Anxiety Is a Stronger Harbinger of Alcohol Problems Than Stress

Newswise, March 20, 2017 — Stress and anxiety are widely believed to contribute to drinking. Alcohol is thought to reduce tension caused by stress (the “flight or fight” response) as well as alleviate the unpleasant symptoms of anxiety (anticipation of the unpredictable, impending threats).

Prior research, however, has yielded inconsistent findings as to the unique relations between stress and anxiety, on the one hand, and alcohol consumption and alcohol use disorders, on the other hand.

This study was designed to examine how differences in self-reported levels of anxiety, anxiety sensitivity, and perceived stress impact the frequency and intensity of drinking, alcohol craving during early withdrawal, and alcohol craving and stress reactivity.

Recent drinking was assessed in 87 individuals (70 men, 17 women) with alcohol use disorders (AUDs). Three distinct measures were used to evaluate anxiety, anxiety sensitivity, and perceived stress.

A subset of 30 subjects was admitted to a medical center to ensure alcohol abstinence for one week: measures of alcohol craving were collected twice daily. On day 4, subjects participated in a public speaking/math challenge, before and after which measures of cortisol and alcohol craving were collected.

In these heavy drinkers, measures of anxiety as compared with perceived stress were more strongly associated with a variety of alcohol-related measures.

While alcohol studies often use the terms anxiety, anxiety sensitivity, and stress interchangeably, this study showed the importance of differentiating among the three terms given their unique relationships with drinking, craving, and stress reactivity among individuals with AUDs.

National Organizations Band Together to Ensure that Congress Passes Comprehensive Policies to Combat the U.S. Opioid Epidemic

The Coalition to Stop Opioid Overdose Launches to Advance Legislation that Will Address this Public Health Crisis

WASHINGTON, May 25, 2016 -- More than 10 million Americans report misusing opioids. In response to this unprecedented and growing epidemic in the United States, the Coalition to Stop Opioid Overdose launched today, uniting diverse stakeholders around the common goal of achieving meaningful legislative solutions to address opioid misuse and overdose.

The Coalition is composed of leading state and national groups that are committed to advancing meaningful legislative and regulatory policies.

Congress, the Administration, public health agencies and a number of state legislatures have taken important initial steps to combat the opioid epidemic.

Last week the House passed 18 bills. In March, a wide-ranging bill was passed by the full Senate and the Senate Committee on Health, Education, Labor and Pensions (HELP) approved additional important legislation, which is pending before the full Senate.

Now is the critical time to build on this progress and ensure that comprehensive legislation aimed at addressing opioid misuse, overdose and addiction is passed and funded appropriately, according to R. Corey Waller, MD, DFASAM, Chair of the American Society of Addiction Medicine's Legislative Advocacy Committee.

"There remains an urgent need for simple and achievable prevention, treatment and recovery policies that can reduce opioid overdose," says Dr. Waller.

"Now is the time for us to come together as a unified group to ensure that Congress sends meaningful legislation to the President's desk this year."

The Coalition's efforts will focus around five key strategies to combat the opioid epidemic:

• Improving access to medication-assisted treatment for those with opioid addiction
• Expanding availability of naloxone in health care settings and beyond
• Implementing enhanced prescription drug monitoring programs that track the dispensing and prescribing of controlled substances
• Raising the level of opioid prescriber education
• Enacting the Comprehensive Addiction and Recovery Act
•  

Addiction is a chronic disease that too often goes untreated. More than half of Americans (56 percent) say that they or someone they know has misused, been addicted to, or died from prescription pain medications, according to a recent Kaiser Health Tracking Poll.

When patients can't access treatment and recovery support services, addiction can lead to disability or premature death.

According to the U.S. Centers for Disease Control and Prevention, the rate of death from opioid-related overdose has quadrupled since 2000.

Drug overdoses are the leading cause of accidental death in the United States, surpassing even traffic fatalities. And emergency room visits linked to misuse of prescription opioids are up by more than 50 percent since 2004.

"Emergency physicians see first-hand the devastating consequences of opioid misuse. We often pick up the pieces, from first-contact psychiatric care to acute resuscitation after overdose," says Jay Kaplan, MD, FACEP, President of the American College of Emergency Physicians.

"We need to do more to prevent these life-shattering, or even life-ending, events."

The epidemic is compounded by the vast gap in access to opioid addiction treatment. There are three FDA-approved medications approved to treat opioid use disorder.

Patients need access to all available options so they can find what works for them; however, current prescribing limits restrict access to one of these treatment options. Additionally, there is a lack of access to medication that can help prevent and reverse opioid overdose.

The Coalition held its inaugural meeting at the U.S. Capitol Visitor Center in Washington D.C. where speakers, including Dr. Kaplan, Justin Luke Riley, Advocate, Young People in Recovery and Yngvild Olsen, MD, MPH, Director at Large of the American Society of Addiction Medicine, discussed strategies for addressing the opioid epidemic.

The following organizations have joined the Coalition to date, including:

• American Academy of PAs
• American Association of Nurse Practitioners
• American College of Emergency Physicians
• American Congress of Obstetrics and Gynecology
• American Medical Student Association
• American Society of Addiction Medicine
• Association of Women's Health, Obstetric and Neonatal Nurses
• Facing Addiction
• National Association of Clinical Nurse Specialists
• National Association of Social Workers
• The Association of Recovery Schools
• The National Center on Addiction and Substance Abuse
• Young People in Recovery
•  

For more information about the Coalition to Stop Opioid Overdose, please visit http://www.stopopioidoverdose.org/ . 

About the Coalition to Stop Opioid Overdose
The Coalition to Stop Opioid Overdose is an organization of state and national groups that are committed to advancing meaningful legislative and regulatory policies in response to the opioid epidemic.

The Coalition seeks to address the U.S. opioid epidemic by engaging policy makers, public health leaders, chronic pain and addiction specialists, individuals in and seeking recovery and family members, so that legislation and policies get the support needed to pass Congress this year and become law.

Financial support for the Coalition is provided by the following: Adapt Pharma, The American Society of Addiction Medicine, CleanSlate Centers, Indivior, Merck and Proove.

Smoking and Schizophrenia: Understanding and Breaking the Cycle of Addiction

Newswise, April 21, 2016– Smoking addiction in schizophrenia can be explained by significantly increased activation of the ventro-medial prefrontal cortex (vmPFC), a region involved in the brain reward system.

These new data, the result of a study by researchers at the Institut universitaire en santé mentale de Montréal (CIUSSS EST, Montreal) and the University of Montreal confirms the tendency to smoke and low smoking cessation rates of people with schizophrenia.

“Smoking is a real problem for people with schizophrenia,” said Stéphane Potvin, a researcher at the Institut universitaire en santé mentale de Montréal and lead author of the study.

"Their health and life expectancy are often undermined by this addiction, whose brain mechanisms were until now largely unknown," said the associate professor at the University of Montreal’s Faculty of Medicine.

Essentially, the research team observed greater neuronal activation of a specific region of the brain (vmPFC) in schizophrenia smokers compared with healthy subjects when presented with appetitive cigarette images.

At the behavioural level, the researchers also found that schizophrenia smokers had more depressive symptoms than did participants in the control group.

“These observations suggest that smoking has a greater rewarding effect in schizophrenia smokers. This corroborates the hypothesis already formulated of their increased vulnerability to this addiction but also demonstrates the great difficulty for them when it comes to quitting smoking," said Potvin.

The prevalence of smoking in people with schizophrenia is high, and cessation rates are low. Schizophrenia smokers are twelve more times likely to die from heart disease related to smoking than are those who do not smoke.

“It is necessary to explore avenues that will help people in their efforts to free themselves from smoking,” said Potvin. “

That is why we want to continue our research into whether this activation of the ventro-medial prefrontal cortex (vmPFC) is caused by the disease itself or by the effects of antipsychotics,” concluded the researcher.

In-Car Breathalyzers for DUI Offenders Curb Drunk-Driving Deaths by 15 Percent

So-Called “Ignition Interlocks” Save Lives with Similar Success as Airbag Laws, Penn Study Says

Newswise, March 18, 2016 —  State laws that require drivers who’ve been convicted of drunk driving to pass a breathalyzer-type test before starting their cars saved an estimated 915 lives between 2007 and 2013, according to a study published in the American Journal of Public Health by researchers at the Perelman School of Medicine at the University of Pennsylvania.

The findings represent a 15 percent reduction in drunk driving-related deaths compared to states without legislation requiring DUI offenders to use “mandatory ignition interlock.”

The research, led by Elinore J. Kaufman, MD, a student in Penn’s Health Policy master’s degree program and a resident at New York-Presbyterian Weill Cornell Medical College, used National Highway Traffic Safety Administration data to compare alcohol-related crash deaths in the 18 states that required ignition interlocks for all those convicted of DUI as of 2013 with the number of alcohol-related crash deaths in states without mandatory interlocks.

States with mandatory interlock laws saw a 0.8 decrease in deaths for every 100,000 people each year – which is comparable to lives shown to have been saved from mandatory airbag laws and the 21-year minimum legal drinking age combined (0.9 and 0.2 lives saved per 100,000 people, respectively).

Car crashes involving alcohol make up 30 percent of vehicular fatalities, resulting in 11,000 deaths each year. The National Highway Traffic and Safety Administration estimates that for each of the million drunk driving convictions each year, there are 88 previous instances of drunk driving.

“These laws are proven feasible and effective, and they are low hanging fruit for the remaining half of states, including Pennsylvania, that don’t have this protection in place yet,” Kaufman said.

Following increasing support for interlock laws in other states, Pennsylvania’s House of Representative’s Transportation Committee is considering legislation – SB 290 – that would require first-time DUI offenders with a blood-alcohol content of .10 or higher to install these devices.

“Our findings show that by preventing intoxicated drivers from starting their vehicles, these ignition interlock laws can directly prevent drunk driving and save lives,” Kaufman said. “We are encouraged by growing public and governmental support for expansion of interlock programs and innovative ways to use this technology to prevent more lives lost resulting from drunk driving.”

Previous research on mandatory interlock laws focused on recidivism rates, but the new Penn study serves as the first national analysis of the impact of a universal interlock requirement on alcohol-involved crash deaths.

“Although crashes and crash fatalities decline, we’re not seeing a significant reduction in those involving alcohol,” said the study’s senior author, Douglas J. Wiebe, PhD, an associate professor of epidemiology in the department of Biostatistics and Epidemiology and a senior scholar in the Center for Clinical Epidemiology and Biostatistics.

“We’re encouraged by the increasing number of states enacting mandatory interlock laws since 2013 and hope these findings advance public health conversations aimed at saving more lives.”

The researchers note that the variation in state ignition interlock laws and enforcement of those laws further illustrates the importance of taking a comprehensive approach to ensuring driving safety.

While mandatory minimum drinking age and interlock laws have shown progress in curbing drunk-driving incidence, the authors call for further steps, including new strategies to encourage alternative forms of transportation and changing “alcohol culture” and social behaviors to reduce binge drinking.

The Medical Minute: The Path From Prescription Pain Killers to Addiction

Newswise, March 9, 2016 — Abuse of prescription pain killers has become an epidemic in the United States, according to the Centers for Disease Control and Prevention (CDC). Even more concerning is that those going through withdrawal may turn to heroin as an inexpensive, easy-to-access substitute.

 

Dr. Vitaly Gordin, division chief of chronic pain management in the Department of Anesthesiology at Penn State Hershey Medical Center said it’s because heroin is an opiate analgesic, just like drugs such as oxycodone and tramadol, which are frequently prescribed for pain control.

The problem is not with patients who use the medicines to relieve short-term acute pain, like the kind after surgery. 

“The vast majority of them will very easily get off these medications as their condition improves and pain is decreasing,” he said.

Nor does it lie with those who have chronic conditions that require them to be on high doses of narcotic painkillers for long periods of time: “There are a lot of very legitimate patients who are receiving these medicines in a chronic setting who are not abusing them.”

The challenge comes when someone is taken off the medication after using a high dose for a length of time.

“Because of this declared epidemic, many primary care physicians, specialists and surgeons are taking these patients off the narcotics,” Gordin said. “But if they don’t have an exit strategy and get referred for alternate treatment, addictions counseling or rehabilitation, they can become desperate as they go through withdrawal.”

Without a renewing prescription for narcotics, the patients may turn to heroin.

Unlike with prescription painkillers, which are regulated by the Food and Drug Administration, it’s hard to verify exactly what is in the heroin you buy from a dealer.

“Several years ago there was a string of deaths of addicts who bought heroin laced with a potent painkiller called fentanyl,” Gordin said. “Because it’s all an underground, illegal business, you don’t know exactly what you’re getting.”

Many of the 20,000 deaths that occur each year from abuse of prescription pain killers happen when the narcotics are combined with another substance such as benzodiazepine or alcohol, which creates a dangerous – if not deadly – mix.

Gordin said patients with a history of drug abuse, untreated psychiatric conditions or pre-adolescent abuse of any kind are much more likely to develop addictions.

“In my 17 years working here, I have never seen as many inpatients on heroin as I have in the past six to 12 months,” he said. “Those who have abused heroin are getting into car accidents or involved in violent crimes because of being on the drug or trying to obtain it. I think it’s directly related.”

Gordin also said it is important that society begin to de-stigmatize addiction as a character flaw. “We need to understand it is a disease with psycho-social components and we need to have resources available to both prescribing physicians and patients who need drug rehabilitation.”

The Medical Minute is a weekly health news feature produced by Penn State Milton S. Hershey Medical Center. Articles feature the expertise of Penn State Hershey faculty physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

Overdose Deaths from Common Sedatives Have Surged, New Study Finds

 Newswise, February 21, 2016--Headlines about America’s worsening drug epidemic have focused on deaths from opioids—heroin and prescription painkillers such as OxyContin.

But overdose deaths have also soared among the millions of Americans using benzodiazepine drugs, a class of sedatives that includes Xanax, Valium, and Klonopin, according to a study led by researchers at Albert Einstein College of Medicine, Montefiore Health System and the Perelman School of Medicine at University of Pennsylvania. Their findings appear online today in the American Journal of Public Health.

“We found that the death rate from overdoses involving benzodiazepines, also known as ‘benzos,’ has increased more than four-fold since 1996—a public health problem that has gone under the radar,” said lead author Marcus Bachhuber, M.D., MS., assistant professor of medicine at Einstein and attending physician, internal medicine at Montefiore. 

“Overdoses from benzodiazepines have increased at a much faster rate than prescriptions for the drugs, indicating that people have been taking them in a riskier way over time.”

An estimated 1 in 20 U.S. adults fills a benzodiazepine prescription during the course of a year. The drugs are prescribed for conditions including anxiety, mood disorders and insomnia.

In 2013, benzodiazepine overdoses accounted for 31 percent of the nearly 23,000 deaths from prescription drug overdoses in the U.S. But little was known about the national trends in benzodiazepine prescribing or in fatalities from the drugs. To find out, the researchers examined data for the years 1996-2013 from two sources:

•The Medical Expenditure Panel Survey. This federally sponsored survey includes a nationally representative sample of families and individuals who provide information about healthcare purchases including prescription drugs.

•Multiple-cause-of-death data from the Centers for Disease Control and Prevention. The researchers extracted reports from physicians, medical examiners or coroners on all overdose deaths involving a benzodiazepine, including deaths also involving other medications, alcohol or illicit drugs.

Their analysis revealed that the number of adults purchasing a benzodiazepine prescription increased by 67 percent over the 18-year period, from 8.1 million prescriptions in 1996 to 13.5 million in 2013.

 For those obtaining benzodiazepine prescriptions, the average quantity filled during the year more than doubled between 1996 and 2013. Most crucially, the overdose death rate over the 18-year period increased from 0.58 deaths per 100,000 adults in 1996 to 3.14 deaths per 100,000 adults in 2013, a more than four-fold increase.

Overall, the rate of overdose deaths from benzodiazepines has leveled off since 2010. But for a few groups—adults aged 65 and over and for blacks and Hispanics—the rate of overdose deaths after 2010 continued to rise.

“The greater quantity of benzodiazepines prescribed to patients—more than doubling over the time period—suggests a higher daily dose or more days of treatment, either of which could increase the risk of fatal overdose,” said senior author Joanna Starrels, M.D., M.S., associate professor of medicine at Einstein and attending physician, internal medicine at Montefiore.

Dr. Starrels also offered two other possible reasons for the spike in benzodiazepine deaths. “People at high risk for fatal overdose may be obtaining diverted benzodiazepines [i.e., not from medical providers], and we know that combining benzodiazepines with alcohol or drugs—including opioid painkillers—can lead to fatal overdoses,” she said.

She noted that opioid prescribing has increased rapidly during most of the period covered in her study and that opioids are involved in 75 percent of overdose deaths involving benzodiazepines.

“An obvious way to improve benzodiazepine safety would be for people to reduce their use of these medicines,” said study co-author Chinazo Cunningham, M.D., M.S., professor of medicine and of family and social medicine at Einstein and associate chief of the division of general internal medicine at Einstein and Montefiore.

“But we should also be emphasizing the danger of fatal overdose from taking benzodiazepines concurrently with opioid painkillers or with alcohol.”

“This epidemic is almost entirely preventable, as the most common reason to use benzodiazepines is anxiety—which can be treated effectively and much more safely with talk therapy,” said Sean Hennessy, Pharm.D., Ph.D., professor of epidemiology at Penn’s Perelman School of Medicine and co-author of the study.

“Given the high prevalence of anxiety symptoms, we need a more constructive approach to the problem than popping pills.”

The study is titled “Increasing benzodiazepine prescription and overdose mortality in the United States, 1996-2013.” The research was supported by the National Institutes of Health (NIH K24DA036955, R25DA023021 and K23DA027719). The authors report no conflicts of interest.

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.”

FAU’s Medical School to Work with foundation2recovery.org to Combat Narcotic Prescription Drug Epidemi4

Foundation to Implement Novel Practices Supporting Treatment, Prevention and Education Programs

Newswise, September 10, 2015 — More people die from overdose of prescription opiate pain medications than from all other drugs combined, including heroin and cocaine.

According to the National Institute on Drug Abuse (NIDA), more than 2 million people in the United States suffer from substance use disorders related to prescription opiate pain medications, and overdose deaths have more than quadrupled in the past decade and a half.

According to NIDA, in 2013, 207 million prescriptions were written for these pain medications.

Physicians and researchers in the Charles E. Schmidt College of Medicine at Florida Atlantic University will work with www.foundation2recovery.org   to target this major public health problem using novel approaches to support treatment, prevention and education programs.

The brainchild of entrepreneur and founder Joe Randazza, foundation2recovery will develop a portfolio of tools and resources to address prevention and education as well as treatment programs that include the use of FDA-approved “opiate blockers.”

“The statistics are staggering and the causes for misuse of opiates are extremely complex,” said Randazza. “foundation2recovery.org has been put in motion to begin the dialogue and propel the effort needed to fight this scourge at its source, and we are very pleased to partner with FAU’s Charles E. Schmidt College of Medicine on our important mission.”

FAU and foundation2recovery.org have begun discussions to establish a national advisory board composed of medical, scientific and business experts who will help www.foundation2recovery.org  identify highly effective and novel approaches to this growing problem, including vital resources that enable families to identify problems early.

  

FAU’s College of Medicine will provide its expertise to help create educational programs and materials, treatment assessment criteria and prevention tools, and will work with the foundation to develop strategies to support evidence-based treatment programs.

“The misuse of opiate pain medication is a huge public health problem that impacts families all over the country, at all socioeconomic levels,” said John W. Newcomer, M.D., executive vice dean in FAU’s Charles E. Schmidt College of Medicine and an internationally renowned neuroscientist.

“As physicians, we look forward to working with foundation2recovery to help them identify, assess and support highly effective approaches, both existing and novel, to address prescription opiate addiction.”

According to Partnership for Drug Free Kids, every day 2,000 teens in the U.S. try prescription drugs and 60 percent of them do so before age 15.

Furthermore, the Centers for Disease Control and Prevention estimates that of the 22 million Americans who need treatment, only 11 percent actually receive the treatment they need.

“I’ve been very fortunate and successful throughout my career and in my business endeavors. Now, I want to use my knowledge and resources to give back and most importantly to save lives,” said Randazza.

Study Finds Lack of Ultimate Meaning in Life Associated with Alcohol Abuse, Drug Addiction and Other Mental Health Problems

Newswise, August 15, 2015 — One of the most commonly used treatment models in addiction is the 12-step model developed in the 1930s and rooted in spirituality. Yet, surprisingly, there is no clear understanding about how to nurture spirituality among people struggling with addictions.

In a unique study titled “Attachment Style, Spirituality, and Depressive

Symptoms Among Individuals in Substance Abuse Treatment,” published in the Journal of Social Service Research, Gail Horton, Ph.D., associate professor; Naelys Luna, Ph.D., associate professor, School of Social Work in the College for Design and Social Inquiry at Florida Atlantic University, and Tammy Malloy, LCSW, chief clinical officer, Behavioral Health of the Palm Beaches (BHOPB), demonstrate that the lack of ultimate meaning in life, an important dimension of spirituality, is associated with alcohol abuse and drug addiction, as well as other mental health problems including anxiety and depression. 

Although adult attachment styles and spirituality have been shown to be protective factors against depressive symptoms among individuals in treatment for substance use disorders, no studies to date have examined how these two factors together are related to depressive symptoms in this population.

Horton, Luna and Malloy looked at how adult attachment styles (secure vs. insecure) and two distinct spirituality dimensions (existential purpose/meaning in life and religious well-being or the perceived relationship with God) are associated with depressive symptoms.

Working in collaboration with BHOPB, a substance abuse treatment center in Palm Beach County, Horton, Luna and Malloy developed a research model that looks at how creativity, service and solitude can be used in addiction treatment to foster purpose and meaning in life. They found that encouraging people’s creative talents (painting, writing), giving them opportunities to serve others, and helping them to connect to core values and their true self through prayer and meditation helped them to discover ultimate purpose and meaning as part of their recovery process.

A key finding of their research shows that having an insecure attachment style appears to be a risk factor for developing depressive symptoms. Another significant finding shows that the existential-purpose and meaning-in-life dimension of spirituality seems to be the most important factor related to depressive symptoms in this sample population.

Horton and Luna note that although their research results suggest that practitioners could consider focusing on promoting improved interpersonal relationships for individuals with insecure attachment styles, they may want to place fostering purpose and meaning in life as a higher priority for treatment planning.

“Programs such as the 12-step model might want to take into consideration the relative importance of the two spiritual dimensions and put into place programmatic support for the development of purpose and meaning in life rather than only stressing the perceived closeness to God,” said Malloy.

Addiction is one of the most damaging health problems in the U.S. today and the World Health Organization (WHO) reports that by 2020, mental health and substance use disorders will be a major cause of disability worldwide surpassing physical illness. 

In 2009, an estimated 23.5 million Americans ages 12 and older required addiction treatment. The societal cost of substance abuse problems is approximately $511 billion.

“The cutting-edge research conducted by Drs. Horton and Luna and Ms. Malloy is extremely important because it sheds light on different ways to help individuals in treatment addiction,” said John R. Graham, Ph.D., professor and director of FAU’s School of Social Work. 

“This in turn not only helps the clients receiving treatment, but also improves how addiction professionals do their work - contributing to the health and well-being of the broader community.”

-FAU-

Florida Atlantic University
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, the University, with an annual economic impact of $6.3 billion, serves more than 30,000 undergraduate and graduate students at sites throughout its six-county service region in southeast Florida. FAU’s world-class teaching and research faculty serves students through 10 colleges: the Dorothy F. Schmidt College of Arts and Letters, the College of Business, the College for Design and Social Inquiry, the College of Education, the College of Engineering and Computer Science, the Graduate College, the Harriet L. Wilkes Honors College, the Charles E. Schmidt College of Medicine, the Christine E. Lynn College of Nursing and the Charles E. Schmidt College of Science. FAU is ranked as a High Research Activity institution by the Carnegie Foundation for the Advancement of Teaching. The University is placing special focus on the rapid development of critical areas that form the basis of its strategic plan: Healthy aging, biotech, coastal and marine issues, neuroscience, regenerative medicine, informatics, lifespan and the environment. These areas provide opportunities for faculty and students to build upon FAU’s existing strengths in research and scholarship. For more information, visit www.fau.edu.

Behavioral Health of the Palm Beaches
Behavioral Health of the Palm Beaches (BHOPB) is a leading addiction care organization located in South Florida offering patients comprehensive treatment for chemical dependency and mental illness. Comprised of four specialty facilities (the Recovery Center for Men, the Recovery Center for Women, Seaside Palm Beach, and Mental Health Rehab of the Palm Beaches). BHOPB provides patients with individualized care programs that span the entire treatment process, from intervention services to medically supervised detoxification to customized inpatient rehab to aftercare. Since its inception in 1997, BHOPB has grown to be one of the top addiction care organizations in the country through an ever-expanding spectrum of therapies, world-renowned research department and industry-leading clinical staff. For more information visit