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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Bath Salts: Devastation from Addictive "Thinking"

The phenomenon of "bath salts" abuse and dependence is hard to believe. Nevertheless, since late 2010 young people and adults have been swallowing, smoking, sniffing, and injecting dangerous white or colored powders that they purchase from head shops, convenience stores, or the Internet.[ NIDA Message] Colorful packages with catchy names such as Arctic Blast, Cloud 9, Ivory Wave, Snow Leopard, Vanilla Sky, and White Lightning may contain 50 milligrams or more of powder and sell for $25-50. They are labeled as bath additives (or glass cleaner or plant food) that are "not intended for human consumption." How this can be happening? Neurobiology helps explain it. Basically, addiction doesn't make sense : people with addiction pursue their relationship with a mood-changing chemical even when it ruins their body and other relationships. This happens because: (1) addictive substances provide reward and escape that condition the user to seek the substances over and...
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Alcohol and Bodily Harm to Women

Popular belief does not expect women to "hold their liquor" as well as men, and this is one of those instances when science agrees with popular belief. If a man and a woman drink the same amount of alcohol, even if they are equal weight, the woman will have a higher concentration of alcohol in her blood. That's because a greater proportion of the man's body weight is water, which dilutes the alcohol; and also because the stomach walls of women compared to men contain less alcohol dehydrogenase, an enzyme that breaks down alcohol. Therefore, repeatedly drinking the same quantity of alcohol is likely to damage a woman's organs—liver, heart muscle, brain—more quickly than a man's. ( Alcohol Metabolism ) Published dietary guidelines reflect these differences and, for example, define moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men....
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Recovery: Can You Have It Your Way?

Many individuals with a personal or professional stake in addiction recovery consider recovery a spiritual process and diligently defend the right of everyone in need of recovery to practice spirituality in whatever non-hurtful ways are meaningful for them. When it comes to how these people in need practice "recovery" itself, there is no such unanimity among stakeholders—except for possible agreement that the process won't go very well if everyone pursues their recoveries with the same diversity as their spiritualities. Decades of accumulated practical wisdom and medical-scientific knowledge inform how various stakeholders think about addiction and recovery. But their individual knowledge bases and points of view differ as well as overlap. They debate definitions of recovery and what the willing person must do or not do to achieve recovery. For a generous sample of discourse on these matters, look at the consensus document from the Betty Ford Institute Consensus Panel, the...
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