On October 28, 2015, Dr. Elizabeth Wassenaar, Lindner Center of HOPE Psychiatrist and Williams House Medical Director, joined Lon Woodbury on the Woodbury Report radio show. Their discussion focused on outlining the benefits of a residential assessment for mental health concerns in adolescents.
Opioids are indicated in treatment of acute and chronic non-cancer pain. Opioids are psychoactive substances and can cause an increased sense of euphoria via their action on the brain opiate receptors. This effect, which is beneficial for altered pain perception, is also the main reason for their misuse potential.
Opioids can be highly addictive. When used for recreational purposes, or when prescribed by treatment providers and not adequately monitored, can progress rapidly to an opioid related disorder. Opioid related disorders include opioid use disorder, opioid withdrawal, opioid intoxication, opioid induced mood disorder, opioid induced anxiety disorder and opioid induced psychotic disorder. There is an increased prevalence of mental illness in individuals with opioid related disorders than within the general population. About 90% of patients with opioid dependence will also have an additional psychiatric disorder, most commonly major depressive disorder, alcohol use disorders, anxiety disorders and personality disorders.
Since the 1990s, there has been greater awareness about adequate pain control for patients experiencing not just acute pain, but also chronic non-cancerous pain. This has led to an increase in the rise of prescription opioids, which in turn has led to a steady rise in opioid prescription addiction. The United States and Canada have significantly higher rates of prescribed opiates than any other developed country in the world. Prescription opioids are costly and the high cost of obtaining them has led individuals to seek cheaper alternatives. Heroin resurgence has occurred in the last decade. Patients addicted to prescription opiates are seduced by its cheap price and more rapid onset of action. Increased prevalence of heroin use has led to a rise in drug related felonies (larceny, prostitution) and medical complications such as HIV and Hepatitis C seroconversion and accidental overdose.
Accidental Overdose
Opioid overdose is a global health concern accounting for considerable mortality among patients with opioid use disorders. About 50% of all deaths of heroin users in the United States are as a result of opioid overdose. 73% of all prescription overdose related deaths are due to prescription opioid medications.
To understand overdose, we first need to define the term “Tolerance”. This refers to an individual requiring more of a psychoactive substance to achieve a desired effect or when the same dose of a previously used substance does not give the desired effect. Individuals with opioid use disorders develop tolerance to the drug over a prolonged period of time. Opioids have respiratory depressant as well as euphoric effects. Tolerance to respiratory depressant effects occurs much slower than to the euphoric effects. This means whenever an individual rapidly increases the amount of the drug used in order to achieve a euphoric effect, they are at significant risk of respiratory compromise and death. Tolerance also rapidly decreases during periods of abstinence, such as following an opioid detoxification. Risk of overdose is greatly increased during the immediate opioid detoxification period. This is as a result of intense craving for the drug, as well as loss of tolerance to the drug.
Treatment of Overdose
Naloxone (Narcan) is a short acting opioid receptor blocker that is a life saving measure and should be immediately administered in suspected overdose. Signs to look for in an individual with suspected overdose include diminished level of consciousness or coma, pinpoint pupils and respiratory depression with rate less than 12 per minute (normal is 12-20). Administration of intravenous Narcan works within 2 minutes and slightly longer if given intramuscularly. This medication is safe and has no significant side effects. The main draw back with Narcan is the short half-life so its effects last much shorter than the effects of most opioids. Thus, once the medication has been administered, emergency medical services must be called immediately. Failure to do so will lead to immediate return of overdose symptoms within minutes, after effects of Narcan have worn off.
Administration of Narcan is easy and everyone, not just trained professionals can administer it. It can be administered in the community by trained lay persons. Family members and friends usually witness early symptoms of overdose. Training the support network as well as the individual with a history of opioid use disorder is imperative for the risk reduction of overdose deaths. Prescription of a Narcan kit to all individuals with a history of opioid use disorder has been shown to significantly reduce overdose deaths in the community. This is being practiced in some European countries and in several states across the U.S.
Narcan is not treatment, it is only an emergency life saving measure to prevent death and buy time before the arrival of emergency services and referral to treatment centers for long term treatment. Long-term treatment of opioid use disorders will be discussed in the subsequent series.
Each year, millions of Americans find themselves caught in a cycle of addiction to alcohol, drugs, gambling, or other substances/ behavior. They must struggle daily with the effort to become and remain free of the drugs or behaviors to which they feel uncontrollably drawn.
Affected individuals are diagnosed on the basis of the particular substance or activity to which they are addicted. However, individuals with any type of addictive disorder may exhibit related symptoms, and both causes and treatment are similar.
The Nature of Addiction
An addictive disorder, as opposed to temporary reliance on a particular substance or behavior, can be distinguished by several distinct symptoms:
Tolerance. Over time, an individual requires increasing amounts of the preferred substance/behavior to achieve the same physical or psychological effects.
Withdrawal. When an individual tries to curb the addiction, withdrawal symptoms such as anxiety, rapid heartbeat, sweating, etc., will occur.
Lack of control. The individual has extreme difficulty cutting back or controlling the addictive behavior, even when aware of negative consequences.
Preoccupation. Cravings for the desired substance or behavior are constant. Increasing amounts of time are spent planning, participating in, and then recovering from the addictive behavior, with employment and relationships often threatened.
Causes of Addiction
Are addicts “born that way,” or do they develop addictive disorders due to environmental factors? In this nature vs. nurture debate, both answers may be true. Psychological, genetic, environmental, and other factors that determine a particular individual’s likelihood of developing an addiction may be interrelated.
Biological factors. Studies have shown that the likelihood of twins developing the same addiction is 50-70%, and familial rates of such addictions as alcoholism are significant. Other research has pointed to such biological factors as abnormal dopamine levels influencing addictive behavior.
Psychological factors. Is there such a thing as an addictive personality? While no such diagnostic code exists, many experts believe that certain personality traits make individuals more vulnerable to addiction. They include: sensation seeking, impulsivity, poor coping skills, anxiety or depression, insecurity, and feelings of social alienation.
Environmental factors. Stress may the factor that figuratively pulls the addiction trigger in an individual who is biologically or psychologically prone to develop one. A history of trauma, for example, is frequently found in individuals who develop an addiction, particularly any type of severe stress in childhood. Physical or sexual abuse also increases the risk of developing an addictive disorder.
Treatment of Addiction
Numerous treatment approaches have developed that provide benefit to individuals in acute stages of addiction, and a robust recovery movement provides ongoing support and management of the illness. Treatment modalities include:
Medical approaches. Depending upon the nature of the addiction, an individual may benefit from medical detoxification and an inpatient rehabilitation program. While the use of medication is often discouraged, short-term use of medication is necessary in some instances.
Psychotherapy. Many contemporary forms of “talk therapy” have demonstrated positive results in individuals with addiction, including the following:
These therapies teach individuals better coping skills, including recognition of triggers to addictive behavior, stress reduction, relapse avoidance, and impulse control.
Psychotherapy may be conducted in an individual or group setting. Family therapy is often encouraged in order to reduce enabling of addictive behaviors, as well as to heal broken relationships.
Community and family supports. Peer support is a cornerstone of most successful recovery programs. Recovering individuals find ongoing support through a variety of community organizations such as Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or similar groups. Many support groups are based on the twelve-step recovery model first established for AA.
In addition to counseling, families may benefit from support groups such as Al-Anon for assistance in dealing with a loved one’s addictive behavior.
Addictive disorders can be daunting, but with proper treatment and support, individuals can experience recovery and return to full function in their homes and communities.
Do you know someone who gambles excessively? If so, perhaps you’ve wondered if this individual just had a bad habit or if he or she was actually addicted to gambling. It’s a question that even the experts have debated. But the latest diagnostic publication of the American Psychiatric Association, the Diagnostic and Statistical Manual (DSM)-V, confirms that excessive gambling can indeed be an addiction, just like substance abuse.
The Nature of Gambling Addiction
“Problem” gambling, also referred to as pathological or compulsive gambling, affects an estimated 2 – 4% of the population. Before recent changes by mental health clinicians, it was classified as in impulse control disorder. Like kleptomania (uncontrollable stealing) or pyromania (impulsive fire setting), compulsive gambling was considered a mental disorder associated with poor impulse control.
With further research, a new classification of the disorder has been made. In the DSM-V, compulsive gambling is considered to be one of the “substance-related and addictive disorders.” Why the change? There is growing clinical evidence that pathological gambling has much in common with traditional substance abuse disorders.
First, the effects of the respective disorders on individuals’ work, financial, and personal lives can be similar. Neurochemical testing and brain imaging have also made a case for the belief that gambling activates the brain’s reward system in a manner similar to drugs. For example, compulsive gamblers report highs from gambling as well as cravings. Furthermore, gambling problems tend to run in families, indicating potential genetic factors. Finally, pathological gamblers are more likely to abuse alcohol and other drugs.
Symptoms of Gambling Addiction
In order for an individual to be classified as having a gambling disorder, at least 4 of the following symptoms must be present:
Many of these symptoms resemble classic addictive symptoms, such as withdrawal and loss of control.
Individuals with pathological gambling problems are more likely to exhibit symptoms of other psychiatric problems. In addition to substance abuse, such problems may include mood disorders, anxiety, or personality disorders.
While the effects of pathological gambling should not be minimized, viewing the behavior as evidence of an addiction rather than a character flaw can be helpful in encouraging an individual to seek treatment. It may also remove some of the stigma associated with the behavior. With appropriate intervention, individuals with gambling addictions can recover and live productive lives. (And that’s a sure bet!)
When the subject of disabilities surfaces in our thoughts or conversations, it is common to first consider those caused by some type of physical ailment or affliction. Conditions such as arthritis, heart disease and back problems are certainly primary causes of long-term disabilities in our nation. However, mental illness is the leading cause of disability in U.S. citizens ranging in ages from 15 to 44, according to National Institute of Mental Health (NIMH) statistics.
What these numbers show is that many Americans and people around the world are affected by illnesses such as depression, bipolar disorder, schizophrenia and a host of other mood and anxiety disorders in the prime of their working lives. Unfortunately, these numbers show no sign of subsiding anytime soon. In fact, they continue to rise, as do the number of filings with the U.S. Social Security Administration (SSA) for disability benefits due to mental illnesses.
The SSA and Mental Illness Claims
The SSA has established specific criteria that qualify those suffering with mental disorders for disability benefits. Basically, it must be determined that an existing mental condition limits or impairs one’s ability to fulfill their work obligations. In most situations, assessments and evaluations must be performed by mental health professionals. Additionally, evidence must be submitted to the SSA that indicates the individual in question is unable to perform their assigned job duties as a consequence of their condition.
Getting Back on their Feet
It is important for those with mental health issues to make their employers aware of their situation. All too often, workers are hesitant or afraid to address their condition with their employers for fear of negative repercussions. But behavioral or productivity problems could lead to termination, which also often results in the loss of insurance, creating even more problems for these individuals in regard to receiving treatment.
When documented mental health issues are reported to an employer, they are obligated under Americans with Disabilities Act (ADA) regulations to accommodate that employee with whatever they need to successfully perform their job duties, or to make their working situation as comfortable as possible. In lieu of applying for disability benefits, this can allow an employee to continue to work while receiving mental health treatment and take measures that will eventually enable them to effectively manage their condition.
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This blog is written and published by Lindner Center of HOPE.
Whether an individual is addicted to alcohol, drugs or a combination of both, addiction recovery is often a long and arduous process. In fact, recovery is a lifelong endeavor where the addict may experience many ups and downs and ride a figurative “roller coaster” of emotions and cravings until they have achieved abstinence and settled into healthier patterns.
In many instances, some type of intervention by friends, family or other sources is the first step toward encouraging an addict to enter into a recovery program. Then, the addiction treatment and recovery process begins, which generally consists of detoxification, intensive counseling and sometimes a stay at a rehabilitation facility.
Continuing Care is Crucial
Though many addicts eventually go into “remission,” and reach a point where they are able to manage their desire to use, the tendency to relapse is always a concern. Many addicts are able to eventually completely cease their addictive behaviors and move forward with their lives. However, others may fall back into destructive patterns at some point, even if their former behaviors lay dormant for years.
This is why aftercare plays such a vital role in the recovery process. After successful completion of a treatment program, counselors or clinicians will tailor an aftercare or “continuing care” plan to fit the individual needs of a recovering addict.
Aftercare programs are usually administered for at least six months after initial treatment. They may include admission into a transitional facility for a period of time, and in most cases are ongoing at least on some level. Continuing care can consist of a variety of activities including regular meetings, counseling sessions and the joining of a 12-step or group support program.
Developing relationships with other recovering addicts who have achieved sobriety is often very helpful. Avoiding unhealthy environments where temptations may exist is strongly encouraged. With attentive support, ongoing education and periodic counseling, the recovering addict can change their course and develop the skills necessary to live a good, productive and sober life.
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This blog is written and published by Lindner Center of HOPE.
The prevalence of the “quarterlife crisis” – essentially, a midlife crisis that occurs in your 20s – seems to be on the rise.
Many young people experience some degree of stress, self-doubt and lack of motivation upon entering the “real world” after college. However, the phenomenon of the quarterlife crisis seems to be increasingly common as fewer young adults reach the traditional milestones of success, though pressures to achieve them remain the same.
Research shows that up to 86 percent of young adults feel pressure to succeed in careers and relationships by the time they reach age 30. However, only 11 percent actually attain conventional markers of achievement such as obtaining a steady job, getting married and having children by their 30th birthday. Likely due to this discrepancy, up to 73 percent of 26 to 30 year olds may experience a quarterlife crisis.
So what are some things you can do to deal with a quarterlife crisis? Experts say it’s important to redefine your idea of success and stop comparing yourself to others. Instead of despairing over why you don’t have your dream job or the perfect relationship, try defining success by what you have to offer others. Try volunteering and other skill- and character-building activities. Remember that life is not a race and that everyone is on their own path.
Dr. Paul E. Keck, Jr., President and CEO of Lindner Center of HOPE, recently gave a talk on this subject on LA Talk Radio’s Answers 4 the Family radio show. Check out Dr. Keck’s talk, “Failure to Launch – What’s Really Holding Back Emerging Adults?”
In some cases, quarterlife crises may lead to anxiety, depression, eating disorders or even addictive disorders. If you or a twenty-something family member is displaying signs of a psychological or addictive disorder, it’s important they receive prompt and effective treatment. Contact Lindner Center of HOPE for more information on screening and treatments for mood disorders and other conditions.
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This blog is written and published by Lindner Center of HOPE.
23 million people need treatment for an illicit drug or alcohol use problem. Check out this infographic from the National Council for Community Behavioral Healthcare for more info on addictions and treatment.
Addictions not only affect the physical, emotional and mental health of the addict, but also create a burden for the people in their lives. Even after emphatically urging them to seek treatment, those close to an addict or severe substance abuser are often helpless as they watch their friend or loved one sink further into the depths of addiction.
There are many dangers and potentially deadly complications associated with drug, alcohol abuse and addiction. But the greatest danger is the unwillingness of the addict to accept the fact that there is a problem and admit they need help. Unfortunately, it sometimes takes a devastating event in their life — such as an automobile accident, an arrest or an overdose — for the addict to finally agree to receive addiction treatment.
Signs of an Addiction
An addictive disorder exists when an individual is unable to control their drug or alcohol use to the point where these substances play a dominant role in their life. Other addictive behaviors and signs include changes in mood and appearance, the eschewing of personal and work responsibilities and experiencing symptoms of withdrawal when the substance is not available.
Overcoming Denial
It is not uncommon for drug or alcohol addicts to minimize the seriousness of their problem or flat out deny its existence. Denial is often deeply ingrained within an individual, convincing themselves there is no real problem or they can “quit anytime they want to.”
Denial is a major reason why addicts many times hit “rock bottom” before they begin to consider taking steps toward recovery. Optimally, the realization that help is needed will emerge within the addict before intervention becomes necessary. From there, addiction recovery can begin through routes such as education, therapy, support groups and specialized treatment centers. But it all begins with the addict admitting their dilemma, and expressing a sincere desire to recover.
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This blog is written and published by Lindner Center of HOPE.
Substance abuse is certainly not restricted to the young. Anyone at any age can develop a repetitive pattern of drug and alcohol use that can damage their physical and mental health, threaten their relationships and diminish their performance at school or on the job.
From Use to Abuse to Addiction
Why are some people able to eventually move away from use and abuse while others become captives of addiction? The answer to this question is not always easy to pin down. But there are a number of factors that may play into the development of an addiction.
Genetic, psychological and environmental influences are key contributors toward addictive behaviors. Numerous studies have revealed that a biological predisposition exists in a large percentage of those addicted to drugs or alcohol. Other types of individuals prone to self-medicate include those that suffer with a mental illness; were raised in extremely dysfunctional homes; or have been subjected to some form of abuse.
What usually begins as occasional drug or alcohol use to soothe wounds or provide temporary pleasure will often evolve into regular use or abuse. The next stage is dependence or the inability to stop consumption of drugs or alcohol without showing symptoms of withdrawal. These are sure signs of full-blown addictive disorders.
Addiction Treatment
Addiction centers can be found in most metropolitan in the U.S. One example is Lindner Center of HOPE’s Sibcy House. Located just north of Cincinnati, Ohio, Sibcy House offers cutting-edge addictive disorders treatment and a patient analysis that begins with a thorough diagnosis.
Addiction recovery can be lengthy and at times difficult. But with the establishment of proper care and a willingness from the patient to get to a healthier place in their lives, a successful recovery is well within reach.
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This blog is written and published by Lindner Center of HOPE.