Marijuana – A Country Divided

People in the United States don’t shrink from passionate expressions of opposing views.  Whigs vs. Tories , Republicans vs. Democrats, and Red Sox fans vs. Yankees fans are just a few cases in point.  People’s views on marijuana are no less passionate and no less polarized.  During treatment for addiction to opioids a man in his early twenties said, “Marijuana is an herb; it’s natural.  It relaxes me; I’m not addicted to it; and I’m going to smoke it when I get out of here.”  In the same room, a man in his early thirties also in treatment for addiction to opioids said, “People disagree whether marijuana is a gateway drug.  It is for me.  If I never smoked marijuana I never would have gotten hooked on harder drugs.  And if I hadn’t tried to smoke it again after my first treatment, I wouldn’t be here right now.” Opposing views...
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Five Ways You Can Reduce Stigma

Too often society is unfair to people with addiction—a fact that disturbs most people with active addiction, most people who are recovering from addiction, and most people who advocate for those groups.  Fortunately we can do something about it.  Don’t be daunted—small steps can have a powerful impact. Social stigma exists within culture.  Culture may be understood as the collective knowledge, beliefs, and behaviors of a group of people that is often stable across generations.  Stigma occurs when a characteristic of a person or subgroup is perceived as different from others, is labeled, and the label becomes associated with a negative stereotype. Not only is the culture that surrounds a person important, but also the culture he or she has internalized.  For example, the labels “alcoholic” and “addict” may evoke prejudice and distancing in the general population, but acceptance and warmth in the population committed to Twelve-Step recovery.  Individuals who...
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The Prevention of Substance Use Disorders 3

Part Three:  Evidence-Based Practices: This series has advocated that society make disease prevention a priority—especially the prevention of substance use disorders—while recognizing that the prevention of substance use disorders (SUDs) is already a priority for some providers and agencies.  Before organizers of SUD prevention services present an intervention to a target population, they like to be confident that their efforts will result in healthy change.  Also, before funding sources contribute to SUD prevention services, they like to be confident that their investment will produce worthwhile results.  For both these reasons, organizers of SUD prevention services prefer to deliver prevention approaches that are evidence-based.  That is, organizers like to replicate programs that were shown to be effective when they were presented before. It is increasingly difficult for organizers to attract funding for anything other than evidence-based practices ( EBPs ).  Simply believing or hoping a program will work is no longer...
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The Prevention of Substance Use Disorders 2

  Part Two:  Preventing Alcohol Problems:  The harmful use of alcohol is the third leading risk factor for poor health worldwide and the estimated costs of alcohol abuse in the United States, which encompass lost productivity as well as medical problems, top $220 billion per year.  There’s a lot to be done.  Fortunately, a lot is being done.  April is Alcohol Awareness Month, a fitting time to acknowledge creative and effective prevention approaches that are reducing risk now—we’ve come a long way from the ineffective and sometimes harmful information-only scare tactics of the 1950s and 1960s.   Preventive interventions target the population at large ( universal ), persons at increased risk ( selective ), or persons with prodromal symptoms ( indicated ).  Depending upon the characteristics of a particular person, existing programs might influence that individual at one or many points across his or her lifespan. Universal interventions generally address...
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The Prevention of Substance Use Disorders 1

Part One - Overview and Terminology. Our society pays far more attention to disease treatment than disease prevention.  And some of the reasons for this are understandable.  When medical-scientific technology saves lives, for example, the outcomes often generate hype because they are dramatic.  When prevention works, however, nothing happens.  The resulting non-events attract little if any attention—even though the number of people saved may be larger than the number who benefit from seemingly miraculous disease treatment.  In addition, preventive interventions reduce the occurrence of other dangerous and unpleasant situations—assaults, for example, are reduced by training young people in coping skills even if the stated objective of the training is to prevent substance abuse— that might not be counted at all in tallies of disease.  The bias for treatment over prevention encompasses most or all health concerns including addiction.  One indicator is the 2013 budget of the Substance Abuse and Mental...
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Sedative-Hypnotic Medications: Nothing to be Relaxed About

Sedative-hypnotic medications are not good choices for individuals with addiction.  Even those with vulnerability to addiction due to, for example, a family history of alcohol dependence, run a higher risk of developing problems.  Nevertheless, some medical practitioners are quick to prescribe these drugs when patients complain of anxiety or insomnia.  The prescribers aim to be helpful, but too often these prescriptions end up harming the patient and possibly others. Though some authors classify sedating antidepressants and antihistamines as sedative-hypnotics, this discussion restricts the category to medications that act in the brain by augmenting the effects of gamma-aminobutyric acid (GABA).  GABA is a chemical messenger that inhibits the activity of brain cells. Boosting GABA both calms the brain and increases dopamine in the nucleus accumbens .  That increase of dopamine is the neurobiological event most identified with the experience of pleasure and reward.  The intensity of the pleasure might be subtle...
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Healthcare Reform — Now is the Time to Make It About You!

Confused about healthcare financing and where it's headed?  What about future access to addiction treatment?  These days it's hard not to be confused; the experts can't even agree on what's happening now, never mind on what will happen next.  For example, analysts concur that the United States spends far more on healthcare—dollars per capita and percent of gross domestic product—than 12 other industrialized countries.  But beyond that, they disagree on which statistics are appropriate to measure the return on that investment and whether the money is well spent .  Some say the United States has tens of millions of people without health insurance; others say those numbers are misleading, a myth . Besides conflicts of opinion, there are conflicts of interest.  In the United States, modern health insurance emerged in the 1930s to enable the sick to pay their bills and healthcare providers to get paid for their services.  Employers...
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Hope & Caution - for Happy Holidays

As we approach the holiday season—the time of year from Thanksgiving through New Years when "joy" is the word but not necessarily the reality—it's worth reflecting on ways we can protect ourselves and those we care about from inconvenience and tragedy due to use of alcohol or other mood-changing substances. Start by believing that some measure of holiday joy and fulfillment, provided we are open to it, is available to us all. But stay mindful that if we are not cautious about the use of mood-changing substances, we leave ourselves open to indelible regret. Caution is needed. But the holidays evoke strong feelings, and strong feelings often override caution. Strong feelings could include the stress of keeping up with the seasonal parade of expectations and events such as shopping, travel, cooking, social gatherings, and so forth—or the stress of not having any of those to keep up with. Strong feelings...
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DSM-5 – Coming May 2013

Addiction treatment and other mental health professionals are accustomed to applying the diagnostic criteria published by the American Psychiatric Association (APA) in the 1994 Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) and the 2000 "Text Revision" version of the same compendium (DSM-IV-TR), which updated the narrative material but kept the same diagnostic criteria. Criteria in the substance-related disorders section of DSM-IV are all the more familiar to veterans in the addiction field because they were barely changed from the criteria in the previous DSM, the 1987 "Revision" of the Diagnostic and Statistical Manual Version III (DSM-III-R).   The names we give diseases are no more than useful categories for grouping individuals whose ailments have similar physical or behavioral manifestations or similar causes, and that respond to similar therapeutic or preventive efforts. Disease names and criteria to diagnose them evolve because scientific knowledge and technology evolve. Revisions of...
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Falling Dominoes: Or, Why You Can't Have "Just One"

Search the Internet or type in "falling dominoes" on YouTube and you will be deluged with opportunities to watch videos, often set to music, of vast numbers of colorful rectangles knocking one another over. These productions are extravagant examples of the original "domino effect." They show domino tiles arranged in both straight lines and intricate patterns, each tile balanced on a narrow end with its rear flat facing the front flat of the next. As long as the distances between the tiles are shorter than their length, once the first domino is toppled, all the rest must fall. Or more accurately, all the rest usually fall; once in a while a chain reaction jams, the audience sighs, and the videographer cuts to dominoes that are falling. The middle and last dominoes in these arrangements fall because they are subject to laws of nature. Physics and gravity may not yield the...
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Facing Addiction and The National Council on Alcoholism and Drug Dependence (NCADD) are proud to announce the merger of our organizations – creating a national leader in turning the tide on the addiction epidemic.
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