Picture of Map

New Analysis Examines the Importance of Location in the Opioid Crisis

An age-old problem lies at the center of the opioid crisis. Is it driven by people seeking escape or relief — by a demand for drugs? Or instead, are poor prescribing practices and a cheap heroin supply responsible?

Of course, the answer is a mix of both. But to chip away at that puzzle, a team of researchers including Stanford economist Matthew Gentzkow, PhD, and MIT’s Amy Finkelstein, PhD, and Heidi Williams, PhD, a visiting professor at Stanford, has examined the role of migration in the use of opioids.

The thought was they could control for personal factors (i.e. mental health, education level, family support) by following individuals as they moved. And they found that indeed, community-level factors, such as the local availability of prescription opioids, are important and individuals are more likely  to abuse opioids if they move to a county where the opioid abuse rate is higher than at their previous home.

Both supply and demand are clearly important, Gentzkow explained in the piece. “Our results suggest that supply-side would account for about 30 percent of what’s different and the individual circumstances would account for about 70 percent,” Gentzkow says in a recent Stanford Institute for Economic Policy Research article.

The article explains:

“Their migration analysis is based on the data of a random sample of 1.5 million recipients of the Supplemental Security Disability Insurance enrolled in Medicare Part D, the federal prescription drug benefit program, from 2006 to 2014…

A main finding cited in the study: When individuals move to a county where the rate of opioid abuse is 20 percent higher than from where they moved, a migrant’s rate of abuse increases by 6 percent.

The extent of that jump suggests that 30 percent of the difference in abuse can be tied to place, according to their calculations.”

The research suggests that policies to control the supply of opioids are a key part of an overall strategy to rein in the epidemic.

“The magnitude of the opioid crisis is simply staggering, and trying to make progress on understanding the underlying causes of the crisis is — or should be — on the ‘wish list’ of many researchers,” Williams says in the article.

Original article here on scopeblog.stanford.edu/.

Stanford Medicine

Rural Ohio

3 in 10 Ohioans Do Not Believe Addiction is a Disease, Poll Shows

Do you believe addiction is a disease? If you’re an Ohioan who says yes, you’re in the majority.

Six in 10 Ohio residents say addiction is a disease, according to a new Ohio Health Issues Poll. Still, a strong minority does not agree.

Interact for Health, a nonprofit organization that promotes good health in 20 counties around Cincinnati, and sponsored the poll, released the results Thursday morning.

The poll also showed that 3 in 10 people surveyed said addiction isn’t a disease, while 7 percent were uncertain.

The nonprofit asked the same question in a poll for Kentucky residents in April. But in the Bluegrass State, 7 in 10 said they believed addiction is a disease.

Here’s how the National Institute on Drug Abuse defines addiction: “Addiction is a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences.”

Dr. O’dell Owens, president and CEO of Interact for Health, said the poll is indicative of a population that’s learning more about addiction, which has become a key Ohio health issue because of the opioid epidemic.

Ohio Welcomes You

“Recognizing that addiction is a disease is a key strategy for partners working to build solutions around the opioid epidemic that continues to impact Ohioans,” Owens said in a statement. “Reducing stigma around addiction starts with acknowledging that it’s a chronic, reoccurring disease that’s influenced by biology, environment and brain development.”

When the Kentucky poll results came out, Dr. Mina “Mike” Kalfas, an addiction specialist from Northern Kentucky, said the understanding that the condition is a disease was crucial to quelling the raging opioid epidemic.

“Every facet of our mission – from using Narcan to medication-assisted treatment to syringe exchange – relies on the general consensus recognizing this as a disease,” Kalfas said in April.

The Ohio Health Issues Poll revealed clear differences among people of different political affiliations.

The poll found that people who identified as Democrats (74 percent) were more likely to believe addiction is a disease than Republicans (53 percent) and independents (57 percent).

In addition, the data show that respondents living in an urban community were more likely to believe addiction is a disease (67 percent) than those living in rural or suburban communities (58 percent), the Interact for Health report notes.

The Institute for Policy Research at the University of Cincinnati conducted the poll, from May 22 through June 19. A random sample of 816 adults from throughout Ohio was interviewed by phone. The poll’s margin of error was plus or minus 3.4 percentage points.

Original article here posted on Cincinnati.com.

By: Terri DeMio Published 11:55 p.m. ET Oct. 17, 2018

Cinci Enquirer Logo

I’m a Doctor, and I Was Addicted to Opioids. It Can Happen to Anyone.

What started as a fun-filled day to celebrate her children’s birthdays ended with a fall that changed Dr. Faye Jamali’s life forever.

Near the end of the birthday party, Jamali went to her car to get goody bags for the children. As she was walking in the parking lot, she slipped and broke her wrist.

The injury caused Jamali, then 40, to undergo two surgeries in 2007.

“After the surgeries, the orthopedic surgeon gave me a bunch of pain meds,” Jamali tells Healthline.

With 15 years of experience as an anesthesiologist, she knew that the prescription was standard practice at the time.

Dr, Jamali

“We were told in medical school, residency, and our [clinical] workplaces that… there wasn’t an addictive issue with these medications if they were used to treat surgical pain,” Jamali says.Because she was experiencing a lot of pain, Jamali took Vicodin every three to four hours.“The pain got better with the meds, but what I noticed is that when I took the meds, I didn’t get as stressed as much. If I had a fight with my husband, I didn’t care and it didn’t hurt me as much. The meds seemed to make everything OK,” she says.

The emotional effects of the drugs sent Jamali down a slippery slope.

I didn’t do it often at first. But if I was having a hectic day, I thought, If I could just take one of these Vicodin, I’ll feel better. That’s how it started,” explains Jamali.

She also endured migraine headaches during her period for years. When a migraine struck, she sometimes found herself in the emergency room getting an injection of narcotics to ease the pain.

“One day, at the end of my shift, I started getting a really bad migraine. We discard our waste for narcotics at the end of the day in a machine, but it occurred to me that instead of wasting them, I could just take the meds to treat my headache and avoid going to the ER. I thought, I’m a doctor, I’ll just inject myself,” Jamali recalls.

She went into the bathroom and injected the narcotics into her arm.

“I immediately felt guilty, knew I crossed a line, and told myself I’d never do it again,” Jamali says.

But the next day, at the end of her shift, her migraine hit again. She found herself back in the bathroom, injecting the meds.

“This time, for the first time, I had euphoria associated with the medicine. Before it just took care of the pain. But the dosage I gave myself truly made me feel like something broke in my brain. I was very upset with myself for having access to this amazing stuff for so many years and never using it,” Jamali says. “That’s the point where I feel like my brain was hijacked.”

Over the next several months, she gradually upped her dosage in an attempt to chase that euphoric feeling. By three months in, Jamali was taking 10 times as much narcotics as she first injected.

Every time I injected, I thought, Never again. I can’t be an addict. An addict is the homeless person on the street. I’m a doctor. I’m a soccer mom. This can’t be me,” Jamali says.

Your average person with addiction problems, just in a white coat.

Dr Jamali scrubs

Jamali soon found out that the stereotype of a “typical addict” isn’t accurate and wouldn’t keep her safe from addiction. She recalls a time when she got into a fight with her husband and drove to the hospital, went straight to the recovery room, and checked out medication from the narcotic machine under a patient’s name.“I said hi to the nurses and went right to the bathroom and injected. I woke up on the floor about one or two hours later with the needle still in my arm. I had vomited and urinated on myself. You’d think I would have been horrified, but instead I cleaned myself up and was furious at my husband, because if we hadn’t had that fight, I wouldn’t have had to go and inject,” Jamali says.

Your brain will do anything to keep you using. Opioid addiction is not a moral or ethical failing. Your brain becomes changed,” Jamali explains.

Jamali says the clinical depression she developed in her 30s, chronic pain from her wrist and migraines, and access to opioids set her up for an addiction.

However, causes of addiction vary from person to person. And there’s no doubt the issue is prevalent in the United States, with the Centers for Disease Control and Prevention reporting that more than 200,000 people died in the United States from prescription opioid-related overdoses between 1999 and 2016.

Additionally, overdose deaths connected to prescription opioids were 5 times higher in 2016 than 1999, with more than 90 people dying each day due to opioids in 2016.

Jamali’s hope is to break the stereotypical addict often portrayed in the media and minds of many Americans.

This can happen to anyone. Once you are in your addiction, there is nothing anybody can do until you get help. The problem is, it is so hard to get help,” Jamali says.

“We are going to lose a generation to this disease unless we put money into recovery and unless we stop stigmatizing this as a moral or criminal failing of people,” she says.

Losing her job and getting help

A few weeks after Jamali woke up mortified in the bathroom at work, she was questioned by hospital personnel about the amount of medications she’d been checking out.

“They asked me to hand over my badge and told me I was on suspension until they completed their investigation,” Jamali recalls.

That night, she admitted to her husband what was going on.

“This was the lowest point in my life. We were already having marital problems, and I figured he’d kick me out, take the kids, and then with no job and no family, I’d lose everything,” she says. “But I just rolled up my sleeves and showed him the track marks on my arms.”

While her husband was shocked — Jamali rarely drank alcohol and never did drugs previously — he promised to support her in rehab and recovery.

The next day, she entered an outpatient recovery program in the San Francisco Bay Area.

My first day in rehab, I had no idea what to expect. I show up dressed nicely with a pearl necklace on, and I sit down next to this guy who says, ‘What are you here for? Alcohol?’ I said, ‘No. I inject narcotics.’ He was shocked,” Jamali says.

For about five months, she spent all day in recovery and went home at night. After that, she spent several more months attending meetings with her sponsor and exercising self-help practices, such as meditation.

“I was extremely fortunate that I had a job and insurance. I had a holistic approach to recovery that went on for a year,” she says.

During her recovery, Jamali realized the stigma that surrounds addiction.

“The disease may not have been my responsibility, but the recovery is 100 percent my responsibility. I learned that if I do my recovery daily, I can have an amazing life. In fact, a much better life than I did before, because in my old life, I had to numb the pain without actually feeling the pain,” Jamali says.

About six years into her recovery, Jamali received a breast cancer diagnosis. After undergoing six operations, she wound up having a double mastectomy. Through it all, she was able to take pain medication for a few days as directed.

“I gave them to my husband, and I didn’t know where they were in the house. I upped my recovery meetings during this time, too,” she says.

Around the same time, her mother nearly died from a stroke.

“I was able to cope with all of this without relying on a substance. As ridiculous as it sounds, I’m grateful for my experience with addiction, because in recovery, I gained tools,” Jamali says.

A new path forward

It took the Medical Board of California two years to review Jamali’s case. By the time they put her on probation, she’d been in recovery for two years.

For seven years, Jamali underwent urine testing once a week. However, after a year on suspension, her hospital allowed her to go back to work.

Jamali returned to work gradually. For the first three months, someone accompanied her on the job at all times and monitored her work. The physician in charge of her recovery also prescribed the opioid blocker naltrexone.

A year after she completed her probation in 2015, she left her job in anesthesia to embark on a new career in aesthetic medicine, which includes performing procedures like Botox, fillers, and laser skin rejuvenation.

“I’m 50 years old now, and I’m really excited about the next chapter. Because of recovery, I’m brave enough to make decisions that are good for my life,” she says.

Jamali also hopes to bring good to others by advocating for opioid addiction awareness and change.

Although strides are being made to help alleviate the opioid crisis, Jamali says more needs to be done.

“Shame is what keeps people from getting the help they need. By sharing my story, I can’t control people’s judgement of me, but I can potentially help someone who needs it,” she says.

Her hope is to break the stereotypical addict often portrayed in the media and minds of many Americans.

My story, when it comes down it, is no different than the homeless person shooting up on the street corner,” Jamali says. “Once your brain is hijacked by opioids, even though you may not look like a typical user, you are the person on the street. You are the heroin addict.”

Jamali also spends time talking with doctors who find themselves in the same situation she once was.

“If this started over an orthopedic injury to someone like me in their 40s with no history of drug or alcohol problems, it can happen to anyone,” Jamali points out. “And as we know in this country, it is.”

Original article here, posted on Healthline.com.

Medically reviewed by Timothy J. Legg, PhD, PsyD, CRNP, ACRN, CPH on April 26, 2018 — Written by Cathy Cassata


Illustration of internal organs

Study Sheds Light on Cocaine Addiction

For decades, the nation has struggled to combat cocaine addiction, leading many cities, including New Haven, to declare public health emergencies in the past.

In an effort to improve upon current treatments for addiction, a new study by researchers at the Connecticut Mental Health Center — a collaboration between the Yale School of Medicine and the Connecticut Department of Mental Health and Addiction Services — explored the mechanisms behind cocaine addiction.

“Cocaine addiction is highly rampant in the U.S. right now. Regular cocaine use not only changes the structural aspects of the brain, but it also alters behavior,” said Sheng Zhang, professor at the School of Medicine and first author of the study. “In the end, we’re just trying to help people recover from substance addiction, be it cocaine use or even alcohol use. If you want to develop some sort of drug for addiction control, you have to know the brain mechanisms behind addiction.”

The researchers compared the activity of different regions in the brains of cocaine-dependent individuals with the brain activity of nonusers of the drug. They found that activation of the hypothalamus, a region that plays a critical role in the brain’s reward responses, was strongly correlated with the severity of an addicted individual’s cocaine craving.


While many researchers have conducted studies on mice regarding the hypothalamus’ role in addiction, these studies have seldom been replicated in humans because the hypothalamus occupies a very small area of the brain, according to Zhang.

This makes imaging data, like those collected from MRI scans, much harder to analyze. However, with a variety of computational tools and methods, the Connecticut Mental Health Center researchers were able to overcome this barrier.

The study recruited 23 cocaine-dependent individuals and administered questionnaires on the severity of their cocaine addiction. Through these measures, the team was able to evaluate the extent of each individual’s addiction and found a correlation between addiction severity and hypothalamus activation.

The other half of the study’s research focused on the effect of stimuli on the brain activity of cocaine-dependent individuals. During a MRI scan, participants were shown a series of pictures, which were either cocaine-related or neutral stimuli. After each series of pictures, the participants were asked to rate on a scale of one through 10 how much they craved cocaine. The researchers then compared this rating to the activation of the hypothalamus.

Surprisingly, although the hypothalamus was implicated in the severity of addiction and craving, as measured by the questionnaires, the study did not find a significant correlation between the tasks and brain activation.

Chiang-Shan Ray Li, a psychiatry professor at the School of Medicine and lead author of the study, said the discrepancy may have resulted because the presentation of pictures did not truly measure levels of craving. The researchers had limited opportunities to space out the cocaine-related and neutral stimuli, he explained, preventing them from distinguishing the participants’ differential responses to the stimuli.

Li said that by comparing the data sets of healthy individuals to those suffering from substance addiction problems, one may be able to pinpoint the precise reasons behind cocaine dependence.

The researchers interviewed told the News that they hope a better understanding of the brain activity of those suffering from addiction will lead to more effective treatment and therapeutic options, improving lives of individuals suffering from cocaine addiction. Currently, behavior therapy is the primary treatment option available to cocaine-dependent individuals — there are no FDA-approved drugs to treat cocaine addiction.

Identifying the mechanisms behind cocaine dependence may enable the development of personalized treatment plans and medication to combat addiction, Li said. For instance, while one cocaine-dependent individual may require stress regulation measures, another might suffer from poor cognitive control, he explained.

In 2014, there were 1.5 million current cocaine users above the age of 12, according to estimates by the National Institutes of Health.

Karena Zhao | karena.zhao@yale.edu

Ishana Aggarwal | ishana.aggarwal@yale.edu

2:27 AM, OCT 16, 2018

Original article here on yaledailynews.com

Yale Daily News logo

Actress crying over actor

Why ‘Beautiful Boy’ Is An “Uplifting” Look At Addiction & Recovery, According To Amy Ryan

Former Office costars Steve Carell and Amy Ryan have reunited onscreen for a very different kind of project — the heartwrenching film Beautiful Boyin which they play divorced parents to a son struggling with addiction. The film (playing in limited release now) is a brutal and unflinching look at how addiction affects not only people who get hooked on methamphetamines, but how their family and loved ones deal with the heartbreaking consequences as well. Ryan, who plays Vicki Sheff, hopes people from all walks of life goes to see Beautiful Boy in theaters, whether they directly identify with this experience or not.

“It’s so beautiful,” she says with a heavy sigh at the beginning of our conversation. “I’m glad you liked it – well, I guess ‘like’ is a funny word. But I’m glad you experienced it.”

Based off the real-life memoirs of journalist and father David Sheff and son Nic Sheff, the movie is a realistic depiction of addiction and how there is no magic cure. Nic (played by Timothée Chalamet) slips in and out of rehab, flirting with sobriety each time to varying degrees of success and failure through both internal and external demons. He wants to get better — to get his life and relationships on track — but the pull of crystal meth is too strong to resist. The phrase, “relapse is part of recovery,” is spoken out loud by rehab counselors and Nic multiple times. It’s a narrative that has hardly, if ever, been a part of the mainstream conversation about addiction and the opioid crisis.

Beautiful Boy, while presenting extremely important lessons about addiction, is not a hard-stance, clinical PSA against drug use. It’s a personal story that offers no solution but rather opens up a dialogue about what it’s like for an addict and for the people who love them. There is no happy ending, but rather the implication that this is a lifelong journey for Nic and his family, which is ultimately true about addiction in real life. Director Felix Van Groeningen plays with time and memory so that Beautiful Boy is not just one linear story but rather a collection of moments strung together with a through line of the love David and Nic share as father and son.

“I was surprised by how Felix went forward in memory and backward in memory and I loved that so much,” Ryan says. “That pulled me in as much as the emotions because, especially as a parent, you realize how fast time does go by. It seems like only yesterday that they were little kids. That’s where the emotional punch came for me in such a personal way.”

After about a decade of development, Beautiful Boy is debuting to a country deep in the throes of an opioid epidemic, so the beats of David and Nic’s story ring true in a way that no one could have predicted 10 years ago.

“It’s kind of a weird happenstance that it came together when it did because right now, I mean, with our own country’s opioid addiction, there is no hiding this anymore,” Ryan says. “That’s how this film is going to resonate with people. It has touched so many lives, unfortunately. I love that the film isn’t just about addiction — it’s more about recovery and the family’s recovery as well and how they treat it with love. I find it hopeful and I hope people do too, as much as it’s a heavy watch. I find it quite uplifting.”

Stories of addiction and what it can do to a person are never easy to tell, so Ryan went straight to the source material — David and Nic’s memoirs — to bring authenticity to Vicki Sheff, David’s ex-wife and Nic’s estranged mother.

Beautiful Boy Film Shot 3

“The books by David and Nic Sheff are so rich and open and generous. They put their lives on the pages,” Ryan says. “And they were so generously involved in the film. Vicki was a bit more shy about her participation but she saw the film and was very pleased.”

Ryan lets out a small nervous laugh, then continues, “I drew from what was on the page in the books and our actual script and I felt like I didn’t really need to go outside and do any other kind of emotional homework on it because they had given me the road map of their lives and how it was at that time.”

Since Beautiful Boy isn’t a traditional biopic about the Sheff family, Ryan was grateful to have some of the pressure taken off her performance. “I just tried to convey this honesty and openness,” she says. “My heart just goes out to her because I can’t imagine going through this with a child.”

Beautiful Boy Film Shot 4

If anything, Ryan hopes Beautiful Boy helps to take away the stigma that so often is associated with talking about addiction. “You know, if you have diabetes you go get treatment,” she says. “It’s not a moral lapse in judgment, why people are addicted to drugs or alcohol. It really affects us all and can affect us all — it doesn’t have prejudice on an economic class or race or gender. I still find there is so much shame and whispers about talking about it if it’s someone in your own family or a friend of a friend or even yourself. I hope people will find ways to rid the shame out of it.”

There will be tears, that’s for certain. But Beautiful Boy is a film that deserves to be seen and should be seen by everyone, whether you’re young, old, a parent or child, rich or poor, educated or not.

By Sydney Bucksbaum

Original article here.

Opinion: Everyone has a role to play in fighting opioid crisis

We’re out of euphemisms at this point: national emergency, addiction crisis, drug epidemic, “a 9/11 every three weeks.” But there’s no mistaking that we’re in the midst of the biggest drug epidemic to ever hit our country – and the death toll is rising.

The federal government estimates that over 600,000 Americans have heroin-associated opioid use disorder. The wave of death we’ve already experienced – losses over the next decade on par with the Civil War, or over half a million Americans – is unprecedented. Make no mistake: Ohio is at the center of this.  And whether we all know it or not, Cincinnati is an epicenter community.

Worse yet, these tragedies do not exist in a vacuum. They leave broken families, shattered dreams and devastated communities in their wake. Only more shocking than the toll itself is the scale of our collective inaction.

Answers can be hard to come by in an unprecedented public health crisis. While translating science into practice tends to take at least 10 years, literature about how to treat opioid use disorder has existed for decades. Demonstrably effective methods to address a mortality crisis like ours have been shared from around the world.

What’s clear is we have to move beyond our fragmented approach. And everyone has a role to play.

In Cincinnati, we had to break down the siloed ways the health care system treats addiction. Mercy Health started by leaving stigma and bias at the door. We made a concerted effort to approach people with substance use disorders using the same methods we use when addressing patients with any other chronic, relapsing medical conditions – by standardizing compassionate care, collaborating with specialists, and ensuring rapid access to comprehensive, quality treatment programs. And we formed the Addiction Treatment Collaborative.

A cultural shift is afoot in health care. While there still aren’t national training standards and requirements around addiction medicine in medical school, residency and continuing education, we decided we could no longer treat people with these conditions the way health care has in the past. The urgency is too great and the costs of inaction too severe. To that end, we’ve trained ourselves to adopt addiction treatment into the general medical setting across the Mercy Health system – in our emergency rooms, in our hospitals and in our primary care clinics.

We have a long way to go to ensure these methods are universally embraced across our community. We need the other hospital systems at the table. And an even more refined, community-level understanding of what comprises quality addiction treatment.  The coordinated approach taken by over a dozen organizations in our community has produced a significant drop in mortality to start 2018. Flooding our community with Narcan, ensuring immediate access to addiction treatment, and integrating all five Mercy Health hospitals into the continuum of addiction care with novel clinical protocols was just the start.

The bipartisan legislation Congress recently sent to President Donald Trump’s desk includes many ideas that will remove barriers to our progress. While not truly transformative, it is a meaningful start to real change in this space. And it is a collaborative success at a time when such achievements feel impossible.

Once this is signed, legislators should seek to build on this new foundation by considering the dozens of ideas still on the table. Taking these actions will save American lives. Legislators in both houses can’t take their foot off the gas – they need to continue working on the next level of comprehensive reform in this space to more fully address easy access to treatment.

But government alone isn’t the answer. Business owners can play a major role in the recovery process once a patient has stabilized in treatment and is ready to get their life back. Locally, innovative approaches to integrate folks back into the workforce have already produced positive results.

And if you’re anyone – an individual, a faith-based organization, a community group – who has been touched by this crisis and wants to help, do you know how to get engaged?

Consider helping a friend or loved one navigate the system. Familiarize yourself with FindLocalTreatment.com to help people find accredited addiction treatment available immediately here in town. Carry and learn to administer Narcan. Remember that addiction is not a moral failing but a disease that warrants a health care response. These are some suggestions on how you help. We could use your energy and compassion.

What will you say when the next generation asks what we did during this moment of national emergency? When our children are dealing with the ripple effects of this crisis and looking to us for an understanding of how we all got here in the first place? We honestly won’t have much in the way of excuses. The science was there. The ideas were shared. Why did we wait to put them into practice?

Original article here on Cincinnati.com

Navdeep Kang


Cinci Enquirer Logo





woman on balcony

Does Addiction Last a Lifetime?

I am now 11 years into recovery from my battle with opiate addiction, and I have always been fascinated with two related questions: is there truly such a thing as an “addictive personality,” and do people substitute addictions?

The myth of the addictive personality

The recently deceased writer and television personality Anthony Bourdain was criticized by some for recreationally using alcohol and cannabis, in what was seemingly a very controlled and responsible manner, decades after he quit heroin and cocaine. Was this a valid criticism? Can a person who was addicted to drugs or alcohol in their teens safely have a glass of wine with dinner in their middle age?

It depends on which model of addiction and recovery you subscribe to. If you are a traditionalist who believes that addictions last a lifetime, that people readily substitute addictions, and that people have ingrained “addictive personalities,” the answer is: absolutely not. This would be playing with fire.

During my 90 days in rehab, it was forcefully impressed upon me that addictions are routinely substituted, and that if one is ever addicted to any substance, then lifelong abstinence from all potentially addictive substances is one’s only hope of salvation. This seemed to make sense, as a person would have the same lifelong predispositions to an addiction: genetic makeup, childhood traumas, diagnoses of anxiety or depression — all of which could plausibly set them up to become addicted to, say, alcohol, once they have put in the hard work to get their heroin addiction under control. In medical terms, the concern is that different addictions can have a common final pathway in the mesolimbic dopamine system (the reward system of our brain), so it is logical that the body might try to find a second pathway to satisfy these hungry neurotransmitters if the first one is blocked, a “cross-addiction.”

Old Habits - New Habits signpost

I learned early in my own recovery how critical it is to apply logic and evidence to the field of addiction, and that just because things make sense, and because we have thought about them in a certain way for an extended period of time, that doesn’t mean that they are necessarily true. While in rehab, I was actually told a lot of other things that turned out to have no basis in scientific evidence. For example, I was told on a daily basis that “a drug is a drug is a drug.” This mentality doesn’t allow for there being a difference between, for example, the powerful opiate fentanyl, which kills thousands of people every year, and buprenorphene (Suboxone) which is a widely-accepted treatment for opioid use disorder.

I have come to believe that an uncompromising “abstinence-only” model is a holdover from the very beginnings of the recovery movement, almost 100 years ago, and our understanding has greatly evolved since then. The concepts of addiction and recovery that made sense in 1935, when Alcoholics Anonymous was founded, and which have been carried on by tradition, might not still hold true in the modern age of neurochemistry and functional MRIs. That said, mutual help groups today do have a place in some people’s recovery and they can encourage the work of changing and maintaining change.

Recovery may improve resiliency to new addictions

It seems as if no one definitively knows the answer about whether people substitute addictions. According to the National Institute on Drug Abuse in response to a request for comment from the website Tonic: “A previous substance use disorder is a risk factor for future development of substance use disorder (SUD),” but “It is also possible that someone who once had an SUD but doesn’t currently have one has a balance of risk and protective genetic and environmental factors that could allow for alcohol consumption without developing an AUD [alcohol use disorder].”

One study published in JAMA in 2014 showed that, “As compared with those who do not recover from an SUD, people who recover have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution, but rather is associated with a lower risk of new SUD onset.”

The authors of this study suggest that factors such as “coping strategies, skills, and motivation of individuals who recover from an SUD may protect them from the onset of a new SUD.” In other words, by making the life-affirming transition from addicted to recovered, we gain a recovery “toolbox” that helps us navigate life’s challenges and stresses in a much healthier way. We learn to connect with people, push our egos aside, and to ask for help if we need it. Thus, when faced with stressful situations that formerly would trigger us to drink or drug, we might respond by exercising or calling a friend, rather than using a substance. As such, we substitute addictions with healthier activities that perform the function that the drink or drug used to, albeit in a much more fulfilling way.

This issue is also, partly, a question of semantics, and of how narrowly or widely we define addictions. Many hold that an addiction can be to either a substance or a process: gambling, eating, video game playing, Internet use, sex, work, religion, exercise, or compulsive spending. Lots of people gain weight when they quit smoking. Is that a case of substituting an addiction? I like to joke that, in my observations, the only reliable outcome from a stay at rehab was a nicotine addiction, because many people, in an attempt to cope with the trauma and dislocation of being sent away to rehab, pick up cigarettes.

People grow and change

Personally, I am skeptical that many people substitute addictions. In my experience, people who are addicted tend to have a particular affinity for a particular class of drug, not for all drugs and alcohol. This is probably based on some combination of their neurochemistry and their psychological makeup. I was addicted to opiates, but didn’t have difficulties with substances in other classes. I have seen this to mostly be the case with thousands of my brothers and sisters in recovery who I have had the honor to interact with. People continue to add to their coping skills toolbox throughout life, so the unhappy 18-year-old who is struggling is the well-adjusted 50-year-old who has worked through many of their problems, or who has improved their life circumstances. Vulnerabilities can improve over time. People aren’t static, which is what reminds us to never give up hope when dealing with an addicted loved one, no matter how dire the circumstances appear to be.

Original article here on https://www.health.harvard.edu/

Peter Grinspoon Author

Contributing Editor

Young Man LeaningOn a Wall

Don’t Wait For Rock Bottom – The Addiction Series Video

The concept of “rock bottom” can help people describe their experience of recovery from addiction by turning it into a narrative with a clear event that helped turn their life around. But the idea that we should wait for the disease to get worse before seeking treatment is dangerous.

Belief in this “rock bottom” can keep people who are struggling from reaching out for help. It can also keep family, friends, and care providers from addressing the issue when they have been wrongly told that the disease has to “run its course” and that they should practice “tough love” until a person hits bottom—when they will be ready and willing to engage in treatment.

But these ideas aren’t backed by science, and not everyone survives the fall.

You shouldn’t wait for the worst to happen—or a profound moment of awakening—before seeking treatment or helping a loved one, even if they don’t feel “ready.” Decades of research has proven that the earlier someone is treated, the better their outcomes and that treatment works just as well for patients who are compelled to start treatment by outside forces as it does for those who are self-motivated to enter treatment.

Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. If you or a loved one is struggling, don’t wait—reach out for help.

Link to original article here on AddictionPolicy.org.

Addiction Policy Forum Logo

Finding the Right Treatment Environment

Knowing what type of treatment will work best for you can make the recovery process easier.

Getting treatment for substance use disorder is a daunting process. People who are trying to get sober need to overcome their physical dependency in order to live life without mind-altering substances. They also need to do the emotional and therapeutic work to discover why they began abusing drugs or alcohol in the first place.

There are many different types of treatment and varied environments for recovery. From 12-step meetings to wilderness therapy or luxury rehabs, the options for getting sober are as diverse as the people who struggle with substance use disorder. In order to help yourself or your loved one have the best chance at sobriety, it’s important to ask what treatment environment will be the right fit. Here’s what to consider:

What does your ideal program look like?

Before deciding on a treatment center, ask yourself what your ideal recovery program would look like. Some people prefer a sterile and medical environment, while others want recovery programs that focus on spirituality. Many people want a blend of the two, like the approach to treatment taken by Sierra Tucson in Tucson, Arizona, which provides a biopsychosocial-spiritual approach to treatment.

Using this model, clients have access to the latest medical advances around the treatment of addiction. They also receive individual and group therapies and social supports including family involvement in the treatment plan. Combined, these varied approaches offer a pathway to well-rounded recovery.

What therapy do you respond to best?

In order to maintain sobriety long-term, recovering addicts need to address the underlying issue that led to their substance abuse. Some people were self-medicating for mental illness or pain, while others were trying to fill a hole left by attachment issues or trauma. Understanding what issues led to your addiction — and how to cope with them in a healthy way — usually requires therapy.


For therapy to work well, you must be comfortable. Some people are most at ease in a traditional therapeutic setting, talking one-on-one with a counselor. Others find this very unnerving, and benefit from experiential therapies like art, wilderness or equine therapies. Having access to a wide variety of therapies will help you find the fastest and easiest way to begin healing.

Are there co-occurring mental health issues or trauma?

Many people with substance use disorder also have mental illness or a history or trauma. To stay sober for good, it’s critical to address these underlying issues. Mental illness and trauma are both complex conditions that require intricate care, especially when they’re being treated alongside addiction.

People with co-occurring mental illness often need medication to stabilize their disease. Working with qualified medical professionals who have experience treating mental illness and substance abuse is the best way to find a medication regimen that is effective and non-addictive.

At the same time, a trauma history can have just as many side effects as an untreated mental illness. Having access to therapists who are well-versed in treating trauma and PTSD is important for anyone who has trauma in their past.

Taking time to do a bit of reflection before you enter rehab can help you find the best treatment environment, and get you started on the road to recovery.

Original article here on thefix.com.

Sad Man

Underlying Social Issues May Be Fueling The Opioid Epidemic

A new study has affirmed that there are underlying social issues when it comes to the opioid epidemic.

The study, published Thursday (Sept. 20) in the journal Science, determined that drug overdose deaths have been increasing since 1979, well before opioid abuse began climbing in the 1990s.

According to researchers from the University of Pittsburgh, this could mean that rising overdose deaths are actually connected to “larger societal problems like alienated communities and an increasingly disaffected population.”

During the study, researchers examined data from about 600,000 deaths categorized as drug overdoses from the National Vital Statistics System. In doing so, they discovered that the overdose deaths “followed an almost perfectly exponential trajectory” from 1979 to 2016.

Researchers found that the overdose deaths doubled about every nine years, and that by 2016 it had increased to one death every eight minutes.

Two friends hugging

“This smooth, exponential growth pattern caught us by surprise,” Dr. Donald S. Burke, senior author and dean of the University of Pittsburgh Graduate School of Public Health, told ABC News. “It can be hard to grasp what exponential growth really means, but you can think of it as a nuclear explosion: you start with 2 [deaths due to drug overdose], then 4, then 8, then 16, and so on.”

Though the increase in overdose deaths was consistent, researchers did not find that there was any similar predictability when determining deaths from a specific drug.

By utilizing a method called heat-mapping, researchers were able to plot overdose patterns across the country and found that while certain drugs were more prominent in certain areas, nearly every region showed an overdose “hotspot” for at least one drug.

In doing so, the researchers came to the conclusion that overdose deaths have continued to increase even though the use of individual drugs has fluctuated over time.

“It implies that there are other forces at work, besides the specific drugs,” Burke told ABC News. “The forces are broader and deeper than we thought, including social determinants of health and technological determinants of health.”

Burke further explains, “The drugs have become cheaper over the years and their delivery systems have become more efficient… These factors increase drug availability. People are losing a sense of purpose in their lives and there has been dissolution of communities, making people more susceptible to using drugs—increasing demand.”

While Burke agrees that treatment programs and availability of the overdose antidote naloxone are helpful for individuals, he worries that not enough is being done to address the underlying issues.

“If we solve the [opioid] sub-epidemic, will there be another sub-epidemic that comes on its heels?” Burke said. “If we don’t address the social determinants of health that underlie drug use and addiction, there’s a good possibility that the drug overdoses will start to emerge again.”

Original article here on thefix.com.

The Fix logo