Friday, December 2, 2016

21st Century Cures Act Covers Addiction

opioid addiction
If there is a perfect solution to be found regarding ending the American opioid epidemic, it has yet to show itself. The American public has been made fully aware of the situation, with hundreds of people dying every week; they also know that we cannot arrest our way out of the problem, as lawmakers have attempted to accomplish in similar situations of the past. It is understanding this, that should lead to the eventual end of stigma and discrimination that has long been associated with any form of mental illness, and especially addiction which many believe is the result of a lack of moral fiber or a weak constitution.

Lawmakers have hopped on the band wagon as well, with many politicians who historically would never have lifted a finger to help someone with a substance use disorder, now working on bipartisan bills to address the deadly epidemic. However, while legislation like the Comprehensive Addiction and Recovery Act (CARA) was designed to address the many aspects of the epidemic, there are serious concerns that have been raised by critics of the bill regarding a shortage of funding to pay for the various programs called for by the legislation.

As we mentioned earlier this week, the American Academy of Family Physicians (AAFP), called upon all members of the U.S. House and Senate to fully fund CARA. This funding is desperately needed to ensure that everyone with an opioid use disorder can access and receive treatment in a timely manner. We will just have to wait to see if our elected officials will heed the call.

Interestingly, and albeit somewhat surprisingly, while the American electorate was focused on a vicious Presidential election, another piece of dense legislation was in the works in the House, a bill that, among other things, seeks to tackle the opioid epidemic. The 21st Century Cures Act was approved in Congress, a bipartisan bill, which seeks to divert almost $4.8 billion to the National Institutes of Health for research, and provide $1 billion in new funding for opioid addiction prevention and treatment, USA Today reports. Despite a number of objections being raised on both sides of the aisle, the bill was approved 392-to-26.

Unlike CARA which is focused specifically on addiction, the 996-page Cures Act covers several areas of medicine, such as allowing the Food and Drug Administration (FDA) to speed up the approval time for new drugs and medical equipment, according to the article. Additionally, the Cures Act seeks to:
  • Channel $1.8 billion to the "Cancer Moonshot" initiative, designed to accelerate research into new cancer therapies, expand prevention and early detection.
  • Create a mental health and substance abuse "policy laboratory."
  • Fortify existing mental health parity laws.
At first glance, the new legislation, if approved in the Senate as many expect it to be, should bring about a lot of change, the good kind of change. Unfortunately, a number of politicians on the right believe that the Cures Act is “a legislative goodie bag loaded with special-interest surprises,” the article reports. Where critics on the left argue:

"When American voters say Congress is owned by big companies, this bill is exactly what they are talking about,” said Sen. Elizabeth Warren, D-Mass., in a speech on the Senate floor earlier this week. 

But, at the end of the day, we will just have to wait and see how the Cures Act will play out. There is no question that every dollar directed towards ending the opioid epidemic is a dollar well spent. However, everything else that is packed into the bill in the fine print could mean that addressing the opioid crisis may come at a great cost.

Wednesday, November 30, 2016

Urging the Federal Government to Fund CARA

The new year is knocking on the door and it is time to see if opioid addiction legislation has the desired effect in 2017. You are probably aware of the Comprehensive Addiction and Recovery Act (CARA), a dense piece of legislation that was written to address the most serious drug epidemic in our history. It stands to reason that you are also apprised of the fact that combating the opioid epidemic has proved challenging, for several reasons.

First, and perhaps the most important impediment to mitigating the devastating costs of the epidemic, is the reality that we live in world that is reliant on opioid painkillers for managing pain. Second, making it more difficult to acquire prescription opioids and failing to address a patient's reliance on said opioids, only has one logical outcome—finding your narcotics on the street often in the form of heroin. While treatment is widely considered to be the best method for lowering active opioid addiction rates, accessing effective addiction treatment services has been trying for many Americans. Which brings us to the third challenge, there are not enough treatment centers for the millions of Americans battling opioid addiction.

The goal of CARA is to provide everyone suffering from the disease of addiction access to proven, effective methods of addiction treatment. The legislation is sweeping, on top of increasing access to addiction treatment services, the bill addresses many different facets of the epidemic, such as:
  • Prevention
  • Recovery
  • Law Enforcement
  • Criminal Justice Reform
  • Overdose Reversal
Since the adoption of CARA, there have been a number of concerns raised over a lack of funding to pay for everything the bill proposes to accomplish. CARA only authorizes for $181 million each year, which many critics argue is not even close to enough. Which is why the American Academy of Family Physicians (AAFP), one of the largest medical organizations in the United States, wrote a letter to all members of the U.S. House and Senate, urging them to fully fund CARA, according to an organization press release.

"As legislators, you have heard the personal experiences of your constituents whose lives have been affected by opioid abuse," the organizations said in its letter. "As providers, we strongly urge Congress to ensure that existing and newly created programs have the necessary resources to meet the needs of patients and families struggling with opioid abuse disorders."

"We therefore urge you to provide the maximum possible allocation to fund not only the grant programs designated under the bipartisan Comprehensive Addiction and Recovery Act passed earlier this year, but to also substantially increase funding for much-needed prevention and treatment efforts for opioid misuse and abuse disorders."

Wednesday, November 23, 2016

Thanksgiving: Young Adults in Recovery

Thanksgiving Day is tomorrow, but for many the holiday begins at the close of business today. Many of us will be traveling through the night to be with our loved ones tomorrow afternoon for a good wholesome meal and to watch football on the television. If you are going to be on the road tonight we hope that you are aware of the fact that some people let loose the night before Thanksgiving, which is why the Wednesday before Thanksgiving is known as “Blackout Wednesday.”

Due to the fact that most businesses will be closed tomorrow, and college kids are back home for the first time since the beginning of the semester, there will be no shortage of imbibing this evening. And many of those who “binge drink” tonight, will think that they can safely operate a motor vehicle—despite the fact that they most certainly cannot. Believe it or not, the night before Thanksgiving is actually a bigger drinking night for some people, than other holidays typified by heavy alcohol use—such as St. Patty’s and New Year's Eve. If you can avoid being on the road tonight, please do.

Young people working a program of addiction recovery need to be extra careful when heading home for the holiday. There is a good chance you will be gathering with your friends from high school. Many of whom may not understand just how important your program is to you. They may even try to pressure you into having a few drinks, a pressure that you may find difficult to resist.

If you are not strong enough in your recovery to be in an environment comprised of people drinking a lot of alcohol, it is probably best that you do not attend. There is no shame in putting your recovery before your friends. In fact, making that kind of decision is a sign of progress, indicative of how far you have come that you would forgo your past for your future.

If you are coming home from school and plan to be there for a few days, it is a good idea to have a meeting schedule planned. It is important for you to stay connected with the program, even when you are traveling. Please remember that your disease follows you wherever you go. If you decide to take a break from meetings, it is an opportunity for old thinking and behavior to creep back in.

Cottonwood Tucson would like to commend everyone who is committed to keeping their program intact over the holiday and please do not forget that help is only a phone call away.

Tuesday, November 22, 2016

When Your Partner Has an Addiction

In the field of addiction medicine there is a clear link between trauma and substance use. People who experience traumatic events are far more likely to turn to drugs and alcohol to cope with their feelings. A traumatic event can take shape in a number of different ways, such as experiencing the loss of a loved one prematurely, sexual assault or witnessing a tragic event. While many who are exposed to uncomfortable stimuli can dust themselves off and just move forward, the same cannot be said for others who essentially relive the trauma over and over commonly referred to as post-traumatic stress disorder (PTSD).

When you read the bold letters, PTSD, you are likely to have images of war come to mind. The soldier who can’t stop trembling, or falls to the floor in response to a loud noise. However, PTSD is not a condition exclusive to service men and women. Those who are subject to any form of abuse, whether that be physical or visual, are eligible for developing symptoms of post-traumatic stress. Without treatment, the afflicted will struggle to function on a day to day basis; holding down a job or being a present and involved member of the family can prove to be a serious challenge.

An American family who has known no end to tragedy is the Kennedys. The list of horrific events that has befallen the United States first celebrity family is long, culminating with the assassinations of President John F. Kennedy and his younger brother Attorney General Robert F. Kennedy. Those two events affected everyone in the United States, people across the globe and most importantly the family left behind to pick up the pieces in the wake of tragedy.

One family member who struggled immensely with such loss is Christopher Kennedy Lawford, 61, who began a 17-year battle with addiction at the age of 13 to cope with the pain of the loss of his uncle Robert Kennedy, Lawford told the Palm Beach Daily News in an interview. As the entire nation grieved the loss of one Kennedy after another, no one really stopped to ask themselves, “are the kids alright?” Naturally, many of them were not!

“I grew up with PTSD [post traumatic stress disorder] in my family,” Lawford said. “No one ever acknowledged it. Nobody ever said ‘Get these kids some help. Two family members got their heads blown off and they have to live with that every day of their lives.'"

Lawford was not the only Kennedy who found themselves in the grips of addiction, his cousin David Kennedy died of a drug overdose in 1984, according to the interview. His other cousin Patrick Kennedy, the son of the late Ted Kennedy, struggled with addiction for many years. Both Patrick Kennedy and Lawford managed to eventually find recovery and dedicated their efforts to opening up the conversation about mental illness and addiction. Patrick Kennedy played a huge role in the passing of the Mental Health Parity and Addiction Equity Act (MHPAEA), and Christopher Kennedy Lawford has published several books about addiction and recovery, which we have written about in the past.

Lawford's latest book, co-authored with psychotherapist Beverly Engel is titled: When Your Partner Has an Addiction. Lawford points out that not everyone should stay with their addicted partner, “If it’s dangerous or you’re being abused, you shouldn’t be there.” On the other hand, not every relationship that involves a partner struggling with addiction is doomed.

When Your Partner Has an Addiction is essentially a how-to manual for people who want to stay with a partner who is active in their addiction. Engel says that their book is different than other books on the subject because “the focus on compassion, both having compassion for the person with the addiction and compassion for the partner, who is suffering also.”

Cottonwood Tucson offers a Family Program designed to address all family relationships. The goal of Family Program is to help families relearn behavioral interaction so that healthy behaviors become logical. Interpersonal change that can be sustained after treatment requires a movement from following direction (first order change) to internalizing new ways of interacting (second order change).  Families shift from obsessive worry and controlling behaviors to acknowledging that which is outside of their control and learn to focus on their own personal needs and boundaries.  They learn to detach from the pain, and not from the person.

Thursday, November 17, 2016

Surgeon General's First Addiction Report

It has been just over 50 years since the United States Surgeon General issued a report, highlighting the dangers of tobacco use. Back in 1964, the little research available indicated a direct link between cigarettes and cancer. The 1960’s was a time of change in America on several different levels, from “civil rights” to an escalating cold war. However, it was also a time of changing sentiments regarding drugs and alcohol, considering the rampant drug experimentation among both young adults and high school students.

In the ‘60’s, it was well understood among most doctors and medical professionals that smoking was deadly, yet Americans continued to smoke at super high rates because “big tobacco” spent hundreds of millions of dollars to convince the public that tobacco was perfectly safe. The unprecedented, 1964 Surgeon General’s report was arguably the beginning of the end for big tobacco's ability to pull the wool down over the eyes of Americans. The paradigm shift in thinking regarding cigarettes among Americans adults can clearly be seen, in 1965 nearly half of adults smoked (47 percent), per the Centers for Disease Control and Prevention (CDC). When you compare that number to 16.8 percent in 2014.

We are not out of the woods yet regarding the use of nicotine products, especially with the rise of electronic cigarettes. Yet, we should all marvel at what the Surgeon General's report led to IN the long run. Today, cigarettes and their close relatives (i.e. chewing tobacco) still cut the lives short of millions of Americans. Unfortunately, it is not talked about as much as it once was, being cast into the shadows of drug addiction—such as prescription opioids and heroin. Opioid addiction and complications painkiller use, leads to around hundred overdose deaths every day in the U.S.

Taking a page out of the smoking prevention book, U.S. Surgeon General Dr. Vivek Murthy issued the first-ever Surgeon General's report on addiction, according to Reuters. The report is one aspect of the Federal Government’s inter-agency effort to prevent, intervene and provide treatment for the millions of Americans battling with addiction.

"The most important thing is, we have to change attitudes towards addiction and get people into treatment," Murthy said in an interview. "Addiction is a disease of the brain," he added, "not a character flaw." 

We invite you to watch a national summit with the Surgeon General live, regarding the report:

If you are having trouble watching, please click here.
CARF - Commission on Accreditation of Rehabilitation FacilitiesNATSAP | National Association of Therapeutic Schools and ProgramsNBCCNAADAC