addiction Medicine. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

English: Source: The National Institute on Drug Abuse, part of the National Institutes of Health (NIH), which is part of the U.S. Department of Health and Human Services. Image taken from http://www.drugabuse.gov/pubs/teaching/Teaching2/Teaching4.html http://www.drugabuse.gov/pubs/teaching/Teaching2/largegifs/slide18.gif (Photo credit: Wikipedia)

The study by Scott C. Bunce, PhD, of Penn State University College of Medicine, Hershey, and colleagues provides evidence of “physiological re-regulation” of disrupted brain and hormonal responses to pleasurable stimuli—both drug- and nondrug-related.

Signs of Reward System Disruption After Drug Withdrawal…
The pilot study included two groups of seven patients in residential treatment for dependence on opioid pain medications. One group had recently gone through medically assisted opioid withdrawal—within the past one to two weeks. The other group was in extended care, and had been drug-free for two to three months. A group of normal controls were studied for comparison.

The researchers performed several tests to assess changes in the “brain reward system” during early recovery. After drug withdrawal, many people with opioid dependence have “persistent changes in the reward and memory circuits”—they may experience heightened “rewards” or “pleasure” in response to drugs and related stimuli, but greatly reduced responses to naturally pleasurable stimuli (such as good food, or friendship).

Dr Bunce explains, “This is thought to occur because opiates are potent stimulators of the brain’s reward system; over time, the brain adapts to the high level of stimulation provided by opiates, and naturally rewarding stimuli can’t measure up.” Such dysregulation of the natural reward system may contribute to the high risk of relapse during recovery.

The test results showed several significant differences in the reward system between groups. A test of startle reflexes showed that patients with recent drug withdrawal had reduced pleasure responses to “natural reward” stimuli—for example, pictures of appetizing foods or people having fun.

In brain activity studies, patients with recent drug withdrawal showed heightened responses to drug-related cues, such as pictures of pills. In the extended-care patients, these increased responses to drug cues—in a region of the brain called the prefrontal cortex, involved in attention and self-control —were significantly reduced.

…May Lead to New Objective Measures of Recovery
Patients who had recently withdrawn from opiates also had high levels of the stress hormone cortisol (adrenaline). In the patients who had been drug-free for a few months, cortisol levels were somewhat reduced, although not quite as low as in healthy controls. The recently withdrawn group also had pronounced sleep disturbances, while sleep in the extended care group was similar to controls.

All of these changes—brain and hormonal responses to drug cues and natural rewards, as well as sleep disturbances—were correlated with abstinence time. The more days since the patient used drugs, the lower the abnormal responses.

The study supports past research showing dysregulation of the reward system during early recovery from opioid dependence. It also provides evidence that these responses may become re-regulated during several weeks in residential treatment—a period of “clinically documented” abstinence from opioids.

That’s a potentially important step forward in addiction medicine research, Dr Bunce believes. “It shows that if the patient remains in treatment and off drugs for several months, the body’s natural reward systems may have the capacity to return toward normal, making it easier for them to remain drug-free outside the treatment setting.” With further study, tests of the natural reward system might provide useful, objective markers of recovery—clinical tests that help to evaluate how the patient’s recovery is proceeding.

Such tests might help in managing the difficult problem of prescription opioid dependence—an ongoing epidemic associated with a high risk of relapse after drug withdrawal. Dr Bunce and colleagues are conducting a follow-up study, funded by the National Institute on Drug Abuse, to determine whether measures of the brain’s reward system, sleep and the stress response system indicate the capacity for re-regulation and the patient’s risk of relapse during recovery.

Click here to read “Possible Evidence for Re-regulation of HPA Axis and Brain Reward Systems Over Time in Treatment in Prescription Opioid-Dependent Patients.”

[Press release] Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence | Full Text Reports…

Shared psychological characteristics that are linked to aggression between patients with Internet addiction and those with alcohol dependence | Full Text Reports….

Background
Internet addiction (IA) is considered as one of behavioral addictions. Although common neurobiological mechanisms have been suggested to underlie behavioral addiction and substance dependence, few studies have directly compared IA with substance dependence, such as alcohol dependence (AD).

Methods
We compared patients with IA, AD, and healthy controls (HC) in terms of the Five Factor Model of personality and with regard to impulsiveness, anger expression, and mood to explore psychological factors that are linked to aggression. All patients were treatment-seeking and had moderate-to-severe symptoms.

Results
The IA and AD groups showed a lower level of agreeableness and higher levels of neuroticism, impulsivity, and anger expression compared with the HC group, which are characteristics related to aggression. The addiction groups showed lower levels of extraversion, openness to experience, and conscientiousness and were more depressive and anxious than the HCs, and the severity of IA and AD symptoms was positively correlated with these types of psychopathology.

Conclusions
IA and AD are similar in terms of personality, temperament, and emotion, and they share common characteristics that may lead to aggression. Our findings suggest that strategies to reduce aggression in patients with IA are necessary and that IA and AD are closely related and should be dealt with as having a close nosological relationship.

Addicts May Be Seeking Relief from Emotional Lows More Than Euphoric Highs

From the 6 November 2013 ScienceDaily Report

Cocaine addicts may become trapped in drug binges — not because of the euphoric highs they are chasing but rather the unbearable emotional lows they desperately want to avoid.

In a study published today online inPsychopharmacology, Rutgers University Behavioral and Systems Neuroscience Professor Mark West, and doctoral student David Barker in the Department of Psychology, in the School of Arts and Sciences, challenge the commonly held view that drug addiction occurs because users are always going after the high. Based on new animal studies, they discovered that the initial positive feelings of intoxication are short lived — quickly replaced by negative emotional responses whenever drug levels begin to fall.

If these animal models are a mirror into human addiction, Rutgers researchers say that addicts who learned to use drugs to either achieve a positive emotional state or to relieve a negative one are vulnerable to situations that trigger either behavior.

“Our results suggest that once the animals started a binge, they may have felt trapped and didn’t like it,” said West. “This showed us that negative emotions play an equal, if not more important role in regulating cocaine abuse.”

…

Read the entire article here

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Pregnant women who abuse drugs, alcohol need compassion, not stigma from doctors and society: experts

Smoking and drinking during pregnancy (Photo credit: Wikipedia)

 

My sentiments exactly, real humans do not shame!

 

From the 4 November 2011 Toronto National Post

 

Seeing a pregnant women smoking a cigarette, imbibing a glass of wine or using drugs is sure to raise a societal eyebrow.

But a new report says women with substance abuse problems should be treated with compassion by health providers and society at large, especially during pregnancy, because addiction is a brain disorder and not a personal failing.

“It’s harmful for us to look upon pregnant women with addiction issues and assume it’s as simple as saying: ’For the sake of the baby, stop using,”’ said Colleen Dell, research chair in substance abuse at the University of Saskatchewan.

…

The report says pregnancy offers an opportunity for doctors to help women seek treatment for addiction, while providing comprehensive care aimed at maximizing the health of both mother and baby.

That treatment should involve a wide range of care providers and programs, including addiction counselling, medication-assisted therapy and community resources for parents, the report says.

“When this continuum of care is provided, we see healthier babies and fewer premature births, and overall maternal and infant mortality rates go down,” said Finnegan.

But many women are hesitant to seek treatment because of the stigma around using a substance that’s known to be harmful to their developing fetus, she said.

It’s important to look at the antecedents to drug addiction, said Finnegan, noting that about 98% of the women in her clinic had been sexually or physically abused as children or as adults.

Often women also won’t seek medical help because they’re afraid of losing their children

“This is very much like PTSD (post-traumatic stress disorder). They have had trauma and taking a drug permits them to forget these terrible feelings that they have had. When they take the psychoactive drugs … they become addicted.

“So the first step is that we get them into treatment and help them feel welcome.”

Often women also won’t seek medical help because they’re afraid of losing their children to protective services if they admit to an addiction, she said, suggesting the judicial system has to change.

Dealing with stigma is the greatest challenge in trying to help pregnant women with an addiction, said Franco Vaccarino, a professor of psychiatry and psychology at the University of Toronto and chairman of the CCSA’s scientific advisory council.

“Addiction is a disorder of the brain,” he stressed.

‘Simply put, your brain is different after prolonged substance abuse than it was before’

“Simply put, your brain is different after prolonged substance abuse than it was before. Addiction fundamentally changes neurological functioning and it makes it next to impossible to just quit for the sake of the baby without significant supports.

“The challenge is anchoring the narrative of this discussion in health terms,” Vaccarino said. “If you anchor it in health terms and move it away from justice and moral and will-related issues, you focus the narrative around addiction, which is where it should be.”

 

 

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Listen to the stories behind substance dependence

English: Most significant possible long-term effects of ethanol. Sources are found in main article: Wikipedia:Ethanol#Long-term. Model: Mikael Häggström. To discuss image, please see Template_talk:Häggström diagrams (Photo credit: Wikipedia)

 

From the KevinMD blog of June 27, 2013

 

“You don’t have any idea what you’re dealing with, do you?” asked Mr. Johnson a mere two minutes into my interview. The scene is the Crisis Intervention Unit. The time is 3:00am. I have a feeling my breath is terrible. The hospital pizza I engulfed earlier in the evening has decided to stage a churning acidic protest in my guts. However, far worse than my half-closed eyes, my halitosis or my gastrointestinal distress is the fact that he’s absolutely right. Mr. Johnson is here because he has come to the realization that living sober is about as awful as living as an alcoholic. As a result, he has decided life is simply not worth living.

As a practitioner, patients caught in this double-bind are among the most frustrating to treat. They are living proof that substance dependence treatment can be quite shortsighted. The logic is charmingly simple and irritatingly simplistic: if you’re drinking too much, then you should probably stop. Once you stop, all will be better.

To properly understand the failure of this logic, we need to distinguish the brain from the mind. Although our medications and therapies are effective in removing alcohol from the brain, we are less successful filling the empty space left in the mind. Mr. Johnson’s alcohol use started as a coping strategy and slowly evolved into a way of navigating the world: a drink to take the edge off at a dinner party; a libation or five to take the edge off of a bad day at the office; a quick stop at the corner bar after work to steel himself against a troubled marriage and a wayward teen. Alcohol played prominently in the way his mind functioned for years….

 

Read entire blog post here

 

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[Reblog]Re-framing Drugs as a Public Health Issue

Re-framing Drugs as a Public Health Issue.

From the Criminal Injustice Blog item of April 2, 2013

By Louellyn Lambros

It is time that drug use be viewed as a public health issue, rather than a matter for the criminal justice system. Too many drug users are saddled unnecessarily with criminal records, making it extraordinarily difficult to have fulfilling lives including being able to work and to make other kinds of valuable contributions to their families and society.

The skyrocketing incarceration rate in our country has been an outgrowth of the War on Drugs, which began over thirty years ago and had its roots in a political strategy to gain the votes of disaffected whites, in the wake of a successful Civil Rights struggle. Since outright discrimination on the basis of race was no longer acceptable or legal, an alternative route was to label African-Americans as criminals, thereby opening the door to reintroduce all the same forms of discrimination – in employment, housing, voting rights, and so on.

As the number of incarcerated people in the US grew from 300,000 in the last half of the 20th century to over 2.2 million today, racism continues to fuel the revolving door of our fellow citizens into the criminal justice system. In addition, the system has become big business, employing a growing number of judges, lawyers, prosecutors, and all types of ancillary personnel. Prisons themselves are becoming increasingly privatized, run as money-making corporations which sell shares on the NYSE. In thirty-seven states, prison labor is contracted to major corporations who pay 16 to 28 cents an hour, ensuring astronomical profits.

While the majority of Americans, once educated on the issue, may be persuaded by the injustice of the situation as it affects minority communities and may be horrified by how the one percent is capable of turning anything into a lucrative business, it will take more time and effort to address the concerns of those whose loved ones have suffered from addiction and subsequent incarceration.

The truth is that no one, particularly the most vulnerable dealing with drug addiction, is served by the current system. Those who are susceptible to addiction are even more vulnerable and in need of self-soothing in the face of extreme stress. Why do therefore we respond to their difficulties with a system of incarceration which stresses them to the max and saddles them with second-class citizen status as a ‘felon’ upon release back into their home communities?

A policy of decriminalization, as has been in place in Portugal since 2001, would take the whole issue of drug addiction out of the criminal justice system and make it a civil and public health matter. A panel of three– made up of two individuals with a health background and one with a legal background–would make a determination: is this person’s drug use a problem? If not, perhaps a fine or a warning will suffice. If it is deemed a problem, treatment and rehabilitation are in order. Treatment facilities could easily be funded by resources reallocated from the criminal justice system.

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New definition of addiction: Addiction is a chronic brain disease, not just bad behavior or bad choices

From a 15 August 2011 Science Daily news article

The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.

When people see compulsive and damaging behaviors in friends or family members — or public figures such as celebrities or politicians — they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation’s largest professional society of physicians dedicated to treating and preventing addiction…..

Read the article

 

Food May Act Physiologically Like A ‘Drug Of Choice’ For Some

From a 19 July 2011 Medical News Today article

Authorities in the field of foodaddiction at the University of Florida say new research indicates that overeating andobesity problems might be effectively tackled if people would limit their food choices.

Editorializing in the August edition of the American Journal of Clinical Nutrition, Nicole M. Avena, Ph.D., a research assistant professor, and Mark S. Gold, M.D., chairman of the UF College of Medicine’s department of psychiatry, suggest modern living presents many delicious possibilities for people at mealtime – too many for people who respond to food as if it were an addictive drug…

Read the article

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