Friday, October 17, 2014

Looking Through Google Glass™ ~ Internet Addiction Disorder

Checking-in for addiction treatment...

Checking-in for addiction treatment and/or co-occurring disorders is often a shock to one's system.
The day for check-in frequently occurs after coming to terms with oneself, family members and/or employer that now is the time to get sober and deal with any other mental health issues that may yet to be discovered.

The patient always has questions about "what can I expect when I check-in," like:
  • Will I have roommates?
  • How long will detox/withdrawal take?
  • Is smoking allowed?
  • Can I bring my laptop or tablet?
  • Can I have visitors?
  • Can I make phone calls?
  • Can I check my email?
  • Can I bring my cellphone or smartphone?
Of course, as our world of hardware and software technology advances most treatment centers' admissions teams continually reevaluate the list of what a patient can and cannot bring with them and what restrictions will be placed on access to devices which allow using the internet while in treatment. 

U.S. Navy's Substance Abuse and Recovery Program (SARP) has requirements, too

The U.S. Navy's SARP unit requires that all patients admitting for treatment must abstain from alcohol, drugs, and cigarettes; additionally, all electronic devices are surrendered for the length of the 35 day program. And so it was, in September 2013 when a 31 year old serviceman checked-in for alcoholism treatment.

Soon the doctors treating this young man realized that he was exhibiting withdrawal symptoms that were worse than his withdrawal from alcohol. reports that one of the electronic devices surrendered by the patient was his Google Glass. He explained to the doctors that he had been wearing the glasses for 18 per day for the two months prior to his admittance. The following are the withdrawal symptoms noted in this case:
  • frustration and irritability 
  • involuntary movements to the temple area; involuntary tapping of temple with forefinger, especially when asked questions
  • short-term memory problems 
  • trouble focusing; unclear thought processes
  • viewing dreams as if through the device's gray window

U.S. Navy team identifies first known case of "internet addiction disorder" (IAD)

Dr. Andrew Doan of the Naval Medical Center San Diego's Department of Mental Health and Department of Ophthalmology co-authored a study of this case. The research results were published on-line September 26, 2014, and will appear in the February 2015 issue of Addictive Behaviors: Internet addiction disorder and problematic use of Google Glass™ in patient treated at a residential substance abuse treatment program.

The treatment team concluded:
Over the course of his 35-day residential treatment, the patient noted a reduction in irritability, reduction in motor movements to his temple to turn on the device, and improvements in his short-term memory and clarity of thought processes. He continued to intermittently experience dreams as if looking through the device. To our knowledge, this is the first reported case of IAD involving problematic use of Google Glass™.

Going forward...

This is an interesting paper that sheds real time light on understanding internet addiction disorder. Newsweek contributes the following observations:
Internet addiction is commonly linked with cellphones, laptops and personal computers. This is the first reported case involving Google Glass. Though it is a growing problem, Internet addiction does not appear in the Diagnostic and Statistical Manual of Mental Disorders, a book of standard criteria for the classification of mental disorders. Instead, it is included in the appendix as a disorder that requires further study. While some psychiatrists believe it can be a primary problem, others maintain that it is merely a symptom of other psychological issues.
IAD: A disorder that requires further study...

Wednesday, October 15, 2014

Study: Examines Stress, Rumination and Depression

How often do you reminisce about your adolescent years? 

The word "reminisce" infers a pleasant experience. Don't you think? Consider meeting with childhood friends, paging through scrapbooks, attending a family reunion...or just daydreaming about days gone by. We might recall great teachers, school plays, dances, sporting events, and graduations. But for as many wonderful memories one might have about their adolescent years, there can be and often are just as many stressful memories.

For women remembering the adolescent years they may recall being bullied, suffering from acne, struggling with grades, experiencing problems with their menstrual cycle, fretting about socializing with the opposite sex, determining their sexual orientation...the list goes on.

Men, too, may recall stressful memories regarding their adolescent years dealing with bullying, team sports, physical issues like weight, facial hair, voice change or acne, dating relationships, sexual orientation...again, the list goes on.

So does stress experienced in adolescence have long term affects?

Researchers at Temple University in Philadelphia, PA, asked this question.  Their research was published online this month in the Clinical Psychological Science Journal: Stress and the Development of Cognitive Vulnerabilities to Depression Explain Sex Differences in Depressive Symptoms During Adolescence.  The lead author was Jessica Hamilton of Temple University. They conducted what is referred to as a multi-wave study with the following parameters:
  • 382 boys and girls participated
  • the adolescents completed initial evaluations of their cognitive vulnerabilities and their depressive symptoms
  • Each received a three follow-up assessments with each were spaced seven months apart

Study's findings...

As reported by PsychCentral:

  • As expected, teens who reported higher levels of interpersonal dependent stress showed higher levels of negative cognitive style and rumination at later assessments. 
  • This finding was confirmed even after the researchers took initial levels of cognitive vulnerabilities, depressive symptoms, and sex into account. 
  • Girls tended to show more depressive symptoms at follow-up assessments than did boys — while boys’ symptoms seemed to decline from the initial assessment to follow-up, girls’ symptoms did not. 
  • Researchers also discovered that girls were exposed to a greater number of interpersonal dependent stressors over time. 
  • Investigators believe this observation shows that it is this exposure to stressors that maintained girls’ higher levels of rumination and, thus, their risk for depression over time. The researchers emphasize that the link is not driven by reactivity to stress; girls were not any more reactive to the stressors that they experienced than were boys. 

Some closing thoughts...

For sure growing up in today's world brings many challenges, even when children are being raised in a stable and healthy family unit. Family life can be complicated by health issues, divorce, and parent's jobs or lack of same. Stress is part of life, both interpersonal dependent stress as well as non-dependent interpersonal stress.

This study goes a long way in starting a conversation so that young people can learn how to deal with stress and ruminate less. This is particularly important for teen-age girls.  Additionally Jessica Hamilton explained to PsychCentral: “Parents, educators, and clinicians should understand that girls’ greater exposure to interpersonal stressors places them at risk for vulnerability to depression and ultimately, depression itself."

Friday, October 10, 2014

#14Days On The Wagon...You In?

Logo of CBS News
Logo of CBS News (Photo credit: Wikipedia)

Are you participating in #14Days on the Wagon

CBS News' #14Days project actually started on Monday, October 6, 2014. So today is #day5. Have you heard about this project? We came across it last evening and it started us thinking about #14days and what it can mean to the average person.

For the record, #14days is equal to two weeks, 336 hours and 20,160 minutes. Seems like a long time, right? But really only if you are trying to NOT do something for #14days or trying to WAIT in anticipation of something happening in #14days: Like giving birth, hearing about your SATs or your BAR exam, waiting for the school year to end, anticipating going off to college, starting a new job, leaving an old job, coming home from war, voting for the first time, starting a vacation.

The truth is life is a waiting maybe #14days isn't really so long!

CBS News announced #14Days on the wagon on October 1, 2014

Throughout the #14Days CBS is publishing advice and inspiration from leading experts on addition, recovery, health and wellness.  Here is part of their announcement...
CBS News invites you to join the movement by "going on the wagon," meaning ditching alcohol and any non-medically necessary drugs for two weeks. In cutting these substances out of our lives for 14 days, we are supporting our own health and wellbeing as well as showing solidarity with friends and loved ones in recovery.

It's our hope that becoming more conscious of our own habits will allow us to develop more compassion for those struggling with the disease of addiction -- a disease that contributes to the deaths of more than 90,000 Americans each year.

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

Some thoughts about Cottonwood's family program

Have you ever attended a family program when your loved one has gone through treatment for addiction?  If so, you might remember wondering quietly or even asking the question out loud: "Since my loved one needs to abstain, does this mean the whole family should abstain from drinking alcohol?"

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.

Family program counselors will suggest that family members avoid having alcohol in the home and from partaking of alcohol when their recovering family member is present. This change starts slowly, but before you know it #14days goes by, then a month or two, and before you know it you have changed your own behaviors and everyone in the family is feeling healthier. 

Share your own stories...

It is easy to share your story...use the hashtag #14days in your Twitter messages, your Istagram photos, and even find it on FACEBOOK.  Be part of the conversation...

Wednesday, October 8, 2014

Mental Illness Awareness Week - It's Time To Get Involved

Mental Illness Awareness Week - October 5 - 11, 2014

Yes, it's true...once again it's time to get involved. It is time to realize that 1 in 4 American Adults and 1 in 5 children will experience mental illness this year. Think about it this way, if you are an adult sitting in a room with three complete strangers, then you can be assured that one of the four of you will experience a mental illness this year!

Since 1979 the National Alliance on Mental Illness (NAMI) has existed with the following mission: NAMI is a grassroots organization of individuals with mental illnesses, especially serious mental illnesses, their family members, and friends whose mission is to advocate for effective prevention, diagnosis, treatment, support, research and recovery that improves the quality of life of persons of all ages who are affected by mental illnesses.  

It was in 1990 that our U.S. Congress set the first full week of October as Mental Illness Awareness Week (MIAW). Establishing this week was a way to recognize the work being done by NAMI to raise awareness of mental illness. NAMI is also actively involved in Mental Health Month (MHM) which is in May.

If you are looking for ways to participate in MIAW Week you can visit this page on NAMI's website to get a lot of great ideas, including updating your FACEBOOK page.

How aware are you of mental illness?

You might think this an odd question, but it is important to realize that many of us can be oblivious to others' mental health and behavioral health issues. We tend to get so busy with our own lives that we look beyond another fellow human being's suffering. It might be easier for us to take note if someone is suffering from the disease of addiction, particularly alcoholism, than it is to see mental illness.

New research asks simple questions...

This past week the results of new research were published online in the journal of Psychiatric Services: Stigma, Discrimination, Treatment Effectiveness, and Policy: Public Views About Drug Addiction and Mental Illness. 

This study was conducted at the Johns Hopkins Bloomberg School of Public Health and was led by Colleen L. Barry, Ph.D., an associate professor in the Department of Health Policy and Management. The goal was to compare public attitudes about mental illness and drug addiction.

The researchers asked 709 adults to complete an on-line survey between October 30, 2013 and December 2, 2013. The survey asked questions about stigma, discrimination, public policy and treatment.

Study's findings...

According to the HUB ( News from Johns Hopkins) article:

  • Not only did they find that respondents had significantly more negative opinions about those with drug addiction than those with mental illness, the researchers found much higher levels of public opposition to policies that might help drug addicts in their recovery. 
  • Only 22 percent of respondents said they would be willing to work closely on a job with a person with drug addiction compared to 62 percent who said they would be willing to work with someone with mental illness. 
  • Sixty-four percent said that employers should be able to deny employment to people with a drug addiction compared to 25 percent with a mental illness. 
  • Forty-three percent were opposed to giving individuals addicted to drugs equivalent health insurance benefits to those afforded the public at-large, while only 21 percent were opposed to giving the same benefits to those with mental illness. 
  • Respondents agreed on one question: Roughly three in 10 believe that recovery from either mental illness or drug addiction is impossible.

Some closing thoughts...

It would seem after reading the results of this survey that NAMI is having success in educating the public about mental illness. Now in its 24th year Mental Illness Awareness Week must be having some impact, as well as Mental Health Month.

It is important for people to understand that both mental illness and addiction are treatable health conditions. A discussion surrounding this study would be a good conversation to have.

Friday, October 3, 2014

Heroin Deaths Double ~ It's A Volatile Situation

English: A view of the Centers for Disease Con...
English: A view of the Centers for Disease Control and Prevention. (Photo credit: Wikipedia)

So many dreams, so many requiems...

This week there was grim news being reported by the Centers for Disease Control (CDC). For sure the headlines are exploding with news about the Ebola virus and Enterovirus D68, but on October 2, 2014, another item caught our attention.

Here is the CDC's headline: Heroin overdose deaths increased in many states through 2012. This report was part of their October 3, 2014 Morbidity and Mortality Weekly Report (MMWR).

Increases in Heroin Overdose Deaths - 28 States, 2010 to 2012

While there were many authors/researchers involved in this research, the corresponding author is Len J. Paulozzi, M.D. who works for the Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. This study began in February 2014 when state health departments were invited to submit data from their mortality files from 2008-2012. You can read the report here or download and print a PDF copy of the full report here.

Study's parameters

  • 28 states participated in the study
  • The 28 states sampled represent more than half (56%) of the United States population
  • These states account for more than one-half of the country's drug overdose deaths
  • Examined death certificates with death resulting from heroin overdose from 2012 and compared these rates from 2010

Study's findings as reported in the CDC's press release

  • From 2010-2012, the overall heroin death rate across the 28 states doubled. 
  • The sharp heroin overdose increase extends the trend observed in the 2011 national mortality data. 
  • Five states had increases in prescription opioid death rates, seven states had decreases, and sixteen states had no change. 
  • Of the 18 states with reliable heroin overdose death rates examined individually in this study, 15 had statistically significant increases in heroin death rates. 
  • No state had a decrease in the heroin death rate. 
  • The increases in state heroin death rates from 2010-2012 were associated with increases in prescription opioid death rates. 
Actual numbers may be even more insightful: The death rate doubled to a rate of 2.1 deaths per 100,000, which accounted for an increase to 3,665 in 2012 deaths up from 1,779 in 2010.  There were increases in both men and women, in every age group, and among whites, Hispanics and blacks.

According to the CDC's report:
Though not directly addressed by this study, two things appear to be driving the increase in heroin overdoses: (1) widespread prescription opioid exposure and increasing rates of opioid addiction; and (2) increased heroin supply. While the majority of prescription opioid users do not become heroin users, previous research found that approximately 3 out of 4 new heroin users report having abused prescription opioids prior to using heroin. This relationship between prescription opioid abuse and heroin is not surprising; heroin is an opioid, and both drugs act on the same receptors in the brain to produce similar effects. Heroin often costs less than prescription opioids and is increasingly available.

Some final thoughts...

Actually, Dr. Paulozzi offered to the Associated Press when asked about the future - "It's a volatile situation." This we know for sure, everyday more families are impacted by heroin addiction. Most parents have the same reaction of disbelief, unimaginable that their son or daughter would even think of trying heroin. We've talked about the unsupervised medicine cabinets; we've written about celebrities dying from heroin overdoses, like Philip Seymour Hoffman and Cory Monteith. Each of these posts focused in on the heroin epidemic. And still, the families are always just can't be real.

Requiem for a Dream
Requiem for a Dream (Photo credit: Wikipedia)
Today we thought back to 2000 when Darren Aronofsky directed the stellar cast of Ellen Burstyn, Jared Leto, Jennifer Connelly and Marlon Wayens in Requiem for a Dream. The words of critic Roger Ebert still come to mind:
What is fascinating about "Requiem for a Dream," the new film by Darren Aronofsky, is how well he portrays the mental states of his addicts. When they use, a window opens briefly into a world where everything is right. Then it slides shut, and life reduces itself to a search for the money and drugs to open it again. Nothing else is remotely as interesting...The movie was given the worthless NC-17 rating by the MPAA; rejecting it, Artisan Entertainment is asking theaters to enforce an adults-only policy. I can think of an exception: Anyone under 17 who is thinking of experimenting with drugs might want to see this movie, which plays like a travelogue of hell.

At Cottonwood Tucson, the treatment of opiate addiction usually starts with medically-managed detoxification. Our doctors prescribe medications that help the patient safely negotiate the opiate withdrawal process. Our counseling staff then focuses on helping the opiate addicted patient find more adaptive ways of managing emotional pain, anxiety and an often-present sense of boredom, restlessness and dis-ease. Mind/body therapies can help our opiate addicted patients become more aware of how and where in their body they carry these feelings.

It is also sometimes necessary to address issues relating to the addict identity and lifestyle. Addictions to substances like opiates and prescription drugs often exist in tandem with co-occurring mood disorders like anxiety and depression, or with other addictions.