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.