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Monday, December 31, 2012

Military Institutes New Methods for Treating Addiction

Drinking in the military has long been a problem worth addressing considering the fact that alcohol related issues have been steadily rising over the years. In response to a new report published by the Institute of Medicine, the United States military has formed a number of new measures to combat the report's findings.

According to the report, substance abuse in the military and their families has become a public health crisis. Their findings showed that the Defense Department’s methods for preventing and treating substance abuse are outdated. Binge drinking in the military increased from 35 percent in 1998, to 47 percent just a decade later.

The new initiatives include:
  • Random breathalyzer tests to Marine Corps members.
  • Bans on some overnight liquor sales for U.S. military personnel in Germany.
  • Barring American service members in Japan from leaving their residences after having more than one alcoholic beverage.
Chairman of the panel, Dr. Charles P. O'Brien director of the Center for Studies of Addiction at the University of Pennsylvania, wrote the report and spoke with NBC about his findings; he stated that the panel found that there is only one doctor in the entire U.S. Army that has training in addiction medicine. "This is a specialty where we need more people and they’re not there," he said. "So, most people are not getting treated with evidence-based medicine."

Wednesday, December 26, 2012

Can Addiction be Cured?

Is it possible to cure addiction? It has long been argued that addiction is a disease that cannot be cured only maintained through a path of recovery. There is no quick fix for dealing with one’s addiction; those who have managed to maintain a successful recovery achieved it through hard work, heartache, and strife. Fortunately, recovery is possible for those who want it bad enough.

Despite this long held belief, there are a number of scientists and doctors who continue to work tirelessly to find a cure for addiction. In China, a controversial surgical procedure attempting to cure addiction by destroying parts of the brain’s “pleasure centers” is being studied, Time.com reports. The subjects being studied are alcoholics and people addicted to heroin.

However, not surprisingly, the procedure risks permanently damaging a person’s ability to have longings and feel joy, according to the article. Despite the Chinese Ministry of Health banning the procedure in 2004, some doctors were granted permission to continue to perform the dangerous operation for research purposes only.

The journal Stereotactic and Functional Neurosurgery published a new study and the researchers called the surgery "a feasible method for alleviating psychological dependence on opiate drugs." Nevertheless, the researchers also noted that more than half of the 60 patients in the study had lasting side effects, including the loss of memory and loss of motivation. Although, after five years, 47 percent of the test subjects were still drug free.

Experts are opposed to using the procedure to treat addiction - thankfully. "To lesion this region that is thought to be involved in all types of motivation and pleasure risks crippling a human being," Dr. Charles O’Brien, head of the Center for Studies of Addiction at the University of Pennsylvania, told Time.com.
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Monday, December 24, 2012

Walgreens Illegally Dumps Pharmaceuticals

Proper disposal of prescription drugs is of the utmost importance, it is the only sure way to keep powerful narcotics out of the wrong hands. Every year prescription drug take back days are organized across the country, allowing individuals to hand over unwanted medications to the authorities for safe disposal. What’s more, businesses that handle pharmaceuticals are obligated to dispose of medication and bio-hazardous waste safely; drugs cannot just being thrown in the normal waste bins. Apparently one pharmacy chain failed to receive the memo.

Walgreens was caught illegally dumping pharmaceutical and bio-hazardous waste in California and has been ordered to pay $16.5 million in damages, to settle a lawsuit on the matter. The suit claimed that employees of the drugstore chain illegally dumped the drugs and waste into regular trash bins, instead of sending it to authorized disposal sites. District attorneys who represent more than half of the counties in the state were behind filing the suit.

Naturally, Walgreens admits no wrongdoing, and settled the case to avoid lengthy litigation. “All hazardous materials are shipped by licensed environmental haulers to a hazardous waste disposal facility, where they are incinerated,” spokesman Jim Graham said. “We are continuing to strengthen our programs to ensure that these procedures are properly followed.”

Walgreens will pay $16.5 million in penalties and costs, and will fund environmental projects to advance consumer protection and environmental enforcement in the state, according to the Contra Costa Times.

We wish all our readers a very Healthy and Merry Christmas. 
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Wednesday, December 19, 2012

Maintaining Sobriety Through the Holidays

The holiday season is upon us, considered by most people as the "happiest time of the year." Family, food, and presents are on every one's mind as we all prepare to rejoice together. Unfortunately, many of those in recovery find this time of the year especially stressful which often leads to relapse.

A number of addicts while in the grips of their addiction become estranged from family members and in many cases have lost their welcome at family gatherings due to past indiscretions. Rebuilding ties can take years of recovery, leaving many with the feeling of loneliness during the holidays.

A well known physician in the field of addiction made this list of common challenges that present themselves at this time of the year:
  • Families can be a strong trigger, especially during the holidays.
  • Painful memories of holidays past come to the forefront.
  • Social situations offer an abundance of alcohol and days with opportunities to relapse.
  • Travel and busy schedules increase overall stress and fatigue and can lead to emotional swings.
  • We are often away from our support network and our routines, enhancing a feeling of aloneness and making it harder to "work our program." We also often "beat ourselves up" because we believe we should be happy now that we are sober, but we often actually feel more isolated.
Fortunately, in most cities you can find a meeting every hour of the day during the major holidays. There is always someone to talk to about how you are feeling; one never has to be by themselves if they do not want to be. It is important that you stay active throughout the holidays, reaching out to those who are new to recovery.

We wish everyone a happy holiday and hope you all stay safe...

Monday, December 17, 2012

Marijuana Users Not a Top Priority for Obama

It's been just over a month since Americans went to the polls to exercise their the right to vote. Most Americans are aware that both Washington and Colorado voted to legalize the recreational use of Marijuana despite it being continued to be classified as a Scheduled I drug federally. A fact made clear by President Obama in a news interview with Barbara Walters; however he believes that it should not be a top priority for federal law enforcement officials, stating, "We’ve got bigger fish to fry."

Obama does not currently support widespread legalization of the drug, although he acknowledged public opinion on the issue is changing and there are few government resources to punish people who use marijuana.

"This is a tough problem, because Congress has not yet changed the law," he said. "I head up the executive branch; we're supposed to be carrying out laws. And so what we're going to need to have is a conversation about, 'How do you reconcile a federal law that still says marijuana is a federal offense and state laws that say that it’s legal?'"

Attorney General Eric Holder and the Justice Department have been asked by the President to look into legal issues involved in the conflicting federal and state laws on drugs.

"There are a number of issues that have to be considered, among them the impact that drug usage has on young people, [and] we have treaty obligations with nations outside the United States", Holder told ABC News.
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Wednesday, December 12, 2012

Genetics Can Lead to Binge Drinking

Binge drinking is a major problem amongst teenagers and young adults, a problem that sends thousands to the emergency room every year and can cause loss of life. Those who binge drink are not necessarily alcoholics, but the behavior can certainly lead to alcoholism. A new study conducted by scientists on mice and teenage boys in London found a genetic variation that may play a role in binge drinking in teenagers, Reuters reports.

“People seek out situations which fulfill their sense of reward and make them happy, so if your brain is wired to find alcohol rewarding, you will seek it out,” lead researcher Professor Gunter Schumann of King’s College Institute of Psychiatry in London said in a news release.

The gene called RASGRF-2 was found by researchers, they determined that it is important in controlling how alcohol stimulates the brain to release the brain chemical dopamine, causing a feeling of reward. Previous studies conducted believed that RASGRF-2 increased the risk for alcohol abuse, but the mechanism was unclear, the article notes.

The RASGRF-2 gene was removed from the mice by the researchers in order to see how they would react to alcohol. Without the gene they found it to significantly reduce alcohol-seeking behavior. When the mice consumed alcohol, there was a reduction in the release of dopamine in the brain, limiting the sense of reward.

The brains of 663 teenage boys were scanned during the course of the study. When the boys were expecting a reward in a mental test, those with genetic variations in the RASGRF-2 gene had more activity in the brain involved in dopamine release. This suggests that people with the genetic variation release more dopamine when they anticipate a reward.

The researchers re-tested the boys two years later; many of the boys had begun drinking frequently by that time. The boys with the gene variation drank more often than those without it.  

The findings appear in the Proceedings of the National Academy of Sciences.
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Monday, December 10, 2012

Genetics and Addiction

Marc A. Schuckit, MD
Modern medicine has come a long way over the last 100 years in the field of addiction. What was once thought to be a moral disorder and a lack of will power has become recognized as medical disease that can be treated much like any other medical ailment. Addiction is a disease that can arise from heavy use of a substance over an extended period of time or can be passed down genetically from one generation to the next.

New research has shown that genes account for about 60 percent of the risk for addiction, while the environment accounts for the other 40 percent, according to Marc A. Schuckit, MD, distinguished Professor of Psychiatry at the University of California, San Diego. Schuckit is an expert who has developed a pilot program to prevent high-risk drinking in college freshman. He based the first evaluation of a prevention program on his 30 years of research in the field, dealing with more than 400 families.

Dr. Schuckit explained how genes and the environment relate to the risk for alcoholism at the Association for Medical Education and Research in Substance Abuse annual meeting, laying out the risk factors that impact alcoholism. “Genes operate through these risk factors,” he notes. One of the risk factors is a low sensitivity to alcohol. “Some people are a good deal less sensitive to alcohol from the very first time they drink,” Dr. Schuckit says. “They require higher doses of alcohol to get the effect they want.” Low sensitivity to alcohol is seen in groups of people at high risk for alcoholism, including children of alcoholics and Native Americans, he adds. Low sensitivity to alcohol predicts alcoholism and alcohol-related problems, he says.

The low sensitivity to alcohol combined with factors in the environment magnify the risk of alcoholism, some environmental factors are associating with heavy-drinking peers or higher levels of life stress where alcohol is used to help cope with the stress. Dr. Schuckit has identified four genes related to the low response to alcohol.

Schuckit is planning on beginning a much larger, potentially more definitive study in 2013.  

The study results were published earlier this year in Alcoholism: Clinical & Experimental Research.

Wednesday, December 5, 2012

New Report on Synthetic Marijuana

Synthetic drugs continue to make headlines with more and more people ending up in emergency rooms after use. Substances like synthetic marijuana and bath salts contain chemicals that have hardly been tested and are clearly harmful to one's health. A new government report has found that synthetic marijuana sent more than 11,000 to the emergency rooms in 2010.

The majority of those experimenting with synthetic marijuana and bath salts were teenagers and young adults, USA Today reports. The report found 12-to-17-year-olds accounted for one-third of the emergency room visits, while young adults ages 18 to 24 accounted for an additional 35 percent. Among patients ages 12 to 29, the report found 59 percent of those who made visits to the emergency room for synthetic marijuana use had no evidence of other drugs in their system.

Commonly known as K2 or Spice, synthetic marijuana is a mixture of herbs, spices or shredded plant material that have been treated with a synthetic compound chemically similar to THC which is the psychoactive ingredient found in marijuana.

The effects of synthetic marijuana include:
  • Loss of Control
  • Lack of Pain Response
  • Increased Agitation
  • Pale Skin
  • Seizures
  • Vomiting
  • Profuse Sweating
  • Uncontrolled Spastic Body Movements
  • Elevated Blood Pressure
  • Elevated Heart Rate
  • Heart Palpitations
Users experience:
  • Severe Paranoia
  • Delusions
  • Hallucinations
  • Increased Agitation
President Obama signed legislation last July banning synthetic drugs.
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Monday, December 3, 2012

Updated Diagnostic and Statistical Manual for Mental Disorders To Be Published Spring 2013

After a decade of debate addiction and substance abuse finally have their place in the American Psychiatric Association's handbook, the Diagnostic and Statistical Manual for Mental Disorders (DSM). In the new (DSM-5), substance abuse and dependence will be combined into a single category of “substance use and addictive disorders.” The DSM is the official guide to classifying psychiatric illness, according to The Wall Street Journal.

In the current Diagnostic and Statistical Manual for Mental Disorders (DSM-4), substance abuse is defined as short-term binging, whereas substance dependence is considered to be addiction, notes the WSJ. There will be 11 specific symptoms for the new spectrum of substance use and addictive disorders; including the inability to cut down or meet obligations at home or at work. A person with two or three symptoms will be diagnosed with a mild disorder. Someone who meets six or more will be diagnosed with a more severe disorder.

The updated classification will affect who qualifies for:
  • Subsidized Services
  • Insurance Reimbursements
  • Treatment Programs
The DSM-5 will also combine the subcategories of autism, such as Asperger’s syndrome, into one category of autism spectrum disorder.

The new edition of the manual will be published next spring.
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Wednesday, November 28, 2012

Canada Allows More Oxycodone

It doesn’t take long for one to become dependent on pain medication with the amount of highly potent prescription opiates available. Acquiring a drug like OxyContin (oxycodone),even without a prescription, is not that difficult; a number of people will sell their unused medication for a pretty penny. Oxycodone is one of the most abused prescription narcotics and there is about to be a lot more of the drug available.

Six generic drug companies have just been given the approval by the Canadian government to manufacture oxycodone products. Apparently the Canadian health minister had been under pressure to forbid the generic version of OxyContin due to concerns about widespread abuse of the painkiller, but went ahead and approved more production of the drug, CBC reports.

Canadian Health Minister Leona Aglukkaq defended her move by saying that the drug is safe and effective when used as prescribed; announcing that drug manufacturers and pharmacists will be required to report spikes in sales, or changes in distribution patterns. Furthermore, the government will also require drug companies that manufacture oxycodone products to provide better education for healthcare professionals and the public regarding the dangers associated with the drug.

Montana Attorney General Steve Bullock sent a letter to Aglukkaq asking the government to reconsider its decision, saying this will make oxycodone easier to abuse, the Associated Press reports. Pointing out that features that OxyContin’s manufacturer, Purdue Pharma, had included to make the drug harder to abuse will not be included in generic versions.

“Studies have shown that the tamper-resistant changes OxyContin manufacturers have made to the drug have resulted in less abuse among addicts,” Bullock wrote. “I have concerns that allowing easier-to-abuse oxycodone in Canada could undo some of the work that both Canadian and U.S. government and community leaders have accomplished in combating this epidemic.”
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Monday, November 26, 2012

International Legalization Debate

Legalization is a hot-button topic these days in the wake of both Colorado and Washington legalizing the recreational use of marijuana. As a result, leaders in other nations have called for a debate regarding the impact of legalization on an international level. Four Latin American countries presidents have called for the international debate.

The presidents of Mexico, Belize, Honduras and Costa Rica have raised concerns about rising crime and violence related to the U.S. government’s drug wars, according to CBS News. Their report points out that it is no longer against the law in 10 Latin American countries to possess small amounts of marijuana; however, the production and distribution of marijuana remains illegal.

Mexican President Felipe Calderon stated that the legalization of recreational marijuana use in two states limits the United States’ “moral authority” to ask other countries to fight or restrict illegal drug trafficking, according to Fox News.

Calderon was joined by leaders of Belize, Honduras and Costa Rica in calling on the Organization of American States to study the new state laws’ impact. He stated that the United Nations (UN) should hold a special session on drug policy. The violence created by drug cartels in Mexico has been on the rise, which is mostly the result in large part because of drug consumption and arms smuggled from the United States, the article notes.

Many believe that legalization will reduce violence throughout North and South America. Nevertheless, legalization may also cause a steep rise in addiction which is a major concern among others and should be addressed.

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Wednesday, November 21, 2012

Drugged Driving Statistics Exceed Drunk Driving In California

Driving under the influence

Driving under the influence plagues this country on a daily basis. Everyday lives are lost as a result of people drinking and driving or driving and drugging. It turns out that more people test positive for drugs, illicit or legal, than those for alcohol in the state of California.


California study zeroed in on "drugged" driving

Almost twice as many drivers are likely to test positive for drugs that may impair driving, compared with alcohol, according to a new California study. 7.3 percent of drivers tested positive for alcohol, compared with 14 percent who tested positive for impairing drugs, including both illegal and prescription drugs, The Los Angeles Times reports.

Of those who tested positive for alcohol, 23 percent also did so for at least one other drug, according to the report. Marijuana was the most common drug found in the system of drivers. More than one-quarter of drivers who tested positive for marijuana also tested positive for at least one other drug. States which recently legalized marijuana should take note of this report.

1,300 drivers who voluntarily provided breath and/or saliva samples at roadside stops on weekend evenings took part in the survey conducted by the California Office of Traffic Safety.

“These results reinforce our belief that driving after consuming potentially impairing drugs is a serious and growing problem,” Christopher J. Murphy, Director of the Office of Traffic Safety, said in a statement.

KEYT.com reports on this new study

If you are having trouble viewing the video, you can see it here.

As we begin the holiday season, it is important to remember that driving under the influence of alcohol or any drug will endanger your life and those around you. We wish all of our readers a peaceful and safe Thanksgiving.
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Tuesday, November 20, 2012

Social Media for Interventions

Social media websites are used more than any other websites to share information with one another across the globe. The most popular of these is FaceBook, with more users than anyone could have ever imagined. What if FaceBook could be used to not only share information, but, rather to give people guidance with behavior problems and mental health or substance abuse problems? Please take a moment read Dr. Nathan Cobb's thoughts on the subject.

Cobb is a Research Investigator at the Schroeder Institute for Tobacco Research and Policy Studies at Legacy®, a practicing physician, and expert in the field of behavioral informatics. His prior work as a smoking cessation counselor and computer programmer for health risk assessments were a springboard for the development of QuitNet, one of the first Internet based behavior change interventions. Dr. Cobb’s current work leverages social networks to effect behavior change through social support and social influence. This includes both retrospective exploration of a 10 year database of interactions of participants in the QuitNet network, as well as novel interventions using social utilities such as FaceBook and alternative delivery mechanisms such as text messaging.

“This month Facebook announced that it had reached one billion active users. Not one billion accounts or registrants, but one billion individuals using the website every month. Of these approximately 200 million are in the U.S. and Canada – a staggering number. Each one of the users is connected to hundreds of their friends, actively exchanging information, sharing photos and news and even playing games together. 

Two studies published at the same time in the American Journal of Preventive Medicine suggest that Facebook can do more. It can be used to deliver evidence-based health behavior interventions. Particularly interesting was the study by Sheanna Bull and colleagues where they used Facebook with youth to increase condom use and potentially prevent sexually transmitted diseases. Not only did their randomized control trial show that it’s possible to build an effective intervention within Facebook, but they also showed that a well-designed intervention will spread from friend to friend more efficiently than something that lacks interest or utility. 

Taken together, these facts suggest that we may be on the cusp of a tremendous change in how we deliver health behavior interventions. An intervention that can reach people where they live and work, but can also involve and spread through their own social network, would have tremendous impact. An accompanying editorial that I wrote with Dr. Amanda Graham lays out some of this potential. But equally important, here at Legacy we have similar work underway, including a randomized control trial funded by the National Cancer Institute to evaluate how a Facebook app may spread through a quitter’s network and involve their friends. 

We think that health behavior change interventions in the future will be inherently social, leveraging the Internet to involve your friends, family and co-workers, but also exposing you to people you have never met. What role Facebook will ultimately play is unknown, but as of today, the future is incredibly exciting.”

In the scheme of recovery, maybe it doesn't matter where a person starts to seek help, but that the person starts somewhere!

Wednesday, November 14, 2012

Boston Drug Epidemic

Metropolitan areas are constantly struggling with illicit drug use due to the availability of such drugs. In the past decade we have seen a rise in prescription drug abuse like never before, which has somewhat shadowed the more notorious hard drugs such as methamphetamine and heroin. A new report has shown that the Boston area is being hit hard by the abuse of illicit drugs.  

A nonprofit group concludes that communities throughout Massachusetts are experiencing an epidemic of substance abuse. The Boston area has had a particularly high number of emergency room visits involving illicit drugs.

The Boston region ranked first among major metropolitan areas in emergency department visits involving illicit drugs, according to a report by the Massachusetts Health Council which cites a study by the Substance Abuse and Mental Health Services Administration in 2009.

Massachusetts Gov
ernor Deval Patrick called the report worrisome, according to the Associated Press. The problem was the easy availability of potent heroin, he said.

Communities need to remain vigilant against the dangers of illicit drugs and the heavy toll that they can put on communities across the nation.

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Monday, November 12, 2012

PTSD Research Honors All Veterans

Today is Veterans Day. Many will honor our Veterans by participating in community events, volunteering at a Veterans Administration hospital, visiting a cemetery to honor the fallen, or reaching out to thank Veterans for their years of service. There will be a few who really don't know the history of Veterans Day.
"On the 11th hour of the 11th day of the 11th month of 1918 an armistice between Germany and the Allied nations came into effect. On November 11, 1919, Armistice Day was commemorated for the first time. In 1919, President Wilson proclaimed the day should be 'filled with solemn pride in the heroism of those who died in the country’s service and with gratitude for the victory'".
We sometimes confuse Veterans Day with Memorial Day. Veterans Day is not to be confused with Memorial Day; Veterans Day celebrates the service of all U.S. military veterans, while Memorial Day is a day of remembering the men and women who died while serving.

PTSD research is another way to honor our Veterans

It may seem odd to consider scientific research as an honor to our Veterans, but when you think about this it is true. Many scientist work tirelessly to perfect research in the field of medicine to discover new ways to save lives on the battlefield discovering new surgical techniques and procedures to immediately react to the visible wounds. However, just as many research scientist work to study the invisible wounds like post traumatic stress disorder (PTSD).  Many people often wonder why some people are affected by PTSD and others are not. Perhaps even in our own families we have wondered about this, recognizing that brothers and sisters will volunteer for service and one or more may return with PTSD and the others do not.

New study looks at brain anatomy as it relates to PTSD

On November 5, 2012, the results of a new study were published in the Archives of General Psychiatry: Amygdala Volume Changes in Posttraumatic Stress Disorder in a Large Case-Controlled Veterans Group.  Here are some details of the study:
  • The lead author was Dr. Rajendra Morey, assistant professor of psychiatry at Duke University
  • The setting for this study was the Durham Veterans Affairs Medical Center
  • 200 patients, all combat veterans, were studied. All had served in Iraq or Afghanistan after September 11, 2001 
  • 99, roughly one-half, of the patients had a current diagnosis of PTSD
  • 100 of the patients had also been exposed to trauma, but did not have a diagnosis of PTSD
  • The authors also controlled statistically for the important potential confounds of alcohol us, depression, and medication use. 

The study's findings

According to the Courier Journal article, the study indicated:
"In combat veterans with post-traumatic stress disorder, the area of the brain that controls fear and anxiety responses is much smaller than normal, according to a new study. The finding is the first to provide evidence that a smaller amygdala is associated with post-traumatic stress disorder (PTSD), but it's not clear whether this smaller size is caused by PTSD or whether people with a smaller amygdala are more likely to develop PTSD."

One step closer...

Research is like most things in life...it happens one step at a time.  As Dr. Morey points out in the study's conclusions: Our results may trigger a renewed impetus for investigating structural differences in the amygdala, its genetic determinants, its environmental modulators, and the possibility that it reflects an intrinsic vulnerability to PTSD.

Learn a bit more about Veterans Day from The History Channel 

If you are having trouble viewing the video, you can see it here.

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Wednesday, November 7, 2012

Depression Is An Expensive Risk Factor For Employer Insurance Plans, But Less Than Obesity Or Physical Inactivity

Do you know someone who suffers from depression? While we all can sometimes feel sad, unhappy, or as we often say, "down in the dumps," clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time. For the majority of adults their everyday life includes "going to work," whether they are an employee or self-employed, clinical depression will have an impact on productivity. And it is important to remember that while bottom-line productivity is important, a new study now examines the cost of depression as a health risk factor and how it relates to health insurance expenditures for employee health plans.

Considering health risk factors

Much of the Affordable Care Act is yet to be put in place, but one important part of the Act encourages employers to be pro-active in health care preventative measures. A new study was published online in the November issue of Health Affairs: Ten Modifiable Health Risk Factors Are Linked To More Than One-Fifth of Employer-Employee Health Care Spending.

Study's details

This study was conducted by lead researcher Ron Z. Goetzel, a research professor and the director of Emory University's Institute for Health and Productivity Studies and a vice president of consulting and applied research at Truven Health Analytics, in Washington, D.C. According to the study's abstract:
"An underlying premise of the Affordable Care Act provisions that encourage employers to adopt health promotion programs is an association between workers’ modifiable health risks and increased health care costs."
Goetzel and his colleagues looked at the correlation between modifiable health risk and increased healthcare costs at seven organizations over three years.
  • The study surveyed 92,400 employees
  • The employers administered health assessments through the MarketScan database from 2005 to 2009.
  • Researchers did adjust for age, sex, health plan, location, industry type and other factors. 
  • Health risk factors studied were: High blood glucose, high blood pressure, obesity, tobacco use, physical inactivity, high cholesterol, poor nutrition, high alcohol use, stress, and depression.

Study's findings

According to a GlobeNewswire article the researchers found:
  1. The two health risk factors that contributed the most per capita per year to excess medical costs were obesity ($347) and physical inactivity ($178.6). Those were followed by depression ($128.2), tobacco use ($106.2), high blood glucose ($104.1), high blood pressure ($80.8) and stress ($38.3). 
  2. Persons with biometric values related to obesity, high blood pressure and high glucose had higher health care costs compared to those not at risk. Similarly, individuals with who were depressed, had high stress, smoked or were physically inactive also had higher medical costs.
  3. Physical inactivity and poor stress management also were cited as significant independent drivers of costs, and were also directly related to all the other risk factors in this study. 

Some final thoughts...

Hard numbers are always helpful. It is estimated that depressed employees make up 11% of the workforce. While medical costs associated with depression as a risk factor are high, these costs come in third behind obesity and physical inactivity.  If your employer offers any health promotion programs, carefully consider taking advantage of these programs. If you have a co-worker who you think would benefit from health promotion programs, encourage their participation.

Many years ago Benjamin Franklin offered this advice: An ounce of prevention is worth a pound of cure!  The same holds true today...

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Monday, November 5, 2012

What Are The Risks Associated Opioid Analgesics?

If you are a regular reader of our blog, then you know that we often write about the dangers involved in becoming addicted to prescription drugs particularly when they are prescribed for an acute or chronic pain. The headlines offer warnings of the dangers of opiate based prescription drugs and we know that many people will try opioids in this form simply because that are readily available, they are a legal form of the drug and many don't recognize the dangers; however, once addicted the individual will often turn to hard illegal drugs because they are cheaper and their source for the prescription form dries up. These headlines can work to make people fearful that if they receive a prescription for pain they will risk the chance of developing an addiction to opioids. Interestingly, experts often debate how many people actually do become addicted to opiate based prescription drugs.

Reviewing the research

This past month a new article was released online in the journal Addiction. Three researchers completed a  review of the literature: Development of dependence following treatment with opioid analgesics for pain relief: a systematic review.   This review was conducted by Silvia Minozzi, Laura Amato, and Marina Davoli from Department of Epidemiology, Lazio Regional Health Service, Cochrane Drugs and Alcohol Group, Rome, Italy.

Review methods

The aim of this review was to assess the incidence or prevalence of opioid dependence syndrome in adults (with and without previous history of substance abuse) following treatment with opioid analgesics for pain relief.
  • Reviewers examined 17 previous studies
  • These studies included date from 88,325 participants
  • Most studies included adult patients with chronic non-malignant pain
  • Two studies included patients who were being treated for cancer
  • One study included patients with a previous history of drug dependence
This systematic review prompted the researchers to conclude: Taken together, the studies found that 4.5 percent of people developed a dependency on the painkillers. This rate seems low, so it is important to remember it is an average and the researchers offer that the rate of developing a dependency ranged from 0 to 31%!

Other experts weigh in on the review's conclusions

As we said the online Addiction article was published on October 18, 2012; therefore, now some addiction experts in the United States have had time to read the article and offer some of their own observations. For example, according to Reuters news:
  • Addiction specialist Dr. Michael Fleming at Northwestern University's Feinberg School of Medicine: "If you're a person that doesn't have a history of addiction and doesn't have any major psychiatric problems, narcotics are relatively safe as long as your doctor doesn't give you too much and uses the right medication."
  • Joseph Boscarino of the Geisinger Clinic in Danville, Pennsylvania, who studies pain and addiction offered: '"I think the jury's still out" on how worrisome prescription opioid addiction is.'

Some cautionary thoughts...

When research is conducted we always hope that it is extensive and thorough. Often new research or a review of previous research offers new facts or a revision of previously accepted facts. So what is the average person to do?  First, understand that opioids are addictive. Second, if you had a history of addiction and you are in recovery, then you need to share this information with your doctor so that he/she can prescribe appropriate pain medication. Third, if someone else in your household suffers from opioid addiction, then carefully monitor your prescription making sure that no one else is using your pain medication.

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Wednesday, October 31, 2012

Study Tells Women: Quit Smoking, Live Longer

For as many times as we have written about smoking cigarettes usually these posts have been about the inherent dangers of smoking and the fact that cigarette smoking is like any other addiction. The bottom line is this: cigarette smoking is a health hazard for the smoker and for those impacted by second hand smoke and once addicted quitting is very difficult. Though quitting is not impossible, sometimes we need a reason to quit. If someone told you quitting could add ten years to your life, would you try to quit?

Do smoking regulations or warning labels make you want to quit smoking?

It might surprise you to know that in 1965 42% of Americans smoked cigarettes. By 2006 that number dropped to 20.8%. Most of this decrease has resulted from studies that show the negative health effects of smoking. People watched their loved ones die as a result of smoking. Regulations and laws were passed to lessen the places where people could smoke. No longer are we allowed to smoke while working; no longer can we smoke on planes, trains or buses; many communities have outlawed smoking in public parks and beaches; and, we can no longer smoke in restaurants and theaters. Adding to these health regulations we also have warning labels on cigarette packaging. These warning labels were first introduced in 1966 with the CAUTION: Cigarette Smoking May be Hazardous to Your Health.

This caution evolved into WARNINGS and in 2009 the Family Smoking Prevention and Tobacco Control Act was passed which required color graphics with supplemental text depicting the negative consequences of smoking to cover 50 percent of the front and rear of each pack. While these graphic labels were to be in place by September 2012, the courts are still trying to sort out whether or not this act is a violation of the First Amendment.

So have you quit yet?

Women and smoking...

The American Lung Association offers some interesting statistics regarding women and smoking. Here are just a few eye-opening stats:
  • Annually cigarette smoking kills an estimated 173,940 women in the US
  • As of 2008, 21.1 million women smoked cigarettes
  • Female smokers are nearly 13 times more likely to die from emphysema and chronic bronchitis, compared to women who never smoked
  • Women who smoke also have an increased risk for developing cancers of the oral cavity, pharynx, larynx, esophagus, pancreas, kidney, bladder, and uterine cervix.
  • Women who smoke also double their risk for developing coronary heart disease

New study highlights the benefits to women who quit smoking

This past week the results of a new study were released on-line in the journal Lancet,  The 21st Century Hazards of Smoking and Benefits of Stopping: A Prospective Study of One Million Women in the UK. Here are some of the studies methods and findings:
  • 1.3 million UK women were recruited in 1996-2001
  • These women were resurveyed about three and eight years later.
  • All were followed until January 1, 2011
  • Among UK women, two-thirds of all deaths of smokers in their 50s, 60s, and 70s are caused by smoking; smokers lose at least 10 years of lifespan. 
  • Although the hazards of smoking until age 40 years and then stopping are substantial, the hazards of continuing are ten times greater.  
  • Stopping before age 40 years (and preferably well before age 40 years) avoids more than 90% of the excess mortality caused by continuing smoking; stopping before age 30 years avoids more than 97% of it. 

NBC Today Show's Robert Bazell features study results


If you are having trouble viewing the video, you can see it here.

In closing...

If you are a woman and you smoke, we hope that you will take the time to at least think about what this study is saying. You can quit smoking, if you need help then visit the American Lung Association's site to learn more about getting help to quit smoking. Also, remember that quitting smoking is like quitting any other addictive substance...you can do it one day at a time.


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Monday, October 29, 2012

"Back on My Feet" ~ Anne Mahlum's Vision For the Homeless

Homelessness and mental health

Homelessness has become a very visible part of our culture. If you are old enough to remember 1963, then you might recall the passing of The Community Mental Health Act of 1963. While this act was to allow for Federal funding for community mental health centers, many experts believe that it was this act that set the stage for increasing the number of homeless in the United States. According to Wikipedia, following the enactment of The Community Mental Health Act:

Long term psychiatric patients were released from state hospitals into SROs and supposed to be sent to community mental health centers for treatment and follow-up. It never quite worked out properly, the community mental health centers mostly did not materialize, and this population largely was found living in the streets soon thereafter with no sustainable support system.

Homelessness and addiction

Studies of the homeless indicate that many who are homeless also suffer from prolonged drug and alcohol abuse. On any given night in America approximately 636,000 individuals are homeless.  According to the Substance Abuse and Mental Health Services Administration (SAMHSA): "One study reported a 23 percent lifetime prevalence rate of co-occurring disorders for individuals who were homeless. Individuals with co-occurring disorders who are homeless face complex physical, social, and psychological challenges to recovery."

Adult children of alcoholics and the homeless

The homeless are often alienated by their family and close friends. This alienation almost always starts with the homeless person's disease of addiction alienating an addicted individual's family and friends who could otherwise provide support during difficult economic times. The family members may want to help, but they may also be physically, emotionally and financially exhausted from living with the addict and the disease. It is after all, a family disease. Any every family member needs to figure out how they can deal with watching their loved one's life implode from addiction. This is particularly true of adult children of alcoholics.

Meet Anne Mahlum founder of "Back on My Feet"

According to the Back on My Feet (BoMF) website:

"Anne's relationship with running began when she was 16 as a way to deal with her father’s struggle with a gambling addiction. While Anne could never find a way to help her dad, she found her own answers in the life lessons that surround running, such as taking things one step at a time and learning the value of being on difficult roads. Ten years later, Anne's running led her past a homeless shelter in Philadelphia where she developed a friendly rapport with some of the residents. One morning, she realized that running could benefit these individuals in the same way that it helped her. Back on My Feet had its first official run on July 3, 2007 and in just a few years, has grown to a $4.8 million nonprofit that’s moved hundreds of individuals experiencing homelessness from dependency to self-sufficiency."

CBS Evening News "Turning Around the Lives of the Homeless"

If you are having trouble viewing the video, you can see it here.

World Homeless Day 2012

World Homeless Day 2012 was held on October 10th. While the homeless population in the United States seems staggering, you may be surprised to know that worldwide it is estimated that the number considered homeless is 100 million.

As always, advocacy for any cause cannot be about one day, it must be about one day at a time.

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Wednesday, October 24, 2012

Substance Abuse Diagnoses Increase, But So Do Prescriptions For Addiction Treatment

If you are an addiction treatment professional, then you have probably noticed trends when it comes to the number of people suffering from the disease of addiction and seeking treatment. Now a new study has determined that while the number of those diagnosed with addiction is up, there are also encouraging statistics as to how many patients are seeking treatment.

Study overview

A study was conducted by Joseph W. Frank, MD; John Z. Ayanian, MD, MPP; Jeffrey A. Linder, MD, MPH, with the lead author being Dr. Joseph W. Frank from Brigham and Women's Hospital in Boston. They reviewed two national surveys reviewing data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 through 2009.

The study's results were published online on October 2012 in the Archives of Internal Medicine as a research letter. An overview of the study can be seen here: Management of Substance Use Disorders in Ambulatory Care in the United States, 2001-2009.

Study findings

The authors analyzed 8930 visits, which represented an estimated 42.2 million adult visits which involved substance abuse disorders. Findings point out:
  • Such visits increased 70% from 10.6 million in 2001 through 2003 to 18.0 million in 2007 through 2009.
  • Visits of opioid use disorders increased 6-fold from 772,000 in 2001 through 2003 to 4.4 million in 2007 through 2009, accounting for 7% of all substance use disorder visits in 2001 through 2003 and 25% of visits in 2007 through 2009. 
Dr. Frank estimated that a review of the data indicates 22.5 million US residents are currently dependent on alcohol or drugs. That number represents 6.8% of the US population.

There is some good news

The researchers also point to some good news:
  • When patients were seen by their doctors, the doctors did prescribe medicine to treat the drug and alcohol problems. 
  • These prescriptions were issued to 643,000 patients between 2001 and 2003; this number grew to 3.9 million patients between 2007 and 2009. 
  • Most of these prescriptions were written to treat people with opioid addiction.
  • The most popular prescribed treatment was "talk therapy" (psychosocial therapy, mental health counseling, stress management) which was used for 25 million patients.
The disease of addiction is treatable. Recovery is possible. Stay informed, talk to your primary care physician or if you find yourself in an emergency room suffering from your addiction - be honest with the hospital staff that is trying to assist you through your current acute symptoms.  

The first step (We admitted we were powerless over alcohol - that our lives had become unmanageable) is all about being honest with yourself and those who are trying to help you.

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Monday, October 22, 2012

Remembering Paul Wellstone - The Senator, An Advocate For Mental Health Parity and Addiction Equity Act

, former member of the United States Senate fr...
Paul Wellstone former member of the United States Senate from Minnesota. (Photo credit: Wikipedia)
If you suffer from addiction and/or co-occurring mental health issues or you have a child who is diagnosed with either, then there is a good chance that you are familiar with the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. But you may not realize that it was 10 years ago this week, specifically October 25, when Paul Wellstone died in a plane crash 11 days before the 2002 US Senate Election.

Remembering Paul Wellstone

Though gone now almost ten years, Paul Wellstone is remembered for many projects and causes that he diligently fought to bring to the public's awareness. But it was his awareness of how impactful a mental health disorder can be to the person and his/her family (Wellstone's older brother suffered from crippling depression) that inspired him to work tirelessly for mental health parity and addiction equity.

Sometimes the wheels of legislation turn slowly. According to a October 12, 2012, Huffington Post article: "In 1995 Wellstone and Senator Pete Domenici, a New Mexico Republican, co-sponsored a bill that would require insurance companies to provide mental health patients with the same level of care as those suffering from physical illnesses."  And it took until 2008, six years after his passing, for the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 to be passed by both houses of Congress. In case you are counting...that is 13 years!

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (a part of Division C) mandates that if U.S. health insurance companies provide coverage for mental health and substance abuse, the coverage must be equal for conditions such as psychological disorders, alcoholism, and drug addiction.

Senator Wellstone's son, David Wellstone continues his father's work

It is important to remember that on the plane crash that took the life of David Wellstone's father also took the life of his mother Sheila Wellstone and his younger sister, Marcia Wellstone. David was devastated, as was his younger brother, Mark Wellstone. David retreated; he stayed out of the public spotlight for five years until he was asked to testify before the US Congress in July 2007. And testify he did saying of his father's work: "Although he was passionate on many issues, there was not another issue that surpassed this in terms of his passion."

Now David Wellstone has written a book: "Becoming Wellstone: Healing from Tragedy and Carrying on My Father's Legacy." 

CBS Minnesota recently interviewed David:
If you are having trouble viewing the video, you can see it here.

David recently founded a nonprofit group, the Wellstone Mental Health Initiative, which is pushing for a federal rule that will put teeth in the mental health parity legislation. The Post-Bulletin quotes David Wellstone:

"It's like my dad used to tell me and others. Folks with mental illness and addiction are a besieged minority. They are struggling with their own struggles, don't have a lot of political clout," he said. "So if I can help in that field and do good work on the policy side, then that's what I'll do." 

In closing...

Senator Paul Wellstone worked for all people suffering from addiction and mental health issues...his work also has helped parents as they seek treatment for their children. We are hopeful the fruits of his labor will continue to help establish parity and we are thankful for David Wellstone's willingness to continue working on this goal.

As we close today remembering Senator Paul Wellstone, we would also like to recognize the passing of Senator George S. McGovern who lost two children to the disease of addiction and also worked as an advocate for families touched by mental health issues and alcoholism. 

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Wednesday, October 17, 2012

Gambling Initiatives On The November Ballot - What's The Risk, What's The Price?

This November we will have an election. We will go to the polls to select someone to be our President for the next four years, we will pick our U.S. Representative, many will be voting for a U.S. Senator, some state governors will be chosen, many local political seats will be decided upon...and we will also be asked to vote for or against statewide or local initiatives. Sometimes it is these ballot measures that can impact our lives for years to come, either by what was approved or not, what program was funded or not, what tax was passed or not. This year a few states have ballot measures that deal with gambling.

States with ballot gambling initiatives

On October 6, 2012, a gambling website posted an update on which states will have ballot initiatives and which states failed to succeed in getting a gambling initiative on the ballot in 2012. Those states that for sure will have a gambling related initiative are:
  • Maryland ~ Question 7
  • Oregon ~ Measure 82 and Measure 83
  • Rhode Island ~ Question 1 and 2

A focus on Maryland

Maryland's Question 7 is known as the Gaming Expansion Referendum. Specifically it asks the voter if they are "for" or "against":

"Do you favor the expansion of commercial gaming in the State of Maryland for the primary purpose of raising revenue for education to authorize video lottery operation licensees to operate “table games” as defined by law; to increase from 15,000 to 16,500 the maximum number of video lottery terminals that may be operated in the State; and to increase from 5 to 6 the maximum number of video lottery operation licenses that may be awarded in the State and allow a video lottery facility to operate in Prince George’s County?"

Notice that the primary purpose is for raising revenue for education. This purpose type always pulls at the heartstrings of a voter. Who could vote against raising revenue for education? If you have school-aged children or grandchildren chances are you will vote for the referendum. Or if you are employed as a teacher, school administrator, or school employee, then chances are you want more funding for education. When you add these potential voters to those who might be able to find a new job in the building of a casino or working in a casino, then chances are you will vote for the referendum.

Here are few blogs/articles that discuss the Question 7 referendum:

A few final points...

On October 15, 2012, Petula Dvorak wrote a column for The Washington Post. Here are a few of her observations:
  • Based on statistics on the effect of the proximity of casinos within 50 miles of a person's neighborhood, Maryland could expect to have 60,000 people with gambling problems
  • To deal with this projection there is a new Maryland Center of Excellence on Problem Gambling based at the University of Maryland's School of Medicine. This center opened with a $5 million grant from the Maryland Department of Health and Mental Hygiene.
Do you have a problem with gambling? Do you have a loved one who has a gambling addiction? How has it impacted your life? 
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