Showing posts with label Substance abuse. Show all posts
Showing posts with label Substance abuse. Show all posts

Monday, November 29, 2021

Meth addiction and treatment


From Scientific American, by Claudia Wallis, April, 2021. p.21

Poor results remain all too typical for what is more formally
known as methamphetamine use disorder. About one million
people in the U.S. are addicted to meth, a powerful stimulant
that—smoked, snorted, injected or swallowed—ruins lives and
contributed to more than 12,000 overdose deaths in 2018. Fatal
overdoses appear to have spiked by nearly 35 percent during the
COVID pandemic. Unlike people battling alcoholism or opioid
misuse, meth users have no approved medications to help them
shake their habit. And most behavioral therapies fail.

But this tragic picture at last may be changing. A recent study
found that a regimen of two medications helped some users stay
off the drug. In addition, a psychosocial intervention called contingency
management (CM) has been shown to be especially effective...
.....
All addictions are tough to beat, but methamphetamine poses
a particular challenge. A key way that researchers measure the
addictive grip of a substance is to look at how much dopamine (a
neurotransmitter associated with pleasure) floods into the brain’s
major reward center during use, based on animal studies. “Methamphetamine
is the drug that produces the largest release,” says
Nora Volkow, director of the National Institute on Drug Abuse.
“An animal will go crazy pressing a lever in order to get the drug,”
she adds. Another metric involves real-world human experience:
When you try a new substance, what is the likelihood of becoming
addicted? “In this respect, methamphetamine ranks along
with heroin among the top addictive drugs,” Volkow says.

...
The medication study used two substances that target withdrawal.
Bupropion, an antidepressant also prescribed for smoking cessation,
raises dopamine levels in the brain and thus may buffer the
misery of steep drops that occur when people stop using meth. Naltrexone,
the second medication, is an opioid blocker that “has an
effect on the reward circuit, potentially relieving cravings,” explains
the study’s lead author, Madhukar H. Trivedi, a psychiatrist at the
University of Texas Southwestern Medical Center. In a trial with
403 heavy users of meth, a regimen of the two medications helped
13.6 percent stay off the drug, testing meth-free at least three quarters
of the time over a six-week period. Only 2.5 percent of those
given placebos achieved that level of abstinence.

Contingency management works on behavior by reinforcing
abstinence with prizes. At VA clinics, addicted veterans submit a
urine sample twice a week. If the sample is meth-free, they get to
pull a slip of paper from a fishbowl. Half the slips show various dollar
amounts that can be spent at VA shops, and the rest feature
words of encouragement. Two clean samples in a row earn two
draws from the fishbowl, three in a row earn three draws, and so
on, up to a maximum of eight. But drug-positive urine means no
prize. The key “is the immediacy of the reinforcement,” says Dominick
DePhilippis, a clinical psychologist at the Corporal Michael J.
Crescenz VA Medical Center in Philadelphia. That is important, he
notes, because the rush of meth is also immediately reinforcing,
whether it is the “euphoric feeling that substance use brings or the
escape from fatigue or unpleasant mood states” of withdrawal.

Some interesting facts and trends:

Meth addiction rates tend to be worse west of the Mississippi and opioid addiction rates tend to worse east of the Mississippi.

The hit TV series, "Breaking Bad" depicted the manufacturing, distribution, and deadly consequences of the meth industry.

Friday, November 19, 2021

Lethal drug overdoses in the year ending in April 2021 killed 100,000 people.

 Anybody notice this?

Lethal drug overdoses in the year ending in April 2021 killed 100,000 people.

In my practice I know far more people who have died from drug overdoses than from Covid-19.

The interesting observation is that people have much more control over lethal drug overdoses than they do of Covid-19 in the sense that the exposure to the agent of death is under the individual's control.

What are the factors that contribute to the high level of substance misuse in the United States?
What can we do as psychotherapists do to ameliorate the suffering that contributes to this phenomenon?

Saturday, April 11, 2020

Do 12 Step Programs Really Work?

Do 12 Step programs really work?

From So Alcoholics Anonymous Is "Proven" to Work After All? Not So Fast by Stanton Peele on Filter on 03/08/20. For more click here.


Sunday, March 10, 2019

The problems with Benzodiazapine drugs.

Xanax is a benzodiazepine drug. There are many others. While we are focused on the opioid epidemic, the abuse of benzos is growing in the U.S. as well. I see many clients who have been prescribed a benzo for anxiety. It is very easy to develop a tolerance, become addicted, and then have worst symptoms than the ones being treated to begin with during withdrawal.


Tuesday, February 19, 2019

Should cannibis be used as harm reduction treatment for opioid addiction?


From Medscape Psychiatry, 02/12/19, by Alicia Ault
Thirty-three states, Washington, DC, Guam, and Puerto Rico have legalized cannabis for medical use, and 10 states and Washington, DC, have legalized it for recreational use, according to the National Council on State Legislatures.
Both New York and Illinois recently amended medical marijuana laws in favor of cannabis as a substitute, which was another factor in writing the article, said Saitz.
New York issued emergency regulations in July 2018 allowing opioid users to become certified to use medical marijuana instead. In August 2018, the Illinois governor signed a bill allowing individuals over age 21 with conditions for which opioids might be used to apply for the medical marijuana program.
For more click here

Saturday, January 26, 2019

Monroe County, NY jail offers treatment for opioid addiction

From WHEC NBC Channel 10 news on 01/17/19

 

For more click here.

What does the devastation of the opioid epidemic look like on the ground?

Jan Rader is the fire chief, first responder, and a nurse in Huntington, West Virginia who describes her community's reponse to the opiod epidemic.

Huntington is a county of 95,000 people which, in 2017, experienced 1831 overdoses, and 183 deaths.

Rader describes some innovative programming in her community to deal with substance use disorder which as reached epidemic proportions not only in her county but across the U.S.

 

Editor's note:
I was the executive director of GCASA, the Genesee Council on Alcoholism and Subtance abuse in Genesee and Orleans Counties in Western New York state from 2000 - 2011. I continue to consult with counselors at GCASA who are obtaining psychotherapy superivision hours for their licensure.

The opioid crisis has hit Western New York hard as it has in Huntington. As Chief Rader describes, the deaths and crisis nature of the phenomenon are very difficult for people suffering from substance use disorder as well as their families, friends, and communities.

The opioid epidemic in 2018 created more deaths in the U.S. than car fatalities. It takes a whole community working together with people from multiple sectors to restore our communities back to an acceptable level of public health.

Thursday, October 25, 2018

Fentanyl is a killer drug in 50% of opioid overdoses.

Fentanyl is 10 times more powerful than heroin. Gets mixed into street heroin and kills users by unintentional overdoses.

 

Tuesday, February 28, 2017

Benzodiazepines Continue to be Prescribed Without Psychotherapy to Older Adults

From Mad In America, 02/24/17

"A new study, published in the Journal of the American Geriatric Society, finds that older adults continue to be prescribed benzodiazepines without being offered psychotherapy. This practice persists despite decades of research warning of safety concerns with these drugs and demonstrating the effectiveness of alternative treatments."

I have a few "geriatric" clients in my practice. When they get off the benzos which is difficult because of the withdrawal which exaggerates the symptoms, such as anxiety, for which they were prescribed to begin with, they usually report that they feel better. I usually suggest they only take them if absolutely needed, and don't take them on a regular basis to avoid the development of physical tolerance.

Listening to older people's complaints takes time, time the primary care physician is not reimbursed for in our mercenary system of health care. There are many barriers and obstacles to the PCP referral to mental health professionals, but when done and psychotherapy is engaged in, benefits are worth in the cost in most cases.

Friday, January 13, 2017

New York State 37th in opiod-involved overdose deaths in 2015

Increases in drug and opiod involved overdose deaths 2010 - 2015 by state


Source: Centers for disease control and prevention. For more click here.

Thursday, July 14, 2016

Mixing Pot and Tobacco Increases Dependence Risk

From MedlinePlus on 07/06/16:

TUESDAY, July 5, 2016 (HealthDay News) -- People who mix marijuana with tobacco are at greater risk for dependency and less motivated to find support to quit these drugs, researchers report.
One billion people around the globe use tobacco and 182 million people smoke pot, making these two of the world's most popular drugs, according to the World Health Organization and the United Nations Office on Drugs and Crime.
For more click here.
When I have been asked by clients to help them quit pot and they also smoke cigarettes, i strongly suggest that they quit smoking tobacco also and help them figure out a way to do that that will work best for them. If the client is willing to make a tobacco quit attempt, they usually are more successful at also quitting pot.

Monday, June 27, 2016

Risk factors in later adolescent alcohol abuse

Adolescent drinking

As former Executive Director of GCASA, the Genesee Council On Alcoholism and Substance Abuse, I am proud of the fact that we won the Drug Free Communities coalition of the year in 2006 out of 711 coalitions in the United States. I have continued to follow the prevention research and noticed today a study reported by Science Daily entitled, "Understanding Risk Factors Involved In The Initiation of Adolescent Alcohol Abuse" which was based on information provided by the Research Society On Alcoholism. 

The article highlights the findings that adolescent alcohol abusers tend to be male from higher socioeconomic groups, have poorer executive functioning, and who have begun dating at earlier ages under 14.

For more information click here.