Monday, November 26, 2012

Time Viewpoint: Are Doctors to Blame for Prescription-Drug Abuse?


Viewpoint: Are Doctors to Blame for Prescription-Drug Abuse?

Image: Doctor handing a prescription to a patient
JAMIE GRILL / GETTY IMAGES
Prescription painkillers are creating a massive public-health crisis. Since 1990, deaths from unintentional drug overdoses in the U.S. have increased by over 500%. Most of this rise can be attributed to prescription painkillers, which now kill more people more than heroin or cocaine combined. Where are all these pills coming from? Not Mexico. Not all from those “Florida pill mills.” Much of those pills are coming from prescriptions generated by doctors like us who are seeking to help our patients with real pain. It’s true: conscientious and well-trained doctors are partially to blame for the rapidly rising death rate among thousands of Americans every year from prescription pills.
The backstory goes like this: in the 1980s and ’90s, the medical community recognized that patients in pain were often undertreated. Oligoanalgesia, the scientific term for undertreatment of pain, rightly concerned a lot of people. Studies showed that doctors didn’t do a good job asking about pain or treating it properly when they did identify it. Worse, there were documented disparities in pain treatment — affluent white patients were much more likely to get their pain addressed compared with poor or minority patients.
In response, there was a major effort to redress this oversight. Doctors were encouraged to think about pain severity on a self-reported numerical score as the “fifth vital sign” (in the same league as blood pressure and body temperature). Next, medical students and trainees were instructed that patients could never become dependent on narcotics if prescribed for legitimate pain (we both remember being taught this myth). Last, opioid pain medications like oxycodone and hydrocodone (the active ingredient in Percocet and Vicodin, and Lortabs respectively) were framed as safer alternatives to nonsteroidal anti-inflammatory drugs, or NSAIDs — like ibuprofen, naproxen and Vioxx — which could trigger peptic ulcers or cardiac conditions. Some of this push toward opioids was driven by the drug companies that made them. And, some of it was driven by patient pain-advocacy groups (many with opaque ties to these drug companies) and medical societies seeking to boost treatment for patients with debilitating pain.
Unfortunately, we went too far in the wrong direction. Between 1999 and 2010, the amount of opioid narcotics prescribed by American doctors tripled. The numbers for kids are just as worrying: narcotic prescriptions have doubled for children since the 1990s. Let’s try to put these numbers in context: in 2011, enough hydrocodone (the narcotic medication in Vicodin) was prescribed to medicate every American around the clock for a month.
Beyond the increase in prescriptions, doctors are more likely than ever to diagnose patients with chronic-pain syndromes. The Institute of Medicine estimates that 100 million Americans have chronic pain. That would mean that almost 1 in 2 people have chronic pain if you exclude children.
It’s hard to know what has changed so drastically to drive these massive numbers, either on the diagnosis side or the treatment side. But one thing we do know is that chronic pain almost always starts as acute pain, usually from an injury or surgery. Many of these patients are given opioid prescriptions, but their pain persists — possibly from hyperalgesia, a hypersensitivity to new pain caused by those very opioid prescriptions. Between tolerance and hyperalgesia, patients often need escalating doses of opioids just to feel pain-free. Higher doses of painkillers may disturb breathing patterns in sleep and the additional use of sleeping medications or alcohol can be lethal. This is at least partly why we are seeing so many prescription-medication deaths.
Medical guidelines already state that doctors shouldn’t be choosing opioids for most patients with chronic pain. But we doctors also need to start scaling back on prescribing opioids for acute pain, since some acute pain turns into chronic pain. Everyone with new pain should be started on a high dose of ibuprofen (like Motrin or Advil) or acetaminophen (like Tylenol). These medications have been proved to work as well as the opioids even for conditions like gall-stone attacks. For some patients, we can add a prescription for a limited number of opioid pills to be filled only if absolutely necessary. With that small prescription should come abig warning. Something like: “These drugs are highly addictive, even in short-term use. These drugs have been associated with death, even in therapeutic dosing. These drugs, when accidentally ingested by children, are fatal.” As doctors, we must stop fearing patient-satisfaction surveys and talk honestly to our patients about pain. It may take an extra few minutes, but it will save lives.


Read more: http://ideas.time.com/2012/11/26/viewpoint-prescription-drug-abuse-is-fueled-by-doctors/#ixzz2DLxic6j0

Thursday, November 15, 2012

4 Benefits of Helping an Addict into Treatment



Helping someone into treatment for addiction is a gift that yields a lifetime of returns for the individual struggling with chemical dependency, but its benefits extend much further than that. Loved ones, typically driven by unselfish motives to help turn the addict’s life around, also stand to benefit in very personal ways:

Improved Quality of Life

Living with an addict is traumatic and life-altering in ways only affected loved ones can fully understand. Everyone in direct contact gets swallowed up by the addiction. Once a respite from the outside world, the home becomes a battlefield where trust and honesty are replaced with worry, resentment and a constant state of alert. Rates of domestic violence and mental illness go up. Daily life becomes unworkable.
Treatment improves quality of life not only for the addict, but also for the people who live with and care for them. In a study from the Central Institute of Mental Health (CIMH) in Mannheim, Germany, loved ones reported significant improvements in quality of life scores (from 60.6 to 68 on a 100-point scale) after the addict completed inpatient or outpatient treatment. These changes impacted not only their social relationships and living environment but also their own mental and physical health.

Reduced Economic Burden

Maintaining a drug or alcohol addiction is expensive. Since many addicts lose their jobs, homes and earning power, the costs of both the illness and the treatment often fall on loved ones.
Although treatment requires a substantial investment of time and money, the burden on the family budget lifts and the benefits continue to accrue over time. In the CIMH study, direct alcohol-related expenses dropped from 20 percent of the family’s total pretax income to just 4 percent one year after starting treatment. Spending on alcohol, cigarettes and other nonmedical expenses went from an average of $868 per month to $186 per month.

Less Time Spent Caring for the Addict

When a loved one is struggling with addiction, family members often form a web of protection around them. Sometimes this enables the addiction; sometimes it helps the addict understand the consequences of their actions and accept the need for treatment. In either case, instead of focusing on their own goals and desires, family members rally around the addict – a process that can zap the entire family system of its ability to function normally.
Treatment teaches addicts to take care of themselves, freeing the family to reinvest in their own lives – not just for those few weeks or months of rehab, but also long after the addict leaves treatment. In the CIMH study, time spent caring for and supervising the addict dropped from an average of 32 hours per month to just eight hours per month following treatment.

Treatment Is a Win-Win

A number of treatment centers provide counseling for the family members of the addict. Family programs encourage loved ones to explore their own feelings of anger, disappointment and guilt, develop more effective ways to communicate, and establish a support system they can lean on to ensure their own needs are being met. The changes that take place in the addict are mirrored in the family dynamics, resulting in improved relationships and a healthier environment at home, along with personal growth for all.
As addiction is a “family disease,” research shows recovery is greatly enhanced when the family gets involved. While taking further steps to help the addict may seem like too much to ask at a time when frustrations and resentments run high, the decision to get help for the addict is as much for the health and well-being of the family as it is for addicts themselves.
, M.D., is board certified in addiction psychiatry and addiction medicine.  Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology.  He currently serves as CEO  of Elements Behavioral Health, a network of addiction treatment centers that includes California drug rehab Promises, The Ranch in Tennessee, The Recovery Place rehab in Florida, and Texas drug rehabs Right Step and  Spirit Lodge.

Wednesday, November 14, 2012

Hopeful Drug Addiction Solution Pill Vigabatrin, Fails Trial Study


Hopeful Drug Addiction Solution Pill Vigabatrin, Fails Trial Study

Vigabatrin a proposed drug addiction “solution" for cocaine and methamphetamine dependence fails to provide results when recently tested. St Jude Retreat's theory on replacement therapy drugs stands correct.

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Addiction Solution Drug Fails Trial Study
Quote startThere is no data that supports long term replacement therapy maintenance is necessary or helpful; yet there is an abundance of data to support that it is actually harmful.Quote end
Amsterdam, NY (PRWEB) November 14, 2012
According to a trial study released by Catalyst Pharmaceutical Partners, after being tested, treatment by vigabatrin was lackluster and did not lead to a "significant amount of cocaine free subjects." The St Jude Program, offered at the St. Jude Retreats, a leading non-treatment alterative to drug treatment, does not adhere to replacement pill or maintenance programs as a means of curing a drug addiction and the researchers there have made their thoughts known for decades on this topic.
Through cognitive educational methods the post-program results of abstinence and moderation at St. Jude’s have been many times higher than the published results received from vigabatrin trials.
According to the study, Vigabatrin, which can be compared to another popular replacement drug, suboxone, not only failed to produce cocaine-free subjects but it also did not meet "secondary end points of fewer negative urine tests or fewer cocaine-free days by subjects during the study period."
Chairman of St Jude Retreats, Mr. Mark Scheeren when questioned about the study responded, "I'm not surprised by the failed results of this drug. There are no chemical solutions to a drug or alcohol problem, because cocaine use is not caused by brain chemistry, but rather by values, choices and emotions. Using prescription pills as a blocker or replacement for getting high is absurd. Replacement therapy solves nothing and simply reinforces the treatment idea that you still have no control over your thoughts and actions. How can that end up positive?"
The Saint Jude Retreats are a non-disease, non-treatment based drug and alcohol program implementing proprietary methodology called Cognitive Behavioral EducationSM(CBE). The program is the only alternative to alcohol rehab and drug treatment centers in the United States and currently is 85% more effective than treatment. The program is endorsed by internationally acclaimed professionals and addiction research authors such as Prof. Emeritus David Hanson, PhD; Prof. David Rudy, PhD; Dr. Joy Browne and the late Joseph Vacca, PhD, among others.

Tuesday, November 13, 2012

Why Addiction is NOT a Brain Disease

Why Addiction is NOT a Brain Disease


Why Addiction is NOT a Brain Disease

Addiction to substances (e.g., booze, drugs, cigarettes) and behaviors (e.g., eating, sex, gambling) is an enormous problem, seriously affecting something like 40% of individuals in the Western world. Attempts to define addiction in concrete scientific terms have been highly controversial and are becoming increasingly politicized. What IS addiction? We as scientists need to know what it is, if we are to have any hope of helping to alleviate it.
There are three main definitional categories for addiction: a disease, a matter of choice, and self-medication. There is some overlap among these meta-models, but each has unique implications for treatment, from the level of government policy to that of available options for individual sufferers.
The dominant party line in the U.S. and Canada is that addiction is a brain disease. For example, according to the National Institute on Drug Abuse (NIDA), “Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” In this post, I want to challenge that idea based on our knowledge of normal brain change and development.
Why many professionals define addiction as a disease.
The idea that addiction is a type of disease or disorder has a lot of adherents. This should not be surprising, as the loudest and strongest voices in the definitional wars come from the medical community. Doctors rely on categories to understand people’s problems, even problems of the mind. Every mental and emotional problem fits a medical label, from borderline personality disorder to autism to depression to addiction. These conditions are described as tightly as possible, and listed in the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases) for anyone to read.
I won’t try to summarize all the terms and concepts used to define addiction as a disease, but Steven Hyman, M.D., previous director of NIMH and Provost of Harvard University, does a good job of it. His argument, which reflects the view of the medical community more generally (e.g., NIMH, NIDA, the American Medical Association), is that addiction is a condition that changes the way the brain works, just like diabetes changes the way the pancreas works. Nora Volkow M.D. (the director of NIDA) agrees. Going back to the NIDA site, “Brain-imaging studies from drug-addicted individuals show physical changesin areas of the brain that are critical for judgment, decisionmaking, learning and memory, and behavior control.” Specifically, the dopamine system is altered so that only the substance of choice is capable of triggering dopamine release to thenucleus accumbens (NAC), also referred to as the ventral striatum,while other potential rewards do so less and less. The NAC is responsible for goal-directed behaviour and for the motivation to pursue goals.
Different theories propose different roles for dopamine in the NAC. For some, dopamine means pleasure. If only drugs or alcohol can give you pleasure, then of course you will continue to take them. For others, dopamine meansattractionBerridge’s theory (which has a great deal of empirical support) claims that cues related to the object of addiction become “sensitized,” so they greatly increase dopamine and therefore attraction — which turns to cravingwhen the goal is not immediately available. But pretty much all the major theories agree that dopamine metabolism is altered by addiction, and that’s why it counts as a disease. The brain is part of the body, after all.
What’s wrong with this definition?
It’s accurate in some ways. It accounts for the neurobiology of addiction better than the “choice” model and other contenders. It explains the helplessness addicts feel: they are in the grip of a disease, and so they can’t get better by themselves. It also helps alleviate guilt, shame, and blame, and it gets people on track to seek treatment. Moreover, addiction is indeed like a disease, and a good metaphor and a good model may not be so different.
What it doesn’t explain is spontaneous recovery. True, you get spontaneous recovery with medical diseases…but not very often, especially with serious ones. Yet many if not most addicts get better by themselves, without medically prescribed treatment, without going to AA or NA, and often after leaving inadequate treatment programs and getting more creative with their personal issues. For example, alcoholics (which can be defined in various ways) recover “naturally” (independent of treatment) at a rate of 50-80% depending on your choice of statistics (but see this link for a good example). For many of these individuals, recovery is best described as a developmental process — a change in their motivation to obtain the substance of choice, a change in their capacity to control their thoughts and feelings, and/or a change in contextual (e.g., social, economic) factors that get them to work hard at overcoming their addiction. In fact, most people beat addiction by working really hard at it. If only we could say the same about medical diseases!
The problem with the disease model from a brain’s-eye view.
According to a standard undergraduate text: “Although we tend to think of regions of the brain as having fixed functions, the brain is plastic: neural tissue has the capacity to adapt to the world by changing how its functions are organized…the connections among neurons in a given functional system are constantly changing in response to experience (Kolb, B., & Whishaw, I.Q. [2011] An introduction to brain and behaviour. New York: Worth). To get a bit more specific, every experience that has potent emotional content changes the NAC and its uptake of dopamine. Yet we wouldn’t want to call the excitement you get from the love of your life, or your fifth visit to Paris, a disease. The NAC is highly plastic. It has to be, so that we can pursue different rewards as we develop, right through childhood to the rest of the lifespan. In fact, each highly rewarding experience builds its own network of synapses in and around the NAC, and that network sends a signal to the midbrain: I’m anticipating x, so send up some dopamine, right now! That’s the case with romantic love, Paris, and heroin. During and after each of these experiences, that network of synapses gets strengthened: so the “specialization” of dopamine uptake is further increased. London just doesn’t do it for you anymore. It’s got to be Paris. Pot, wine, music…they don’t turn your crank so much; but cocaine sure does. Physical changes in the brain are its only way to learn, to remember, and to develop. But we wouldn’t want to call learning a disease.
So how well does the disease model fit the phenomenon of addiction? How do we know which urges, attractions, and desires are to be labeled “disease” and which are to be considered aspects of normal brain functioning? There would have to be a line in the sand somewhere. Not just the amount of dopamine released, not just the degree of specificity in what you find rewarding: these are continuous variables. They don’t lend themselves to two (qualitatively) different states: disease and non-disease.
In my view, addiction (whether to drugs, food, gambling, or whatever) doesn’t fit a specific physiological category. Rather, I see addiction as an extreme form of normality, if one can say such a thing. Perhaps more precisely: an extreme form of learning. No doubt addiction is a frightening, often horrible, state to endure, whether in oneself or in one’s loved ones. But that doesn’t make it a disease.