Opioid Crisis Discussion

Today, I attended an event that is part of the Addiction Professional Panel Series.  This particular event was entitled “Driving Community Solutions for the Opioid Crisis”.  This event was at the lovely Capital Grill in Troy, MI, and was well attended.  The panel was made up of a few clinical directors as well as a drug court judge.

While there was some disagreement about whether or not we have seen the peak of the crisis, all agreed that there is a need for a multi-disciplinary approach to the problem.  There is a need for medical professionals, legal professionals, employers, first responders, and families to have a better understanding of the disease of addiction.  Understanding the level of shame that is part of the disease and keeps users isolated.  Understand and acknowledge the barriers to treatment, which come in many forms.

Lack of quality treatment, a lack of understanding of the disease by judges who, by sentencing individuals to jail or home confinement increase the isolation for the user, and financial barriers to treatment all contribute to these barriers.

There were examples given of successful initiatives, such as the Operation Rx and Hope Not Handcuffs programs here in Michigan, and a recognition that the stigma of drug use and addition still exists and often prevents an individual from seeking help.

And I was very pleased to hear the recognition on untreated PTSD as both a contributing factor to opioid abuse and a barrier to recovery.  PTSD, along with other co-occurring disorders, must be addressed as part of an overall treatment plan.

In some ways I was struck with a sense of deja-vu, as if we have had these conversations before.  While I was working in an inpatient program in the mid to late 1980’s, we had similar conversations about what we then labeled the “crack cocaine epidemic”.  We developed specific tracks within our treatment program for folks who abused cocaine.  There were public service announcements on TV and radio about the dangers of this drug.  Many book and articles published, etc.

In the early 2000’s, we had a similar response to the “methamphetamine epidemic”.  Much attention (and many dollars) was given to intervening and treating users of this very dangerous drug. 

And here we are now with the “opioid epidemic”.  So, if much is the same, what is different now?  Well, I think for starters, the sheer number of deaths is staggering.  The fact that this is evident in not only the younger population, but in the over-50 age group is alarming.  And, thankfully, I think old stigmas may be changing, albeit slowly.  Part of the conversation today focused on the use of the word “addict” and the negative connotations that may stem from that.  Language matters, and while we can get bogged down into issues like this that may not be a priority given the circumstances, there does appear to be more societal acceptance of folks in recovery, and that could go a long way to lessening the stigma and removing at least one of the barriers to treatment.

But conversation is not action, and I hope the folks in the room left with a renewed purpose to form community partnerships, to work together to remove barriers, and by doing so begin to lessen the staggering numbers we see reported.

Oh, and by the way, in what I thought was an inevitable turn in the conversation, a participant asked about medical marijuana as an alternative to opioids for pain management.  If there had been time, I am sure there would have been no shortage of opinions on this very important and current topic.  That will be for another day.

Alcohol in the Media

With the Super Bowl just last month, many recall their favorite commercials that were produced specifically for this event. According to an article in Forbes, Super Bowl ads last year were selling for up to $5 million each, up 11% from the previous year. Many industries will pay this high cost to spotlight their product for 30 seconds during this game.

Alcohol companies are a big part of this, and their messages reach all members of the TV audience, from adults to young children. Alcohol commercials from Super Bowls in the past have varied greatly, with a wide range of messages, but all promote the goodness of alcohol consumption.

Whether it's with humor, a fun party, pretty women, or a cute animal, the end message with all of these ads is that alcohol makes things better and is good. But what kind of message is this sending to young children, or even teens?

According to a fact sheet published by Johns Hopkins' Center on Alcohol Marketing and Youth, "A national study published in January 2006 concluded that greater exposure to alcohol advertising contributes to an increase in drinking among underage youth." The report goes on to say, "Specifically, for each additional ad a young person saw (above the monthly youth average of 23), he or she drank 1% more."

What do you think of alcohol advertisements and their effect on youth? Let us know in the comment section.

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Prescription Drug Advertising

The United States and New Zealand are the only two countries where direct-to-customer (DTC) advertising of prescription drugs is legal. And in recent years, these drugs and drug ads have become a huge business.

"Pharmaceutical companies like to say that the revenue they generate, thanks in part to advertising and price increases, helps fund further innovations; but despite the astronomical costs of developing new drugs, the drug industry is still one of the most profitable in the world," according to a 2016 Thrillist article.

The article goes on to say that all this revenue makes it easy to forget the health of real people is at stake. It continues, "Prescription drug advertisements contribute to misinformed patients, since they've been shown to increase drug consumption without measurable health benefits.... Patients tend to be more familiar with a drug's benefits than with its risks... and believe pills really are the solution to every problem."

These misinformed patients lead to problems of manufacturing illness and over-diagnosis. Now, conditions that used to be taken care of naturally (i.e. menopause) have treatable symptoms. Other conditions are being over-diagnosed, leading otherwise healthy people to purchase and take unnecessary drugs.

According to the National Institute on Drug Abuse (NIDA) for Teens, some of the drugs that are marketed on TV carry a risk of addiction. Some of these drugs include opioids (which include painkillers), depressants (used to treat anxiety and sleep disorders), and stimulants (used for treating ADHD). The NIDA also reports increases in prescription drug misuse over the last 15 years. This misuse can mean taking a higher dose of a prescribed medication, taking someone else's medication, or taking medication to get a high.

What do you think of prescription drug advertisements? And do these advertisements lead to drug abuse? Let us know your thoughts in the comments below!

Thoughts on Marijuana - Update

On October 20, we posted a blog entry with some of my thoughts about marijuana. Now that the November elections are complete, I thought I would go back and revisit this topic.

What may have gotten lost in the conversation regarding the presidential election were the results regarding marijuana. There were significant developments in regards to legalization.

California, Nevada, and Massachusetts all passed measures legalizing recreational marijuana. In California, the passage of Proposition 64 means adults 21 and over can now possess an ounce of marijuana and grow up to six plants in their residence.

In Nevada and Massachusetts, adults will be able to legally possess up to one ounce of marijuana. This will go into effect on December 15 in Massachusetts and in Nevada on January 1.

A similar proposal was on the ballot in Maine, and appeared to pass with a slim margin. At the time of this writing, opponents of the ballot measure are pushing for a recount, so we will keep our eye on that.

These states join others that have already passed similar measures (Colorado, Washington, Oregon, Arkansas), as well as the increasing number of states that allow medical marijuana or cannabis oil for their residents.

Regardless of how you feel about this subject, it is hard not to be a bit taken aback by the speed at which marijuana laws are being passed. Will the movement continue at this pace going forward? What will the new administration have to say about this? What do you who work in the field have to say?

Please feel free to comment below. We would love to hear from you.

College Binge Drinking

As a recent college graduate, I can say with confidence that binge drinking in college is an epidemic. Frat parties, keggers, tailgates, and house parties have become normalized on many college campuses across the nation. And these weekends of excessive drinking are not contained to major drinking holidays like Halloween or St. Patrick's Day either. From Welcome Weekend to Finals Weekend and basically every weekend in between, drinking becomes the norm from Thursday night to Sunday at 2 a.m. for many students.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men - in about 2 hours.

In 2001, the Harvard School of Public Health College Alcohol Study found that 44% of the nation's college students drank at "binge" or "heavy binge" levels during the previous year. And on top of that, the Higher Education Center for Alcohol and Other Drug Abuse and Violence Prevention reported that each year, while intoxicated, approximately 1,700 U.S. college students die and 600,000 are injured.

While researchers do say that most college students eventually "mature out" of heavy drinking, many do not. Many college students will enter into the pressurized "real world" where cultural and environmental forces sustain their abusive patterns.

And this problem is only getting worse. Harvard researchers found from 1993 to 2005, the rate of heavy drinking at colleges rose 16%.

I believe this growth can be attributed to pop culture, social media, and the fear of missing out (FOMO) if you don't participate in weekly shenanigans with your peers. The Princeton Review releases a list of top party schools each year, further normalizing the culture of heavy drinking and partying. In my experience, it doesn't even occur to students that what they're doing could lead to serious consequences or future problems with drinking.

So what is being done to combat this growing problem? Some colleges have implemented alcohol education programs aimed at first-year students, sorority/fraternity members, and athletes. Some states have tougher alcohol control laws, such as mandatory keg registration, happy hour restrictions, and tough DUI laws. Those states have fewer students who binge drink.

But education programs and tougher control laws alone aren't going to get the job done. The entire culture has to change, and while this may take some time, it can be done.

Let us know what you think of this binge drinking epidemic on college campuses, and what you believe can help fix this growing problem. Leave a comment below or Tweet your thoughts to @ADE_Incorp.

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Like My Addiction on Instagram

On a Friday evening, it wouldn't be out of the ordinary to have a glass of wine when you go out to dinner. A beer or two is a staple of Sunday or Monday night football. A mimosa or bloody Mary is the perfect addition to any Sunday brunch.

In our society, alcohol consumption during social situations has become a norm. So much so, a woman in France gained nearly 60,000 followers on Instagram before most people noticed she had some form of alcohol in every single photo.

Louise Delage, 25, posted pictures of her travels and quickly garnered tens of thousands of Instagram followers interested in her "enviable lifestyle".

Louise was actually an actress for the group Addict Aid, and this Instagram campaign was created by ad agency BETC to show how easy it is to be distracted from a problem that should be obvious. The campaign lasted about two months, and only a few people "sensed the trap". Most just saw a happy girl having the time of her life, not someone suffering from a debilitating issue.

The campaign was named "Like My Addiction". A video revealing the campaign was posted to Instagram on September 22 and explains it's easy to miss the addiction of someone close to you.

As substance abuse professionals, we may be more inclined to notice an issue, but unfortunately, Louise proved that most people don't see the problems many face with substance abuse. This Instagram campaign was a good step towards shedding light on this issue. But there's always more that can be done.

In the comments below, let us know how you can help others identify a substance use problem. Or tweet your thoughts about this story at us @ADE_Incorp on Twitter.

Read the full article here.

Thoughts on Marijuana

It is interesting to me how some topics seem to rise up in our public consciousness, and the conversations, opinions and perceptions seem to move at quite a rapid pace. One of these recently is the issue of marijuana.

Increasingly, marijuana has become a topic of conversation in both my professional and social circles. From the still controversial issue of medical cannabis use, to the pros and cons of the movement toward legal recreational marijuana, there are no shortage of opinions.

I have read and heard a wide range of opinions. I read recently in the Washington Post that approval of legalization of marijuana is leading the polls in every state in which it appears on the ballot in November. The City of East Lansing, MI, recently passed an ordinance decriminalizing the use and possession of less than an ounce of marijuana, mirroring what has been done in numerous other locations. However, these actions may run counter to Federal and State laws, and attempts to move marijuana from the list of Schedule 1 drugs recently failed, so clearly the conversation is a fluid one.

In more casual conversations, I have had people, both professionals and non-professionals alike, express to me their thoughts. These range from thoughts that legalization is inevitable and the correct move, to objections on both moral and public health related grounds.

The August 2016 Counselor Magazine had an interesting and thorough article on Cannabis Dependence that addressed some of these issues, including the fact that the cannabis of today is much more powerful than that of years past.

All of this leads me to this question: as ADE continues to work on developing new and useful assessment tools, what should we be asking about marijuana? What is important to you in terms of understanding marijuana use by your clients. Feel free to leave your feedback, we value your opinions.

Jim Haggerty
President