Wednesday, November 18, 2015

The Great American Smokeout: How to Diplomatically Help a Friend/Relative Stop Smoking

Newswise,November 18, 2015 — November 19, 2015 marks the date of the American Cancer Society’s Great American Smokeout, when cigarette smokers are asked to refrain from smoking for one day in hopes that the effort will lead to quitting forever.

Most people know a smoker they would like to see stop, but wonder if making that request is appropriate. Research from the University of Vermont (UVM) says “yes” – smokers who are exposed to cues to stop are twice as likely to try to quit.

What are these cues? According to John Hughes, M.D., a UVM professor of psychiatry who has been studying how smokers quit for the last 30 years, prompts can range from simply feeling embarrassed to direct requests from others – spouses, friends, children – to quit.

A recent study he conducted featured 134 smokers from across the U.S. who tracked their thoughts about quitting, cues to stop smoking, and actual smoking nightly for three months. The study appears in the journal Drug and Alcohol Dependence.

“Our study found that the large majority of quit attempts were spontaneous,” says Hughes, “so there must have been a ‘straw that broke the camel’s back’ and induced a quit attempt.”

The research suggests that cues to quit often lead to quit attempts. The more cues, the greater the chance of a quit attempt.

So how best can nonsmokers provide a cue that helps prompt quitting? Hughes has four recommendations, based on his research:

• Diplomacy is important. Refrain from using terms like “ought to,” “should” or “need to” and instead use statements that express concern, like “I am worried about your smoking,” or less threatening statements, such as “Have you thought about quitting?”
• Mention new treatments as an icebreaker. For example, say “I heard about this new app that you can use to stop smoking – have you seen it?” and be prepared to mention the local telephone help line (802Quits in Vermont) and provide contact information for free phone counseling and medication sources.
• Remember that more is not necessarily better. A single comment is probably as effective as a 30-minute discussion.
• Repetition is usually necessary. It’s o.k. to say “I know I asked about your stopping smoking several months ago – has anything come of that?” Most of the time, it will take several diplomatic comments from friends and/or loved ones to have an effect.

Monday, November 16, 2015

Public Health Leaders Urge Far-Reaching Reforms to Curb Prescription Opioid Epidemic

Comprehensive report calls for mandatory prescription monitoring programs, expanded naloxone access, tamper-resistant drug packaging, among other measures

Newswise, November 16, 2015 — A group of experts, led by researchers at the Johns Hopkins Bloomberg School of Public Health, today issued recommendations aimed at stemming the prescription opioid epidemic, a crisis that kills an average of 44 people a day in the U.S.

The report calls for changes to the way medical students and physicians are trained, prescriptions are dispensed and monitored, first responders are equipped to treat overdoses, and those with addiction are identified and treated.

The report grew out of discussions that began last year at a town hall co-hosted by the Bloomberg School and the Clinton Health Matters Initiative, an initiative of the Clinton Foundation.

The recommendations were developed by professionals from medicine, pharmacy, injury prevention and law. Patient representatives, insurers and drug manufacturers also participated in developing the recommendations.

The call to action comes at a time of heightened awareness about the prescription opioid epidemic. More than 16,000 people died in the U.S. from overdoses related to opioid pain relievers in 2013, four times the number who died in 1999, according to the U.S. Centers for Disease Control and Prevention (CDC). Prescription opioid sales have increased 300 per cent since 1999. The CDC estimates that two million Americans were dependent on opioid medications in 2013.

“What’s important about these recommendations is that they cover the entire supply chain, from training doctors to working with pharmacies and the pharmaceuticals themselves, as well as reducing demand by mobilizing communities and treating people addicted to opioids,” says Andrea Gielen, ScD, ScM director of the Johns Hopkins Center for Injury Research and Policy at the Bloomberg School and one of the report’s signatories.

“Not only are the recommendations comprehensive, they were developed with input from a wide range of stakeholders, and wherever possible draw from evidence-based research.”

Carefully used, opioids provide important pain relief for many patients with acute or post-surgical pain. Up until the late 1990s, prescription opioids were prescribed primarily to cancer patients.

They became more widely used as new products were developed and aggressively promoted for wider use. In addition, their addictive potential was substantially underestimated.

Another complicating factor is so-called diversion–use by friends and family rather than those actually prescribed the painkillers. According to the CDC, in 2012, health care providers wrote 259 million prescriptions for opioid pain relievers, enough to supply every adult in the U.S. a four-week, round-the-clock supply.
The report, titled “The Prescription Opioid Epidemic: An Evidence-Based Approach,” breaks its recommendations into seven categories:
• Prescribing Guidelines
• Prescription Drug Monitoring Programs (PDMPs)
• Pharmacy Benefit Managers (PBMs) and Pharmacies
• Engineering Strategies (i.e., packaging)
• Overdose Education and Naloxone Distribution Programs
• Addiction Treatment
• Community-Based Prevention Strategies

“This is a complex epidemic with no simple solutions,” says G. Caleb Alexander, MD, MS, co-director of the Johns Hopkins Center for Drug Safety and Effectiveness at the Bloomberg School and another of the report’s signatories.

“We tried to identify as many windows as possible, and to tie together as much research as available, to inform these recommendations which together we believe provide the best chance of turning this steamship around.”

The report calls for stricter oversight of clinical prescribing and more comprehensive training of medical students, who presently receive very little instruction on the subject.

The signatories also recommend expanding the role of pharmacies and Pharmacy Benefits Managers, both of which stand between the prescribers and the patients who receive the medication.

For example, increased use of electronic prescribing to identify high-risk patients and prescribers, along with expanded availability of drug take-back programs, would give pharmacies a greater role in reducing opioid misuse and abuse.

The authors also call for mandatory use of Prescription Drug Monitoring Programs (PDMPs), state databases that include controlled substance prescriptions from in-state pharmacies.

Every state but Missouri has a version of a PDMP, as do Washington, D.C., and Guam. At present, PDMPs are voluntary in many states and actual use varies – many prescribing providers are not aware of them – and their design varies from state to state. In addition to making PDMPs mandatory, the report recommends making them more accessible to law enforcement when warranted.

The report calls for expanding the availability of naloxone, which can reverse the effects of an overdose if administered promptly.

Among the recommendations to address addiction, working group members call for providing funding for treatment programs to communities with high rates of addiction and educating prescribers and pharmacists on ways to prevent addiction.

Among the report’s other recommendations: develop more secure and tamper-resistant packaging through design contests and other approaches and, as noted above, expand “take back” programs that allow patients to return unused medication to pharmacies to reduce chances that the pills might be taken by potential abusers.

The report will be among topics discussed at a forum hosted by the Bloomberg School of Public Health and the Clinton Health Matters Initiative on Nov. 17, 2015 at the Bloomberg School.

Participants include Michael Botticelli, MEd, Director of the White House Office of National Drug Control Policy; Christopher Jones, PharmD, MPH, director of Science Policy, U.S. Department of Health and Human Services; and Bloomberg School faculty Joshua Sharfstein, MD, and Shannon Frattaroli, PhD, MPH. (Sharfstein and Frattaroli are signatories to the report.)

Kicking an Addiction? Replace It with Joy, UCLA Expert Advises in New Book

Bringing pleasure into recovery is the key to turning over a new leaf

Newswise, November 16, 2015 — People in the midst of alcohol or drug addiction tend to imagine life without those substances as one of deprivation, which can make kicking the habit seem like a joyless and dreary prospect.

But recovery from addiction has at least as much to do with rewarding oneself as it does with depriving oneself, according to a new book by a UCLA expert in addiction treatment.

“People with the most success in staying sober tend to get involved in a range of pleasurable activities and do them frequently,” said Suzette Glasner-Edwards, author of “The Addiction Recovery Skills Workbook,” which is to be published Dec. 1 by New Harbinger Publications.

“These activities can replace the time and energy that they had been spending on addictive behaviors, enabling them to experience pleasure without the devastating consequences of alcohol or drug use.”

Glasner-Edwards is an adjunct associate professor at UCLA’s Semel Institute for Neuroscience and Human Behavior and a licensed clinical psychologist. Her research focuses on advancing treatments for addictions and mental health problems at the UCLA Integrated Substance Abuse Programs.
Subtitled “Changing Addictive Behaviors using CBT, Mindfulness and Motivational Interviewing Techniques,” the workbook details the science of a wide range of treatment options for addicts and their loved ones, and it is filled with worksheets, lists and questionnaires that allow readers to try them out.
Among the newest approaches it describes is behavioral activation therapy, which advocates rediscovering life’s healthy rewards. Glasner-Edwards said the strategy is effective because it combats the allure of drugs and alcohol at their source.

Both drugs and alcohol release dopamine, a chemical that the brain associates with the pleasure of receiving rewards, but both cause the brain to release dopamine at a far greater rate than life’s normal pleasures. As a result, the book explains, activities that once brought pleasure pale by comparison.

“While the feeling of disappointment at routine pleasure does get better over time, it is one of the things that prevents people from really getting a head start in recovery,” Glasner-Edwards writes.

“They keep relapsing in that early phase when nothing feels enjoyable. Their brain is still really healing from all that depletion and depression that the depletion can lead to.”

To combat these disappointments and blues, Glasner-Edwards encourages people in sobriety to resume activities that they once enjoyed or discover new ones: Cook something new. Plan a party. Exercise. Go to a museum. Take up a sport. And, to increase the likelihood that readers will carry out the activities, the book advocates scheduling them for specific times.

“Ideally you should have one pleasant activity worked into each day,” Glasner-Edwards writes. What if embarking on the activity feels more like a chore than a diversion?

“The workbook urges readers to rate how good — or miserable — they expect the experience will be on a 10-point scale, and then, after the activity, to rate how fun (or not) it actually proved to be.

“More often than not, an activity is more fun than you thought it was going to be,” she said, adding that seeing the pattern play out repeatedly can break down people’s resistance to enjoying future fun pursuits.

Readers are also urged to reward themselves again after the activity: Get a massage or eat a piece of chocolate cake, for example. The intent is to make them more inclined to pursue the activity again.

“Just like the rewarding feelings that follow the use of drugs or alcohol in the early stages lead to forming a damaging habit, rewarding healthy behaviors can establish positive habits,” Glasner-Edwards said.

In choosing which activities to pursue, the book notes, one important consideration is whether the activity is likely to trigger a relapse. Glasner-Edwards counsels against activities that a recovering addict would associate with their substance abuse.

Someone trying to stop using marijuana, for instance, might avoid attending concerts by musicians they used to listen to while high.

Another consideration is people the recovering addict spends time with during their new activities. One person who Glasner-Edwards treated for alcoholism began grilling dinners for his friends.

Although he relished his guests’ compliments about his cooking, there was one problem: They often arrived with bottles of wine or six-packs of beer.

“I finally had to say, ‘OK, you have this love of grilling, but you have to be careful who you grill with,’” she said. “Because if they bring booze, all of a sudden you’re feeling like, ‘Why not just one?’”

Although behavioral activation therapy has not yet been extensively studied as a treatment for substance abuse, the new approach builds on some of the oldest and most often validated findings in addiction therapy, Glasner Edwards said.

Since the 1970s, repeated studies have shown that individuals with all kinds of addictions are more likely to stay sober if researchers routinely test them for substance abuse and then reward clean results, especially when the value of the rewards climb with each negative test.

“It could even be a gift card — a whole range of prizes will do,” Glasner-Edwards said. “It doesn’t even matter what the income level of the addict is, so long as the value of the rewards escalates with consecutive good outcomes. There’s something about the process of being rewarded that’s very motivating.”

Tuesday, November 10, 2015

Prescription Painkillers Source of Addiction for Most Women

Women need different treatment from men with addiction

Newswise, November 10, 2015 --Painkillers prescribed by doctors are the starting point for an opioid addiction for more than half of female methadone clinic patients, and they need different treatment from men with addiction, says a study led by McMaster University researchers.

The results, published in the open access journal Biology of Sex Differences today, show that more than half (52%) of women and a third (38%) of men reported doctor-prescribed painkillers as their first contact with opioid drugs, a family of drugs which include prescription medicines such OxyContin and codeine, as well as illicit drugs such as heroin.

The study of 503 patients attending Ontario methadone clinics identified significant gender differences between the men and women attending the clinics. Compared to men, women were found to have more physical and psychological health problems, more childcare responsibilities, and were more likely to have a family history of psychiatric illness.

Men were more likely than women to be working and more likely to smoke cigarettes. Rates of cannabis use were relatively high (47%) among both men and women.

“Most methadone treatment is based on studies with few or no women at all. We found men and women who are addicted to opioids have very different demographics and health needs, and we need to better reflect this in the treatment options that are available,” said Monica Bawor, first author of the paper and a recent PhD neuroscience graduate of McMaster.

“A rising number of women are seeking treatment for opioid addiction in Canada and other countries yet, in many cases, treatment is still geared towards a patient profile that is decades out of date – predominantly young men injecting heroin, and with few family or employment responsibilities.”

The study highlights the changing profile of people addicted to opioids. Compared to results from studies in the 1990s, the average age of patients being treated for opioid addiction is older (38 compared to 25 years), with opioid use starting at a later age (25 rather than 21 years).

Injecting drug use has reduced by 60%, and there has been a 50% reduction in rates of HIV in opioid users as a result.

At the same time, there has been a 30% increase in the number of patients becoming addicted to opioids through doctor-prescribed painkillers, usually for chronic pain management.

In Canada, the number of opioid painkiller prescriptions has doubled in the last two decades, and according to the World Health Organization (WHO), Canada consumes more opioid painkillers than any other country.

Senior author Dr. Zena Samaan added that the reasons are not clear why women are disproportionately affected by opioid dependence originating from prescription painkillers.

“It may be that they are prescribed painkillers more often because of a lower pain threshold or because they are more likely to seek medical care than men,” said Samaan, an associate professor of psychiatry and behavioural neurosciences at the Michael G. DeGroote School of Medicine.

“For whatever reason, this is a growing problem in Canada and in other countries, such as the U.S., and addiction treatment programs need to adapt to the changing profile of opioid addiction.”

Major funding for the study was from the Canadian Institutes for Health Research.

“Even more important, is its potential for greatly reducing the incidence of cardiovascular disease.”