Wednesday, April 26, 2017

Opioid Use Disorder and General Healthcare

opioid use disorder
Abusing a drug of any kind carries certain inherent risks, firstly being addiction. Continued use for long periods of time wreaks havoc on both mind and body, severely impacting one’s quality of life and more times than not leading to premature death. But the outcome does not need to be a foregone conclusion, given that individuals can and do recover from alcohol and substance use disorder. And there is significant evidence that suggests that the earlier the intervention, the better the chance of achieving successful long term recovery.

However, it is important to point out that intervention early on does not necessarily mean that you will succeed at working a program of recovery on the first attempt. For some people, relapse is a part of their story leading up to an honest effort to adopt the principles of recovery, practicing these in all their affairs. In many cases, getting one’s foot in the door of a recovery program can lay the groundwork for eventually achieving long term recovery, and relapse should never be an excuse for giving up.

That being said, while some mind-altering substances take their toll over seemingly geologic periods of time, other drugs are not as forgiving. Being significantly riskier to abuse. Of late, opioids have taken the prize for deadliest narcotic. One only need scan major news outlets to learn of the death toll associated with abusing opioid painkillers and heroin. Being unbelievably addictive is just the tip of the iceberg when it comes to the dangers of this class of drugs. Beneath the surface, lies the risk of fatal overdose or contracting deadly diseases from intravenous (IV) drug use.

If you are reading this and are currently abusing opioids, we implore you to take such risks seriously. If you think it can’t happen to you, rest assured that those events have not occurred Y.E.T. — ‘You’re Eligible, Too.’


Early Intervention

Of late, efforts to better educate primary care doctors in spotting the signs of opioid use disorder (OUD) have been of the utmost concern. Nearly 100 people die from overdoses every day in the United States, many of whom died from abusing narcotics they received from their doctor. While it has become a little more difficult to sustain an addiction by way of one’s doctor alone, it does still occur and new research reaffirms the need for doctor/patient interventions.

Researchers at the University of California, Los Angeles (UCLA) found that nearly one-fifth of patients with opioid use disorder (OUD) in a large university healthcare system died during a four-year follow-up period, ScienceDaily reports. The findings highlight the fact that many physicians are not equipped to spot addiction and provide aid. The study was published in the Journal of Addiction Medicine.

Yih-Ing Hser, PhD, of University of California, Los Angeles, and colleagues identified 2,576 adult patients who met the criteria for OUD, according to the article. Four-years later, 465 of the identified patients had passed away, the average age of the patients when first diagnosed with OUD was 41. These deaths were not only attributable to overdose (19 percent) and infectious disease like hepatitis C, but one’s OUD likely complicated other health conditions and should be considered as contributing factors. The authors write:

"Further research is much needed to better engage the entire spectrum of healthcare services, with the goal of developing and delivering efficient and effective chronic care management approaches and services for OUD."


Getting Help Now

The longer you travel the road of the abuse, the more dependent you become. More of the drug is required to achieve the desired effect of treating pain (if present), avoiding physical withdrawal symptoms and euphoria. Increasing one’s dose exponentially increases one's risk of overdose. Even if your doctor has not identified you as having an opioid use disorder, if the aforementioned behavior sounds familiar to you—then it is likely you know what it means.

At Cottonwood Tucson we can help you break the cycle of addiction and address alternative forms of pain management. We will also provide you the tools needed to work a program of addiction recovery, giving you the ability to abstain from deadly opioid narcotics. Please contact us today to begin the life-saving experience of recovery.

Friday, April 21, 2017

Addiction Treatment's Debt to Science

addiction treatment
The western world has undergone dramatic, revolutionary changes regarding drugs and addiction—specifically by way of placing greater emphasis on treating addiction rather than imprisoning those whose only real crime was developing this debilitating mental health disorder. In the United States, we have seen the damage done by draconian drug policies that disproportionately affect the lives of the impoverished and ethnic minorities. And while lawmakers on both sides of the political landscape have become more enlightened about addiction, there is much more work to be done to end mandatory minimum sentences and ensuring that everyone who needs addiction treatment has access.

It is abundantly clear that we owe the paradigm shift in thinking, in respect to addiction, to science. Even though there is much more to learn about substance abuse and the brain, science irrefutably shows that the disease is not a lack of moral fiber or willpower. Rather, it is a form of mental illness that can be treated, provided however that the afflicted are given the chance to recover and society exercises compassion as opposed to ostracization.

Given the fact that millions of this nation's citizens have experienced first-hand the weight of addiction, it stands to reason that exponentially more people have watched their loved ones fall into the depths of despair due to this incurable disease. Yet, society struggles to view people dying from active addiction as they would someone with another potentially fatal health disorder. Which is why it's paramount for scientist to continue their important work of uncovering the nature of addiction, so that everyone can understand more clearly that the condition is not a choice. Naturally, for researchers to continue their ever-important work, funding is required.


Drug Policy Alliance

Tomorrow, tens of thousands of Americans around the country plan to March for Science, with the expressed goal of communicating that science is a pillar of human freedom and prosperity. Calling for “science that upholds the common good and for political leaders and policy makers to enact evidence based policies in the public interest.”

Among the many marchers will be researchers and supporters of the Drug Policy Alliance (DPA), the nation's leading organization promoting drug policies that are grounded in science, compassion, health and human rights. The organization has been one of the biggest opponents of the American “war on drugs” and understands that science is the greatest weapon against the pernicious stigma of addiction and other forms of mental illness that that still exists. Jules Netherland, director of the Office of Academic Engagement at the Drug Policy Alliance, and Sheila Vakharia, an assistant professor at Long Island University, write:

“We know better, and we must do better. Scholars who work in drug policy and all those who care about effective, evidence-base drug policy cannot stand by and watch all the progress we’ve made be undermined. Too much is at stake… It’s time to turn from the misinformation, fear, and stigma that too often drive drug policy and insist on approaches that ground our policies in science and compassion.”


Addiction Treatment Rooted In Science

It cannot be stressed enough just how important advances in science have been to the field of addiction medicine. Researchers have developed medications and studied various modalities, to ensure that addiction treatment is rooted in evidence-based methods. Thanks to tireless research, addiction treatment providers can give patients and clients the best chance at achieving long-term recovery.

At Cottonwood Tucson, we employ the use of evidence-based methods of therapy in conjunction with holistic behavioral health treatment. Our center is a clinical and academic partner of the University of Arizona School of Medicine - Department of Psychiatry. We utilize state-of-the-art whole person addiction treatment and have been helping people recover from both addiction and co-occurring behavioral health conditions for more than 25 years.

If you, or a loved one has been touched by the disease of addiction, please reach out to us for help today.

Wednesday, April 19, 2017

Factoring PTSD Into Discharge Decisions

Some months ago, we covered a topic that many readers may have found disturbing. It dealt with the military and what is known as “bad paper.” That is, being discharged from the military under less than favorable circumstances, or dishonorable discharge. At the time, upwards of 10 percent of post-9/11 veterans were found to have received dishonorable discharges—without the various branches of the military taking into consideration conditions like traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD).

The irony of this observed trend is that people who are given bad paper lose their Veterans Affairs (VA) benefits, which people with honorable discharges have access to—such as primary and psychiatric care services. The very conditions that had gone untreated, symptoms of which likely had a role in the event that led to a dishonorable discharge, would likely remain untreated afterwards for having lost one's benefits. In many of these cases, losing your job in the armed services could be tantamount to a death sentence given that people with untreated mental health conditions often turn to substance abuse and/or suicide to cope with mental illness.


Factoring PTSD Into Discharge Status

Anyone who makes the decision to serve in the military should be considered courageous, even if they never see combat. It is vital that the military acknowledge the sacrifice of young service men and women. Sacrifice does always take the form of physical wounds. Quite often, it is the wounds that cannot be seen that do the most damage...psychiatric responses to witnessing the lurid horrors of war.

As long as there has been armed conflict, there has been PTSD. And one would think that the various branches of the military would be acutely aware of the correlation between war and post-traumatic stress. Considering the disturbing bad paper trend, the Yale Law School Veterans Legal Services Clinic has filed a lawsuit against the U.S. Army, alleging the U.S. Army potentially gave thousands of less-than-honorable discharges without considering mental health conditions, The New York Times reports. The attorneys who filed the suit are hoping to obtain class-action status.

The lawsuit is directed at the review boards responsible for hearing veterans who would like to argue against the status of their discharge, according to the article. One such veteran and plaintiff in the lawsuit, Steve Kennedy, fought in Iraq in 2007 and 2008. He was diagnosed with depression by the Army, but was given bad paper for going AWOL to attend his wedding. At a later time, the VA diagnosed Kennedy with PTSD, but he was not eligible for benefits because of his discharge status. The suit alleges that his mental health was not considered a factor in his discharge status. Kennedy is one of two plaintiffs in the suit.

"As my PTSD became impossible to manage on my own, my commander told me that the only way I could receive treatment was by leaving the Army with a bad paper discharge," said Kennedy. "Just like that, the Army wiped away years of distinguished service to my country and deemed it less than Honorable."

PTSD and Depression Treatment

We will continue to follow this important lawsuit. Steve Kennedy’s case does not appear to be unique in the military. Nor his condition. His untreated mental illness led to alcohol abuse and self-injury (cutting himself). Thousands of men and women with untreated conditions like PTSD and depression, turn to drugs and alcohol to manage their symptoms. The substance use often leads to addiction. It has the unintended effect of exacerbating the symptoms that led to the use in the first place.

If you are struggling with a mental health disorder, or addiction with a co-occurring mental illness—please contact Cottonwood Tucson. We specialize in treating addiction and mood disorders concurrently. A failure to address the whole patient can have drastic consequences, preventing recovery.

Friday, April 14, 2017

Older Women Are Binge Drinking More

binge drinking
Alcohol use education and prevention is almost always geared towards teenagers and young adults, populations that are believed to be at the greatest risk of harm from using the pervasive substance. Young people tend to think that they are invincible, that they can handle situations that they likely cannot. While there is plenty of evidence to support the idea that the younger one is when they start drinking the greater the likelihood of them developing an alcohol use disorder in the future, the immediate dangers of alcohol use among young people include having one’s life cut short. For instance, alcohol poisoning and alcohol-related traffic fatalities.

Equipping young men and women with the facts about alcohol is of the utmost importance, having the power to impact the relationship that young people develop with the substance early on, in order to mitigate the risk of problems later in life. The risks of forming an unhealthy relationship with alcohol go beyond just developing an alcohol use disorder, the list of alcohol related health problems that can arise from even moderate drinking is long.

Both educators and parents have a duty to shatter the myths about alcohol use, lest they [young people] formulate deleterious perceptions about alcohol that will follow them for the rest of their lives. Efforts should be equally directed at males and females, even though factually women have historically drank at lower rates in smaller amounts. Researchers have determined that while women may drink less than men, the substance affects females in different ways and smaller amounts can do damage comparable to that of males who drink more. Especially in people's “golden years.”


Binge Drinking Baby Boomers

The causes are not easily explained away, but the evidence is clear. Older women are drinking far more often and in exceedingly unhealthy ways. A trend occurring even among women who didn’t drink much in their middle years. As “baby boomers” reach and settle into retirement, there is significant interest in how they are filling their time—particularly regarding alcohol or substance use and abuse. While drinking rates and unhealthy consumption behaviors among older men have remained relatively consistent for more than a decade, far from the same can be said about that of women.

There is a growing body of evidence indicating that not only are older women drinking more than women of generations past, more older women are “binge drinking” (4 drinks for women in about 2 hours). A new study found that the average prevalence of binge drinking remained stable from 1997 to 2014 with men, but binge drinking increased an average of nearly 4 percent per annum among women, HealthDay reports. Study author Rosalind Breslow, an epidemiologist at the U.S. National Institute on Alcohol Abuse and Alcoholism, and colleagues found that binge drinking among women has risen dramatically, at a far greater rate than older males. The findings were published in the journal Alcoholism: Clinical and Experimental Research.

"We know that, overall, women are more sensitive to the negative health consequences of alcohol than men," said Dr. J.C. Garbutt, medical director of the University of North Carolina Alcohol and Substance Abuse Program, in Chapel Hill. "These consequences include liver disease, high blood pressure, stroke, heart disease and cognitive impairment -- serious problems -- and addiction to alcohol is possible as well."

Dr. Garbut points out that the reasons for the dramatic increase in unhealthy drinking behaviors among older women is not currently understood, according to the article. While he cautions against conjecture, he says that cultural factors likely have a role, including:
  • Greater Acceptance for Women to Drink
  • Family Structural Changes
  • Greater Access


Never Too Old To Recover

Engaging in regular, heavy drinking at any age can be extremely harmful to one’s health. It is a pattern that often leads to alcohol use disorder and several other negative health effects. However, the effects of alcohol on older adults are far more insidious. Fortunately help is available. If you or a loved one is struggling with alcoholism, please contact Cottonwood Tucson. There is never a “too soon” when it comes to beginning the journey of recovery. But unfortunately, there is such a thing as “too late.” Far more people perish prematurely from alcohol-related illnesses, than from that of drug overdoses. When it comes to addiction, time is not an ally.

Wednesday, April 12, 2017

PDMPs: Mandatory Physician Registration

There are tools available that can save people’s life, even if those people do not yet know that their lives require saving. Over what has now been nearly two decades, prescription opioid painkillers have become one the nation's biggest causes of premature death. While such medications are necessary in certain instances, they are prescribed far too often in amounts that can have fatal results. It does not take much more than a prescribed dose to experience a potentially fatal overdose.

In recent years, there has been much talk about finding ways to limit people's exposure and reliance on opioids for all things pain. Given that it is not uncommon for prescriptions painkillers to be written for the treatment of even moderate pain, discomfort that could likely be treated with opioid alternatives, there is a dire need for altering the societal mindset that says oxycodone and hydrocodone is the answer.

What often starts as pain management, quickly morphs into opioid dependence and addiction. Given that doctors will only prescribe a certain amount of a narcotic at a time, some patients will visit multiple doctors to get more of the same kind of drug. It is a practice that is referred to as “doctor shopping” and it can be deadly. But, it is also a practice that can easily be prevented.


Prescription Drug Monitoring Programs

In practically every state, there is a some version of a prescription drug monitoring program (PDMP). These are databases which allow doctors to more easily identify patients who may be struggling with opioid use disorder. You may think that doctors would be gung-ho about utilizing such a tool, given that PDMPs have the power to help medical professionals intervene and help patients. Unfortunately, most doctors are not utilizing such programs and that may be because they are not required to use the potentially life-saving tools.

A study conducted by researchers John Hopkins University published in 2015 in the journal Health Affairs, found that only about half of the prescribing doctors questioned admitted to using PDMPs. The low record of usage comes even though 72 percent of doctors indicated they were aware that there was a PDMP in their state. As a result, there was a clear need to encourage use, by not only emphasizing its value, but by making it easier to use. One such barrier being that PDMPs from state to state are not linked, allowing patients to cross state lines to avoid detection.

While there have been some logistical hiccups with monitoring programs, there are still some doctors who have been reticent to use them, for their own personal reasons. Which may have the unintended effect of hurting patients.


Mandatory PDMP Use

So, preventing doctor shopping can save lives, maybe PDMPs use should be required. Research published in Health Affairs showed that mandating that physicians register in their state's’ PDMP resulted in an almost 10 percent drop in prescriptions written for the most potent opioid painkillers, Philly reports. Both New Jersey and Pennsylvania require physicians to register with the state database. Interestingly, the researchers found that registration was just as effective as actually requiring that doctors check the database before prescribing. The researchers speculate that it may be the result of registration leading to awareness.

The researchers wrote that requiring registration "might have further raised prescribers’ awareness of misuse and abuse of controlled substances among their patients, leading to subsequent changes in prescribing practices."

It is worth noting that physician organizations have been vocally against laws requiring doctors to register and use PDMPs. A trend that will hopefully change, sooner rather than later. The stakes are enormously high, and while PDMPs are not perfect and could use revision, making such programs more effective requires the medical community, as a whole, being committed to affecting change.
CARF - Commission on Accreditation of Rehabilitation FacilitiesNATSAP | National Association of Therapeutic Schools and ProgramsNBCCNAADAC