Wednesday, July 20, 2016

How Alcohol Affects Marriage

alcohol use
It is quite common for people in committed relationships to engage in the same leisure activities. Part of what attracts one person to another is having similar interests, such interests when pursued together can serve to strengthen a relationship. Sometimes a couple's leisure activities can include the consumption of alcohol. Naturally, couples who drink alcohol together and in similar ways can be OK for a relationship, if done in moderation; however, many many marriages have ended on account of one or the other's drinking habits. Alcohol is an insidious substance that can wreak havoc on a relationship, especially one that is co-dependent in nature.

Research has shown that many “baby boomers” are consuming alcohol at alarming rates. In fact, the 2012 National Survey on Drug Use and Health found the rate of binge drinking among people ages 65 and older was 8.2 percent, and the rate of heavy drinking was 2 percent. The researchers estimated that 5.7 million people over the age of 50 will need substance use disorder treatment by 2020.

Alcohol and Marriage 


Given the fact that many older adults are engaging in heavy alcohol use, it would stand to reason that it is having an impact on people’s marriage. A group of researchers set to determine how alcohol affects the quality of marriage among older adults. Interestingly, the research didn’t focus as much on how much spouses were drinking, but rather whether spousal drinking patterns were concordant. The researchers found that the amount one’s spouse drank wasn’t as much as a factor in having a satisfied marriage as was whether or not both partners consumed alcohol the same way, Reuters reports. The findings were published in Journals of Gerontology B: Psychological Sciences.

Study author, Dr. Kira Birditt of the University of Michigan in Ann Arbor, and colleagues came to their findings by analyzing survey responses from 4,864 married participants, according to the article. The findings indicated that in more than half of the couples, both partners consumed alcohol. Wives only reported marital dissatisfaction when only one partner drank alcohol.

“The study shows that it’s not about how much they’re drinking, it’s about whether they drink at all,” said Birditt.

 

Concerning Alcohol Use


At people approach or reach retirement age, they often find themselves with more time on their hands than they know what to do with. Idle time can lead one spouse or the other to turn to alcohol as a way to fill the day. It is a behavior which can quickly become a slippery slope that potentially leads to an alcohol use disorder. The research showed that 20 percent of men and 6 percent of women had an unhealthy relationship with alcohol which could be characterized as having a drinking problem.

“Problem drinkers are a whole different kettle of fish,” said Dr. Fred Blow, also at the University of Michigan. “Serious heavy drinkers have disruptive relationships with people, particularly their partners. That’s an important issue that should be looked at going forward.” 

At Hemet Valley Recovery Center & Sage Retreat, our Older Adult Addiction Treatment Program is tailored to meet the varying needs and special circumstances the older adult faces. Patients flourish in an intimate, age specific, non-confrontational group of peers.

Please contact Hemet Valley Recovery Center & Sage Retreat 866.273.0868 to begin the journey of recovery.

Monday, July 18, 2016

THE OTHER TRAGEDY BEHIND PRINCE'S DEATH

The following Op-Ed was published on CNN.com Monday, July 11th.

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Editor's Note - Chris Johnson is an emergency medicine physician who practices in the Twin Cities, Minnesota. He is chair of the Minnesota Department of Human Services Opioid Prescribing Work Group and serves on the Board of Physicians for Responsible Opioid Prescribing, as well as the Board of the Steve Rummler Hope Foundation. The opinions expressed in this commentary are solely those of the author. 

(From CNN): So the recent report from the Midwest Medical Examiner's Office made it official -- Prince Rogers Nelson died in his residence April 21, 2016, from an accidental overdose of the prescribed opioid, fentanyl. He was 57.


In the aftermath of the death of such an iconic figure we are experiencing a flurry of political activity as our elected leaders, both Republican and Democrat, hurry to pass some form of legislation that will help stem the tide of opioid-related death that claimed the lives of some 165,000 Americans from 2000-2014.

Most of the proposals debated last week in Washington -- including the compromise package the House approved Friday -- aim at improving access to treatment for those who are already addicted.

Medications such as Suboxone (buprenorphine) are proven effective in helping those who are addicted to opioids avoid relapse. Narcan, the opiate reversal agent, can save the life of someone who is acutely overdosing and needs to be in the hands of first responders everywhere.

Improving affordability and access to these and other proven treatments is a must and I am in full support of those measures. But that alone will not stop this epidemic nor turn back this tide of misery.

Because missing in these conversations is an even more necessary and urgent discussion -- one that takes a long hard look at the medical industry itself. Where has the "healing" profession been in all this? It is very important to understand how and why this epidemic happened so that meaningful change can occur.

To convey that understanding, I am forced to paint an unflattering picture of the industry that I have been a part of for the last 15 years. I wish I could tell you that this epidemic was due to an honest mistake. That the science was unclear or had mixed results that only later became evident. But I can't.

There was never good science that these medicines worked effectively in the long term. I also wish I could tell you that the only reason the problem persists is a "lack of physician awareness." But I won't. The reason this opioid problem started and the reason it continues is sadly for the most American reason there is -- business.

Prior to the 1990s, doctors in the United States had prescribed opioids, such as Percocet or Vicodin, for pretty much the same reasons that doctors in most countries did -- for pain resulting from acute injuries such as fractures, and for pain from the tissue damage caused by cancer

But that all changed in 1996 when Purdue Pharma introduced its new, extended release oxycodone preparation -- OxyContin. Instead of just focusing on patients with chronic pain from cancer, Purdue Pharma sought a much bigger market -- patients who suffered chronic pain from everyday conditions, such as back and joint pain.

To do this, they recruited and paid experts in the field of pain medicine to spread the message that these medicines were not as addictive as previously thought. This effort was enormously successful and thus was born campaigns such as "Pain as the 5th Vital Sign." As a physician in training, I remember being told that the risk of addiction for patients taking opioids for pain was "less than one percent."

What I was not told was that there was no good science to suggest rates of addiction were really that low. That "less than one percent" statistic came from a five-sentence paragraph in the New England Journal of Medicine in 1980. It has come to be known as the Porter and Jick study. However, it was not really a study. It was a letter to the editor; more like a tweet. You can read the whole thing in 90 seconds.

All the authors said was that among the many hospitalized patients who were given a dose of opioid for their acute injury, very few developed addiction. That is all it said. It said nothing about what happens to patients who take these medicines indefinitely.

Yet those few sentences got transformed by relentless marketing into "opiates are not addictive." Which was as crazy as saying "tobacco is not addictive," if someone smoked four cigarettes and did not become a chain-smoker. It was blatantly irresponsible medicine. But it worked. Prescriptions soared.

By now, you know that the U.S. consumes 80% of the world's opioid painkillers while comprising just 5% of the world's population. And as the sales have increased, so, too, have the overdose deaths and the rates of admission to addiction treatment centers. In 1999, 4,030 Americans lost their lives to accidental opiate overdose. In 2014, that number had increased to 18,893. That is more than six World Trade Centers.

Some of you no doubt are asking: Where have the good doctors been in all this? Aren't they supposed to be watching out for our safety? The answer to that question is very discouraging, but I can reach no other conclusion after studying and fighting this problem for the last 10 years. The answer is we are right where we have always been -- minding the register.

The values currently prioritized by medicine were made explicit to me several years ago. During my annual performance review, my medical director told me: "You know, we are so proud of you for all the work you are doing fighting the opiate prescription problem. But it is such a fine line between increasing the risk of addiction and HCAHPS scores."

Wow. Every health care professional reading this knows exactly what I am talking about. HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. These are "patient satisfaction" surveys and they talk about pain management specifically. Hospitals are required to participate in these surveys and reimbursement is tied to how well they do. Hence, every hospital administrator and department chair is acutely aware of their "score."

The buzzword in the industry right now is the "patient experience." This is simply the notion of "customer experience" as applied to health care. Notice that the focus is not on "patient outcome." Physicians are under enormous pressure to move quickly and generate that positive experience, often with just 12 to 15 minutes to complete a visit.

In such a system, it is no wonder that the prescription pad is used as the solution. There is no time to do anything else.

To solve the opiate crisis therefore requires more than telling doctors to simply "stop prescribing." The prescription is just the final "output" of a care delivery system that has multiple inputs at multiple levels. These inputs must be addressed if we are going to solve this.

We must change the system that creates the pressures that result in such bad medicine. Time with the patient should actually be valued. And the long-term health of the patient should matter more than "throughput" and "relative value units per hour."

If this sounds too fuzzy and "Kumbaya" for you, I would point out that this exact sentiment is expressed in the Hippocratic oath. The 1964 version (which I recited in medical school) admonishes us to remember "that there is art to medicine as well as science, and that warmth, sympathy and understanding may outweigh the surgeon's knife or the chemist's drug."

In America, we are far too heavy on the knives and drugs, and far too light on the warmth and sympathy.

I realize that making these fundamental changes to our health care delivery system will be very difficult. There are a lot of powerful interests with very little to gain by changing the current system. But change must happen. Because the yearly body count due to the opiate epidemic is simply not acceptable.

I believe we can do better. For the memory of Prince and the thousands of others whom we have lost too soon.

Hemet Valley Recovery Center & Sage Retreat offers a full continuum of care including: Acute Medical Detoxification, Rehabilitation, Residential, Partial Hospitalization and Recovery Residences.

Call Hemet Valley Recovery Center & Sage Retreat 866.273.0868 or visit our website.

Wednesday, July 6, 2016

Discrimination and Alcohol Abuse

Discrimination and disenfranchisement is something that occurs every day in the United States despite America being the land of the free. While we have come a long way since the 1960’s and the passing of the Civil Rights Act, a number of minorities in the United States are still subject to discrimination. A sad reality that is likely to continue.

As you might imagine being discriminated against can cause insidious harm, dramatically affecting the course of one’s life. The effects of prejudice don't just have an impact on individuals, it takes its toll on society. Those who feel the burn of one-sidedness can cause severe stress. Without the proper tools to cope with such stressors, people are likely to turn to unhealthy methods of survival.

Discrimination and Drinking



It is not hard to imagine that those who experience the pressure of prejudice would turn to drugs or alcohol to dull the stings of existence. However, until recently there had never been a review of all the existing evidence supporting such a postulation. Researchers have long known that those who experience significant physical or emotional trauma are more likely to have unhealthy relationships with drugs and/or alcohol—often resulting in addiction.

At the University of Iowa, a team of researchers may have found a link between discrimination and alcohol abuse, ScienceDaily reports. The findings of the study: "Discrimination and Drinking: A Systematic Review of the Evidence," were published in Social Science & Medicine.

"We've had this idea that discrimination is associated with heavier drinking and drinking-related problems, but we didn't have a clear understanding of the evidence underneath that," said study lead author, Paul Gilbert, assistant professor of the Department of Community and Behavioral Health at the UI College of Public Health. "I wanted to uncover what we know and how we know it. What does the science actually say?"

Discriminating Research



Gilbert and his colleagues looked at 1,200 scientific studies that dealt with alcohol use and discrimination, according to the article. Of the 1,200, they focused on 97 peer-reviewed published research papers that identified a connection between discrimination and alcohol misuse or abuse. Seventy-one studies focused on racial discrimination, the remaining centered around sexual orientation and gender discrimination.

"The basic knowledge is now there," says Gilbert. "The next step to advance science is to say what specific groups are involved, what specific type of discrimination are they experiencing, and what specifically were the alcohol outcomes. Was it just heavier drinking, or was it heavy drinking that led to dependence--or is it alcohol-related problems like getting in a car crash or work and family problems?"

At Hemet Valley Recovery Center & Sage Retreat, we offer a full continuum of care including: Acute Medical Detoxification, Rehabilitation, Residential, Partial Hospitalization and Recovery Residences.

Please contact Hemet Valley Recovery Center & Sage Retreat 866.273.0868 to begin the journey of recovery.

Wednesday, June 22, 2016

Mandatory Addiction Treatment Can Be Ineffective

addiction recovery
In the circles of addiction recovery around the globe, it is often said that people with substance use disorder need to want to get better in order to do so—often times a “rock bottom” experience is required for such a desire to arise. The friends and families of addicts and alcoholics know all too well that there is an element of truth to that idea. No matter how much you want someone to seek help and recover, the onus falls on the afflicted to accomplish the feat.

Naturally, there are exceptions, but most people with long term recovery would probably agree that they had to want sobriety—and did whatever it took to maintain it—before recovery came to fruition. It is no secret that relapse is quite common, being a part of many an addict or alcoholic’s story. Putting down the drink or drug can sometimes happen with ease, managing to not pick drugs or alcohol again is the hard part.

Recovery for the Wrong Reasons


People living with the disease of addiction will often find their way to treatment and/or 12-Step meetings on account of wanting to please someone close to them. And, while their intentions are no doubt good, the reality is that drug and alcohol use is merely a symptom of the mental health disorder known as addiction. Breaking free from the disease requires not only steadfast dedication to a new way of thinking and living, but also eternal vigilance.

Those who seek recovery to appease others will often “cherry pick” their way through the process, failing to see the forest for the trees. Another common saying in recovery is: “the only thing you need to change is everything.” The people who are willing to go the distance are typically those who want recovery for themselves; life had become so unmanageable that a paradigm shift was required.

Involuntary Recovery


In the United States, and in a number of other countries where illicit drug use is illegal, it has become more and more common to offer addiction treatment to those who would otherwise be sent to jail for a criminal charge like possession. While there is little doubt that treatment is certainly the preferable punishment, it is rare that those who complete required treatment will stay sober and live a life in recovery.

In prisons and jails across the country, the majority of people serving time were incarcerated for nonviolent drug offenses. This the byproduct of fighting a war on drugs for nearly half a century. Naturally, as we continue to face an unprecedented opioid epidemic, we cannot continue to arrest away the scourge of addiction. Offering access to treatment over jail is certainly the lesser of two evils, and may actually help people with a substance use disorder find recovery, said addicts will actually need to want recovery. We know that involuntary addiction treatment is not the most effective.

Mandatory Treatment


New research suggests that mandatory treatment for people with substance use disorders is not effective in reducing their drug use, BMJ reports. A global data analysis conducted by researchers at Boston Medical Center and Boston University School of Medicine found that most countries “often lack the capacity to treat substance use disorders.” What’s more, they found that treatments often fail to utilize effective treatment modalities.

"The evidence presented in this article provides additional argumentation supporting the position of all UN organizations that mandatory treatment settings do not represent a favorable or effective environment for the treatment of drug dependence," said Fabienne Hariga, MD, MPH, senior adviser to the United Nations Office on Drugs and Crime during the recent meeting in New York. "The United Nations therefore calls on States to transition from mandatory drug treatment and implement voluntary, evidence-informed and rights-based health and social services in the community.'' 

At Hemet Valley Recovery Center & Sage Retreat, we offer a full continuum of care including: Acute Medical Detoxification, Rehabilitation, Residential, Partial Hospitalization and Recovery Residences.

Please contact Hemet Valley Recovery Center & Sage Retreat 866.273.0868 to begin the journey of recovery.

Tuesday, June 7, 2016

American Opioid Epidemic Angel Programs

opioid epidemic
An unprecedented epidemic requires novel approaches, if the United States is ever going to rein in the prescription opioid painkiller and heroin epidemic that has brought hundreds of thousands Americans to their knees in despair—and thousands to their death. In 2014, 18,893 people lost their lives due to prescription opioid overdoses, and another 10,574 overdose deaths were linked to heroin, according to the Centers for Disease Control and Prevention (CDC). With such staggering statistics it may come as little surprise that overdose is now the leading cause of accidental death in the U.S. In that same year, over two million Americans met the criteria for having an opioid use disorder.

There are two sides to the American opioid epidemic. On one hand it is crucial that researchers and addiction experts pinpoint the causes that led to the opioid problem that became so dire; while on the other hand it is crucial that addiction professionals continue to do the good work they have done for decades in helping those in the grips of addiction and seeking recovery.

It is no secret that the opioid scourge has been driven largely by over a decade of over-reliance and overprescribing of opioid pain medications. Subsequent efforts to combat rampant over prescribing and widespread unused medication diversion throughout the country, by way of prescription drug monitoring programs (PDMPs) and prescription drug take-back campaigns had an unintended, albeit hardly unsurprising, consequence in the form of heroin use.

 

Unintended Consequences


Here’s the rub, both lawmakers and doctors can make it next to impossible to acquire prescription opioids, and people will still find a way to get their hands on an opioid of some kind—such as heroin. If steps are not taken to advance and expand addiction treatment resources, simply making it harder to acquire a drug does not mean that the dependence and addiction will fade away. Opioid withdrawal is extremely unpleasant; most addicts will do whatever it takes to avoid the symptoms that accompany it—even if that means doing a drug that that one often says they would never use.

Over the last few years the nation has seen a dramatic rise in heroin use among people from all walks of life, the opioid epidemic has shown us that everyone is eligible. Historically, the idea that we could arrest our way out of addiction has been the status quo, despite the fact that it is widely accepted that incarceration does little to stifle addiction. Unlike the crack epidemic in the 1980’s and the heroin scourge in New York in the late 1960’s which affected people of ethnic descent or those on the lower end of the socioeconomic spectrum—today’s prescription painkiller and heroin crisis in the United States crosses the stereotypical boundaries of previous drug epidemics in this country.

The majority of today’s heroin users began down the perilous road of opioid addiction with prescription pain medications. People from all age groups, ethnic background and various social strata have turned to heroin for three reasons, the drug is:
  • Easier to Acquire
  • Less Expensive
  • Often Times More Potent
Heroin is Schedule I narcotic, meaning, it is a drug with no currently accepted medical use and a high potential for abuse. Unlike, drugs like OxyContin (oxycodone), which are classified as Schedule II and are legal to have with a prescription, heroin is illegal across the board. Those caught with heroin, at least traditionally, were at risk of jail time. Thus beginning a cycle of drug use, incarceration, release, relapse and recidivism. In the wake of the opioid epidemic we face, both lawmakers and law enforcement understand that how they once handled addiction did not work and thinking outside the box is required for stemming the tide of opioid addiction in this country.

 

Surrender Salvation


Just over a year ago, a police chief in Massachusetts started a program in Gloucester that encouraged those who were addicted to opioids to go to a police station and surrender their drugs; in return, they would be given access to substance use disorder treatment services instead of handcuffs, NPR reports. Gloucester Police Chief Leonard Campanello’s Police Assisted Addiction and Recovery Initiative (PAARI), or so-called “Angel Program,” has made multiple headlines and has been widely hailed as a success. Now, a year later, 400 people have taken advantage of the program, and more than 100 police departments in the U.S. have developed similar programs modeled on of the Angel Program. “We had to stop trying to arrest our way out of this problem,” said Campanello.

“We’re an entity that — right, wrong or indifferent — has a very loud voice in this right now and that people seem to be paying attention. Our job is to lend that voice to people who are suffering from this disease and their support groups.”

 

Recovery is Not Impossible, It’s Necessary


Opioid addiction is deadly disease that claims over 70 lives a day in the United States alone. Failing to access addiction treatment services, usually results in dire outcomes. Those who want to break the cycle of addiction and are willing to take certain steps to bring that to fruition, can do so with the guidance of those who walked the path before them. Recovery begins with reaching out out for help. At Hemet Valley Recovery Center & Sage Retreat, we offer a full continuum of care including: Acute Medical Detoxification, Rehabilitation, Residential, Partial Hospitalization and Recovery Residences.

Please contact HVRC & Sage Retreat 866.273.0868 to begin the journey of recovery.