Monday, February 17, 2014

By SAVANNAH DEMPSEY (sbarr@sungazette.com) , Williamsport Sun-Gazette

The wax paper packets are stamped with names like "Facebook," "Major Pain," "Death Sentence" and "Voodoo."

It's easy to transport, cheap, pure and readily available in Lycoming County.

It's also one of the most addictive drugs known to man - heroin.

Its calming effects entice users across all races, economic classes and religions. And once they're hooked, most people will not be able to stop using without professional intervention.

Earlier this year, police started to see a rise of heroin-related overdoses, which led them to believe that the heroin coming into Lycoming County was quite pure. Around the same time, authorities also began noticing a marked rise in overdoses and heroin-related crime.

Medics are receiving weekly reports of heroin overdoses - people who are technically "dead" but may be brought back with an injection of Narcan, a medication that reverses the effects of opiates.
"In the earlier part of the year, there were a lot of near-deaths. Some individuals were technically dead but were able to be brought back with a Narcan injection. That tells me that the
potency was higher at that point," said city police Capt. Michael Orwig.

Jennifer Reeder, assistant director of the West Branch Drug and Alcohol Abuse Commission, has also seen the devastating effects of this potent heroin.

According to the commission, about 18 percent of the clients they've treated since the beginning of the year have identified heroin as their primary drug of choice. That percentage is up from 11.2 percent last year for the same time period.

"The purity of heroin is greater than it has ever been, which feeds the addictive properties still further," she said. "Once caught in this cycle, life problems develop as a result and that also feeds the ongoing use, as the addict feels powerless to change the circumstances and believes escape back into the drug is the only option he or she has."

According to the National Institute of Drug Abuse, about 23 percent of people who use heroin will become dependent on it.

"Heroin is not a drug to experiment with. It is known to hook people on their first try," Orwig said.
Heroin mimics the brain's naturally produced chemicals responsible for happiness, such as endorphin. Heroin use also disrupts the chemical process which regulates dopamine production, causing the brain to become flooded with dopamine. These two processes combined result in the euphoria, peace, and calm users experience.

Long-term heroin use will change the brain's chemical structure, Reeder explained. Because heroin mimics the chemicals that let us feel happiness, users are literally incapable of experiencing joy without opiates. Simple things which normally cause a person to feel joy, such as a hug from a friend, or a peace of chocolate, no longer hold much meaning for the opiate addict.

"After using heroin the rebound effect, ultimately withdraw, is dramatic. Addicts often feel like they are going to die, or perhaps even wish they would. That alone leads the addict back to using again if only to relieve the effects of withdraw," said

"With ongoing use the body chemistry is significantly altered that misery is prolonged with post-acute withdraw. Users may feel lethargy... the inability to experience any real normal pleasures... and the inability to mister the motivation to do anything," she added.

This depression often leads users, even those who have weeks of sobriety under their belt, back into a life of heroin use. Old friends, lack of problem-solving skills, and even the relentless marketing schemes of drug dealers threaten the former addict on a daily basis.

"I realize that addicts make a choice, but I also know drug dealers who have given 'free' packets of heroin away and often regularly call the addicts to see if they 'need anything,'" said Old Lycoming Police Sgt. Christopher Kriner.

Those who continue to use are often forced into a life of crime to support their habit. About 30 percent of people suspected or arrested for theft in Lycoming Township police's coverage area admitted to being addicted to heroin or prescription medication, Kriner said.

Thursday, February 13, 2014

Trying to help someone you love

With Valentine's day around the corner, it can leave us rushing to the store, buying a gift for our wonderful spouses who listen and care for us each day. Or buying presents for your girlfriend or a boyfriend, someone you care about. Your children arriving home after school with all of their cards they have received from their classmates, And even just sending a card in the mail to your parents.

With so much love spreading all around, we still wonder about the ones that we care for so much, but refuse to take part in our lives. They choose to be their friends, isolate in their homes refusing to come out or only if they have to drive to the liquor store, and those living from place to place, house jumping or even living on the streets. You have tried talking to them, convincing them to come stay with you, but their absolute refusal or I will be fine answer is no longer enough of an answer. You re ready for them to start seeking help instead waiting for something worse to happen to them.

Substance abuse interventions can help you and your loved get the help they so desperately need. Professional interventionist are trained for crisis interventions in getting your loved one not rehab today. It is no longer about next week or next month. Your loved one has been abusing substance for many years and is needing help now to get them where they need to be.

One of the top interventionist Kevin Dixon has helped many families through an intervention. He is a nationally recognized interventionist and addiction specialist and has provided interventions for families throughout the United States and Canada. He specialized in substance abuse and mental health. His experts and guidance have proven to be success in getting intervention help now.

Trying to help someone you love

Wednesday, May 15, 2013

DRUG REHAB: Counselors included sex offenders, embezzlers

DRUG REHAB: Counselors include sex offenders, embezzlers

SACRAMENTO — California’s lax system of credentialing drug and alcohol counselors has allowed convicted sex offenders, embezzlers and people with their own substance-abuse problems to work with vulnerable clients, according to a new report from the state Senate’s oversight office.
With demand for treatment services expected to grow as the federal health care law takes effect, Monday’s report by the Senate Office of Oversight and Outcomes found that California is virtually alone among states in not requiring criminal background checks for people registering to be substance-abuse counselors, or even asking applicants to disclose past trouble with the law.
The Senate investigation found 23 sex offenders who have been registered or certified to work as substance-abuse counselors since 2005. Those are just the counselors with unusual names who could be matched against the state’s sex-offender database; the actual total is likely much larger, the report said.
“Obviously, the main risk is that you could have someone in a counseling position who has quite a bit of control over a client,” Maia Christopher, executive director of the Oregon-based Association for the Treatment of Sexual Offenders, said in the report.
A “balkanized” network of seven accrediting organizations largely fails to detect such problems. Counselors jump from organization to organization to avoid scrutiny of criminal convictions or when they are in danger of missing a certification deadline, the report found.
The Department of Alcohol and Drug Programs, which oversees the counseling industry, is scheduled to disappear in July and its responsibilities folded into the Department of Health Care Services. Monday’s report recommends that lawmakers consider “drastic changes” to repair the system before then, including creating a centralized database to flag people with high-risk backgrounds who seek to become counselors.
The Senate office’s investigation did not include full names. It highlighted several cases in Inland Southern California, including some in which people lost licenses to work in other professions before registering as substance-abuse counselors.
A Redlands doctor identified in the report as “E. W.” surrendered his medical license in 2005 when authorities concluded that he had been prescribing dangerous medicines over the Internet to patients he had never met. The state medical board’s investigation also cited a 1993 case in which E. W. was found to have engaged in sexual conduct with two patients.
In 2011, E.W. registered to work as a counselor with the Sacramento-based Breining Institute, one of seven certifying organizations in the state. His registration expired in January 2013.
In Murrieta, “S. N.” lost his nursing license in 2001 after he was convicted of child molestation. The man also had a history of drug use.
S. N. registered with the Sacramento-based California Association of Alcoholism and Drug Abuse Counselors in 2005 and was certified as a counselor five years later. In 2011, he passed the test to become a higher-level counselor. He works for a substance-abuse treatment program in Murrieta.
Bob Dorris, chairman of the certification board for the California Association of Drinking Driver Treatment Programs, a certifying organization, said he was still reviewing the Senate office’s findings but added that “the problem is not new to us.”
“A this point I don’t think there’s any question that background checks should become a reality — including fingerprint-based background checks,” Dorris said.
Senate President Pro Tem Darrell Steinberg, D-Sacramento, said the report shows a need for more state oversight “to ensure better safety for people, especially children, who are particularly vulnerable.”

PUBLIC AND PRIVATE

There are about 36,000 registered or certified counselors who work in 2,534 private and publicly funded substance-abuse programs. They range from outpatient treatment to upscale inpatient programs, such as the Betty Ford Center in Rancho Mirage.
Some counselors are former substance abusers, the report found. That can help counselors connect with their troubled clients. But California lacks any system to track counselors’ DUI arrests or other brushes with the law.
“Many have struggled with their own addictions. If they relapse as counselors, professionals in the field consider it crucial to keep them away from clients who are trying to stay sober themselves,” the report said.
In another Inland case cited in the report, “G. Y.” was a licensed vocational nurse in 2003 when officers arrested her for stealing from patients at the Riverside hospital where she worked. The nurse eventually accepted a plea deal and was sentenced to three years in prison.
The Senate oversight office cites news media coverage of the case. In 2005, The Press-Enterprise reported that Gemma Lou Yuman, of San Bernardino, started stealing from patients to support a methamphetamine habit.
As of Monday, Yuman was listed on the Breining Institute’s website as having an active certification. The Breining Institute did not return a call for comment.
In a statement late Monday afternoon, the Department of Drug and Alcohol Programs said it was still reviewing the report. “The department remains committed to protecting the health and safety of all clients served in the facilities we license and will take all appropriate action within our authority to do so,” it read.

LENIENT OVERSIGHT

Other states’ oversight of substance-abuse counselors runs the gamut, but almost none have as lenient a system as California.
In Texas, for example, certain crimes such as sex offenses against children or clients disqualify a person from ever working as a counselor, according to the report.
Pennsylvania is the only other state that does not conduct criminal-background checks or ask applicants about their criminal history.
Past legislation to toughen up California’s system, including a bill backed by the certifying organizations, stalled in committee.
Applicants for other professional licenses in California, ranging from doctors to accountants, get much more scrutiny, such as fingerprint checks.
“If you’re a sex offender, you’re not going to be a nurse or a dentist,” Russ Heimerich, spokesman for the Department of Consumer Affairs, said in the report.
CERTIFYING ORGANIZATIONS
There are seven organizations that register and certify substance-abuse counselors in California.

Addiction Counselor Certification Board of California (Lakewood)
American Academy of Health Care Providers in Addictive Disorders (Solano Beach)
Board of Certification of Addiction Specialists (Sacramento)
Breining Institute (Sacramento)
California Association of Drinking Driver Treatment Programs (Sacramento)
California Certification Board of Alcohol and Drug Counselors (Sacramento)
Indian Alcoholism Commission of California Inc. (Redding)

Sunday, March 17, 2013

Bills Target Alcohol Abuse

BILLS TARGET ALCOHOL ABUSE

Written by

Queenie Wong

Statesman Journal

Public intoxication and alcohol abuse have long irked the police and city officials who have to clean up the mess drunks leave behind.

Now they’re asking the Legislature to give the Oregon Liquor Control Commission the authority to designate “alcohol impact areas,” which would allow cities to limit or ban the sale of low-cost drinks with high alcohol content.

“Having worked in a crowded urban environment, I’ve seen first-hand the assault, sex crimes, vandalism and disruption of public order attributed to chronic alcohol abuse,” Sgt. Kevin Hogan with the Portland Police Bureau’s Drug and Vice Division told lawmakers Friday.
Under House Bill 2702, municipalities would have to prove to the OLCC that the particular area had repeated disturbances or crimes tied to alcohol use.

Business groups, grocery stores, wine associations and retailers are pushing back.
Erez Klein, the beer and wine buyer for Whole Foods Market in the Pacific Northwest region, said while they support the goal of increasing public safety the approach in the bill is too broad and unfairly punishes businesses.

“The effort should be on enforcing illegal drinking laws and providing substance abuse treatment for those in need — not banning alcohol products,” Klein told the House Committee on Business and Labor.

Even if the state restricts certain alcoholic beverages, residents would simply shift to a place across the street outside of the alcohol impact area, opponents said.
The lead sponsor of the bill, Rep. Carolyn Tomei, D-Milwaukie, pointed to Washington where there are alcohol impact areas in Seattle, Tacoma and Spokane. In 2011, Seattle Police Department saw a significant decrease in adult liquor violations, park exclusions and trespass offenses in those areas, according to a report submitted to the Washington Liquor Control Commission.

While the report stated it is difficult to determine the direct impact of the alcohol impact areas, it concluded that it was “reasonable to assume” the restrictions did have positive effects on curbing public intoxication.

In September 2010, the city of Portland filed a petition with the OLCC to establish an alcohol impact area in the downtown core.
But the OLCC told the city in 2012 they did not have the authority to establish an alcohol impact area and would need approval from the Legislature.

“We have consulted with counsel on the issue of authority,” the letter stated. “Unexpectedly, we have determined that establishing an AIA under our current rule is not an option.”
The letter never stated why OLCC, which supports the bill, legally did not have the authority to create an alcohol impact area.
OLCC would not release the opinion from the Attorney General’s Office on Friday, citing attorney-client privilege.
qwong@statesmanjournal .com, (503) 399-6694, or follow at Twitter.com/QWongSJ

Thursday, February 28, 2013

The addict's stigma: Perception of weakness hampers treatment: Editorial

By Star-Ledger Editorial Board
on February 24, 2013 at 7:10 AM, updated February 25, 2013 at 11:54 AM

The first time a person sips a drink, takes a painkiller or shoots heroin, there'™s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it'™s weak willpower; medicine says addicts no longer have a choice.File photo

If you’re diabetic and binge on birthday cake, you can go to the emergency room for treatment — and health insurance will pay for it. You get the same medical care for your third heart attack that you did for the first two, again, with full coverage.
But the underlying attitude in the United States, clouded by social and legal stigma, is that addicts get one shot. Get clean, but fall off the wagon, and you’re on your own.
And, as The Star-Ledger’s Dan Goldberg reported in last Sunday’s editions, many families find convincing their health insurers to cover addiction treatment is a life-and-death struggle. Some commit fraud, lying their way into inpatient rehab programs.
Diseases afflicting the body — diabetes, heart disease, cancer — have clear paths for treatment, as recommended by your physician. Depending on your policy, doctors and insurers might quibble over details, but care is typically covered.
Addiction, on the other hand, is stigmatized as a personality weakness. Just as marijuana’s medicinal value was ignored because pot’s illegal, the perception of people addicted to drugs such as heroin is clouded by law, too.
The first time a person sips a drink, takes a painkiller or shoots heroin, there’s no addiction. Over time, however, the substance takes hold and dependency develops. Hardliners say it’s weak willpower; medicine says addicts no longer have a choice.

Insurers told The Star-Ledger cost-benefit calls are made on all medical treatments, including addiction. They might cover less expensive outpatient rehab, even when doctors recommend costlier inpatient stays. In that respect, critics say, addiction is treated differently, and parity laws are needed to ensure addiction has equal access to care.

If a diabetic misses an insulin shot, doctors restore the blood-sugar balance. If an addict slips, we call it relapse and say treatment didn't work.

The Affordable Care Act requires addiction and mental health parity, but it’s still part of the law’s interim rules, and advocates worry there’s too much wiggle room for insurers to deny coverage.
In New Jersey, where heroin addiction is rising at double-digit rates, parity laws have failed to advance in past legislative sessions, though a bill mandating parity in state employee health plans is moving through the Legislature.
Like diabetes, addiction is chronic, forcing patients to make lifestyle changes. When a diabetic misses an insulin shot, doctors try to restore the blood-sugar balance. When an addict slips, we call it a “relapse” and say treatment didn’t work. Both patients need — and deserve — lifetime care to maintain balance.
The “addicts brought this on themselves” argument can be made about overeaters who get diabetes or smokers who get lung cancer. Addictions deserve the same access to insurance coverage. It’s the right path, medically and morally.

Tuesday, February 5, 2013

Intervention for High-Risk Teens Can Reduce Alcohol Abuse

By Rick Nauert PhDSenior News Editor
Reviewed by John M. Grohol, Psy.D. on January 25, 2013

Mental health interventions directed toward high-risk teenagers significantly reduces their drinking behavior and that of their schoolmates.

Results from the randomized study were so strong that UK researchers believe the intervention should be administered throughout the country to help prevent teenage alcohol abuse.
The study is published in JAMA Psychiatry.

The research effort, termed the “Adventure Trial,” involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum.

A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation-seeking.

Eleven students were monitored for their drinking behavior over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. Eleven schools also received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioral strategies for coping with their particular personality profiles.

Clinical psychologist Dr. Patricia Conrod, from King’s Institute of Psychiatry and lead author of the paper, said: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves.
Researchers discovered cognitive-behavioral strategies helped some students better manage high levels of anxiety, reduce their tendency to have pessimistic reactions to certain situations, and helped to control their tendency to react impulsively or aggressively.

“Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behavior than giving teenagers general information on the dangers of alcohol.”
After two years, high-risk students in intervention schools were at a 29 percent reduced risk of drinking, 43 percent reduced risk of binge drinking and 29 percent reduced risk of problem drinking compared to high-risk students in control schools.

The intervention also significantly delayed the natural progression to more risky drinking behavior (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29 percent reduced risk of taking up drinking and 35 percent reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.

An excellent upside of the intervention is the carry-over effect reducing unhealthy behavior among friends and peers of the youth receiving the intensive counseling.

“This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”
Said Conrod, “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”
Drinking is a significant issue in England as approximately 6 out of 10 people aged 11-15 in England drink and approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons.

Across the developed world, alcohol accounts for approximately 9 percent of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, chief executive of Action on Addiction, said: “Dr. Conrod’s study, which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future, is an exciting development for prevention work in the UK.

“This is generally recognized as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

Source: King’s College London

Wednesday, January 23, 2013

World's first alcoholism vaccine to run preclinical trial in Chile

World’s first alcoholism vaccine to run preclinical trial in Chile

Tuesday, 22 January 2013 19:57

Written by Katie Manning

Vaccine promises to cure alcoholism, but without mental health treatment, could society swap one addiction for another?

Splitting headaches and waves of nausea – a drinker’s worst enemy – may soon provide alcoholics with an unlikely rescue from a crippling addiction. A preclinical trial for the Universidad de Chile’s alcoholism vaccine, set to break ground in February, will use mice to determine dosing. Researchers will apply the findings to a human trial in November this year.

Photo courtesy of Imagens Evangélicas/Flickr.

Dr. Juan Asenjo, director of the Institute for Cell Dynamics and Biotechnology at Universidad de Chile, thinks that although the vaccine is not a cure-all, it could provide an important first step.

“People who end up alcoholic have a social problem; a personality problem because they’re shy, whatever, and then they are depressed, so it’s not so simple,” Asenjo said. “But if we can solve the chemical, the basic part of the problem, I think it could help quite a bit.”

The preclinical trial precludes the phase one clinical trial in India, when doctors will inject people with the vaccine for the first time. If all goes well, the vaccination could be available as soon as two years from now, according to Asenjo.

The vaccine could affect hundreds of millions of alcoholics worldwide. In Chile, one in 15 men have an alcohol use disorder, according to the most recent 2011 study from the World Health Organization (WHO).

“If it works, it’s going to have a worldwide impact, but with many vaccines one has to test them carefully. I think the chances that this one will work are quite high,” said Asenjo.

Normally, the liver turns alcohol into the compound acetaldehyde, which can be thanked for the vicious hangovers that often follow heavy drinking. An alcohol-metabolizing enzyme then breaks the compound down.

The vaccine would work for six months to one year through RNA, which can control gene expression. The so-called anti-aldh2 antisense RNA acts as a messenger to tell the liver not to express genes that metabolize alcohol. In other words, the vaccine ups the ante on hangovers in order to discourage consumption.

Asenjo said his research team in Chile is heading up the only trial of alcohol vaccines in the world, but the concept isn’t new.

Nearly a century ago, a drug called Disul?ram hit the shelves. Disulfiram blocks the enzyme from breaking down alcohol, thus intensifying the body’s negative response to alcohol.

The drug doesn’t ease intense cravings and has a high toxicity level. Coping with harsher hangovers is apparently a tough pill to swallow as patients often don’t continue taking the medicine as directed.

The vaccine, once injected, can’t be reversed until completion.

Inspiration for the vaccine struck from the far East, said Asenjo. Some hangover-prone individuals have a gene mutation that, like Disulfiram, inhibits the breakdown of alcohol and subsequently slashes alcoholism rates among those with the gene.

“People who are Japanese, Chinese or Korean and have this mutation – Let’s say 15 to 20 percent of the population – they don’t touch alcohol, and that’s because they feel bad with the vomit and the nausea,” Asenjo said.

Chile’s National Commission for Scientific and Technological Research’s (CONICYT) Fondef program, which gives money to develop science and technology, financed researchers at Universidad de Chile to look into this phenomenon. They found a way to alter a person’s gene expression to mimic this gene mutation, thus providing a long-term treatment.

The only lasting treatment currently available demands an iron will, according to the director of general services at Alcoholics Anonymous (AA) Chile. He said hasn’t picked up a drink in the past 36 of his 75 years.

The recovering alcoholic, who asked to remain anonymous, agreed that a vaccine alone can’t solve addiction.

“Personally, I hope it works, but it’s not so easy for the person who already has alcoholism,” said the director. “Once you have this problem. You don’t have a solution. You pick up a drink, think you can handle a few, but it’s not possible.”

He leafed through a long list of AA’s sister organizations from Neurotics Anonymous, Smokers Anonymous to Compulsive Shoppers Anonymous. A vaccine, he said, can’t cure all. It won’t fix the mental challenges that plague addicts. They might latch onto an even more lethal substance with alcohol out of the picture.

“I had a friend. He quit drinking. Then he became a terrible smoker. He was connected to an oxygen tank for two months to keep him alive,” said the director.

“A person needs to confront themselves,” he added.

By Katie Manning (manning@santiagotimes.cl)Copyright 2013 - The Santiago Times

Monday, November 5, 2012

Corps introduce alcohol intervention program

Corps introduces alcohol intervention program

By Dan Lamothe - Staff writer
Posted : Monday Oct 8, 2012 8:42:43 EDT

The Marine Corps will crack down on reckless drinking by requiring service members cited for drunken driving and other drinking-related incidents to participate in a new program focused on “evidence-based intervention,” the service announced.

The Prime for Life program was outlined briefly in Marine administrative message 527/12, released Sept. 21. It will focus on early intervention, and include interactive programs that force Marines to review facts about high-risk drinking.

The program “equips Marines with the ability to assess high-risk behaviors and influence changes in attitudes and beliefs,” according to the MARADMIN, signed by Brig. Gen. Robert Hedelund, director of the Marine and Family Programs Division of Manpower and Reserve Affairs, in Quantico, Va.
“We will equip our Marines with effective tools to promote readiness within our ranks. Alcohol education affords Marines involved in alcohol-related incidents an opportunity to effectively recognize and mitigate high-risk actions,” the message said.

Marines who are cited for a DUI/DWI receive early intervention services now, but the MARADMIN establishes Prime for Life as the new standard, said Linda Love, substance abuse section head in the Marine and Family Programs Division, Marine Corps Headquarters.

She said this new protocol is evidence-based — tied to the latest social science available that points toward reducing subsequent substance abuse-related incidents — and provides a standardized approach with a curriculum.

“Substance abuse prevention staff across the Marine Corps have received training on how to implement this early intervention tool,” she said. “Prior to this early intervention tool, we had a nonstandardized approach that was not supported by evidence-based practices.”
Prime for Life is just one of an array of new alcohol-related initiatives that will be implemented this year.

Also in the pipeline is an awareness campaign focused on the risks associated with alcohol abuse and misuse, training efforts and the development of educational resources related to risk-taking behaviors, Love said.

“The Alcohol Abuse Prevention Campaign was reviewed by the Executive Force Preservation Board and subsequently forwarded to the General Officer Symposium,” Love said, adding that results from the symposium are pending.

Top Marine officials have cited the role alcohol plays in a variety of societal problems plaguing the Corps. They include spousal abuse, suicide and an embarrassing sexual assault problem that Commandant Gen. Jim Amos has called a “black mark” on the service’s reputation.

There were more than 300 reported sexual assaults in the Corps in 2011, according to a service report released in July. It’s widely held that such crimes are underreported, however.
In a July interview, Hedelund agreed that the road ahead will be difficult.
“I think we’re getting there with senior leadership, and we’re certainly getting there with commanders who understand that drinking responsibly doesn’t mean the same thing to an O-6 as it does to a 21-year-old,” he said.

Thursday, October 18, 2012

As Florida Bath Salts Death Rises, Drug Enforcers, Stymied

Bath salts are synthetic drugs that can be snorted with effects similar to ecstasy or cocaine. But bath salts are easier to obtain — online or at head shops and convenience stores — and cheaper.
	[EDMUND D. FOUNTAIN \| Times photo illustration]

AS FLORIDA BATH SALTS DEATH RISES, DRUG ENFORCERS, STYMIED
By Jessica Vander Velde, Times Staff Writer
In Print: Sunday, October 14, 2012

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Jairious McGhee, 23, was a caterer with no criminal record when he died after using bath salts in Tampa in April 2011.

Tuesday, October 16, 2012

Recognizing the alcohol patient

[Illustration by George Bates / www.georgebatesstudio.com]

Recognizing the alcoholic patient

Patients who struggle with alcohol can be difficult to spot. Better training, starting as early as medical school, can ensure these patients get needed treatment.

By Carolyne Krupa, amednews staff. Posted Oct. 15, 2012.

Some are easier to spot than others.

It may be as obvious as encountering an intoxicated patient in the emergency room. Or as subtle as noting a hypertensive patient who seems otherwise healthy but has mysteriously missed his or her last few appointments.

Alcoholism presents itself through a variety of signs, symptoms and severities, said Jeffrey Samet, MD, MPH, chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. He is president of the American Board of Addiction Medicine.

“They come in a whole spectrum of obviousness,” he said. “It’s not necessarily going to hit you over the head. It can be highly, highly challenging.”

Primary care physicians can feel ill-equipped to identify and care for such patients, but they play a crucial role in ensuring that individuals get treatment, said Raye Litten, PhD, associate director of the National Institute on Alcohol Abuse and Alcoholism’s Division of Treatment and Recovery Research. Most people who have problems with alcohol use don’t seek care from a specialist.

Most doctors are not sufficiently trained to identify or diagnose substance abuse.

“Usually, the primary care physician may be the only medical professional that people with alcohol problems will see, and maybe not for the alcohol, but for whatever other problems it is causing,” Litten said.

For that reason, it’s important that primary care physicians be able to identify those patients and get involved to help ensure they are treated to control their drinking, he said.

“In many cases, if the doctor doesn’t get involved, the patient dies,” said Nicholas Pace, MD, clinical associate professor at New York University Langone Medical Center.

A June report by the National Center on Addiction and Substance Abuse at Columbia University in New York found that most health professionals are not sufficiently trained to identify or diagnose substance abuse. They often are unfamiliar with the signs and symptoms of addiction, and they don’t know the best treatment options for patients. As a result, many of those who do provide treatment for addiction are not medical professionals and lack the knowledge and skills to provide the full range of available evidence-based treatments, the report said.

About one in seven Americans 12 and older (40.3 million people) meets the clinical criteria for substance abuse addiction. Seven percent of Americans have an addiction involving alcohol, either to alcohol alone or to alcohol and one or more other substances, said Susan E. Foster, vice president and director of the Columbia center’s Division of Policy Research and Analysis and principal investigator on the report. The high prevalence of the disease makes it something that primary care physicians encounter on a regular basis, she said.

“You can’t practice primary care without seeing patients with current or past alcohol problems every day,” said Patrick G. O’Connor, MD, MPH, professor of medicine and chief of general internal medicine at Yale School of Medicine in Connecticut.

Beyond full-blown alcoholism, many more people are involved in risky levels of drinking. The National Institute on Alcohol Abuse and Alcoholism defines risky drinking as more than four drinks on any single day and no more than 14 drinks per week for men. For women, such drinking means no more than three drinks on any single day and no more than seven drinks per week. An estimated 18 million Americans have an alcohol use disorder and 40 million are high-risk drinkers, Litten said.

Obstacles to care

Primary care physicians face several challenges in identifying patients who have problems with alcohol. Many patients may not be comfortable talking with doctors about drinking, and doctors have a limited time to meet with each patient, Dr. Samet said.

“With primary care, if you’re seeing a patient in a usual clinic, there are so many issues on the table that this one may be lost in the shuffle,” he said.

18 million Americans have an alcohol-use disorder.

Depending on their training, physicians may not recognize that a patient is addicted to alcohol, Dr. O’Connor said. Historically, medical schools have not provided much training on treating people with alcohol problems, and that lack of training often continues into graduate medical education training, he said.

One issue is that medical schools have a lot of competing subjects to cover in four years. Even so, educating students about alcoholism should be a priority, Dr. O’Connor said.

“There are knowledge barriers in how to identify them, as well as what to do with them when you have them,” he said. “Given that alcohol use disorders are so common in medical populations, it’s ridiculous to think that it’s ignored as much as it is.”

In caring for these patients, there are other barriers, such as the availability of services, the patients’ willingness to undergo treatment and insurance coverage for addiction services, O’Connor said.
Then there is the question of the doctor’s attitude. Despite research proving that alcohol addiction is a disease with serious physiological consequences, some physicians still blame the patient, said Dennis H. Novack, MD, professor of medicine and associate dean of medical education at Drexel University College of Medicine in Philadelphia.

“There is a lot of misunderstanding and bias, even among physicians,” Dr. Novack said. “Until physicians see alcoholism as a chronic disease for which there is no cure, you can’t help the patient.”
Instituting some type of standardized screening process can make a difference, Dr. Pace said. The Alcohol Use Disorders Identification Test can help physicians identify patients with alcohol issues. It involves asking patients questions about how much they drink, what they drink and when they drink.

40 million Americans are high-risk drinkers.

“Alcoholism is the big masquerader,” Dr. Pace said. “If the patient has several issues and a physician can’t figure out what’s really wrong, they should really think about alcohol and alcoholism. You have to keep in mind that you see the whole spectrum of the disease. It comes in all sizes, shapes and colors and really mimics so many other problems.”

Patients struggling with alcohol use may display a variety of symptoms, including indigestion, hypertension and liver problems, Dr. O’Connor said. Physicians should routinely screen patients for alcohol use, he said.

In talking with patients, physicians should make it clear that their discussions are confidential, Dr. O’Connor said. They also should discuss what could happen if the patient pursues treatment. Alcohol counseling can be brief, similar to discussions on other health issues such as diabetes and hypertension.

“If you don’t address those issues, they will make other medical issues worse,” Dr. O’Connor said.
Excessive alcohol use raises blood pressure and can contribute to a litany of medical problems, Dr. O’Connor said. Hypertension can lead to cardiac arrhythmia; problems with the gastrointestinal system, liver and pancreas; and neurological problems such as dementia.

The NIAAA provides resources for physicians and the public. Its guide for doctors recommends asking patients how many times in the past year they have had more than five drinks at a time. Asking that single question can help physicians identify up to 82% of people who have alcohol problems, Litten said.

It’s important that physicians not be reproachful or judgmental of patients, but express concern for their health and welfare, said David Bronson, MD, a general internist and president of the American College of Physicians. If doctors immediately ask a patient about drinking, the patient may feel attacked. It’s important to frame the question as a series of other general health questions that the doctor would ask of all patients.

“You have to make them feel comfortable about it,” Dr. Bronson said. “It should be a routine for all of your patients.”

Educating young doctors about alcohol

Some medical schools are working to make sure students are exposed to the issues of alcohol addiction early in their training. For example, first-year students at Drexel University College of Medicine are required to attend an Alcoholics Anonymous meeting. Two AA members also come to the school to talk with students about their experiences in small group sessions.

“We want our students to understand and see AA as a resource, but we also want our students to understand what people with this disease are going through,” Dr. Novack said. “They have gone through hell and back, and they have a lot that they can share that I think can help break some of the biases of our students.”

At the GME level, Dr. Pace has been leading a course for first-year internal medicine residents on alcoholism and substance abuse for about 10 years. The four-day course is offered once a month to residents at four New York hospitals.

As part of the course, AA members meet one on one with residents. They tell their stories, and residents present those to the class at the end of the course. Students also attend an AA meeting and work with trained actors to practice interviewing patients about their alcohol use. They also meet a physician who has struggled with substance abuse addiction, and they hear how it affected careers and personal lives, Dr. Pace said.

All internal medicine residents at Lenox Hill Hospital are required to take the course, said Robin Dibner, MD, director of the hospital’s internal medicine residency program and clinical associate professor at NYU School of Medicine.

“I just felt that there was nowhere in medical school that they were learning about this,” she said. “I think it should be a major part of curriculum for all residencies.”

Nicole Lapinel, MD, chief medical resident at Lenox Hill, said the program was eye-opening. Being able to talk one on one with an AA member and hear stories made a strong impression.

“You got to know this individual — when they first recognized that they had a problem and how they went about seeking treatment,” Dr. Lapinel said. “Sitting there listening to their very personal stories — as a physician you don’t normally get that perspective.”

The American Board of Addiction Medicine also is working to fill gaps in expertise about alcohol and substance abuse addictions. In 2011, the board launched its first residency programs in addiction medicine. There now are 10 programs around the country, Dr. Samet said.

Specialized training will help ensure that more patients who need help can get treatment, Dr. O’Connor said. “There is a huge dearth of specially trained physicians in this area.”

Weblink

National Institute on Alcohol Abuse and Alcoholism (www.niaaa.nih.gov/)
American Board of Addiction Medicine (www.abam.net/)
Alcoholics Anonymous (www.aa.org/)

“Helping Patients Who Drink Too Much: A Clinician’s Guide,” National Institute on Alcohol Abuse and Alcoholism, Updated 2005 Edition (pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf)

Correction

This article originally incorrectly stated the title of Jeffrey Samet, MD, MPH. He is chief of general internal medicine at Boston Medical Center, professor of medicine at Boston University School of Medicine and professor of community health sciences at Boston University School of Public Health. In addition, the article gave an incorrect percentage of Americans who have an addiction involving alcohol. Seven percent have an addiction involving alcohol. American Medical News regrets the error.

Wednesday, August 22, 2012

Alcoholism Affects Men's and Women's Brains Differently

Alcoholism Affects Men’s and Women’s Brains Differently

By Janice WoodAssociate News Editor
Reviewed by John M. Grohol, Psy.D. on August 11, 2012

New research has demonstrated that the effects on white matter brain volume from long-term alcohol abuse are different for men and women.

Researchers from Boston University School of Medicine (BUSM) and Veterans Affairs (VA) Boston Healthcare System also suggest that when they stop drinking, women recover their white matter brain volume more quickly than men.

Previous research has linked alcoholism with white matter reduction, according to the researchers, who explain that white matter forms the connections between neurons, allowing communication between different areas of the brain.

In this latest study, a research team, led by Susan Mosher Ruiz, Ph.D., a postdoctoral research scientist in the Laboratory for Neuropsychology at BUSM and research scientist at the VA Boston Healthcare System, and Marlene Oscar Berman, Ph.D., professor of psychiatry, neurology and anatomy and neurobiology at BUSM and research career scientist at the VA Boston Healthcare System, employed structural magnetic resonance imaging (MRI) to determine the effects of drinking history and gender on white matter volume.

They examined brain images from 42 abstinent alcoholic men and women who drank heavily for more than five years and 42 nonalcoholic men and women. The researchers found that a greater number of years of alcohol abuse was associated with smaller white matter volumes in the alcoholic men and women. In the men, the decrease was observed in the corpus callosum, while in women this effect was observed in cortical white matter regions.

“We believe that many of the cognitive and emotional deficits observed in people with chronic alcoholism, including memory problems and flat affect, are related to disconnections that result from a loss of white matter,” said Mosher Ruiz.

The researchers also found that the number of daily drinks had a strong impact on alcoholic women, with the volume loss 1.5 to 2 percent for each additional drink. Additionally, there was an 8 to 10 percent increase in the size of the brain ventricles, which are areas filled with cerebrospinal fluid (CSF) that play a protective role in the brain. When white matter dies, CSF produced in the ventricles fills the ventricular space.

The researchers also found that in men, white matter brain volume in the corpus callosum recovered at a rate of 1 percent per year for each year of abstinence. For people who abstained less than a year, the researchers found evidence of increased white matter volume and decreased ventricular volume in women, but not in men. However, for people in recovery for more than a year, those signs of recovery disappeared in women and became apparent in men.

“These findings preliminarily suggest that restoration and recovery of the brain’s white matter among alcoholics occurs later in abstinence for men than for women,” said Mosher Ruiz. “We hope that additional research in this area can help lead to improved treatment methods that include educating both alcoholic men and women about the harmful effects of excessive drinking and the potential for recovery with sustained abstinence.”

The research was published online in Alcoholism: Clinical and Experimental Research.
Source: Boston University Medical Center
Brain scan photo by shutterstock.

APA ReferenceWood, J. (2012). Alcoholism Affects Men’s and Women’s Brains Differently. Psych Central. Retrieved on August 22, 2012, from http://psychcentral.com/news/2012/08/11/alcoholism-affects-mens-and-womens-brains-differently/42963.html

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