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How useful is abstinence alone in understanding the effectiveness of SUD treatment?

The following article was recently published on the research page of the Recovery Research Institute website. It reports that abstinence from alcohol and other drugs is commonly perceived as a defining feature of recovery and has been widely used as a marker by which to evaluate the success of substance use disorder (SUD) treatment. Efforts have been made to define recovery more broadly by incorporating indices of functioning and well-being, but even within such broader definitions, achieving abstinence (as opposed to drinking at low-risk levels) is noted as an important milestone. This research presents three-year outcomes of persons who participated in outpatient treatment for alcohol use disorder, where treatment outcomes are defined in terms of both alcohol use and functioning.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

A focus on abstinence in defining recovery from an alcohol or other substance use problem has a long history in the field of addiction. More recently, however, efforts have been made to broaden the definition of recovery so as to align more closely with the variety of actions one can take toward health and wellness for those with substance use disorder. This broadening of the definition has largely focused on incorporating indices of functioning and well-being, which, of course, are of great relevance to individuals with SUD, both inside and outside the treatment context. When it comes to substance use, however, most definitions of recovery continue to focus on abstinence rather than also considering drinking patterns that do not result in a re-occurrence of substance use disorder symptoms or other harms. Clinically as well, patients are often advised to choose abstinence as their treatment goal. Increasingly, however, it is being questioned if abstinence is a necessary treatment goal for all persons with substance use disorder. To shed further light on this issue, Witkiewitz and colleagues looked at the outcomes of 806 alcohol use disorder outpatients over the course of three years after they started alcohol use disorder outpatient treatment.  

HOW WAS THIS STUDY CONDUCTED?

This study was a secondary data analysis of the well-characterized and frequently analyzed dataset stemming from Project MATCH, a multi-site project conducted in the 1990s in the United States. This analysis used a subsample of these study participants who were followed for up to three years following the initial Project MATCH treatments.  In this subsample, 952 individuals with alcohol use disorder were randomized to receive one of three individually-delivered outpatient treatments (i.e., cognitive behavioral therapymotivational enhancement therapy, or Twelve-Step facilitation). Of these, 806 (85%) provided data on their drinking during the three years following treatment and were included in analyses. Assessments were conducted prior to treatment, during the 12 weeks of treatment, immediately following treatment, and 6, 12, and 36 months after treatment end. In addition to reporting on their drinking and negative consequences they experienced due to their drinking, participants also provided information on their experiences during the past 30 days, using four yes/no items (“employed,” experienced “serious depression,” “trouble understanding, concentrating, or remembering,” “serious anxiety or tension”), and completed several items measuring to what degree they engaged in problematic social behaviors and to what degree they felt satisfaction with their life.   

Witkiewitz and colleagues then conducted two types of analyses. First, they simply defined three groups of participants in terms of their drinking based on cut-off values of public health interest and described their outcomes over time. The three groups they defined were abstainers, low-risk drinkers (i.e. non-abstinent individuals with no heavy drinking days) and heavy drinkers. A heavy drinking day was defined using nationally-defined standards as consuming four or more drinks in a day for women, or five or more drinks in a day for men. Then, they used an exploratory technique called “latent profile analysis” to identify groups of patients based on their reports of alcohol consumption and life functioning (i.e., as described above) over the three years following entry into outpatient treatment. 

WHAT DID THIS STUDY FIND?

When outcomes were defined by public health relevant cut-off values, low-risk drinkers were not significantly different from abstainers (i.e., differences were not greater than could be explained by chance alone) on almost all non-drinking outcomes, with one exception: abstainers were significantly unhappier with life. This may because these individuals tended to have the heaviest drinking and most severe problems prior to treatment and these individuals’ lives can continue to be detrimentally affected for many years even after remission has been achieved.  

In defining groups that emerged by considering participants’ data over time, Witkiewitz and colleagues identified four profiles: 

Figure 1. Four drinking categories identified by researchers.

By far the largest group is ‘high-functioning infrequent non-heavy drinking’ (51.2%), which is good news in and of itself. Among these, only 49% were completely abstinent from alcohol, demonstrating that both abstainers and individuals who experienced at least some low-level re-exposure to alcohol were able to achieve high-functioning. Of note, all of these patients were able to refrain from heavy drinking.   

For the remaining three groups, whether or not someone remained abstinent was also not a very informative datapoint: a third of these participants were high–functioning despite at least some heavy drinking. Note also that achieving infrequent drinking or abstinence did not guarantee higher functioning: roughly 25% of those achieving infrequent drinking had very poor functioning (i.e., the ‘low-functioning infrequent heavy drinking’ group, which comprises 25% of all participants who were able to refrain from occasional or frequent heavy drinking). Of note, this group also seemed to be worse off at the beginning of the study, as they reported higher levels of depression, tension, and difficulties concentrating at the onset of the study, suggesting that this group was struggling to overcome greater psychosocial challenges than the other groups.    

More generally, the study also made observations about how baseline characteristics of patients related to outcomes three years later: 

  • Higher functioning: Patients who at baseline were found to have better mental health, greater purpose in life, and social support from family and friends were more likely to be high–functioning three years after treatment. 
  • More frequent heavy drinking: Patients who at baseline had more high-risk social networks that actually supported continuing to consume alcohol were more likely to engage in frequent heavy drinking three years after treatment.  
  • Achieving high-functioning heavy drinking: Patients who had lower alcohol dependence severity at baseline were more likely to achieve high-functioning despite at least some heavy drinking. Note that high-functioning patients who engaged in occasional heavy drinking were more likely to be White, and at study entry drank fewer drinks per drinking day and experienced fewer consequences due to their drinking than those high-functioning patients who engaged in infrequent non-heavy drinking. 

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

The findings from this secondary data analysis project of a large, multi-site trial delivering outpatient treatment (in the 1990s) to more than 800 alcohol use disorder outpatients lend further weight to recent calls reconsider how the effectiveness of SUD treatments ought best to be measured. It builds on a previous report from the same research group that has highlighted the shortcoming of existing Food and Drug Administration guidance to use heavy drinking as indicative of treatment “failure,” as it fails to acknowledge substantial psychosocial improvements made by individuals who continue to occasionally drink heavily post-treatment. As Witkiewitz and colleagues argue, patient variability (i.e., heterogeneity) has long been acknowledged as an important factor to consider; it may now also be time to acknowledge that there is considerable variability in how some individuals may function following treatment for alcohol use disorder. That said, whereas it is becoming clearer that abstinence is a relatively uninformative indicator of treatment success, engaging in heavy drinking in and of itself confers harm, given that alcohol is a known Group 1 carcinogen – it has the potential to cause cancer. It is also a major cause of liver disease. Thus, while it is possible to engage in heavy drinking occasionally and still function at a high level, such toxicity–related risks need also to be considered. For this reason, perhaps other characterizations of alcohol consumption may be more informative, such as staying within national “low-risk” drinking guidelines. Drinking guidelines, such as those of the American Cancer Society, seek to prevent not only alcohol use disorder, but also the harms posed by both toxicity from alcohol, and recommend that women and men should drink no more than one and two drinks per day respectively, to limit harm due to alcohol’s toxicity-related effects. Beyond broadening our perspective of how alcohol consumption should be considered in terms of defining treatment “success,” the results of this study raise additional intriguing questions surrounding the broad definition of “recovery” that most agree should encompass both indices of functioning and a range of alcohol use indices.  

Also of note, roughly half of those who are low-functioning after outpatient treatment show vulnerability to intermittent alcohol exposure, and continue to struggle psychosocially, underscoring the importance of continuing care that can help address these challenges over the longer term. LIMITATIONS

BOTTOM LINE

This new analysis of a large, multi-site trial with more than 800 alcohol use disorder outpatients showed that some individuals who engage in at least some occasional heavy drinking following treatment may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction, and mental health. Such individuals tend to have lower addiction severity and fewer alcohol-related consequences prior to treatment, suggesting a more favorable prognosis overall.  

  • For individuals and families seeking recoveryAn incidental finding of this study, but good news that deserves highlighting nevertheless, is the finding that more than half of the alcohol use disorder outpatients examined in this study had a positive outcome for at least 3 years following treatment, both in terms of drinking (i.e., no heavy drinking days) and functioning (i.e., low probability of reporting problematic social behaviors, unemployment, other drug use, or life dissatisfaction). This positive finding is in line with other recent findings highlighting that roughly half of the people seeking to recover from a substance use problem need only two recovery attempts.     
  • For treatment professionals and treatment systemsThis paper provides further empirical support to move beyond a reliance on abstinence as the ultimate indicator of treatment success, and instead to move towards a broader range of drinking as well as psychosocial functioning. See our previous Bulletin article on broader definitions of recovery. Patients with higher addiction severity at treatment entry are less likely to achieve high-functioning with occasional heavy drinking. Moving beyond abstinence as the indicator of treatment success may help decrease barriers to treatment–seeking amongst those who do not wish to abstain from alcohol entirely but may otherwise welcome support in achieving low-risk drinking and higher functioning.   
  • For scientists: The present study, as well as similar reports, are based on older datasets, and thus replication in more modern-day datasets would help clarify if observed findings generalize to present day alcohol use disorder treatment contexts and recovery supports. Note also that “functioning” may be defined in a number of ways, but in the present study was limited to the indices used in Project MATCH. As Witkiewitz and colleagues highlight, further research should examine the role and impact of heretofore understudied correlates in this context, such as cognitive functioning/executive control, medical health and chronic pain, and misuse of prescription drugs.  
  • For policy makersAn increasing body of research points to the downfalls of relying on abstinence as a marker of alcohol use disorder treatment success. Far beyond being a simple matter of treatment goal preference of a substantial number of treatment seekers, current evidence, including this paper, suggests that alcohol consumption by itself does not necessarily equate to “treatment failure.” Guidance used to evaluate alcohol use disorder treatment, including FDA regulations, may need to be updated in light of this emerging evidence, with perhaps measures of diagnostic remission status and/or drinking within the national low-risk drinking guidelines being the optimal outcomes.  

CITATIONS

Witkiewitz, K., Wilson, A. D., Pearson, M. R., Montes, K. S., Kirouac, M., Roos, C. R., . . . Maisto, S. A. (2018). Profiles of recovery from alcohol use disorder at three years following treatment: Can the definition of recovery be extended to include high functioning heavy drinkers? Addiction, 114(1), 69-80. doi:10.1111/add.14403 

Council Podcast Launched!

The Council on Recovery Podcast with Howard Lester

The Council on Recovery Podcast, with host Howard Lester, explores the diseases of alcoholism, drug abuse, other addictions, and co-occurring mental health disorders by looking at prevention, education, treatment, and recovery. Through deep and meaningful interviews, we cover every point of view by talking with doctors, educators, researchers, therapists, judges, policymakers, clergy, law enforcement, rehab and mental health professionals, the media, and most importantly, people in recovery.  This long-needed approach brings everyone together for frank discussion of the problems and the sharing of realistic, viable solutions that inspire optimism and hope.

Episode 1 | One Father’s Nightmare: His Daughter’s Life-and-Death Struggle with Addiction

Howard interviews Bob C. who shares his extraordinary story of a father’s incredible efforts to save his daughter’s life during her 15 year odyssey with drug addiction and mental illness. At times, he thought he’d lost her. But he also realized that desperately trying to save his daughter might just kill him. With other family tragedies swirling around him at the same time, he somehow found the solutions for staying alive and helping his daughter survive. One man’s quest for the answers that parents all over are searching for.

Episode 2 | Unspoken Legacy: Claudia Black on the Destructive Impact of Trauma and Addiction within the Family

Howard’s sits down with Dr. Claudia Black, a senior fellow at Meadows Behavioral Healthcare. Claudia is a Ph.D. in Social Psychology who is internationally known and respected for her pioneering and contemporary work with family systems and addictive disorders. Claudia’s cutting-edge work was instrumental in creating the solid foundation for the entire field of codependency. Since the mid-1970s, she’s been a passionate leader in the field of addiction and has helped the world gain a greater understanding of the impact of family trauma and its connection with addiction. Claudia designs and presents training workshops and seminars to professional audiences in the field of family service, mental health, and addictive disorders. She has authored fifteen books, most notably Intimate Treason, It Will Never Happen to Me, and her latest, Unspoken Legacy. Claudia is also Clinical Architect for the Claudia Black Young Adult Center at The Meadows Treatment Center in Arizona.

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What would alcohol sales look like if excessive and problem drinkers drank in moderation?

alcohol sales

The following article was recently published on the research page of the Recovery Research Institute website. It reports a novel new study focusing on the alcohol industry’s public support of moderate drinking amidst speculation that a large portion of alcohol industry profits come from alcohol sales to excessive drinkers and individuals with drinking problems. The research explored what percentage of alcohol sales are accounted for by heavy drinkers, and what the alcohol industry stands to lose financially if everyone drank in moderation (within government health guidelines).

WHAT PROBLEM DOES THIS STUDY ADDRESS?

The alcohol industry has long faced a difficult public relations dilemma. Though many individuals enjoy using alcohol with little or no consequence, for many others, alcohol causes significant emotional, physical, and interpersonal harm. At a population level, alcohol use has a prodigious, adverse social and economic impact. In order to mitigate the perception that the alcohol industry is profiting from suffering, and at times because of government pressure, in many countries major alcohol producers have voluntarily funded public awareness campaigns about the harms of excessive alcohol use. Critics, however, have argued that such voluntary measures are doomed to fail because they involve companies engaging in activities and policies aimed at reducing the harmful behaviors on which their profitability depends. In essence, these companies have a major conflict of interest. 

The alcohol industries in England and the United States have often played down the extent to which profits are driven by excessive use of their products, in spite of evidence from several countries that alcohol consumption is concentrated within a minority of heavier drinkers. The present study explored whether such findings are also true for England. Specifically, the authors asked: 1) What proportion of alcohol sales revenue is accounted for by people drinking more than government recommended guidelines for low-risk drinking (in the UK no more than 14 standard drinks per week, where a standard drink is equal to 7.9g of pure alcohol. This is considerably less than in the U.S. where a standard drink is equal to14g of pure alcohol – almost twice as much). 2) How does financial dependence on heavy drinkers vary between different sectors of the alcohol industry? 3) How would alcohol sales revenue be affected if everyone’s consumption fell to within guideline levels? 

This research has implications not just for public health policy, but for the millions of these heavy drinkers with alcohol use disorder in England, and countries like the United States.

HOW WAS THIS STUDY CONDUCTED?

This paper uses data from the UK Office for National Statistics’ Living Costs and Food Survey and the National Health Service’s Digital Health Survey for England. The Living Costs and Food Survey is distributed to households on a continuous basis throughout the year and asks each individual aged 16 years and over to keep a detailed diary of their daily expenditure over a 2-week period. For alcohol, the survey provides transaction-level data on beverage type (e.g., beer, cider, wine, spirits), price paid, and volume of product purchased. The survey also asks where the alcohol was purchased; either in a hotel, restaurant, or bar (known in the UK as on-trade sales), or from an alcohol retailer like a liquor store (referred to in the UK as off-trade sales). The authors pooled data from the 2013 and 2014 iterations of the survey, comprising a total of 9,975 households. 

The Health Survey for England is a large, nationally-representative survey of 16,872 individuals (2013 and 2014 pooled) which records self-reported ‘typical’ consumption by beverage type. Coverage of total alcohol purchases relative to estimates from more robust national accounts and sales data is approximately 60% (compared to 40% for the Living Costs and Food Survey), suggesting people markedly under-report their alcohol use. 

Drinking groups were defined according to UK government guidelines. ‘Moderate’ drinking is consumption below or equal to 14 standard drinks per week for both sexes, with a standard drink in the UK equaling 7.9g or 10ml of pure alcohol. ‘Heavy’ drinking refers to consumption above this level. Within the ‘heavy drinking’ category, the authors further distinguished ‘hazardous’ (15–35 units for women, 15–50 for men) from ‘harmful’ (36+ for women, 51+ for men) drinking, based on government guidelines.

WHAT DID THIS STUDY FIND?

The authors found that on the whole, the bulk of alcohol sales in England in 2013/14 were to individuals drinking excessively. An estimated 77% of alcohol was sold to drinkers consuming above guideline levels: 30% to harmful drinkers and 48% to hazardous drinkers. Further, alcohol consumed in excess of the guideline levels (i.e., those drinking 14 or more standard UK drinks per week) accounted for 44% of all sales.

Moderate drinkers (i.e., those drinking 14 or fewer UK standard drinks per week), who represented an estimated 59% of the population, were estimated to consume only 23% of all alcohol and accounted for only 32% of all revenue (Figure 1). The 21% of the population who were hazardous drinkers consumed an estimated 48% of all alcohol and accounted for an estimated 45% of all revenue. A relatively small group of harmful drinkers, comprising 4% of the total population, consumed almost a third (30%) of all alcohol sold in England, and accounted for nearly a quarter (23%) of all alcohol sales revenue.

Figure 1. Source: Bhattacharya et al., 2018.

Figure 1. Volume and value of alcohol sales by consumption level in England, 2013/14. The first column represents the makeup of the entire English population by drinking behaviors. The second column shows what percent of alcohol consumed in England was accounted for by each category of drinker. The third column shows the percentage of alcohol revenue accounted for by each category of drinker. As illustrated in this figure, in spite of making up only 25% of the population, hazardous and harmful drinkers accounted for 78% of alcohol consumption and 68% of alcohol revenue. 

In terms of differences between on-trade (i.e., in a hotel, restaurant or bar) and off-trade (alcohol retailors), 81% of off-trade revenue was estimated to come from those drinking above guideline levels (Figure 2). The corresponding amount was substantially lower (60%) for on-trade sales, although heavy drinkers also still accounted for the majority of sales revenue, highlighting the fact that hazardous and harmful drinkers accounted for the majority of both retail and bar/restaurant sales.

Figure 2. Source: Bhattacharya et al., 2018.

Figure 2. Proportion of revenue from harmful, hazardous and moderate drinkers by beverage types and retailer in England in 2013/14. On-trade refers to hotel, restaurant, or bar sales; off-trade refers to alcohol retailors. 77% of beer expenditure was estimated to come from drinkers consuming above guideline levels, compared to 70% for cider, 66% for wine and 50% for spirits. Hazardous and harmful drinkers accounted for the majority of on-trade and off-trade alcohol sales. 

The authors also report that should alcohol consumption be reduced to low-risk levels suggested by the UK government (i.e., 14 or less standard drinks per person, per week), the alcohol industry would stand to lose 38% of their current revenue (Figure 3). In absolute terms, this implies that the industry’s market value would fall by £13 billion (approximately US$17 billion).

Figure 3. Source: Bhattacharya et al., 2018.

Figure 3. Predicted percentage decline in alcohol revenue in England if alcohol consumption were to fall to government guideline levels for low-risk drinking (i.e., 14 or less standard drinks per person per week). Percentage declines in revenue are broken down by point of sale (on-trade versus off-trade), and alcohol category (beer, wine, etc.), as well as point of sale type crossed with alcohol category (in box, bottom right of figure). Altogether, the alcohol industry in England would stand to lose 38% of its revenue if everyone drank in accordance with government guideline levels for low-risk drinking.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Findings indicate the alcohol industry in England derives a large portion of its profit from excessive and/or problem drinkers. Given the consistency of this finding with similar research in Australia and Brazil, it seems likely that such a study conducted in the United States would find similar results. These findings raise serious questions about the conflicts of interest arising when an industry reliant on hazardous and harmful drinking is allowed to self-regulate and manages its public image with largely ineffective ‘safe drinking’ mantras (e.g., “Drink responsibly”). These findings also reinforce the need for strong alcohol sales policy, which has been shown to have real impact on problem drinking. Moreover, in so far as they suggest that a financially successful alcohol industry of its current size and form depends upon harmful drinking, the UK government’s economic support for alcohol producers, for example through tax cuts and trade negotiations, appear more problematic. These findings may also have relevance for ongoing debates about whether to restrict alcohol sales to state monopolies or open them up to commercial enterprises.

LIMITATIONS

  1. The authors’ analysis is taken from self-reported survey data, which tends to underestimate alcohol consumption. Their approach assumes implicitly that all sections of the population under-report their drinking in the same proportion. If anything, this probably underestimates the alcohol industry’s full reliance upon the heaviest drinkers, who are less likely to be represented in surveys.
  2. The analyses do not distinguish between specific companies. The degree to which any individual company benefits from sales to heavy drinkers is therefore unclear.

BOTTOM LINE

  • For individuals and families seeking recoveryHarmful and hazardous drinkers drive the bulk of English alcohol sales; a finding observed in other countries and presumed to be the same in other Western countries like the Unites States.
  • For treatment professionals and treatment systemsHarmful and hazardous drinkers drive the bulk of alcohol sales in England, and presumably other Western countries as well. Allowing the alcohol industry to design and self-monitor its own public health messaging regarding harmful/hazardous drinking represents a major conflict of interest. An industry that is financially reliant on harmful/hazardous drinking is unlikely to implement measures sufficient to curb problematic alcohol use.
  • For scientists: Harmful and hazardous drinkers drive the bulk of alcohol sales in England. The questions addressed by this research need to also be asked in the United States. Further, more research on the extent to which the alcohol industry has, in the past, mitigated volume declines by raising prices and selling more premium products would provide an indication of how sustainable such a strategy is likely to be in the long term. A further possible extension would be to explore the tax revenue generated by the government from excise duty on harmful drinkers, and the extent to which that tax revenue helps address some of the consequences of alcohol use disorder (e.g., funding publicly available treatment and recovery support services).
  • For policy makersAlcohol use and alcohol use disorder cost Western economies hundreds of billions of dollars annually and cause tremendous personal and societal harm. The alcohol industry profits directly from this problem. The alcohol industry’s conflicts of interest highlighted in this paper should be considered when creating and enforcing alcohol policy.

CITATIONS

Battacharya, A., Angus, C., Pryce, R., Holmes, J., Brennan, A., & Meier, P. S. (2018). How dependent is the alcohol industry on heavy drinking in England? Addiction, 113(12), 2225-2232. doi: 10.1111/add.14386

The Council on Recovery is the leader in providing a wide range of prevention and education resources aimed reducing alcohol use, especially among adolescents and young adults. We also offer therapeutic counseling and an intensive outpatient treatment program (IOP) for those affected by alcoholism. For more information, please call 713-942-4100 or contact us online.

Bipartisan Legislation Introduced to Require Warning Labels on Addictive Prescription Opioids & Mandate Education for Opioid Prescribers

In a rare bipartisan effort, Senators Edward J. Markey (D-Mass.) and Mike Braun (R-Ind.) introduced two bills last week aimed at combating the opioid epidemic. The first first piece of legislation is called Lessening Addiction By Enhancing Labeling (LABEL) Opioids Act. The bill calls for labeling prescription opioid bottles with a consistent, clear, and concise warnings that opioids may cause dependence, addiction, or overdose.

The second bill, entitled the Safe Prescribing of Controlled Substances Act, requires any prescriber of opioid medication to undergo mandatory education on safe prescribing practices. Specifically, it mandates that all prescribers, who are applying for a federal license to prescribe controlled substances, must complete mandatory education to help encourage responsible prescribing practices.

Nearly 50 percent of opioid dependence originates with prescribed opioid painkillers. The two pieces of legislation seek to make sure patients and prescribers understand the dangers and full impact those prescriptions may have on the life of a patient.

Specifically, the LABEL Opioids Act would require the Food and Drug Administration (FDA) to issue regulations providing for a warning label to be affixed directly to the opioid prescription bottle handed to the patient by the pharmacist. Utah, Arizona, and Hawaii have passed state laws requiring labeling of prescription opioids, and legislation has been introduced in several other states. Last year, Canada issued regulations to require opioid labeling nationally. Congressman Greg Stanton (D-AZ-09) has introduced companion legislation in the House of Representatives.

The Safe Prescribing of Controlled Substances Act mandates education for prescribers that focuses on best practices for pain management and alternative non-opioid therapies for pain. Such education includes methods for diagnosing and treating a substance use disorder, linking patients to evidence-based treatment for substance use disorders, and tools to manage adherence and diversion of controlled substances. The legislation also requires the Department of Health and Human Services to monitor and evaluate the impact this new education requirement has on prescribing patterns.

The Council on Recovery supports these bipartisan efforts by the U.S. Congress to address the opioid epidemic.

If you or a loved one is struggling with opioid addiction or any substance use disorder, call The Council on Recovery at 713-942-4100 or contact us online.

Discrimination, immigration, treatment expectations, and family stigma are among barriers to Latinos seeking treatment

The following article was recently published on the research page of the Recovery Research Institute website. It explores a new study that indicates Latinos have the lowest treatment seeking rates compared to people of other racial and ethnic backgrounds.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

National studies have shown that individuals who identify as Latino are less likely to seek treatment for substance use disorder or complete treatment at specialty treatment facilities. Barriers to treatment engagement by race and ethnicity have been examined in only a few national studies and results are inconclusive. Identifying barriers to treatment is a foundational step that will allow for public health planning aimed at addressing barriers. The purpose of this in–depth qualitative study was to gain a better understanding of barriers to specialty treatment for substance use disorder that are more prominent among Latinos than other racial and ethnic groups.

HOW WAS THIS STUDY CONDUCTED?

From 2017-2018 the authors conducted a qualitative study which consisted of telephone interviews with participants from Riverside, Los Angeles, San Diego, and Oakland, CA; Brooklyn, NY; Chicago, IL; Miami, FL; and San Antonio, TX, recruited via craigslist (i.e., a web-based advertising platform) to compare barriers to treatment utilization among racial and ethnic groups.

WHAT DID THIS STUDY FIND?

Figure 1. Source: Pinedo et al, 2018

Latinos reported attitudinal barriers to specialty treatment more than other racial and ethnic groups (i.e., cultural, perceived treatment efficacy, and non-abstinent recovery goals). Overall, Latinos commonly felt specialty treatment providers did not understand their unique needs and experience. Specifically, they perceived healthcare providers to be unfamiliar with cultural issues such as discrimination and immigration. Providers were, therefore, discussed in terms of not being able to relate to personal experiences associated with being Latino including alcohol or other drug use which was in turn associated with low treatment efficacy. Being able to have a recovery goal of moderated alcohol use, and not complete abstinence, emerged as a larger barrier for Latinos in seeking treatment at specialty facilities. Its is unclear if these barriers could vary according to generation, meaning, foreign versus native born Latinos.

Social norms barriers towards specialty treatment (i.e., stigma and lack of social support) were more pronounced among Latinos than their White and Black counterparts. Stigma for seeking treatment was strong across all groups but most frequently mentioned by Latinos. Lack of social support from family emerged because it was viewed as “confirming” they had a problem and may tarnish the family.

Control over specialty treatment specifically logistical barriers, such as lack of health insurance, cost of treatment, transportation, and long wait times were highlighted by all racial and ethnic groups during interviews, however, showed no considerable differences in number of times mentioned between groups.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This study identified specific barriers that discourage individuals who identify as Latino with alcohol or other drug use disorders from seeking treatment, and compared these to other racial and ethnic groups. Barrier identification is important because Latinos seek treatment at about half the rate as their White counterparts although higher estimates have been reported. Latino expectations that providers do not understand cultural issues like discrimination and immigration was an attitude barrier for seeking treatment. Researchers have suggested acknowledging important social contexts such as immigration and discrimination experiences in the delivery of specialty treatment for substance use disorders may increase service use. Latinos low expectations around treatment efficacy where rooted providers having no lived experience with alcohol or other drug problems and therefore are unable able to relate. Treatment facilities may need to promote their use of, or integration with, peer services as a means of showing that lived experience can be a part of the treatment process. Clinicians should be prepared to work with patients whose recovery goals include an initial goal of moderate alcohol use given about half of people in the US who have resolved a problem with alcohol or other drugs are not completely abstinent.

Stigma was heavily endorsed by Latinos including concerns over being seen by colleagues at a specialty treatment facility. To address this barrier, treatment centers might offer telemedicine which is when treatment is delivered using telecommunications technology like Skype but specially designed for secure health care communication.  In fact, a National Recovery Study found that individuals who identify as Hispanic were over one a half times as likely than White individuals to use recovery-related online technology. So, this may be a way to engage more Latinos with substance use disorder in treatment.

LIMITATIONS

  1. Qualitative studies like this use smaller samples to obtain richer ideas and explanations. This study was on only on a total of 54 individuals, of whom only 20 were Latino, recruited by advertisement, so it’s unclear to what extent findings may generalize to Latinos with substance use disorder as a whole. Particularly given the participants were assessed in terms of meeting diagnostic criteria over a 5 year window instead of 12 months, which is more standard.
  2. The barriers to treatment seeking identified in this qualitative study should be further tested in larger samples, and ideally, in a national study to determine the US prevalence of these barriers among racial and ethnic groups.
  3. Latino alone is a large group and there may be generational issues to consider in these outcomes related to foreign versus native born Latinos.

BOTTOM LINE

  • For individuals & families seeking recovery: This study of barriers to treatment for substance use disorder found that expectations of low efficacy were common. This low perceived efficacy of treatment was related to  experiences with treatment providers who had no lived experience with substance use disorder, or providers who were perceived to not understand stressful cultural issues like immigration and discrimination and its association with the onset, clinical course, and remission of substance use disorder. Talk to a treatment provider about setting expectations around the likelihood of remission, their use or integration with peer services, and provider cultural competency.
  • For scientists: This qualitative study found that social norms around low family support and acceptability of seeking treatment may be a barrier among individuals who identify as Latino. Preventative interventions aimed at adolescents and emerging adults that seek to improve the acceptability of using professional services for substance use disorders may have lasting impacts on creating a future culture of support and reduced stigma, that extends to families and communities across generations. In addition, it is important to develop and test strategies that can help engage Latino individuals with services. For example, 12-step facilitation for Spanish speaking Latinos since they value lived experience.
  • For policy makers: This was a qualitative study that examined barriers to specialty treatment for substance use disorder by race and ethnicity. Latino treatment seeking may be improved (and treatment seeking in general) by promoting the use of peer services (i.e., persons with lived experience in recovery), training providers in “cultural humility” in order to increase education around immigration and discrimination and its effect on recovery, and increasing privacy options during treatment. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied.
  • For treatment professionals and treatment systems: This was a qualitative study that examined barriers to specialty treatment for substance use disorder among individuals who identify as White, Latino, and Black. Latino treatment seeking may be improved by (and treatment seeking in general) by accommodating non-abstinent recovery goals around alcohol use, promoting organizational integration with evidence-based peer services (i.e., persons with lived experience in recovery), training providers in cultural humility to increase education around immigration and discrimination and its effect on recovery, and increase privacy options during treatment seeking. Telemedicine is an emerging option to increase privacy during treatment and provide access to hard to reach populations but research on effectiveness needs to be studied. It may be important for clinicians to process and problem solve around Latinos’ mistrust in professional treatment and address the family and cultural barriers they may face if attending treatment (i.e., stigma or lack of social support).

CITATIONS

Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1-8.

How Does Spirituality Change the Brain?

The following article by Dr. Mark Gold, recently published on the Addiction Policy Forum Blog, explores the growing body of research about what regions of the brain are changed during a person’s spiritual practice. It presents compelling ideas for how fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

Spirituality can be an important component of recovery from addiction, as it can be a key way for a person seeking recovery to connect to something outside themselves – spiritual practices have long been cornerstones of mutual aid groups, such as Alcoholics Anonymous. Recently, researchers and those looking at trends have concluded that Americans are becoming less religious but at the same time identify as more spiritual. Spiritual engagement can be a way to find, as the authors in the study write, a “sense of union with something larger than oneself.” In a recent study of the brain done at Yale directed by Dr. Mark Potenza, Neural Correlates of Spiritual Experiences, scientists used functional Magnetic Resonance Imaging (fMRI) to examine exactly how spirituality activated or deactivated, certain regions of the brain, changing how people perceive and interact with the world around them.

Dr. Christina Puchalski, Director of the George Washington Institute for Spirituality and Health, defines spirituality as “the aspect of humanity that refers to the way individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.” Importantly, the authors of the study encouraged diverse, personally-motivated definitions of spiritual experience, examples of which included participation in a religious service at a house of worship, connection with nature, mindfulness meditation, and contemplative prayer.

How do we Measure the Effect of Spirituality?

Spirituality and religious practices are a key part of many people’s lives – 81% of U.S. adults describe themselves as spiritual, religious, or both. Despite the majority of American adults engaging in some form of spiritual practice, little is known about what happens in certain parts of the brain during these spiritual experiences. Although studies have linked specific brain measures to aspects of spirituality, none have sought to directly examine spiritual experiences, particularly when using a broader, modern definition of spirituality that may be independent of religiousness. This study used a special kind of brain imaging, functional magnetic resonance imaging (fMRI), to examine neural structures and systems that are activated when we engage in spiritual practice. By detecting changes in blood flow to certain regions of the brain, the fMRI is able to detect activity in the brain when participants were asked to recall spiritual experiences.

Methodology

A potential challenge in this study is the wide variety of spiritual experiences that individuals can find personally meaningful. The authors of the study sought to address this by using a personalized guided-imagery fMRI procedure in which participants were asked to describe a situation in which they felt “a strong connection with a higher power or a spiritual presence.” Their accounts were turned into a script, which was recorded and played back to the participant during fMRI. The brain activation measured during the participant’s recall of a spiritual moment was compared to measurements taken while participants listened to narrations of their neutral and stressful experiences.

Key to this study was that the accounts were completely self-directed by the participants — which enabled the researchers to identify commonalities in brain activity among diverse spiritual experiences.

How Does Spirituality Change the Brain?

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The area highlighted in blue is the Inferior Parietal Lobe, which is associated with perceptual processing

Spiritual experiences were associated with lower levels of activity in certain parts of the brain:

  • The inferior parietal lobe (IPL), the part of the brain associated with perceptual processing, relating to the concept of self in time and space
  • The thalamus and striatum, the parts of the brain associated with emotional and sensory processing

This study furthers a growing body of research about spirituality and its connection to brain processing. These findings tell us that spiritual experiences shift perception, and can moderate the effects of stress on mental health. This study saw decreased activation in the parts of the brain responsible for stress and increased activity in the parts of the brain responsible for connection with others. A sense of union with someone or something outside of oneself and community engagement have been found to support a robust recovery from substance use disorders as well as other behavioral health issues. 

Looking to the Future

Marc Potenza, MD, PhD is an expert in Psychiatry, Behavioral Addictions, and his work at Yale in this important area is a welcome addition to the investigators working in this field. Neural Correlates of Spiritual Experiences has positive implications for instituting spiritual engagement in prevention, treatment, and recovery for substance use disorders. Importantly, participants were scanned while they recalled their own, individualized spiritual experience, but the results were consistent between participants. This means that a person does not have to participate in a certain type of spiritual practice to see the benefits, but can engage in whatever version of engagement is most compatible with their personal beliefs. This encourages treatment and recovery programs to encourage patients to pursue diverse means of spiritual engagement.

This study found a way to measure and visualize what many recovery and treatment communities have understood for years—that spirituality can reduce stress and create feelings of connectedness. By understanding what regions of the brain are changed during a person’s spiritual practice, fellowship and treatment programs can empower individuals in recovery to use spirituality as a proven tool to improve their mental health.

References:

  1. Smith, G., Van Capellen, P., (2018, March 7) Rising Spirituality in America [Audio Podcast]. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/articles/2018/rising-spirituality-in-america.
  2. Lipka, M., Gecewicz, C., (2017, September 6). More Americans now say they’re spiritual but not religious. Retrieved from https://www.pewresearch.org/fact-tank/2017/09/06/more-americans-now-say-theyre-spiritual-but-not-religious/

Rx Take Back Day at The Council Nets 400 Pounds of Unused & Expired Prescription Drugs

The Council’s drive-through Rx Take Back site made Rx med disposal quick & convenient
DEA agents collected over 400 lbs. of unused & expired Rx prescriptions for disposal

The Council on Recovery was a busy collection site for the DEA’s 16th National Rx Take Back Day this past Saturday. Nearly 100 people stopped by The Council’s drive-in location on Jackson Hill Street to dispose of their unused and expired prescription medications. By the end of the four-hour collection period, DEA agents had collected more than 400 pounds of Rx drugs.

This is the first time The Council has participated in the DEA’s National Take Back Day. The national initiative was launched after Congress enacted the Disposal Act in 2014, which amended the Controlled Substances Act, that gave the DEA authority to collect unused pharmaceutical controlled substances for disposal in a safe and effective manner.

The Council views unused or expired prescription medications as a public safety issue that contributes to potential accidental poisoning, misuse, and overdose. Proper disposal of unused drugs saves lives and protects the environment. As a Rx Take Back Day collection site, The Council provided a secure, convenient, and anonymous way for its constituency to clear their homes of old or unneeded Rx medications in a responsible manner.

As one of nearly 350 collection sites across the state, The Council provided an easily accessible and central location for residents in the Heights, Rice Military, Montrose, River Oaks, Midtown, and near-Downtown areas to dispose of their medications. During the last Rx Take Back Day in October, over 67,000 pounds of Rx prescriptions were collected in Texas, according to the Drug Enforcement Administration Diversion Control Division. The Council on Recovery is pleased to contribute 400 pounds to this Spring’s total haul and plans to participate in future Rx Take Back events.

If you missed Rx Take Back Day at The Council, you can still dispose of unused or expired prescriptions at DEA authorized collection sites, many of which are located within national and local pharmacies. To search the DEA’s website for a collection site near you, click here.

The Council Taking Back Unwanted Prescription Drugs Saturday, April 27

On Saturday, April 27, from 10 a.m. to 2 p.m., The Council on Recovery and the U.S. Drug Enforcement Administration will give the public its 17th opportunity in nine years to prevent pill abuse and theft by ridding their homes of potentially dangerous expired, unused, and unwanted prescription drugs.

Bring your pills for disposal to The Council at 303 Jackson Hill Street in Houston. (We cannot accept liquids or needles or sharps, only pills or patches). This drive up/drop-off service is free and anonymous, no questions asked. The Council’s drive-through covered portico will keep everyone dry in the event of rain. Additional security personnel will also assure the safety of everyone who participates in the event.

Last fall Americans turned in nearly 460 tons (more than 900,000 pounds) of prescription drugs at more than 5,800 sites operated by the DEA and almost 4,800 of its state and local law enforcement partners. Overall, in its 16 previous Take Back events, DEA and its partners have taken in almost 11 million pounds—nearly 5,500 tons—of pills.

This Take Back initiative addresses a vital public safety and public health issue. Medicines that languish in home cabinets are highly susceptible to diversion, misuse, and abuse. Rates of prescription drug abuse in the U.S. are alarmingly high, as are the number of accidental poisonings and overdoses due to these drugs. The Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health shows year after year that the majority of misused and abused prescription drugs are obtained from family and friends. These include someone else’s medication being stolen from the home medicine cabinet.

In addition, Americans are now advised that their usual methods for disposing of unused medicines—flushing them down the toilet or throwing them in the trash—both pose potential safety and health hazards.

For more information about the disposal of prescription drugs or about the April 27 Take Back Day event, go to www.DEATakeBack.com or call The Council at 713-942-4100 or contact us online.

Andrew McCarthy Captivates Supporters at The Council on Recovery’s 36th Waggoner’s Foundation Speaker Series Luncheon

Andrew McCarthy at Council Luncheon
Andrew McCarthy captivates The Council’s 2019 Spring Luncheon

The excited buzz among the crowd after The Council on Recovery’s Spring Luncheon confirmed it: Andrew McCarthy was one the best speakers The Council has ever had! Speaking on Friday, April 12th, the actor, director, producer, and an award winning travel writer opened up about his personal struggle with alcohol and drugs, as well as the many gifts of his 27 years of sobriety.

Andrew was preceded on the stage by Luncheon Co-chairs, Bob Candito and Amanda Polich, each of whom shared their own personal stories of hope and recovery. Their heartfelt remarks were followed by an exuberant introduction by Jerri Duddlesten-Moore, who spoke of Andrew McCarthy’s decades of achievement and fame. From his iconic films Pretty in Pink, St. Elmo’s Fire, and Less Than Zero to his work as an actor and director of some of today’s most popular and acclaimed television shows to his award-winning writing as a travel journalist, Andrew’s trajectory of success is of inspiration to all.

Bounding to the stage, Andrew immediately thanked and praised The Council, saying, “… it obviously does some amazing work for the community. The Council is such a solid, strong, dependable, in-the-fiber-of-the-community place, that it’s a real cornerstone. It’s impossible to measure actually what The Council does…or really know how many people The Council is really helping. But, it would be hard to imagine if it wasn’t.”

Andrew then proceeded to captivate the audience of 900+ people with an intimate and revelatory story of his experience with alcohol and drugs from the age of 17 until he became sober at age 29. He related the highs and lows of a life that was dominated by alcoholism until a defining moment in 1992 when he finally asked for help. At the time, he was directed to an organization in New York City that he likened to The Council.

“That’s why I say The Council being there is so great. Because when that moment comes, there has to be somewhere to catch us,” Andrew said, “otherwise we fall.”

In early recovery, Andrew said he did exactly what he was told, including going to support groups. Within a couple of years…”my life started to get better”, he said, “…95% of my seemingly unrelated problems had disappeared by simply showing up, doing what’s in front of me that day, and then going to bed. And waking up and then doing what’s in front of me the next day.”

“In sobriety,” Andrew said, “I was able to find out that if I do the next right thing in front of me, I can have the opportunity to be who I am.”

Andrew’s inspiring message of hope, experience, and strength received a standing ovation from the audience who were clearly touched by his invaluable words of grateful recovery.

Read more about the Waggoner’s Foundation Speaker Series here and scroll through the galaxy of celebrities who have spoken at The Council’s Luncheons.

When Detox Turns Deadly

Detox, also known as detoxification or withdrawal, occurs when one abruptly stops or reduces heavy, long-term use of alcohol or drugs. Detox happens when toxic substances leave the body over hours, days, or weeks, and may include a variety of non-life-threatening symptoms, such as distress or discomfort. But, sometimes detox can turn deadly.

In the case of opioids, benzodiazapines, and alcohol, detox can cause serious complications and even death. Most people are not aware of the dangers of detoxing off off these addictive substances, nor the importance of seeking medical care during the withdrawal process. Here are the facts:

Continue reading “When Detox Turns Deadly”

April is Alcohol Awareness Month

Drinking too much alcohol increases people’s risk of injuries, violence, drowning, liver disease, and some types of cancer. This April, during Alcohol Awareness Month, The Council on Recovery encourages you to educate yourself and your loved ones about the dangers of drinking too much.

In Texas alone, there have been 1,024 drunk driving fatalities over the past year. Of these deaths, nearly half were fatalities to people other than the drunk driver, including passengers, pedestrians, and people in other vehicles. The devastating impact of driving under the influence spreads far beyond the driver alone.

During Alcohol Awareness Month, The Council on Recovery urges everyone to take a look at their own use of alcohol and what it means to drink responsibly. Especially, don’t drink and drive.

If you or a loved one are drinking too much, you can improve your health by cutting back or quitting. Here are some strategies to help you cut back or stop drinking:

  • Limit your drinking to no more than 1 drink a day for women or 2 drinks a day for men.
  • Keep track of how much you drink.
  • Choose a day each week when you will not drink.
  • Don’t drink when you are upset.
  • Limit the amount of alcohol you keep at home.
  • Avoid places where people drink a lot.
  • Make a list of reasons not to drink.

If you are concerned about someone else’s drinking, offer to help.

If you or a loved one wants to stop drinking, The Council on Recovery offers many effective outpatient treatment options, including intensive outpatient treatment (IOP), individual counseling, and group therapy. We also facilitate interventions and offer many prevention and education programs related to alcohol and substance use disorders.


For more information, call The Council on Recovery at 713-942-4100 or contact us online.

Do You Know the Signs & Symptoms of Substance Use Disorder?

The term “substance use disorder” is frequently used to describe misuse, dependence, and addiction to alcohol and/or legal or illegal drugs. While the substances may vary, the signs and symptoms of a substance use disorder are the same. Do you know what they are?

First a few definitions: Signs are the outwardly observable behaviors or consequences related to the use of the substance. Symptoms are the personal, subjective experiences related to the use of the substance. A substance use disorder (or SUD) is a clustering of two or more signs and symptoms related to the use of a substance.

The Recovery Research Institute recently published the signs and symptoms of SUD cited by the American Psychiatric Association. These include:

  1. Problems controlling alcohol use, drinking larger amounts, at higher frequency, or for longer than one intended.
  2. Problems controlling alcohol use despite:
    • The desire to cut-down or quit
    • The knowledge that continued alcohol use is causing problems such as:
      • Persistent or reoccurring physical or psychological problems
      • Persistent or reoccurring interpersonal problems or harm to relationships
      • The inability to carry out major obligations at home, work, or school
  3. The development of:
    • Cravings: A powerful & strong psychological desire to consume alcohol or engage in an activity; a symptom of the abnormal brain adaptions (neuroadaptations) that result from addiction. The brain becomes accustomed to the presence of a substance, which when absent, produces a manifest psychological desire to obtain and consume it.
    • Tolerance: A normal neurobiological adaptation process characterized by the brain’s attempt to accommodate abnormally high exposure to alcohol. Tolerance results in a need to increase the dosage of alcohol overtime to obtain the same original effect obtained at a lower dose. A state in which alcohol produces a diminishing biological or behavioral response (e.g. an increasingly higher dosage is needed to produce the same euphoric effect experienced initially).
    • Withdrawal symptoms: Physical, cognitive, and affective symptoms that occur after chronic use of alcohol is reduced abruptly or stopped among individuals who have developed tolerance to alcohol.
  4. Alcohol use that leads to risky or physically hazardous situations (e.g. driving under the influence)
  5. Spending large amounts of time obtaining alcohol
  6. Reducing or stopping important social/occupational/recreational activities due to alcohol use

If you or a loved have experienced the signs and symptoms of a substance use disorder, and need help, call The Council on Recovery at 713-942-4100 or contact us online.

Pediatricians Can Do More to Prevent & Reduce Adolescent Substance Use

Adolescent substance use has begun to boil over in many parts of the country. Concerned parents, spurred-on by tragic stories from the opioid epidemic, are desperate to turn down the heat and protect adolescents from harm.

Among the adults searching for answers is one important group who can do more to prevent and reduce adolescent substance use: Primary care physicians and, more specifically, pediatricians.

Pediatricians routinely see patients for annual checkups, often treating the same children from birth to high school graduation. During these regular visits, they have both the opportunity to talk with adolescents and an existing relationship with them that can make conversations about substance use seem natural and easy. As such, adolescents can feel comfortable talking to pediatricians about drinking and drug use because anything they say is just between them and their doctor (unless the patient is in imminent danger).

During such confidential discussions, pediatricians have an invaluable opportunity to give their young patients information about drinking and drug use, and how it can affect their health. A quick chat about the effect of alcohol and drugs on the developing adolescent brain can greatly influence teenage decisions to either abstain or seek help if substance use is an emerging problem. In those cases, pediatricians can immediately refer them any help they need, such as putting them in touch with a mental health professional or treatment provider.

Research shows that these types of conversations between pediatricians and young people are an effective means of reducing substance-use rates. The Council on Recovery strongly supports making it standard practice for pediatricians to discuss substance use with their adolescent patients.

The Council on Recovery provides a wide range prevention and education resources aimed reducing substance use, especially among adolescents and young adults. For more information about The Council’s Prevention & Education Programs , please call 713-942-4100, email education@councilonrecovery.org  or contact us online.

Infographic: 11 Myths About Narcotics Anonymous (NA)

Here are some of the popular misconceptions about NA that contribute to a lack of attention to the organization as a recovery support resource:

The Council on Recovery believes that Twelve-Step programs, patterned after Alcoholics Anonymous (AA), play a vital role in the recovery process. We strongly recommend attendance of Twelve-Step meetings to our clients. However, the meetings and groups themselves are entirely autonomous and are not affiliated with The Council beyond our provision of space for them to hold their meetings.

For a complete listing of Twelve-Step meetings held each week at The Council, including Narcotics Anonymous, click here:

If you or a loved one has an alcohol or drug problem, and need help, call The Council on Recovery at 713-942-4100 or contact us online.

E-cig Use Associated with Cardiovascular Disease & Other Medical Conditions

Ever since E-Cigarettes (E-cigs) were first introduced in 2007, their use (also known as “vaping”) has been advertised as a safer alternative to smoking. However, new research by the University of Kansas School of Medicine shows that E-cig use, like smoking, delivers ultra-small aerosol particles which may be associated with cardiovascular disease and other medical problems.

The Study

The study, based on a review from the National Health Interview Surveys, analyzed health outcomes for E-cig users vs. non-E-cig users and smokers vs. non-smokers for a variety of medical conditions. These included myocardial infarction, hypertension, diabetes, depression/anxiety/emotional problems, circulatory problems, and stroke.

The Results

Though E-cig users had a lower mean age than non-E-Cig-users (33 vs. 40), E-cig users still had higher odds of having myocardial infarction (MI) and stroke. Depression/anxiety/emotional problems and circulatory problems also appeared higher in the study. E-cig users had lower odds of having diabetes and there was no significant difference between the two groups on the odds of hypertension.

The Conclusion

As one of the more recent studies on the health effects of E-cig use, this research supports the need greater public awareness about the higher odds of myocardial infarction, stroke, depression/anxiety/emotional problems, and circulatory problems facing those who vape. Both the study’s author and the American College of Cardiology recommend additional research to better establish causation linkage between E-cig use and these serious medical problems.

With a 14-fold increase in sales of E-cigs over the past ten years, the use of and addiction to vaping is rapidly becoming a major public health concern. Read the U.S. Surgeon General’s report about E-cigarette use here.

When combined with the misuse of alcohol or drugs, the consequences of vaping can turn deadly. If you or someone you know needs help, call The Council on Recovery at 713-942-4100 or contact us on-line.

8 Shocking Statistics About Underage Drinking

Whether or not parents and educators want to admit it, underage drinking is rampant. Although the statistics are disturbing, it is imperative for parents to educate themselves on this pressing matter. Often, parents look toward outward signs such as grades, extracurricular activities, and other factors as reassurance their children are not partaking in alcohol in their free time. Yet recent data from the National Institute of Alcohol Abuse and Alcoholism (NIAAA) and the Centers for Disease Control (CDC)  show otherwise:

  • By the age of 15 approximately 33% of teens had at least one drink and by age of 18 the number jumps to 60%
  • Even though the legal drinking age is 21, individuals from the age of 12 to 20 account for 11% of all alcohol consumed in the U.S. and, more shocking, 90% is consumed through binge drinking
  • 3 million teens stated they indulged in binge drinking on five or more days and occasions over the past month
  • 8% of youth drove after consuming alcohol and 20% rode with a driver who had consumed alcohol
  • Teens who drink alcohol are more likely to experience issues at school, including failing grades and higher absence rates, and these teens may also abuse other drugs and experience memory problems
  • Excessive drinking is responsible for more than 4,300 deaths per year among underage drinkers
  • Alcohol use during the teenage years can interfere with normal adolescent brain development and can also contribute to grave consequences due to impaired judgment, such as sexual assaults, injuries, and death
  • Individuals who began drinking before the age of 15 are more apt to abuse alcohol or develop alcohol dependence later in life than those who abstained from drinking until the age of 21

Awareness and understanding of the causes of underage drinking is the first step in prevention. Warning signs of underage drinking include, but are not limited to: Changes in mood (i.e. anger, irritability), problems concentrating or remembering, changing of friend groups, rebelliousness, less interest in self-care or activities, and academic or behavioral issues in school. Through education, parents and teachers can gain knowledge, discuss this issue with their youth, and in turn possibly prevent underage drinking.

If you or a loved one has an alcohol or drug problem, and need help, call The Council on Recovery at 713-942-4100 or contact us online.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 50

Guest Blogger and long-time Council friend, Bob W. presents Part 50 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

The 2018 film, A Star is Born, is the fourth remake of an original 1937 film about an aging star and a young new prodigy.  This one stars Bradley Cooper as Jackson Maine, a famous C& W singer, and Lady Gaga, as Ally, a struggling lounge singer whom Jackson takes to stardom.  The story is impeccably done by Cooper and Gaga; its power is in the truly profound impact it seems to have on many of us in recovery.  This recent version also tracks almost precisely with two prior ones, a 1954 version with Judy Garland and James Mason, and a 1976 version with Barbra Streisand and Kris Kristofferson.

In this version, Jackson is a serious alcoholic and addict who stumbles into a back-street drag bar, desperately needing a drink between gigs;  he  finds Ally as a waitress who also sings in the small club venue.  The connection, both in the acting and in the energy Cooper and Gaga bring to the roles, is mesmerizing.  Predictably, and in line with its predecessors, they form a bond and perform together.  The bond leads to an affair of the heart.  Soon Ally’s career begins to take off while Jackson’s is continuing a drunken downward spiral.   

While Ally remains fully committed to Jackson, he becomes a major liability to her career.  He vacillates between loving attention to her and mean-spirited comments and abuse. Her manager does everything he can to try to keep Jackson away from Ally in various phases of her development and touring.  But Jackson’s drinking and drugging just keeps getting worse.  At the Grammy’s, when Ally goes up to accept the Award of Best New Artist, a falling down drunk Jackson goes up with her and, on stage, he wets himself and passes out.

Jackson does rehab and seems to be recovering, but the damage he believes he has done to Ally’s career and the constant pull of the disease lead him to a deep state of remorse and regret.  While Ally is singing at a major concert at which Jackson was to be present, he hangs himself in their garage.

It is interesting that this story seems to have a basic fundamental power…it has been told and retold in the span of generations over the last 80 years…with the players having the same general presence in their generations as Gaga and Cooper do here.  While, to this alcoholic, the option of suicide is never a valid one, there are untold examples where the bottom reached in a drinking life seems to present no other recourse to the sufferer.  It is a sad, sad, tragic reality.

How wonderful it is that many of us have been able to move beyond that point of “pitiful and incomprehensible demoralization” and put the probability of such a tragedy well behind us.  

Guide: 11 Indicators of Quality Addiction Treatment

How to identify high-quality addiction treatment programs.

The Council on Recovery recommends the following guide published by the Recovery Research Institute, an affiliate of Harvard Medical School. We suggest using it to evaluate addiction treatment options for you or your loved ones. [The Council meets/exceeds all 11 quality indicators.]

Intro

With thousands of programs and rehabs to choose from, it can be challenging to assess which addiction treatment programs offer the highest quality of care.

Finding the right treatment facility is all too important, given the time, money, and energy that substance use disorder treatment and recovery requires of not only the individual, but the entire family.

The 11 Indicators of Quality Addiction Treatment:

Research has identified elements that quality substance use disorder treatment facilities should possess. These range from personalized treatments, to national accreditation, to assertive linkages to continuing care.

The experts at the Recovery Research Institute have compiled a comprehensive list of 11 indicators of effective treatment, as a blueprint to help guide you or your loved one to high-quality addiction treatment, maximizing your recovery success.

1. Assessment and Treatment Matching (Identify)

Finding effective help for an alcohol or other drug use disorder begins with reliable and valid screening for a range of substance use disorders and related conditions, as well as any physical or mental health conditions. This is followed by more comprehensive assessment of substance use history and related disorders, medical history, psychiatric history, individual’s family and social networks, and assessment of available recovery resources (“recovery capital”). These endeavors help uncover the many interrelated factors affecting the patient’s functioning and life and assess a patient’s readiness to change. This careful and comprehensive assessment can help prevent missing aspects or minimizing important aspects of a person’s life, such as trauma or chronic pain, inattention to which could compromise recovery success.

2. Comprehensive, Integrated Treatment Approach (Treat)

As discussed above, patients in treatment may have co-occurring psychiatric disorders, like depression and anxiety, as well as other medical problems like hepatitis C, alcoholic liver disease, or sexually transmitted diseases. Programs should incorporate comprehensive approaches that directly address these additional concerns, or otherwise assertively link patients to needed services. Treating the whole patient, will improve the likelihood of substance use disorder recovery and remission.

3. Emphasis and Assertive Linkage to Subsequent Phases of Treatment and Recovery Support          

Continuing care is defined as the ‘ongoing care of patients suffering from chronic incapacitating illness or disease.’ Ongoing care provides essential recovery-specific social support and necessary recovery support services after the patient leaves or transitions away from the initial phase of treatment. Programs that strongly emphasize this continuing care aspect will provide more than just phone numbers or a list of people to call, but instead, will provide assertive linkages to community resources, on-going health care providers, peer-support groups, and recovery residences. This ‘warm hand-off’ or personalized introduction to potential peers and resources in the recovery community, produces substantially better outcomes.

4. A Dignified and Respectful Environment

The treatment program should possess at least the same type of quality environment as one might see in other medical environments (e.g., oncology or diabetes care). You don’t need palm trees and luxury mattresses, but you should expect a clean, bright, cheerful, and comfortable facility. It is important that the program treats substance use disorders with the same professionalism and allocates similar resources for patient care as other chronic conditions. Creating a respectful and dignified environment may be particularly important for addiction patients, because those suffering from substance use disorders often feel as if they’ve lost their self-respect and dignity. A respectful environment helps them regain it.

5. Significant Other and/or Family Involvement in Treatment

Engaging significant others and loved ones in treatment increases the likelihood that the patient will stay in treatment and that treatment gains will be sustained after treatment has ended. Techniques to clarify family roles, reframe behavior, teach management skills, encourage monitoring and boundary setting, re-intervention plans, and help them access community services all help strengthen the entire family system and help family members cope with, and adapt to, the family system changes that occur in recovery.

6. Employ Strategies to Help Engage and Retain Patients in Treatment

Dropout from addiction within the first month of care is around 50% nationally. Dropout leads to worse outcomes, so it is vital to employ strategies to enhance engagement and retention. These include creating an atmosphere of mutual trust through clear communication and transparency of program rules, regulations, and expectations. Treatment programs can also work to retain patients by providing client-centered, empathic, counseling that works to build strong patient-provider relationships. They also can use motivational incentives to reward patients for continued attendance and abstinence.

7. Use of Evidence-based and Evidence-informed Practices

Programs that deliver services founded on scientific research and principles and that are delivering the available “best practices” tend to have better outcomes. In addition to psychological interventions, these should include accessibility to FDA approved medications for addiction (e.g., buprenorphine/naloxone, methadone, naltrexone/depot naltrexone, acomprosate) as well as psychotropic medication for other types of psychiatric conditions (e.g., SSRIs etc.). This is typically combined with qualified staff (see below).

8. Qualified Staff, Ongoing Training, and Adequate Staff Supervision

Having multi-disciplinary staff (e.g., addiction, medicine, psychiatry, spirituality) can help patients uncover and address a broad array of needs that can aid addiction recovery and improve functioning and psychological wellbeing. Staff with graduate degrees, and adequate licensing or board certification in these specialty areas are indicators of higher quality programs. In addition, clinical supervision and team meetings should take place at least once or twice a week for outpatient programs and three to five times a week for residential and inpatient programs.

9. Personalized Approaches that Include Specialized Populations, Gender, and Cultural Competence

Stemming from individualized comprehensive screening and assessment, programs should treat all patients as individuals attending to their needs accordingly. One size does not fit all, and neither does one treatment approach work for every individual. High-quality treatment programs identify the potentially different needs of men and women, adolescents versus adults, and those from different minority communities (e.g. LGBT) or cultural backgrounds, creating in turn, treatment and recovery plans that address their specific needs and acknowledge their available strengths and recovery resources.

10. Measurement of Program Performance Including During-treatment “Outcomes”

A further indicator of quality treatment is having reliable, valid measurement systems in place to track patients’ response to treatment. Similar to regular assessment of blood pressure at each check-up in treating hypertension, addiction treatment programs should collect “addiction and mental health vital signs” in order to monitor the effectiveness or ineffectiveness of the individualized treatment plan and adjust it accordingly when needed. Without any kind of standardized metrics, it is difficult to document and demonstrate patients’ progress.

11. External Accreditation from Nationally Recognized Quality Monitoring Agencies                            

Accreditation from external regulatory organizations such as the Joint Commission on Accreditation of Healthcare organizations (JCAHO; aka “the Joint Commission”), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA); and other programs licensed by the state are required to offer minimum levels of evidence-based care. These licensing and accreditation requirements serve as quality assurance that the treatment program is incorporating a certain level of evidence-based care in its model and is open to random audit of its clinical care.

New Study Finds Distressing Increase in E-cigarette Use by Middle and High School Youth

Electronic cigarettes (e-cigarettes), battery-powered devices that provide nicotine and other additives to the user in the form of an aerosol, have become the most popular form of tobacco use among middle and high school youth. The recent National Youth Tobacco Survey, 2011-2018 found a distressing increase in the use of e-cigarettes, also known as “vaping“, that far surpassed the rate of use of conventional cigarettes during survey period.

What’s more, concurrent studies by both the Center for Tobacco Products at the Food & Drug Administration and the Centers for Disease Control point to a rapidly escalating problem. High school students currently using e-cigarettes increased from 1.5% in 2011 to 20.8% 2018. During 2017–2018 alone, e-cigarette use increased by 78% (from 11.7% to 20.8%).

At the same time, among middle school students, e-cigarette use increased from 0.6% in 2011 to 4.9% in 2018. During 2017–2018, current e-cigarette use increased by 48% (from 3.3% to 4.9%).

Percentage of middle and high school students who currently use e-cigarettes and any tobacco product

The studies also showed that, while current use of any tobacco product among high school students grew from 24.2% in 2011 to 27.1% in 2018, the use of e-cigarettes continued to increase at rates not seen in previous surveys.

This sharp rise in e-cigarette use among U.S. middle and high school students during 2017–2018 is likely because of the recent popularity of e-cigarettes shaped like a USB flash drive, such as JUUL. These products can be used discreetly, have a high nicotine content, and come in flavors that appeal to youth.

Although e-cigarettes can be of potential benefit to adult smokers as a complete substitute for smoking tobacco, adolescent use of any tobacco product, including e-cigarettes, is considered unsafe. The Surgeon General has concluded that “e-cigarette use among youths and young adults is of public health concern; exposure to nicotine during adolescence can cause addiction and can harm the developing adolescent brain”.

The Council on Recovery provides a wide range prevention and education programs aimed reducing tobacco use, especially among adolescents and young adults. These programs are provided at area schools, churches, community centers, employers, and health fairs. For more information about The Council’s Prevention & Education Programs , please call 713-942-4100, email education@councilonrecovery.org  or contact us online.

Baby Boomers and the Alarming Increase in Alcohol Use Disorders

Baby Boomers are the fastest growing segment of the population. They’re also the group with the most dramatic increase in harmful alcohol use. According to a research published in the journal JAMA Psychiatry, increases in alcohol use, high risk drinking, and alcohol use disorders (AUD) among adults 65 years and older were substantially higher relative to earlier surveys.

The most alarming findings indicated that the number of adults 65 years and older who drank has risen higher than the national average by about 23 percent. And the average number of adults 65 and older suffering from alcohol abuse had risen by nearly 107 percent.

The study also reconfirmed the well-known correlation between alcohol use and the higher risk for disability, morbidity, and death from many alcohol-related chronic diseases. According to the National Institute on Aging, drinking too much alcohol over a long time can:

In addition to the medical risks are the many safety risks that alcohol creates for older adults. Drinking can impair a person’s judgment, coordination, and reaction time. This increases the risk of falls, household accidents, and car crashes.

In the midst of the medical and safety risks, the increase in both binge drinking and AUD among older adults has created a new urgency for doctors to screen for and identify unhealthy alcohol use by their older patients. Physicians are ideally positioned to discuss the risks of continued use and the options available to stop drinking for those with the problem. To support this effort, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), offers multiple online resources for providers, such as brochures, fact sheets, alert bulletins, classroom resources, and videocasts. NIAAA’s website also provides the general public with information related to alcohol abuse among older adults.

In Houston, The Council on Recovery’s Wellderly program provides information and resources to help older adults, their family members, caregivers, and service providers identify and address alcohol and substance use and/or misuse. The Wellderly program’s unique suite of services include:

  • Community education and outreach to older adults and service providers
  • Screening, Brief Intervention, Referral to Treatment (SBIRT)
  • Case management
  • Specific help and guidance in talking with an older adult who has questions about their own substance use or a friend’s use of substances
  • Education and support for family members
  • Educational materials that aid older adults in taking better care of themselves

The Wellderly Program is supported by funding from The United Way of Greater Houston. For more information about the Wellderly Program please call 281.200.9109, email wellderly@councilonrecovery.org, or contact us online.

How Pornography Affects the Teenage Brain – An Infographic

Pornography addiction is an adolescent high-risk behavior that is escalating across all segments of the teenage population. By viewing sexually pornographic material, adolescents may face potential emotional, psychological, social, and physiological disorders and issues. The Infographic below, designed by helpyourteennow.com, illustrates the effects that pornography can have on developing adolescent brains. It can help you understand the problem and start important dialogue with your teen about viewing sexually explicit material.

Mindful Choices is the Center for Recovering Families’ adolescent high-risk behavior course that covers pornography addiction and 14 other risky behaviors. For teenagers and their parents, the course addresses these problems in the early, treatable stages. For more information, call 713-914-0556email CRF@councilonrecovery.orgor contact us online.

#192aDay Campaign Launches to Remember those Lost to Addiction

This week, Addiction Policy Forum launched the #192aDay awareness campaign to honor those lost to drug overdose and other complications of substance use. The Centers for Disease Control (CDC)’s 2017 data revealed that more than 70,000 people died from drug overdoses — 192 a day — making it the leading cause of injury-related death in the United States, more than deaths from gun violence or car accidents. The campaign features 192 letters from the family members who have lost a loved one to addiction.

Excerpts from the campaign:

Cassidy C 192aDay
Cassidy

“She was our sunshine, our beautiful and bright angel. But to shine some light on an illness that is taking the lives of far too many, if we allow shame, guilt or embarrassment to cause this illness to become a dark family secret, hiding in the shadows, everyone loses.”-Cassidy’s mom, Charla

Anthony F 192
Anthony

“The disease of addiction is a merciless, non-discriminatory devil. The loss of my big brother has created a sore on my heart that will never heal. We must fight to end this epidemic.”-Anthony’s brother, Gino

Justice 192aDay
Justice

“Heroin took my daughter. She was 21 years old. She had barely lived. Justice never owned her own car; she never traveled the world; she never married or had children; she won’t see her brothers grow to be good men, or meet her future nieces or nephews. My daughter will never dance again. She will never see an amazing sunset, or feel the warmth of the sun on her beautiful face. I will never hear my daughter’s beautiful voice again or hear her call me mom. Heroin took that all away. We all failed my daughter. All those times she reached out for help and was denied, we failed her. I have to live with this for the rest of my life. Justice was my only daughter. She was my girl, she was my dream, she was my everything.” -Justice’s mom, Jennifer

Emmett  192
Emmett

“Emmett was the average American teen; he loved video games and BMX biking. He was a caring, funny, smart young man with the potential for greatness. He was the adored older brother to Zachary and Alice . He had a smile and charm that could light up a room – but heroin stole that from him.”-Emmett’s mom, Aimee

“It’s far past time we recognize addiction for the disease that it is and move beyond the stigma that enshrouds substance use disorders,” said Jessica Hulsey Nickel, founder of the Addiction Policy Forum. “192 a Day helps shine a bright light on the beautiful lives lost to addiction and gives voice to the families that have been affected. We encourage those who have lost someone to share their stories through the campaign so we can show local, state and national leaders the very real impact addiction has on our communities.”

Please read the stories and get involved at 192aDay.org and watch @AddictionPolicy‘s PSA  #192aDay featuring those lost to #addiction at https://bit.ly/2RlhOct .

Call The Council
If you, a loved one, or friend have a problem with drugs or any substance use disorder, call The Council on Recovery at 713-941-4200 or contact us online. We are Houston’s leading non-profit provider of prevention, education, treatment, and recovery services. We can help!

Millennials, Social Media, and Depression

[From a Jan. 10, 2019 article by Kristen Monaco, Staff Writer, MedPage Today]

Facebook “addiction” — not only spending lots of time on Facebook but also seeing negative social impacts from it, yet craving it and trying unsuccessfully to cut down — was associated with impaired decision-making in one study and with self-perceived physical ill health in another.

In the first, researchers gave 71 participants recruited from a German university 100 tries each at the computerized Iowa Gambling Task, in which players should learn from prior rewards and punishments to make better bets — in other words, a test of value-based decision-making.

Higher scores on the Bergen Facebook Addiction Scale were significantly correlated with worse performance in the final 20 game trials (r=-0.31, P<0.01), found Dar Meshi, PhD, assistant professor of advertising and public relations at Michigan State University in East Lansing, and colleagues. Their study was published online in the Journal of Behavioral Addictions.

This finding, that Facebook “addicts” made riskier decisions than non-addicts as the game went on, implies that they were more likely to ignore the potential for losses, the investigators said. Notably, there was no such association between Facebook addiction and decision-making earlier in the game.

The study “further supports a parallel between individuals with problematic, excessive SNS [social networking site] use and individuals with substance use and behavioral addictive disorders,” they concluded. Research published earlier this week also found an association with depression.

Excessive social networking can seep into other aspects of users’ lives as they build up tolerance to sites’ social rewards, Meshi and colleagues said, just as opioid users require increasing doses over time to achieve the same effects. “These excessive SNS users also experience conflict with others because of their use, and when attempting to quit, they display withdrawal symptoms and often relapse,” the researchers wrote.

While many in the mental health field have come to accept online behaviors as potentially addictive, the American Psychiatric Association has not formally recognized any. The closest it has come is designating “internet gaming disorder” in its current diagnostic manual, DSM-5, as a possible condition warranting further study. Addictions to other online activities such as social media are not mentioned at all.

And that aside, one specialist contacted by MedPage Today urged caution in interpreting the current study owing to its design.

“While this area of research is intriguing and it is possible that excessive digital media use may have adverse effects on cognitive functioning, this particular study does not provide strong support one way or another of whether decision making dysfunction may actually be a consequence of excessive digital media use,” commented Adam Leventhal, PhD, director of the University of Southern California’s Health, Emotion, & Addiction Laboratory in Los Angeles, who was not part of the study.

“Because of the study design, we cannot determine whether the risky decision making patterns preceded or followed excessive Facebook use in the participants. It is possible that people who make risky decisions are more drawn to highly-stimulating digital activities like social networking platforms because it suits their sensation-seeking personality styles,” he said.

Facebook and Physical Illness

In a separate study conducted by Bridget Dibb, MSc, PhD, of the University of Surrey in England, Facebook users who reported feeling inspired by friends they perceived as better off tended to feel more sick themselves.

From a survey of 165 Facebook users, the one specific type of social comparison linked to more physical symptoms was the positive feeling of seeing someone better off, Dibb reported online in Heliyon.

“The positive upward comparison relationship in this study shows that the participants were feeling hopeful and inspired but at the same time were aware of worse physical health,” she wrote. “It is also possible that those who had more physical symptoms tended to engage in more positive upward comparison to be more like the better-off target. This may be a coping strategy and would account for why those engaging in upward comparison would also be more aware of their symptoms.”

In contrast, negative feelings after seeing the better-off person (“I could never be like him or her”) weren’t significantly associated with physical health, nor were the negative feelings (“What if I become like him or her?”) or positive feelings (“At least I’m not like that”) after encountering somebody comparably worse off.

Moreover, the more survey respondents said they felt that Facebook was part of their lives, the more physical ailments they perceived personally.

Dibb acknowledged that the study design precluded any causal links between physical health and Facebook use; she suggested a longitudinal study to show whether social comparison leads to perceptions of ill health or if those who experience worse health are inherently more likely to seek inspiration from peers. The experiment by Meshi and colleagues also only documented an association, not a causal relationship.

Moreover, neither study accounted for use of other social media platforms such as Instagram and Twitter.

Sobering Facts About Holiday Drunk Driving

alcohol impaired driving

This is the season for celebrating with family and friends. But, when it comes to drunk driving, this most joyous time of year is also the deadliest. According to the National Highway Traffic Safety Administration (NHTSA), every holiday season, hundreds of lives are lost due to drunk drivers.

Drunk driving facts

Over the past five years, an average of 300 people nationally died in drunk driving crashes during the Christmas through New Year’s holiday period. From 2012-2016, in the month of December, the NHTSA reported 14,472 people lost their lives in traffic accidents. Of those December deaths, 28%, or 3,995, people died in drunk-driving crashes.

Approximately one-third of all traffic crash fatalities in the United States involve drunk drivers (with blood alcohol concentrations [BACs] of .08 of higher). In every State, it’s illegal to drive with a BAC of .08 or higher, yet one person was killed in a drunk-driving crash every 50 minutes in the United States in 2016.

In 2016, the NHTSA reported 10,497 people killed in these preventable crashes. What’s more, over the 10-year period from 2006-2016, an average of more than 10,000 people died every year in drunk-driving crashes.

Steps to Prevent drunk driving

At this time of year, the NHTSA suggests the following steps to prevent drunk driving:

  • If you will be drinking, plan on not driving.
  • Plan your safe ride home before you start the party.
  • Designate a sober driver ahead of time.
  • If you drink, do not drive for any reason.
  • Call a taxi, phone a sober friend or family member, use public transportation, etc.
  • Download NHTSA’s SaferRide app from Google Play or the iTunes Store which helps you identify your location and call a taxi or friend to pick you up.
  • If someone you know has been drinking, do not let that person get behind the wheel. Take their keys and help them arrange a sober ride home.
  • If you see an impaired driver on the road, contact local law enforcement. Your actions could help save someone’s life.

Call The Council

If you, a loved one, or friend have a problem with alcohol, call The Council on Recovery at 713-941-4200 or contact us online. We are Houston’s leading non-profit provider of prevention, education, treatment, and recovery services. We can help!

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 45

Guest Blogger and long-time Council friend, Bob W. presents Part 45 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the aftermath of the fall of Rome in the 5th century and the loss of its literary and cultural majesty, the European continent became widely diverse and generally devoid of scholarship. The Church was the only institution of wide-spread power. In this environment, which lasted almost 600 years, there were a number of mythic systems which emerge. One was the great Celtic legend of King Arthur and the Knights of the Round Table. A host of stories emerged out of this system, about kings, queens, knights and ladies, who pursue glorious quests in search of physical, psychical and spiritual treasures.

The most prominent of these quests is the search for the “Holy Grail,” which is the cup that Christ drank from at the Last Supper and which Joseph of Arimathea used to capture some of Christ’s blood as he was lowered from the Cross. Joseph was portrayed as part of a group that then fled Palestine, traveling West with the Cup to found an order in the Celtic lands charged with keeping the Cup. The Arthurian Knights that sought the Grail were on quests for spiritual enlightenment and ascension, which they achieve by coming into the presence of the Grail.

Those of us on the journeys into lives of sobriety are on similar quests…quests to achieve a sense of freedom, peace and serenity. Having made the decision to commit ourselves to the journey, we must do the work to recover with a sense of determination and rigor. We must explore the dark and frightening elements of our past in all its dimensions and find a conscious contact with our Higher Power so we can repair the harm we may have done in our disease and develop a saner mode of life.

Finally, we fully commit ourselves to a life of service, to mankind and to the cosmos. In relatively short order, we find ourselves in a place just as glorious as those the Arthurian Knights achieved in the presence of the Grail.

Alarming Increase in Adolescent Vaping and Nicotine Use in 2018

teenage vaping

An alarming increase in the prevalence of vaping among adolescents has raised public health concern, according to a recent study published in the New England Journal of Medicine

Research into vaping among teens was conducted by the University of Michigan. It indicated a sharp increase in the prevalence of nicotine vaping: 10% among 12th-graders, 7.9% among 10th-graders, and 2.6% among 8th-graders. These percentages mean 1.3 million additional adolescents engaged in nicotine vaping in 2018, as compared with 2017.

The study’s authors suggest that policies in place in the 2017–2018 school year were not sufficient to stop the spread of nicotine vaping. Additionally, rapid growth of new vaping devices, such as the Juul, will require modified strategies to keep adolescents from vaping and its associated negative health effects.

The Center for Recovering Families’ Adolescent Services department is carefully tracking and responding to the increase in teen vaping.  Through Mindful Choices, our High-Risk Behavior course, as well as prevention, parent education, and counseling services, the Center for Recovering Families is in the vanguard of local efforts to stem the tide of teenage substance abuse in our community.

If you or a loved one needs help to stop vaping, call the Center for Recovering Families at 713-914-0556, contact us online, or download our brochure. We can help. Start here.

Debunking the Myths About Holiday Drinking & Driving

drinking&driving2018Celebrating the spirit of the holidays often includes drinking holiday spirits. Most people celebrate responsibly. But during the holiday season, people are more likely to drink beyond a safe limit than at other times of year. And when driving is involved, the resulting consequences can be tragic. Despite all the evidence of the dangers, myths around drinking and driving still abound. Some of them can prove fatal.

Myths & Facts

Myth: Your decision-making abilities and driving skills are not impaired until intoxication occurs.

Fact: Even a few drinks can diminish your decision-making, including the decision of whether or not to drive. So your driving skills may be compromised well before physical signs of intoxication. Though you may initially feel stimulated by a drink or two, alcohol consumption can rapidly decrease good judgment and reaction times. And while you may not feel or appear drunk, the sharpness needed for good decisions and responsible driving can be dulled by even a small amounts of alcohol.

Myth: If you’re not slurring your words or feeling inebriated, it’s okay to drive.

Fact: Coordination needed for safe driving diminishes long before the signs of intoxication occur. Additionally, the sedative effects of alcohol increase your risk of losing attention or falling asleep behind the wheel.

Myth: After drinking all evening, it’s okay to drive after “sobering up.”

Fact: After finishing drinking, you may misjudge how long alcohol will affect your driving abilities. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol’s effect on the body and brain may persist long after the final drink. Despite a cup of coffee or cold-shower, alcohol in the bloodstream can continue to impair your judgment and coordination for many hours.

Myth: A couple of cups of coffee will sober you up.

Fact: Though caffeine may help avert drowsiness, it doesn’t affect the alcohol that’s still in your bloodstream impairing judgment or coordination. It may take hours for your body to return to normal after metabolizing alcohol. In this way, time without additional alcohol provides you the only way to sober up. And sober is the only truly safe way to drive.

A simple message

Though there are many myths about drinking, driving, and other behaviors, the facts readily dispel each one of them. According the CDC, every day, 29 people in the U.S. die in motor vehicle crashes that involve an alcohol-impaired driver. The Council on Recovery wants everyone in our community to be safe during this season and recommends adherence to the old adage, “Don’t Drink and Drive”.

If you must travel after drinking

If you must travel after drinking, ride with a designated sober driver. Or call a cab, Uber, or Lyft. Some of these offer free or discounted rides during the holidays. METRO offers free rides on local bus, rail, and lift services from 6 p.m. December 31 until 6 a.m. on January 1. AAA-Texas offers free “Tipsy Tow” service on New Year’s Eve, providing a one-way ride up to 10 miles for the driver and vehicle to the driver’s home. However you get home, just get there safely.

We can help

At this season, if you or someone you know has a problem with alcohol, drugs, or other addictive behaviors, call The Council at 713-941-4200 or contact us online. Recovery can be the sweetest gift you give yourself or a loved one this year. Start at The Council. We can help!

9th Annual Run for Recovery Raises Money for The Council on Recovery

2018 Run for Recovery runners & walkers on Memorial Drive

The 9th Annual Run for Recovery took place Sunday, November 2nd. One of Houston’s largest recovery events, the race attracted more than 400 people of all ages. Runners, walkers, and other supporters of recovery participated in the 5K run/walk (timed and untimed) and Kids Race along scenic Memorial Drive next to Buffalo Bayou. Post-race festivities and activities were also held for children at Cleveland Park, adjacent to The Council’s campus on Jackson Hill.

Monies raised by the Run for Recovery go to recovery-based scholarships benefiting program participants at Santa Maria Hostel, STAR Drug Court, and The Council on Recovery. These programs provide substance use treatment and recovery support services for those who are unable to afford such services.

For race results, click here.

For additional information on the 2018 Run for Recovery, visit www.HoustonRunforRecovery.com

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 43

Guest Blogger and long-time Council friend, Bob W. presents Part 43 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the multi-season show, Stargate SG – 1 and its offshoot, Stargate Atlantis, there is a force to be reckoned with called the Replicators, which are antagonistic self-replicating machines that are driven to replicate themselves by consuming both alloys and technologies of the nearest most advanced civilizations. They grow to destroy the societies which spawned them.  Their original beginnings were a mistake of an earlier species and they prove very difficult to eradicate.

It occurs to me that there is an interesting parallel here with the recurring incidence of the disease of alcoholism and drug addiction in families.  The disease seems to replicate itself in strange ways…it consumes us and our families across generations and among siblings and cousins. Sometimes it skips people in generations or in extended sibling or cousin relationships, but when it does strike, it can be as deadly as it was for the original sufferer.

In the Stargate Atlantis story, the Replicators are finally controlled by the development of a “disruptor gun” which breaks down the electromagnetic bonds inherent in the replicator machinery and causes them to disintegrate. My parallel with the disease of alcoholism and drug addiction and the replicator menace as told in these stories provides an interesting twist here.

We break down the replication of our disease in family structures by getting sober, by developing and maintaining a life of committed sobriety and service, which begins to model new, healthy behavior patterns.  These create a psychological and spiritual force which disrupts the development of the disease in our loved ones, thus breaking down the elements of the disease in the family structures and the tendencies for it to replicate.  Our loved ones absorb these patterns of recovery and service into their psyches and, in time, that helps them deal with their own latent or initiatory tendencies; they can thus avoid the patterns that could lead to future development of the disease.

In 1995, Pete Hamill, a journalist in New York, published a memoir called A Drinking Life.  It is the story of his Irish family’s drinking history, his own early life consumed with alcohol abuse, and his career associated with a community of people of some renown where the one defining constant was alcohol.  He hit a bottom one day and, recalling his familial history with alcohol, he said to himself: “The madness must stop.  The madness stops here,” and he stopped drinking forever.

In our own commitment to sobriety and to a life of service, we help to eradicate the replication of the disease for all future generations.

New Study: Hangovers Impair Thoughts & Performance Even After Alcohol Leaves the Bloodstream

According to a recent study, the effects of a hangover from heavy drinking on our thoughts and performance may last longer than originally thought.

The study, published in the journal Addiction, indicates that impairments in cognition observed in drunk individuals still occur the day after a session of heavy drinking, when little to no alcohol present in the bloodstream.

The researchers behind the study at the University of Bath, found that hungover individuals have poorer attention, memory and coordination than when sober. Impairment of psychomotor skills can also occur during a hangover when compared to sober.

The researchers suggest their findings have important implications when it comes to activities performed when hungover, including driving.

For example, while hungover, individuals might assume there’s little to no alcohol left in their system and get behind the wheel of a car. This study suggests there may still be impairment of the cognitive processes necessary for safe driving, even after alcohol is no longer in the bloodstream.

Researchers also warn that such impairments can show up at the workplace. Though most American workplaces have policies regarding intoxication at work, few have policies impairment from hangovers. The study’s authors suggest that employers consider revising those policies for worker safety.

A new report from the Center for Disease Control finds that excessive drinking costs the U.S. economy nearly $250 billion annually. The most significant cost was the lost productivity of hungover workers who either showed up for work barely able to function, or who were unable to show up at all, which cost nearly $90 billion. In total, all forms of lost productivity accounted for about $179 billion of alcohol-related costs.

Craig Gunn of the Department of Psychology and lead author of the study at the University of Bath said, “In our review of 19 studies we found that hangover impaired psychomotor speed, short and long term memory, and sustained attention. Impaired performance in these abilities reflects poorer concentration and focus, decreased memory and reduced reaction times the day after an evening of heavy drinking. Our review also indicated limited and inconsistent research on alcohol hangover and the need for future studies in the field.”

Senior author Dr Sally Adams added: “Our findings demonstrate that hangover can have serious consequences for the performance of everyday activities such as driving and workplace skills such as concentration and memory.

“These findings also highlight that there is a need for further research in this field where alcohol hangover has implications at the individual level in terms of health and well-being, but also more widely at the national level for safety and the economy,” Adams said.

The researchers are currently examining the true health and economic costs of hangover and associated risks with the next day effects of heavy drinking.

 

The Council’s Speakers Series Luncheons 2000-2018 – A Galaxy of Stars

The Council’s Fall & Spring Luncheon Speakers 2000-2018 [Click for larger images]
The Council on Recovery’s 2018 Fall Luncheon with Alice Cooper was the 36th Luncheon  in the The Waggoners Foundation Speaker Series. Since 2000, the Waggoners Foundation along with, more recently, the Wayne Duddlesten Foundation, have underwritten the production of a Spring and Fall Luncheons. These luncheons have raised millions of dollars over the past 18 years. The Luncheon have been headlined by some of the biggest celebrities of their era, each of whom has entertained and inspired thousands with their recovery stories.

On The Council’s website, we proudly present the complete Galaxy of Stars who have helped us raise awareness and funds over the years. View the list here and enjoy the reminiscence!

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 42

Guest Blogger and long-time Council friend, Bob W. presents Part 42 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In an earlier note, I talked about the Greek experience of hieros gamos, the idea of a sacred marriage between an archetypal feminine and masculine.  I likened it to the union of our ego, our conscious being, and our authentic self, the deep elements of who we really are. It is the union that we begin to achieve as we pursue a life of committed sobriety and service to others, that process that comes by working the Steps and connecting with the Fellowship of recovery.  But there is another way to look at the idea of hieros gamos in our individual conscious beings.

Regardless of whether we are woman or man, we have archetypal elements of both genders in each of our individual psyches. Carl Jung spent a good part of his analysis of the human psyche on this, naming that the masculine elements of the feminine psyche as the “animus,” and the feminine aspects of the masculine as the “anima.”  Jung saw these elements as largely part of the unconscious but they are clearly elements that we are to strive to keep  in balance to achieve a level of wholeness in Jungian terms.

The masculine elements can be seen as those qualities of physical and emotional strength, accountability and responsibility, and the propensity for heroic acts. The feminine can be seen as those qualities of tenderness, compassion, sensitivity and loving nurturing. It is not to be inferred that either gender lacks what the other exhibits, by any means; it is only that the ones mentioned tend to be dominant for the particular gender.

In the alcoholic or drug addicted personality, the feminine or masculine elements of the representative gender can be grossly outsized, so much so that the individual is dysfunctional as a man or a woman…too aggressive and domineering or completely wimpy and ineffective…no matter what the gender.  Our pursuit to sobriety is meant to find the right balance so that we can be of service in any and all ways that might be needed by the societies and communities to which we serve. We need to find a true marriage of the masculine and feminine parts of us to achieve the fully committed life of service that we crave and that puts us in the place we were meant to be.

Rock Legend Alice Cooper Helps The Council on Recovery Raise $495K to Fund Addiction Prevention, Education, & Treatment Programs

Rock legend Alice Cooper shares his story at the Fall Luncheon

Alice Cooper, the Godfather of Shock-Rock and Rock & Roll Hall-of-Famer thrilled an audience of more than 1100 with his personal story of recovery from alcoholism and  addiction this past Thursday at the Hilton Americas-Houston. In the process, he helped The Council on Recovery raise more than $495,000 to provide addiction prevention, education, and treatment services in the Greater Houston area.

The total funds raised are expected to rise after on-site green card donations are tabulated.

Alice Cooper in conversation with KPRC’s Frank Billingsly

Alice was the keynote speaker at the 36th Annual Fall Luncheon in The Waggoners Foundation Speaker Series presented by the Wayne Duddlesten Foundation.

The Luncheon was chaired by Council board members Dennis Robinson

Luncheon Co-Chair Dennis Robinson

and Tony Valadez, each of whom related their own personal experience with recovery

Luncheon Co-Chair Tony Valadez

[Read Dennis’ story; read Tony’s story].

With preceding remarks from The Council’s President/CEO, Mel Taylor and Board of Trustees Chairman Bob Newhouse, a heartfelt introduction by Jerri Duddlesten-Moore brought Alice Cooper to the stage.

Jerri Duddlesten-Moore introduces Alice

In an intimate interview conducted by KPRC/Channel 2’s Frank Billingsly, Alice opened up about his illustrious career in rock & roll that spanned the last fifty years. Like many rockers of the late 60’s and early 70’s, Alice’s trajectory into stardom was initially fueled by drugs and alcohol.

“I was never a drunk ‘drunk’, but I never got sober,” Cooper said. “I used to like to drink, but then I got to the point where I hated it.”

In his late twenties, after performing his “Welcome to My Nightmare” show in 65 cities over 72 days, exhaustion and drinking had finally taken their toll.

“I got up and threw up blood, that’s probably a bad sign,” Cooper said. “My wife [Sheryl], we’ve been married 43 years…, she’s the one who said, ‘Hey, superstar, party’s over.’ I was hospitalized…in 1977…for about three months.”

Asked about that experience, Cooper said, “The crazy thing about my sobriety was…no one is ever a cured alcoholic, but I’m a healed alcoholic. I came out of the hospital and I was the classic alcoholic. I went right to a bar, sat down with a Coca Col,a and waited for the craving to come. And it didn’t come…it never came. Thirty-five years later and it never came. Even the doctors said it was a biblical miracle.”

Cooper did use cocaine after he stopped drinking, but quit after a couple of years. He recalled, “I had enough of that and said ‘that’s it’ and, boom, it was done. There was nothing else, I was done.”

Sober more than 35 years, Alice Cooper admits to doing it without a twelve-step program. Speaking of two fellow rock stars, Joe P. and Steven T., Cooper said, “Now, there are two guys…who went through very heavy drug and alcohol [use]… and they are in AA every day. I applaud them for doing that, too, because it means that much to them…two guys that probably should have been dead in the early 70’s are still making records and still out there doing it.”

Relating his role as a sober rock star and the new generation of younger fans, Cooper reminisced about Jim Morrison, Jimmy Hendrix, and Janis Joplin who were brilliant in their field, but never stopped using and all died at 27. “Kids [today] look at us that got sober and they’re smart enough to go ‘ah’, that’s what I’m looking at. It’s not that cool to be high anymore,” Cooper said. “In my lyrics in my songs you’re going to find a lot of warning about drugs and alcohol…some people pick up on it which is good. People [tell me], ‘that one song saved my life’. A simple song can affect somebody enough that they don’t either commit suicide or they get the picture that drugs or alcohol are gonna kill you.”

When asked what he would say to people who are on-the-fence about having a problem with drugs or alcohol, Cooper said, “When you face that realization, and want to go on, you have to face that problem. It took me getting sick before I got control of it. If you think you’re an alcoholic, go two weeks without it and see if it’s part of your body, if it’s an everyday thing.”

Alice Cooper recently finished 190 shows in 17 countries on five continents. “I’m the only one not breathing hard,” Cooper quipped, “and I play golf six days a week [with a 4-handicap].”

Cooper is well-known for helping to support other musicians who struggle with addiction, and has even opened a nonprofit program, Solid Rock, dedicated to helping vulnerable teenagers make healthy choices.

Check our Blog in comings days for additional Luncheon photos!

Video Links:

Senator John Cornyn Visits The Council to Host Roundtable Discussion on Opioid Addiction in Houston

Council CEO Mel Taylor welcomes Senator and Mrs. John Cornyn to The Council on Recovery

Senator Cornyn leads roundtable discussion

U.S. Senator John Cornyn (R-TX) visited The Council on Recovery on October 30th to host a roundtable discussion on opioid addiction in Houston. The discussion came a week after the President signed into law legislation that was originally introduced by Cornyn and U.S. Senator Diane Feinstein (D-CA). The new law, called the Substance Abuse Prevention Act, will help local groups in Houston combat substance abuse.

Participating in the roundtable were representatives from The Council on Recovery; Addiction Policy Forum; the Success Through Addiction Recovery (STAR) Drug Court Program; Houston High Intensity Drug Trafficking Area (HIDTA); both the Fort Bend Community and Southeast Harris Prevention Coalitions; and law enforcement leaders from Houston, Galveston, Harris County, Victoria County, and Fort Bend County.

CEO Taylor describes The Council’s efforts to treat addiction

The discussion focused efforts to fight Southeast Texas’ illegal drug supply, divert those with substance abuse problems to treatment and recovery programs, and work with local communities to prevent illegal drug use.

The group was also given a demonstration of how to use a Naloxone overdose kit to revive an opioid overdose victim. During the meeting, more than 100 overdose kits were distributed to law enforcement officials attending the roundtable.

CEO Taylor addresses media questions

The Substance Abuse Prevention Act, part of the SUPPORT for Patients and Communities Act, reauthorizes critical programs to reduce demand for narcotics, provides assistance to law enforcement and service providers so they can better combat opioid addiction, and supports those recovering from substance use disorders.

The Council on Recovery is Houston’s oldest and largest non-profit provider of prevention, education, treatment, and recovery services for individuals and their families affected by substance use disorders. The Council and its Center for Recovering Families are tirelessly at work battling opioid epidemic on a daily basis. If you or a loved one needs help, call The Council at (713) 942-4100 or contact us online.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 41

Guest Blogger and long-time Council friend, Bob W. presents Part 41 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

There is a literary device that was originated in classical literature and theatre known in Latin as in medias res. It denotes that literary device of starting a story in the middle, “in the middle of things,” as the Latin might be translated.  We all know many stories, in literature, theater and movies that utilize this device; it is usually accompanied by multiple flashbacks and “jumping forwards” as a complex story is revealed. The Odyssey, which we keep talking about as a classic “hero’s Journey” story, uses this device; the story of Odysseus’ long journey home starts in the middle and is told in many, seemingly disjointed, subplots from different parts and different times in the overall story.

If we look at the lives of all of us in addiction and in the long journeys of recovery, this device might seem like a constant for us.  We really do start our recovery “in the middle of things,” usually somewhere in the middle of our lives.  The long story from our early days in the disease, into our descent to the darkest of moments, maybe many such moments, then the excruciating crawl to complete abstinence and the purposeful pursuit of the steps and tools…it is all a long, long story with the critical, pivotal elements appearing “in the middle.”

Odysseus has been traveling around the Aegean and Mediterranean Seas on a 10 year journey trying to find his way home after the Trojan War.  His story, the Odyssey, begins in the ninth year of this journey with his 20 year old son, Telemachus, whom Odysseus hasn’t seen since his infancy, setting out to visit his father’s fellow Greek warriors to gain some news of his father’s possible fates.  Meanwhile Odysseus has landed on the island of Scheria, having lost everything – all his ships, all his possessions, all his men, and any scrap of clothing he may have had on.  Naked, drawn and exhausted, he is at a real bottom.  He is encouraged to tell his story and he does so starting at the beginning after the sack of Troy.  The story unfolds with Telemachus and him finally landing back on Ithaca, Odysseus’ kingdom, and progressing through the process of regaining his rightful place as King.

After we gain some semblance of sobriety and begin to work the steps, the critical element is in telling our story, in recognizing the harm we have done in our disease, and using our new found serenity to repair the harm done to so many.  We work from the middle, back through the past, and then into the future, finally beginning to bask in the sunlight of recovery that a future in fully committed sobriety gives us.

National Prescription Drug Take Back Day Takes Place Oct. 27, 10A – 2P

Don't Be a DealerSemi-Annual event provides safe, convenient, and responsible way to dispose of prescription drugs

The Drug Enforcement Administration is hosting the semi-annual National Prescription Drug Take Back Day on Saturday, Oct. 27. The goal of the event is to provide a safe, convenient, and responsible means of disposing of prescription drugs, while also educating the general public about the potential for abuse of medications.  For a list of local drug collection sites, click here.

The Council on Recovery urges you to check your medicine cabinets, drawers, purses, and glove boxes for unused and/or expired Rx prescriptions. Dispose of them safely and immediately. Drug Take Back day is an ideal time to assure that dangerous, addictive, and potentially deadly prescriptions do not fall into the wrong hands.

If you or a loved one is experiencing a problem with Rx drugs, alcohol, or other addictive behaviors, contact The Council. We can help!

Methamphetamine Abuse: The Other Drug Epidemic

crystal meth
Crystsal Meth

While the opioid epidemic continues to dominate the national headlines, methamphetamine addiction has emerged as a major crisis in Texas.

A big problem

Methamphetamine, known as “meth”, killed 715 Texans in 2016 compared to 539 heroin deaths. During the same period, U.S-Mexican border agents seized seven times more meth than heroin. Over 8,200 meth users were admitted to Texas health department-funded treatment programs, nearly 20% of all admissions.

Dangerous connection with Mexico

According to the DEA, methamphetamine is a major threat to Texas. Though pseudoephedrine (a key to meth production) plummeted after purchase restriction laws were implemented, production of meth simply shifted to south of the border. As Mexico filled the increasing demand, a new production technique, called the “nitrostyrene method”, also created more potent meth. It’s now the predominant form of the drug entering Texas. It is also one of the cheapest, selling for $5 a hit.

A deadly mix

Even more troubling is the uptick in fatalities from the mixing of crystal meth with heroin.  In 2016, 17% of the deaths in Texas attributed to meth also involved heroin. So, as the opioid crisis grows, this mixing and the concurrent increase in meth usage have created an even greater health crisis for the state.

Link to STD increases

The Texas meth epidemic is also being linked with an increases in sexually transmitted diseases, including HIV, according to a recent report from the University of Texas at Austin. A CDC survey in Dallas sited in the report indicated that the proportion of homosexual men who reported non-injection use of meth went from 9% in 2008 to 45% in 2014. Recent HIV trends show that use of crystal meth has more than doubled HIV risk factors.

The Council’s response

In facing the methamphetamine epidemic, The Council on Recovery has redoubled its efforts to address the problem with robust prevention and education programs. The Council’s Center for Recovering Families has also become a vital outpatient destination for individuals affected by crystal meth addiction. We provide substance use assessments, counseling, and Healing Choices, our intensive outpatient treatment program. We also work with family members and loved ones impacted by substance use disorders. For more information, call the Center for Recovering Families at 713-914-0556 or contact us here.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 40

In the parlance of long-running, multi-season TV shows, the term “jump the shark” denotes that point at which the series popularity begins to decline.  It usually cites a particular show in which the characters in the show do something a bit absurd, maybe so much beyond the mythos of the show that it begins to destroy that mythos and, maybe, the TV audience’s love affair with the themes and the characters.  Jumping the Shark

The term got its name, “jump the shark” from the 1970’s TV series “Happy Days,” about a mid-western family and their friends.  Happy Days “jumped the shark,” began to decline in popularity, when one of the characters, Arthur Fonzarelli, aka, Fonzie or The Fonz, in an episode in the later stretch of the series run, pulled off an outlandish water-skiing stunt by jumping a shark pit.

This idea has been linked to virtually all multi-season shows, as well as some other situations, in a 2002 book of the same name by Jon Hein, a magazine writer of some renown.  Hein analyzes nearly 300 TV shows, sports organizations, music groups, celebrities and political careers in the same vein.  This type event seems to be signaling a major inflection point in the history of organizations, events and people and it occurs to me that we could look at our own lives in addiction in just the same way.  We could see such an event, first, as that event in our drinking history when our behavior was so bad, when an event of absolute insanity occurred, in front of a large gathering of our family, friends, and communities, that it absolutely confirmed our descent into insanity in the larger cosmos. For this alcoholic, it happened at the end of a Texas high school football championship game when, before 20,000 people (family, friends, business acquaintances, and just people) in the Astrodome, I took off across an empty field chasing the referee to complain of a bad call that cost us the game.

Or, from a different perspective, it could be that point at which, in our efforts to recovery, we finally got it, when we finally grasped the idea of “doing what it takes.”  Stopping the drinking and using, going to meetings, working the steps, listening intently to our Fellows, it occurs to us one day, almost out of the blue, that we could do this.  That the scourge of alcohol and drugs and debilitating behaviors was being lifted.

We had to, we have to keep working the program, but the realization that recovery had begun, in earnest, was truly at hand.  What a great day…

Senate Passes Broad Opioid Package to Address National Crisis

Senate passes opioid package

The Council on Recovery applauds the U.S. Senate’s passage of the final version of a sweeping opioids package Wednesday. Passed with rare bipartisan support by a vote of 98-1, the bill will be sent it to the White House for expected signature.

The bill represents Congressional response to the opioid epidemic, a growing public health crisis that resulted in 72,000 drug-overdose deaths last year. The House of Representatives passed the bill last week. It combines dozens of smaller proposals, from both sides of the aisle, that affect every federal agency. The bill is aimed at addressing different aspects of the opioid crisis, including prevention, treatment and recovery.

Major Provisions

Among major provisions, the legislation creates a grant program for comprehensive recovery centers that include housing and job training, as well as mental and physical health care. It also increases access to medication-assisted treatment to help people with substance abuse disorders safely detox from the opioids.

Another portion of the bill changes a prohibition that limited Medicaid from covering patients with substance abuse disorders who were receiving treatment in a mental health facility with more than 16 beds. The bill lifts that rule to allow for 30 days of residential treatment coverage.

The bill also gives Medicare beneficiaries more information on alternative pain treatments, and expands treatment options for enrollees who are addicted to opioids.

Funding in the Bill

Congress has appropriated $8.5 billion this year for opioid-related programs, but has not guaranteed funding for subsequent years. Some members of Congress have proposed committing at least $100 billion over ten years to fight the opioid epidemic.

The Council on Recovery

The Council on Recovery is in the vanguard of local efforts to stem the opioid epidemic with a broad array of prevention, education, treatment, and recovery programs. The Council also recently hosted the 2018 Houston Opioid Summit. For more information about our services, contact us today.

Yale Study: Genes May Explain Why Alcohol Detox is Particularly Hard for Some People

Detox
Yale Study Explains Why Detox Symptoms are Worse for Some, Not Others

New findings published in journal Alcoholism: Clinical and Experimental Research

Some heavy drinkers suffer intense withdrawal symptoms when they try to stop drinking — some, less so.  A new Yale-led international study of individuals with alcohol dependence has identified gene variants that may help explain why “detox” from alcohol is particularly difficult for some people. The researchers report their findings September 25 in the journal Alcoholism: Clinical and Experimental Research, the official journal of the Research Society on Alcoholism.

Alcohol takes more lives in the United States every year than opioids, but there are few effective treatments to help people who have an alcohol use disorder,” said Andrew H. Smith, lead author of the study and a research affiliate in the laboratory of senior author Joel Gelernter, Foundations Fund Professor of Psychiatry and Professor of Genetics and of Neuroscience. “For people who experience intense withdrawal symptoms, that’s one more barrier they have to face while trying to reduce unhealthy alcohol use.”

Those physical symptoms of alcohol withdrawal are much worse than any hangover. Sudden cessation of alcohol consumption can lead to shakes, nausea, headaches, anxiety, fluctuations in blood pressure, and in the most serious cases, seizures.

The American team and collaborators in Denmark linked variants in the SORCS2 gene to the severity of alcohol withdrawal in people who have European ancestry, about one in ten of whom carry the variants. No such connection was found in African Americans. Intriguingly, the SORCS2 gene is important for activation of brain areas which respond to changes in the environment. The gene variants identified in the study may impinge on the ability of heavy drinkers to adapt to the sudden absence of alcohol, researchers speculate.

Better understanding of the many genes likely to be involved in withdrawal symptoms could ultimately lead to new medications that moderate these symptoms, which could help with the discontinuation of habitual alcohol use,” Gelernter said.

The research was primarily funded by grants from the National Institutes of Health.


The Council on Recovery does not provide medical detox services, but does refer out to detox facilities in the Houston area. The Council provides outpatient services for people battling alcoholism, including Healing Choices, our intensive outpatient treatment program (IOP). Call 713.914.0556 for more information.

How Drugs Alter Brain Development and Affect Teens

Changes in Brain Development and Function From Drug Abuse

Most kids grow dramatically during the adolescent and teen years. Their young brains, particularly the prefrontal cortex that is used to make decisions, are growing and developing, until their mid-20’s.

Long-term drug use causes brain changes that can set people up for addiction and other problems. Once a young person is addicted, his or her brain changes so that drugs are now the top priority. He or she will compulsively seek and use drugs even though doing so brings devastating consequences to his or her life, and for those who care about him.

(See moreStudy: Regularly Using Marijuana as a Teen Slows Brain Development)

Alcohol can interfere with developmental processes occurring in the brain. For weeks or months after a teen stops drinking heavily, parts of the brain still struggle to work correctly. Drinking at a young age is also associated with the development of alcohol dependence later in life.

What is Addiction?

No one plans to become addicted to a drug. Instead, it begins with a single use, which can lead to abuse, which can lead to addiction.

The National Institute of Drug Abuse (NIDA) defines addiction as:

A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. Addiction is a brain disease because drugs change the brain’s structure and how it works. These brain changes can be long lasting, and lead to harmful behaviors seen in people who abuse drugs.

The good news is that addiction is treatable. The treatment approach to substance abuse depends on several factors, including a child’s temperament and willingness to change. It may take several attempts at treatment before a child remains drug-free. For those teens who are treated for addiction, there is hope for a life of recovery.

The Council on Recovery’s Center for Recovering Families has a broad spectrum of outpatient services for adolescents, including individual therapy, group therapy, high-risk behavior classes, and other education and treatment programs. For information, call 713-914-0556.

(Source: Get Smart About Drugs, a DEA Resource for Parents, Educators, & Caregivers)

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 39

Guest Blogger and long-time Council friend, Bob W. presents Part 39 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In Greek mythology, the heiros gamos is a holy ritual, a sacred marriage of a god and goddess, or of an archetypal masculine and feminine, that results in a perfect union of certain key elements of the human experience. It appears in many other systems – mythological, spiritual and psychological – in the same context, a glorified union of the key elements of both genders of humanity.

It occurs to me, though, that we might see just such a phenomenon in the evolution of our own individual selves in the recovery process from addictions.

In broad psychoanalytic terms, the two key elements of the human psyche could be seen as the ego, the conscious element of ourselves – how and what we see of ourselves – and the self – that part of us that is who we truly are, at the core of our beings. The ego is what is crafted from the earliest times, formed by how we fit into the world in which we are raised.  In time it may be cloaked by a certain persona that we want (or are taught) the world to see. This may or may not be akin to our authentic selves. The self, on the other hand, is who and what we are at the core, from our earliest consciousness, regardless of how we were raised, or what happened to us over our lives.  It is the self that will ultimately define us.

For those of us inflicted with the diseases of alcoholism or addiction, our egos became the ruling elements of our psyche. Maybe we strove to achieve, working hard against all odds, and built a view of ourselves that was at best majestic, at worst massively grandiose. This view fed our alcoholism, both to elevate its absurdity as well as to medicate the hidden anxiety that it created.  When it got to be too painful to perpetuate, we crashed, monumentally. We hit that point at which there had to be another way to live in the world or the grim reaper of death would become our only companion in a descent to oblivion.

The journey to recovery thus begun also became a slow and developing process to rewire our own brains.  For this alcoholic, it signaled a journey of discovery to find myself, the core of who and what I am. The last stages of this journey, for me, is becoming a heiros gamos, a marriage of my ego and my self. The ego is still important to me, to us; it is the warrior part of us, that part infused with a healthy narcissism, enabling me/us to face the world without a debilitating fear that needs medication.  But the self, that core of who and what we are, must come forward, must rise up in stature to form a true union of equals with our ego.

The union thus created by my own heiros gamos, this spectacular sensation of finally feeling, fully and completely, who and what I am and what I can be, is a gift of grace of unimaginable magnitude.  More on this in a later note….

CNN Reports Nearly 30% of All Opioid Prescriptions Lack Medical Explanation

Nearly 30% of All Opioid Prescriptions Lack Medical Explanation [Click to watch CNN report]
This CNN story reported findings of a recent study by the Annals of Internal Medicine that indicated nearly 30% of all opioid prescriptions lack medical explanation:

(CNN) How large a role do doctors play in the opioid crisis? Nearly 30% of all opioids prescribed in US clinics or doctors’ offices lack a documented reason — such as severe back pain — to justify a script for these addictive drugs, new research finds.

In total, opioids were prescribed in almost 809 million outpatient visits over a 10-year period, with 66.4% of these prescriptions intended to treat non-cancer pain and 5.1% for cancer-related pain, according to a study published Monday in the journal Annals of Internal Medicine.

However, for the remaining 28.5% of prescriptions — about three out of every 10 patients — there was no record of either pain symptoms or a pain-related condition, the Harvard Medical School and RAND Corp. researchers say.

‘Inappropriate prescribing’

“For these visits, it is unclear why a physician chose to prescribe an opioid or whether opioid therapy is justified,” said Dr. Tisamarie B. Sherry, lead author of the study and an associate physician policy researcher at RAND. “The reasons for this could be truly inappropriate prescribing of opioids or merely lax documentation.”

Sherry and her colleagues, who analyzed data from the National Ambulatory Medical Care Survey for 2006 through 2015, say the most common diagnoses at doctor visits that lacked medical justification were high blood pressure, high cholesterol, opioid dependence and “other follow-up examination.”

Opioid dependence, which accounted for only 2.2% of these diagnoses, cannot explain why a doctor failed to give an adequate reason for prescribing addictive painkillers.

“If a doctor does not document a medical reason for prescribing an opioid, it could mean that the prescription is not clinically appropriate,” Sherry said. “But it could also mean that the doctor simply missed recording the medical justification for an opioid, perhaps due to time constraints, clinic workflows or complicated documentation systems.”

We cannot assume that poor record-keeping “indicates a nefarious purpose on the part of the doctor,” she added.

Social media’s contribution

Tim K. Mackey, an associate professor at the University of California, San Diego School of Medicine and director of the Global Health Policy Institute, described the new study as “an important analysis,” with the findings highlighting “gaps in our understanding of why clinicians prescribed opioids.”

Mackey, who did not participate in the research, believes that the study could lead to stricter prescribing guidelines, which in turn could give rise to “unforeseen consequences.” For example, if new guidelines and initiatives make it harder for people to access opioids from hospitals and clinics, “this could shift demand to more accessible platforms, including the internet,” he wrote in an email.

“The public health danger of sales of opioids online has been well recognized by the US government, with a US General Accounting Office report from as early as 2004 warning about pain medications available online without a prescription,” he said.

Mackey’s own research highlights how online pharmacies use social media to sell controlled substances while drug dealers use Twitter to sell opioids by including their phone or email information.
Someone may start by getting medication for a legitimate “pain” diagnosis, but once they become addicted, their health provider may no longer be willing to write scripts, Mackey said.

“After exhausting friends, relatives and other personal contacts, many may go to illicit channels, including street buys no longer confined to the ‘street’ but digitized on social media,” he said. Some turn to internet pharmacies despite concerns about fraud and identify theft.

“Either way, this dangerous progression of different access points that continues to enable the opioid epidemic is not well understood,” Mackey said.

With more data needed to make sense of this public health crisis, technology companies, regulators, law enforcement and researchers need to come together to share ideas, innovations and research, he said.
“Unfortunately, some of this needed collaboration may be elusive,” he said. He explained that researchers who use machine-learning and Twitter’s public application programming interface to detect illicit online activity are prevented from sharing their findings with law enforcement due to Twitter’s terms of use.

“This leaves regulators like the US Food and Drug Administration and the US Department of Justice in the dark about how they can cut off this dangerous channel of access that may continue to fuel the opioid crisis even after we make strides in other areas, such as physician prescribing,” Mackey said.

Sherry said another key finding of her study was that “physicians were especially lax at documenting their medical reasons for continuing chronic opioid prescriptions” despite government guidelines from 2016 recommending “periodic formal re-evaluation” in cases of long-term opioid treatment.

“It is now more important than ever for physicians to transparently and accurately document their justification for using an opioid so that we can identify and rectify problematic prescribing behavior,” Sherry said. “Our findings indicate that we still have a long way to go to reach this goal.”

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 38

Guest Blogger and long-time Council friend, Bob W. presents Part 38 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In Herman Melville’s classic, Moby-Dick, Captain Ahab was near mortally wounded by a powerful albino sperm whale named Moby Dick.  He became obsessed with the need to kill Moby Dick and, in a subsequent whaling voyage aboard the whale ship Pequod, he hijacks the vessel and crew and sets out on this murderous quest.  The whale is too powerful, however, and, in the end, the whale destroys the Pequod killing Ahab and all the ship’s hands in the process, all the men except Ishmael, one of the seamen who is also the narrator of the book.

In the description of Ahab’s obsession with Moby Dick early in the book, Ishmael (Melville) describes it as follows: “The White Whale swam before him as the monomaniac incarnation of all those malicious agencies which some deep men feel eating in them, till they are left living on with half a heart and half a lung. [….] All that most maddens and torments; all that stirs up the lees of things; all truth with malice in it; all that cracks the sinews and cakes the brain; all the subtle demonisms of life and thought; all evil, to crazy Ahab, were visibly personified, and made practically assailable in Moby Dick. He piled upon the whale’s white hump the sum of all the general rage and hate felt by his whole race from Adam down; and then, as if his chest had been a mortar, he burst his hot heart’s shell upon it.”

In our days steeped in alcohol and drugs, we may have experienced serious incidents of trauma, not unlike Ahab’s initial encounter with Moby Dick, situations which became monstrous resentments, resentments which we medicated ad nauseam with alcohol and drugs. When we got sober, these “demonisms of life” didn’t go away; we just lost the mechanisms to medicate the feelings. We soon learned that dealing with these situations and events, these deep seated resentments, without the medicating effects of alcohol and drugs required a new set of tools and a connection to a power greater than ourselves. Meetings, reading the literature, rigorously working the Steps with a sponsor, and staying close to multiple friends in the Fellowship became a daily process to handle the issues that arise from those feelings and resentments that continually show up in different forms in our daily lives.

The power of these recurring resentments can become debilitating at times, but we learn to deal with them. For, to give them power, to allow them to control us as his hatred of Moby Dick controlled Ahab, would be to insure our ultimate demise in much the same way, and perhaps as ultimately dramatic, as was Ahab’s.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 37

Guest Blogger and long-time Council friend, Bob W. presents Part 37 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

The story of Homer’s Odyssey, to which we keep returning as a classic Hero’s Journey, ends with Odysseus finally back in Ithaca reunited with his family.  He has traveled all over the Aegean and Mediterranean Seas in a ten year quest to get here, suffering all kinds of ills, some incredibly gruesome, but many of his own making.  His long journey to get home has caused many to believe that he is dead and, as a result, his Kingdom on Ithaca has been overrun by young men seeking to convince his wife, Penelope, to recognize that as fact and marry one of them, so that he could become King.

These men, called the Suitors in the Story, occupy a significant part of the Tale.  Their activities in Odysseus’ Palace over the last year of the Story, begin to turn ugly as they abuse the hospitality of Penelope and engage in long bouts of consumptive behavior with food, wine and the handmaidens of the Palace.  Odysseus’ return to Ithaca, in the final elements of the Story, leads him to plan and then execute a complete slaughter of these Suitors to regain his rightful place as King.

The place of these Suitors has always intrigued me. What might they symbolize, mythologically, in the Story? It seems that they represent much of what was unacceptable in the ethos of ancient Greece of the time.  They lacked a fundamental sense of right behavior, abusing the hospitality of Penelope and her household, consuming her goods and possessions beyond any sense of decorum, and abusing the members of her household ad infinitum. They were just really bad actors, maybe not unlike all of us as we acted out in the heights of our disease.

I have come to believe that, to get sober, something inside of us has to die, at least metaphorically speaking.  Some element of our addictive selves must come to a decisive end, for us to gain Sobriety and maintain a sober state in our ongoing life. So maybe this is what we can capture from this part of the Odyssey, the need for Odysseus to engage in a brutal battle with all the elements of the wicked side of his Kingdom is mirroring what we must do in our pursuit of Sobriety.  It easily conveys to many of us the need to control, maybe destroy, through a rigorous working of the Steps, those parts of us that could re-ignite the worst elements of our disease.  Our future in the Sunlight of the Spirit only happens, and stays alive then, when the “suitors” in us are long since dead.

Time to cut back on drinking? Here’s how…

Written by Felice J. Freyer & published by The Boston Globe, the following article provides excellent tips to those who drink. Timely information for those who use, misuse, or abuse alcohol.

Alcohol is deeply ingrained in American life, central to our habits of socializing, celebrating, and relaxing. But the pleasure of these routines can keep you from noticing when drinking has become a problem.

You can drink too much without necessarily being addicted to alcohol. Although some people who drink excessively find they must abstain, many others can just cut back — and moderation often makes their lives better.

How do you know when it’s time to reassess your drinking? And if you want to drink less, how do you do it?

The Globe asked for tips from experts in alcohol use at Harvard Medical School, the Boston University School of Medicine, the VA Boston Healthcare System, and the National Institute on Alcohol Abuse and Alcoholism. Here’s what they said.

Signs that you might be drinking too much

  • It’s starting to worry you or other people. Friends or relatives comment on your drinking.
  • You’re drinking more frequently and alcohol is starting to take a bigger role in your life.
  • You suffer from poor judgment while drinking, doing or saying things you regret when sober.
  • You find that you’re drinking more than you planned.
  • You can’t control how much you drink once you start.

Other reasons to cut back

Even if you’re not experiencing any of the problems listed above, it might be worth reducing your drinking if any of these apply to you:

  • You’re not getting any younger. At some point after age 55, your body’s ability to process alcohol slows down, and you may get drunk or sick with amounts of alcohol that didn’t faze you in your youth.
  • You have diabetes. Most alcoholic drinks pack a lot of carbohydrates.
  • You have high blood pressure. Alcohol makes it worse.
  • You’re overweight. Alcohol contains a lot of empty calories.
  • You suffer from a mental illness, such as depression and anxiety. Alcohol can bring temporary relief but can make symptoms worse over time.
  • You’re concerned about the health risks. John F. Kelly, Harvard Medical School professor of addiction medicine, lists the hazards: addiction can occur at any time; intoxication leads to accidents and injuries; and alcohol raises the risk of cancer, particularly breast cancer, and damages the liver.

Time to cut back? Here are some ways to do that.

Track your drinking and set a goal

  • Learn what is a standard drink size. Twelve ounces of beer, five ounces of wine, and 1.5 ounces of 80-proof distilled spirits all have the same amount of alcohol. One martini is equal to 2½ standard drinks.
  • Make a note every time you take a drink, advises Amy Rubin, a research psychologist with VA Boston Healthcare. Writing it down will reduce your drinking because you’ll be paying attention, and it’s also the best way to get an accurate tally.
  • Then, decide how much you want to be drinking. One possible goal: the federal guidelines. These define low-risk drinking as having up to seven drinks per week with no more than three on any one day for women, or up to 14 drinks per week with no more than four on any one day for men.

Slow down

  • Make sure to eat before and during drinking to slow absorption into the bloodstream.
  • Start drinking later in the evening, to reduce the amount of time you have for drinking (but don’t drink close to bedtime or you’ll disrupt your sleep).
  • Intersperse every alcoholic drink with a nonalcoholic one. Take small sips. Put the drink down between each sip.
  • Choose drinks with lower alcohol content. Or dilute your drinks with ice cubes or seltzer.

Do something else

  • “Ask yourself, why are you drinking? Try to find other things that meet those needs,” said Aaron White, senior scientific adviser to the NIAAA director. If you drink to relax, for example, try a yoga class or a swim instead.
  • Change your routines. Perhaps go for a walk, or see a movie during the time you would normally be drinking.
  • Avoid places where you expect to see a lot of drinking. Even if you go to a bar, get up and play a game of pool or do something other than sitting there drinking.

Take a break

  • Try abstaining for 30 days. You’ll find other ways to spend your time and money and get a sense  of what it feels like to be alcohol-free. For many that means better sleep, more energy, and better memory. And your tolerance for alcohol will go down, so when you resume drinking you can get the same effect with less.
  • If you don’t want to take a month off, try taking a day off here and there. Make sure there are some alcohol-free days each week.

Be kind to yourself

Don’t beat yourself up if you don’t succeed at first. It’s hard to break habits, and few succeed on the first try. Try different methods or set different goals.

“It’s a trial-and-error process,” said Justin L. Enggasser, an assistant professor of psychiatry at the Boston University School of Medicine. “The people that are most successful are the ones who keep trying and keep it as learning process.”

Face facts

If you still can’t reach your goals, no matter what you do, your drinking problem might be more serious than you realized. The NIAAA ( https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders ) offers a helpful description of alcohol use disorder and a “navigator”to help you find treatment.

The Council on Recovery provides prevention, education, and treatment programs for individuals and their families dealing with alcoholism, drug abuse, other addictions, and co-occurring mental health disorders. Start at The Council. We can help. Call 713-942-4100 for more information or contact us online.

As School Starts, Know the Facts About College Drinking

As students start the Fall Semester at college, The Council on Recovery urges parents and students to consider the facts about college drinking from the National Institute on Alcohol Abuse and Alcoholism.

Harmful and underage college drinking are significant public health problems, and they exact an enormous toll on the intellectual and social lives of students on campuses across the United States.

Drinking at college has become a ritual that students often see as an integral part of their higher education experience. Many students come to college with established drinking habits, and the college environment can exacerbate the problem. According to a national survey, almost 60 percent of college students ages 18–22 drank alcohol in the past month, and almost 2 out of 3 of them engaged in binge drinking during that same time-frame.

Consequences of Harmful and Underage College Drinking

Many college alcohol problems are related to “binge drinking”. Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours. Drinking this way can pose serious health and safety risks, including car crashes, drunk-driving arrests, sexual assaults, and injuries. Over the long term, frequent binge drinking can damage the liver and other organs.

Drinking affects college students, their families, and college communities at large. Researchers estimate that each year:

  • Death: About 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor-vehicle crashes.
  • Assault: About 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking.
  • Sexual Assault: About 97,000 students between the ages of 18 and 24 report experiencing alcohol-related sexual assault or date rape.
  • Academic Problems: About 1 in 4 college students report academic consequences from drinking, including missing class, falling behind in class, doing poorly on exams or papers, and receiving lower grades overall. In a national survey of college students, binge drinkers who consumed alcohol at least 3 times per week were roughly 6 times more likely than those who drank but never binged to perform poorly on a test or project as a result of drinking (40 percent vs. 7 percent) and 5 times more likely to have missed a class (64 percent vs. 12 percent). Alcohol Use Disorder (AUD) About 20 percent of college students meet the criteria for an AUD.
  • Other Consequences: These include suicide attempts, health problems, injuries, unsafe sex, and driving under the influence of alcohol, as well as vandalism, property damage, and involvement with the police.

Factors Affecting Student Drinking

Although the majority of students come to college already having some experience with alcohol, certain aspects of college life, such as unstructured time, the widespread availability of alcohol, inconsistent enforcement of underage drinking laws, and limited interactions with parents and other adults, can intensify the problem. In fact, college students have higher binge-drinking rates and a higher incidence of driving under the influence of alcohol than their non-college peers.

The first 6 weeks of freshman year are a vulnerable time for heavy drinking and alcohol-related consequences because of student expectations and social pressures at the start of the academic year.

Factors related to specific college environments also are significant. Students attending schools with strong Greek systems and with prominent athletic programs tend to drink more than students at other types of schools. In terms of living arrangements, alcohol consumption is highest among students living in fraternities and sororities and lowest among commuting students who live with their families.

An often-overlooked preventive factor involves the continuing influence of parents. Research shows that students who choose not to drink often do so because their parents discussed alcohol use and its adverse consequences with them.

Addressing College Drinking

Ongoing research continues to improve our understanding of how to address the persistent and costly problem of harmful and underage student drinking. Successful efforts typically involve a mix of strategies that target individual students, the student body as a whole, and the broader college community.

Strategies Targeting Individual Students – Individual-level interventions target students, including those in higher-risk groups such as first-year students, student athletes, members of Greek organizations, and mandated students. They are designed to change students’ knowledge, attitudes and behaviors related to alcohol so that they drink less, take fewer risks, and experience fewer harmful consequences. Categories of individual-level interventions include:

  • Education and awareness programs
  • Cognitive–behavioral skills-based approaches
  • Motivation and feedback-related approaches
  • Behavioral interventions by health professionals

Strategies Targeting the Campus and Surrounding Community – Environmental-level strategies target the campus community and student body as a whole, and are designed to change the campus and community environments in which student drinking occurs. Often, a major goal is to reduce the availability of alcohol, because research shows that reducing alcohol availability cuts consumption and harmful consequences on campuses as well as in the general population.

For more information on individual- and environmental-level strategies, the NIAAA CollegeAIM guide (and interactive Web site) rates nearly 60 alcohol interventions in terms of effectiveness, costs, and other factors—and presents the information in a user-friendly and accessible way. For more information, visit www.collegedrinkingprevention.gov/CollegeAIM.

The Council on Recovery provides prevention, education, and treatment programs for individuals and their families dealing with alcoholism, drug abuse, other addictions, and co-occurring mental health disorders. Start at The Council. We can help. Call 713-942-4100 for more information.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 36

Guest Blogger and long-time Council friend, Bob W. presents Part 36 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In 1993, comedian Bill Murray stared in a film called Groundhog Day. It is about a fictitious Pittsburgh TV weatherman, Phil Conners, who is sent to cover the events of Groundhog Day, Feb 2, in Punxsutawney, Pennsylvania, northeast of Pittsburgh.  Punxsutawney is the actual site of an annual event where a real-live groundhog named Punxsutawney Phil either sees his shadow or doesn’t on that day, an event which signals the remaining duration of winter. Conners is a crass, self-absorbed, obnoxious character whom no one likes and who resents horribly that he has to perform such a mundane task as traveling to Punxsutawney and covering the Groundhog Day Festival.

In the process of performing his duties, he insults and abuses everyone and tries to flee the town as fast as he can after the Festival.  A snowstorm makes that impossible so he must stay over.  But he wakes up the next day to find that it is still Feb 2…and he proceeds to re-live that same day over and over and over…every day being Feb 2 with the same things happening, and  he, and only he, being conscious of the repetition.  As it sinks in what is happening, he realizes that there are no repercussions to whatever he does because all the tomorrows will never come. He can do whatever suits him, even things that would otherwise have severe consequences.  He seduces women, steals money, and disrupts the festival.  Despair sets in and he kills himself, over and over.  Each event in such behavior just keeps happening and he wakes up each day starting completely over.  In typical Bill Murray madcap fashion, it is also hilariously funny…but, for this alcoholic it also conjures up a life in the diseases of addiction, doing the same ugly things over and over fantasying that somehow there will be different outcomes.

Finally, the pathos of some of the things Conners experiences, the trauma he sees in some people’s lives and his inability to fix some fundamental wrongs, has a startling effect…he begins to change.  He uses the fact of his recurring Feb 2 to adopt a new view and an alternative pattern of behavior.  He begins to care and the profound changes in his attitude and behavior have some startling impacts on the community.  After a particularly poignant evening, he wakes up the next day and it is finally Feb 3.  He is overcome with joy.

For me this story conveys much of what we experience in our life in our diseases and our dramatic shift to sobriety.  Once we realize what is happening, once we accept the uselessness of our constant bad behavior, once we surrender to the presence of a higher power in our lives, things begin to change…and our future suddenly takes on a brightness that is profoundly joyful.

Magic Mushrooms (Psilocybin) Remain a Popular Hallucinogen

Among the hallucinogens abused by those who have a substance use disorder (SUD), psilocybin mushrooms are still a popular source of getting high.

Similar to other hallucinogens, such as mescaline and peyote, and known on the street as “magic mushrooms”, they contain the hallucinogenic chemical psilocybin and are found throughout the U.S. and Mexico. Fresh or dried, these fungi have long, slender stems topped by caps with dark gills on the underside. Fresh mushrooms have white or whitish-gray stems; the caps are dark brown around the edges and light brown or white in the center. Dried mushrooms are usually rusty brown with isolated areas of off-white.

Psilocybin mushrooms are abused by being eaten or brewed as tea, or added to other foods to mask their bitter flavor. Their effect on the body may include nausea, vomiting, muscle weakness, and lack of coordination. The psychological consequences of psilocybin use include hallucinations and an inability to discern fantasy from reality. Panic reactions and psychosis also may occur, particularly if a user ingests a large dose.

Effects of a psilocybin overdose include a longer, more intense “trip” experience, psychosis, and possible death. Abuse of psilocybin mushrooms can also lead to immediate poisoning if one of the many varieties of poisonous mushrooms is incorrectly identified and ingested.

Psilocybin is a Schedule I substance under the Controlled Substances Act, meaning that it has a high potential for abuse. There is no currently accepted use  in medical treatment in the United States and no level of accepted safe use under medical supervision.

If you or a loved one is suffering from a substance use disorder as a result of psilocybin mushrooms or any other addictive substance, The Council on Recovery can help. Call us today at 713-942-4100 or contact us online.

2018 Houston Opioid Summit Creates Vital Awareness and Cooperation in the Battle Against Opioid Addiction

 

Opening Session Panel view

For two full days last week, nearly 250 leaders from across Harris County gathered  at The Council on Recovery’s first Opioid Summit.

In keynote addresses, topical breakout sessions, panel discussions, round-table discussions, and interpersonal networking, people on the front-line in battling the opioid crisis exchanged ideas, information, and experience to develop understanding and viable solutions for dealing with the problem.

Judge Denise Bradley speech

Unlike other opioid conferences that focus on individual or narrow aspects of the problem, the 2018 Houston Opioid Summit brought together all of the major sectors dealing with the issue. These included experts from the medical, legal, prevention, treatment, legislative, law enforcement and media communities who shared their perspectives of the opioid epidemic and explored ways to work together to stem opioid overdoses, currently the leading cause of accidental death.

Media Panel Discussion chat

Among the unique perspectives discussed at the Opioid Summit were the role and responsibility of media in the local and national dialogue, and the role of the faith-based community addressing the opioid epidemic.

Dr Joy Alonzo speaks

In-depth discourse on the use of medication-assisted treatment (MAT) and the role of specialty medical care in managing substance use disorder shed new light on treatment opportunities and challenges.

Judge Brock Thomas edited

Exploration of innovative criminal justice approaches and therapeutic treatment courts, and a report on narcotics law enforcement efforts, instilled vital understanding of recent legal trends.

Terry ORourke and Dan Downey

An examination of the Harris County Opioid Litigation against manufacturers and distributors of prescription opioids by lawyers from the County Attorney’s office provided a glimpse of how the opioid crisis may be impacted by future court decisions.

Karen Palombo teaching

The individual and family effects of the opioid epidemic were also central to the Opioid Summit as breakout sessions covered addiction treatment modalities and prevention and education programs for children and families.

John Cates speech

Advocacy, another front in the war on opioids was keynoted by John Cates. Frank discussions were held on using technology and other therapeutic tools to promote recovery, as well as community efforts to help addicted pregnant women and deal with Neonatal Abstinence Syndrome (NAS), an increasingly alarming problem in delivery rooms across the Houston area.

Four Person Panel

A poignant and powerful closing keynote session focused on the personal perspectives of three individuals whose lives were forever touched by the opioid crisis. Moderated by KPRC’s Khambrel Marshall, the intimate conversation with Maureen Wittels, Randy Grimes, and Jim Hood drove home the devastating impact of substance use disorder. Maureen lost her son, Harris, to an opioid overdose in 2015, cutting short his 30-year old life as a rising star in Hollywood. Randy, a retired NFL player, suffered for 20 years with opioid addiction, that grew out of treating the pain of his football injuries, before getting sober nine years ago. Jim’s son, Austin, died at the age of 21 from an opioid overdose six years ago and prompted Jim to co-found a national organization, Facing Addiction with NCADD, to fight the opioid addiction with the same fervor of campaigns that have battled cancer and other deadly diseases for years.

The Council on Recovery is leading our community in the effort to find solutions to the opioid epidemic. Your support of The Council is greatly appreciated! For more information, click here.

More Photos from the 2018 Houston Opioid Summit:

Vanessa Ayala teaching

Traci-Gauen

Randy Grimes

Peter Mott speaking

Mireille Milfort

Howard Lester

Harry Wiland

Faith Panel

Doug Thornton

Christian Thrasher, Clinton Health Matters Initiative
Christian Thrasher, Clinton Health Matters Initiative

Carol Alvarado
Texas state representative Carol Alvarado

 

CDC Report: Excessive Alcohol Use and Risks to Women’s Health

Recently reported data from the Centers for Disease Control and Prevention (CDC) are shedding new light on the links between excessive alcohol use by women and the increasing risks to female health. Here are vital the facts from the CDC.

Although men are more likely to drink alcohol and drink in larger amounts, gender differences in body structure and chemistry cause women to absorb more alcohol, and take longer to break it down and remove it from their bodies (i.e., to metabolize it). In other words, upon drinking equal amounts, women have higher alcohol levels in their blood than men, and the immediate effects of alcohol occur more quickly and last longer in women than men. These differences also make it more likely that drinking will cause long-term health problems in women than men.

Drinking Levels among Women

  • Approximately 46% of adult women report drinking alcohol in the last 30 days.
  • Approximately 12% of adult women report binge drinking 3 times a month, averaging 5 drinks per binge.
  • Most (90%) people who binge drink are not alcoholics or alcohol dependent.
  • About 2.5% of women and 4.5% of men met the diagnostic criteria for alcohol dependence in the past year.

Reproductive Health Outcomes

  • National surveys show that about 1 in 2 women of child-bearing age (i.e., aged 18–44 years) drink alcohol, and 18% of women who drink alcohol in this age group binge drink.
  • Excessive drinkingmay disrupt the menstrual cycle and increase the risk of infertility.
  • Women who binge drinkare more likely to have unprotected sex and multiple sex partners. These activities increase the risks of unintended pregnancy and sexually transmitted diseases.

Pregnancy Outcomes

  • About 10% of pregnant women drink alcohol.
  • Women who drink alcohol while pregnant increase their risk of having a baby with Fetal Alcohol Spectrum Disorders (FASD). The most severe form is Fetal Alcohol Syndrome (FAS), which causes mental retardation and birth defects.
  • FASDare completely preventable if a woman does not drink while pregnant or while she may become pregnant. It is not safe to drink at any time during pregnancy.
  • Excessive drinking increases a woman’s risk of miscarriage, stillbirth, and premature delivery.
  • Women who drink alcohol while pregnant are also more likely to have a baby die from Sudden Infant Death Syndrome (SIDS). This risk substantially increases if a woman binge drinksduring her first trimester of pregnancy.

Other Health Concerns

  • Liver Disease: The risk of cirrhosis and other alcohol-related liver diseases is higher for women than for men.
  • Impact on the Brain: Excessive drinking may result in memory loss and shrinkage of the brain. Research suggests that women are more vulnerable than men to the brain damaging effects of excessive alcohol use, and the damage tends to appear with shorter periods of excessive drinking for women than for men.
  • Impact on the Heart: Studies have shown that women who drink excessively are at increased risk for damage to the heart muscle than men even for women drinking at lower levels.
  • Cancer: Alcohol consumption increases the risk of cancer of the mouth, throat, esophagus, liver, colon, and breast among women. The risk of breast cancer increases as alcohol use increases.
  • Sexual Assault: Binge drinking is a risk factor for sexual assault, especially among young women in college settings. Each year, about 1 in 20 college women are sexually assaulted. Research suggests that there is an increase in the risk of rape or sexual assault when both the attacker and victim have used alcohol prior to the attack.

The Council on Recovery offers prevention, education, treatment, and recovery services for women experiencing alcoholism, drug addiction, and co-occurring mental health disorders. Contact The Council today to get help.

The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey – Part 60

In the process of doing these Notes, I keep coming back to the Odyssey, by the ancient Greek poet Homer, as a particularly rich text with many stories that fit the parallel of our own individual journeys to Sobriety. The companion piece to the Odyssey is the Iliad, which is the definitive story of the key closing events of the monstrous Greek war with Troy, the powerful kingdom on the western edge of modern day Turkey. In many ways, the Iliad is about men in war, the men of the various Greek states locked in a mad, addictive rage over deep resentments against their enemy, the people of Troy.  It has all the elements of an epic military struggle in which its protagonists are locked in a berserk-like confrontation.  In this sense, it is very similar to the states of our own being when we were mired in our own diseases, engaged in insane actions and behaviors induced by various substances and actions.

But the Odyssey, on the other hand, can be seen as a parallel to the long process of recovery in which all of us are steeped.  It is the story of the men of Greece trying to recover from the excesses of the Trojan War and find their way home to lives of peace and family.  Odysseus, who was the key figure in the final conquest of Troy, is the central figure of the Odyssey.  His part in the conduct of the war put him in the center of this analogous process of recovery.  We can see his journey home, which was the longest and most tortured of all the Greek leaders, as particularly intense when compared to the events in our own processes of recovery.

Odysseus’ journey takes him to many places with encounters of both intense danger and beautiful delight. Of these encounters, three key ones are, first, with the beautiful Calypso who detains him for 7 years as her lover and offers to make him immortal; then with Circe, the enchantress, who tries to enslave him, but eventually gives him the key to find his way to Hades where he gets the information he needs for his continuing journey; and lastly Nausicca, the young maiden who convinces her father, the King of Phaeacia, to equip Odysseus for the last leg of his journey home. Forgetting about the romantic elements of the first two of these, what Odysseus is receiving from these goddess-like personages are the wonderful elements of nurturing and recovery that will enable him to return as an authentic ruler of his homeland. In a sense they are much like what we learn in our tireless working of the fourth to ninth steps of our own recovery.

In many ways, I see one of the key themes of the Odyssey story as that of the futility of war and all the elements of war.  His journey to Hades, where he meets many of his fallen comrades from the war is very poignant here. Achilles, the key player in the Iliad story, tells him that all of the glory of his life as a warrior was all for naught.  He would take one day as a simple common man for all his years of glory as a warrior.  Similarly, Odysseus’ stay in Phaeacia at the urging of Nausicca results in his telling his long grim story to an assemblage in court, much as we do in our Steps 4 and 5. 

The message for all of us here is to see our recovery, our getting sober, our going to meetings, our working the steps, and our immersing ourselves in service to the cosmos, as a journey so very similar to Odysseus’. It is one where all of our encounters, all the people we meet, all the friends we make, all the advice and direction we seek of our mentors in recovery form a spectacular web for a life in the sunshine of the spirit, just as all of Odysseus’ adventures made him a much more authentic ruler of his homeland once he got there.

Episode 4 Trailer: Who Answers the Desperate Phone Call for Help?

When people are suffering from the diseases of alcoholism or drug addiction, sometimes there’s a moment of desperation or clarity in which they will ask for help. When they or their loved ones reach out for that help, there’s a dedicated team of professionals, whose stories are seldom told, that form a critical lifeline to treatment and hope. Episode 4 tells the stories of those unsung heroes who answer the calls for help day in and day out, one call after another. Their patience, tolerance, compassion, and ability to not only ask the right questions, but also to provide meaningful feedback, is something few people ever see. Yet, taking that call, and it may be the only call someone in crisis makes, can mean the difference between hope and despair, life and death. Follow Howard Lester behind the scenes as he  takes an inside look at the people in the front-line people in the battle against the diseases of alcoholism and drug addiction.

Individuals can get help for alcohol use and PTSD at the same time: A movement toward integrated treatment approaches

The following article was recently published on the research page of the Recovery Research Institute website. The study indicates that individuals with post-traumatic stress disorder (PTSD) are at increased risk of having co-occurring alcohol use disorder. However, it is not known whether the first-line treatment for PTSD (i.e., prolonged exposure therapy) is also effective in reducing problematic drinking. This study replicated prior findings suggesting prolonged exposure therapy is superior in treating PTSD symptoms, but was not more effective in reducing heavy drinking days than an intervention intended primarily to increase coping skills. However, findings from this study do challenge the notion that alcohol use disorder may be a barrier to receiving gold-standard treatment for PTSD. 

WHAT PROBLEM DOES THIS STUDY ADDRESS?

The alcohol industry has long faced a difficult public relations dilemma. Though many individuals enjoy using alcohol with little or no consequence, for many others, alcohol causes significant emotional, physical, and interpersonal harm. At a population level, alcohol use has a prodigious, adverse social and economic impact. In order to mitigate the perception that the alcohol industry is profiting from suffering, and at times because of government pressure, in many countries major alcohol producers have voluntarily funded public awareness campaigns about the harms of excessive alcohol use. Critics, however, have argued that such voluntary measures are doomed to fail because they involve companies engaging in activities and policies aimed at reducing the harmful behaviors on which their profitability depends. In essence, these companies have a major conflict of interest. 

The alcohol industries in England and the United States have often played down the extent to which profits are driven by excessive use of their products, in spite of evidence from several countries that alcohol consumption is concentrated within a minority of heavier drinkers. The present study explored whether such findings are also true for England. Specifically, the authors asked: 1) What proportion of alcohol sales revenue is accounted for by people drinking more than government recommended guidelines for low-risk drinking (in the UK no more than 14 standard drinks per week, where a standard drink is equal to 7.9g of pure alcohol. This is considerably less than in the U.S. where a standard drink is equal to14g of pure alcohol – almost twice as much). 2) How does financial dependence on heavy drinkers vary between different sectors of the alcohol industry? 3) How would alcohol sales revenue be affected if everyone’s consumption fell to within guideline levels? 

This research has implications not just for public health policy, but for the millions of these heavy drinkers with alcohol use disorder in England, and countries like the United States.

HOW WAS THIS STUDY CONDUCTED?

This paper uses data from the UK Office for National Statistics’ Living Costs and Food Survey and the National Health Service’s Digital Health Survey for England. The Living Costs and Food Survey is distributed to households on a continuous basis throughout the year and asks each individual aged 16 years and over to keep a detailed diary of their daily expenditure over a 2-week period. For alcohol, the survey provides transaction-level data on beverage type (e.g., beer, cider, wine, spirits), price paid, and volume of product purchased. The survey also asks where the alcohol was purchased; either in a hotel, restaurant, or bar (known in the UK as on-trade sales), or from an alcohol retailer like a liquor store (referred to in the UK as off-trade sales). The authors pooled data from the 2013 and 2014 iterations of the survey, comprising a total of 9,975 households. 

The Health Survey for England is a large, nationally-representative survey of 16,872 individuals (2013 and 2014 pooled) which records self-reported ‘typical’ consumption by beverage type. Coverage of total alcohol purchases relative to estimates from more robust national accounts and sales data is approximately 60% (compared to 40% for the Living Costs and Food Survey), suggesting people markedly under-report their alcohol use. 

Drinking groups were defined according to UK government guidelines. ‘Moderate’ drinking is consumption below or equal to 14 standard drinks per week for both sexes, with a standard drink in the UK equaling 7.9g or 10ml of pure alcohol. ‘Heavy’ drinking refers to consumption above this level. Within the ‘heavy drinking’ category, the authors further distinguished ‘hazardous’ (15–35 units for women, 15–50 for men) from ‘harmful’ (36+ for women, 51+ for men) drinking, based on government guidelines.

WHAT DID THIS STUDY FIND?

The authors found that on the whole, the bulk of alcohol sales in England in 2013/14 were to individuals drinking excessively. An estimated 77% of alcohol was sold to drinkers consuming above guideline levels: 30% to harmful drinkers and 48% to hazardous drinkers. Further, alcohol consumed in excess of the guideline levels (i.e., those drinking 14 or more standard UK drinks per week) accounted for 44% of all sales.

Moderate drinkers (i.e., those drinking 14 or fewer UK standard drinks per week), who represented an estimated 59% of the population, were estimated to consume only 23% of all alcohol and accounted for only 32% of all revenue (Figure 1). The 21% of the population who were hazardous drinkers consumed an estimated 48% of all alcohol and accounted for an estimated 45% of all revenue. A relatively small group of harmful drinkers, comprising 4% of the total population, consumed almost a third (30%) of all alcohol sold in England, and accounted for nearly a quarter (23%) of all alcohol sales revenue.

Figure 1. Source: Bhattacharya et al., 2018.

Figure 1. Volume and value of alcohol sales by consumption level in England, 2013/14. The first column represents the makeup of the entire English population by drinking behaviors. The second column shows what percent of alcohol consumed in England was accounted for by each category of drinker. The third column shows the percentage of alcohol revenue accounted for by each category of drinker. As illustrated in this figure, in spite of making up only 25% of the population, hazardous and harmful drinkers accounted for 78% of alcohol consumption and 68% of alcohol revenue. 

In terms of differences between on-trade (i.e., in a hotel, restaurant or bar) and off-trade (alcohol retailors), 81% of off-trade revenue was estimated to come from those drinking above guideline levels (Figure 2). The corresponding amount was substantially lower (60%) for on-trade sales, although heavy drinkers also still accounted for the majority of sales revenue, highlighting the fact that hazardous and harmful drinkers accounted for the majority of both retail and bar/restaurant sales.

Figure 2. Source: Bhattacharya et al., 2018.

Figure 2. Proportion of revenue from harmful, hazardous and moderate drinkers by beverage types and retailer in England in 2013/14. On-trade refers to hotel, restaurant, or bar sales; off-trade refers to alcohol retailors. 77% of beer expenditure was estimated to come from drinkers consuming above guideline levels, compared to 70% for cider, 66% for wine and 50% for spirits. Hazardous and harmful drinkers accounted for the majority of on-trade and off-trade alcohol sales. 

The authors also report that should alcohol consumption be reduced to low-risk levels suggested by the UK government (i.e., 14 or less standard drinks per person, per week), the alcohol industry would stand to lose 38% of their current revenue (Figure 3). In absolute terms, this implies that the industry’s market value would fall by £13 billion (approximately US$17 billion).

Figure 3. Source: Bhattacharya et al., 2018.

Figure 3. Predicted percentage decline in alcohol revenue in England if alcohol consumption were to fall to government guideline levels for low-risk drinking (i.e., 14 or less standard drinks per person per week). Percentage declines in revenue are broken down by point of sale (on-trade versus off-trade), and alcohol category (beer, wine, etc.), as well as point of sale type crossed with alcohol category (in box, bottom right of figure). Altogether, the alcohol industry in England would stand to lose 38% of its revenue if everyone drank in accordance with government guideline levels for low-risk drinking.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Findings indicate the alcohol industry in England derives a large portion of its profit from excessive and/or problem drinkers. Given the consistency of this finding with similar research in Australia and Brazil, it seems likely that such a study conducted in the United States would find similar results. These findings raise serious questions about the conflicts of interest arising when an industry reliant on hazardous and harmful drinking is allowed to self-regulate and manages its public image with largely ineffective ‘safe drinking’ mantras (e.g., “Drink responsibly”). These findings also reinforce the need for strong alcohol sales policy, which has been shown to have real impact on problem drinking. Moreover, in so far as they suggest that a financially successful alcohol industry of its current size and form depends upon harmful drinking, the UK government’s economic support for alcohol producers, for example through tax cuts and trade negotiations, appear more problematic. These findings may also have relevance for ongoing debates about whether to restrict alcohol sales to state monopolies or open them up to commercial enterprises.

LIMITATIONS

  1. The authors’ analysis is taken from self-reported survey data, which tends to underestimate alcohol consumption. Their approach assumes implicitly that all sections of the population under-report their drinking in the same proportion. If anything, this probably underestimates the alcohol industry’s full reliance upon the heaviest drinkers, who are less likely to be represented in surveys.
  2. The analyses do not distinguish between specific companies. The degree to which any individual company benefits from sales to heavy drinkers is therefore unclear.

BOTTOM LINE

  • For individuals and families seeking recoveryHarmful and hazardous drinkers drive the bulk of English alcohol sales; a finding observed in other countries and presumed to be the same in other Western countries like the Unites States.
  • For treatment professionals and treatment systemsHarmful and hazardous drinkers drive the bulk of alcohol sales in England, and presumably other Western countries as well. Allowing the alcohol industry to design and self-monitor its own public health messaging regarding harmful/hazardous drinking represents a major conflict of interest. An industry that is financially reliant on harmful/hazardous drinking is unlikely to implement measures sufficient to curb problematic alcohol use.
  • For scientists: Harmful and hazardous drinkers drive the bulk of alcohol sales in England. The questions addressed by this research need to also be asked in the United States. Further, more research on the extent to which the alcohol industry has, in the past, mitigated volume declines by raising prices and selling more premium products would provide an indication of how sustainable such a strategy is likely to be in the long term. A further possible extension would be to explore the tax revenue generated by the government from excise duty on harmful drinkers, and the extent to which that tax revenue helps address some of the consequences of alcohol use disorder (e.g., funding publicly available treatment and recovery support services).
  • For policy makersAlcohol use and alcohol use disorder cost Western economies hundreds of billions of dollars annually and cause tremendous personal and societal harm. The alcohol industry profits directly from this problem. The alcohol industry’s conflicts of interest highlighted in this paper should be considered when creating and enforcing alcohol policy.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Individuals with PTSD are more likely to have an alcohol use disorder than individuals in the general population. One representative survey of adults in the United States found individuals with PTSD were 1.2 times as likely to have an alcohol use disorder in their lifetime than those without PTSDPTSD is also associated with a more problematic course of alcohol useincluding greater difficulty quitting, briefer abstinence periods, and more associated medical, legal, and psychological consequences. These disparities in alcohol use outcomes in individuals with PTSD underscore the need to identify treatments that are effective in treating both symptoms of PTSD as well as problematic alcohol use. To address this need, Norman and colleagues studied the immediate, 3-month, and 6-month outcomes among 119 adult veterans with co-occurring PTSD and alcohol use disorder who received one of two competing treatment approaches. The table below outlines key components of each treatment approach. The first treatment, called Concurrent Treatment for PTSD and Substance Use Disorder Using Prolonged Exposure, or “COPE,” was integrated with prolonged exposure therapy that involves 1) helping individuals gradually approach trauma-related memories, feelings, and situations, and 2) relapse prevention for alcohol use disorder using cognitive and behavioral therapeutic techniques. The second tested treatment, called Seeking Safety (an empirically-supported treatment for co-occurring PTSD and substance use disorder), was a present-focused coping intervention that aimed to teach individuals skills to cope with both symptoms of PTSD and alcohol use disorder. The ultimate goal of this research study was to determine which treatment modality was most effective in supporting the recovery of individuals living with both PTSD and alcohol use disorder. 

Figure 1. Chart comparing the features of both the COPE and Seeking Safety treatment approaches, including general timeframe of treatment, and specific therapy techniques.

HOW WAS THIS STUDY CONDUCTED?

Study authors examined 119 adult veterans (90% male, average age of 41 years, 66% White) with current symptoms of PTSD who were receiving care at the San Diego Department of Veterans Affairs (VA). While individuals were encouraged to avoid other treatment for their PTSD, they were able to receive standard mental health treatment at the VA while participating in this study. For example, 65% were taking psychotropic medication during the study. Participants also needed to have current alcohol use disorder, at least 20 days of heavy alcohol use (see below for heavy drinking definition) in the past three months, and a stated desire to quit or cut back on alcohol use. Participants were randomly assigned to receive either 12-16 90-minute sessions of COPE (i.e., integrated prolonged exposure therapy) or Seeking Safety (i.e., coping skills–focused therapy). Sessions were administered preferably once to twice per week on consecutive weeks, but could span across a 6-month period of time. 

Participants completed assessments of PTSD symptoms and problematic drinking behavior after treatment and at 3- and 6-months posttreatment, and these assessments were administered by study staff who were not aware of (i.e., “blinded” to) the treatment received.The Clinician Administered PTSD Scale for DSM-5 (CAPS-5) was the primary measure used to quantify PTSD symptoms and diagnosis, with scores >=12 suggestive of a PTSD diagnosis (range: 0-80). Frequency and quantity of alcohol use were ascertained via a calendar-based interview (i.e., Timeline Follow-Back), which was used to deduce A) the percent of heavy drinking days defined as the number of days in which 5 or more drinks for men or 4 or more drinks for women were consumed since the last assessment, and B) percent days abstinent for alcohol. A breathalyzer was administered to any participant who appeared intoxicated. 

WHAT DID THIS STUDY FIND?

PTSD symptoms declined more in veterans who received integrated prolonged exposure therapy compared to the present-focused coping intervention.

PTSD symptoms improved over time regardless of therapy assignment; however, the COPE group improved more than did the Seeking Safety group. Immediately after treatment, over 20% of individuals went from having a PTSD diagnosis to no longer meeting criteria for the condition (“remission”), compared to only 7% in the present-focused coping intervention. The advantage for the COPE group became slightly weakened over time but was nevertheless maintained; the greater PTSD symptom gains for the COPE group were still present 6 months after completing treatment.

Figure 2.

Drinking outcomes improved similarly across treatment groups.

All participants showed reductions in the percent of heavy drinking days over time, though the extent of decrease was similar in those who received integrated prolonged exposure and the present-focused coping intervention. Findings were similar – both groups displayed similarly improved drinking – when the outcome was percent days abstinent as well.

Figure 3.

Figure 4.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

This study is responsive to the urgent need to identify treatments that are effective in mitigating both symptoms of PTSD and alcohol use disorder, the co-occurrence of which is both highly common and linked with greater negative outcomes compared to either disorder alone. Findings from this study build upon a robust literature suggesting that prolonged exposure therapy is the gold standard for mitigating PTSD symptoms. Importantly, this study demonstrates that prolonged exposure therapy is effective even among individuals with an active alcohol use disorder. This study, plus a growing body of literature, challenges a commonly held belief that individuals with alcohol use disorder cannot tolerate exposure-based approaches, addressing the notion of alcohol use disorder as a potential barrier to receiving widely–supported, evidence–based therapy for PTSD.

Contrary to the authors’ hypotheses, however, prolonged exposure therapy was no more effective in reducing problematic alcohol use than the present-focused coping intervention. The fact that this PTSD reduction benefit did not translate into lower problematic alcohol use suggests that, whereas some PTSD patients may have initially drunk (and still drink) alcohol to help “medicate” the distress caused by PTSD, for many others, the alcohol use may persist fairly independently of PTSD. Although group differences were not found with regard to drinking use, it is notable that both groups showed significant reductions in drinking over time, suggesting that simultaneous treatment for alcohol use disorder can be integrated into the framework of PTSD treatment without interfering with the treatment of PTSD itself. Future studies are needed to determine which PTSD treatment modalities may have the most beneficial impact on drinking behaviors. Some findings from other groups provide promising preliminary support for approaches that involve teaching individuals to challenge and modify maladaptive beliefs (cognitive processing therapy and cognitive behavioral therapy) and guided eye movements with the goal of diminishing negative feelings associated with traumatic events (eye movement desensitization and reprocessing therapy).LIMITATIONS

BOTTOM LINE

  • For individuals and families seeking recoveryThis study demonstrated that the simultaneous attention to both PTSD symptoms and alcohol use disorder is possible, and attention to both disorders in an integrated treatment approach is linked with improved functioning. Therefore, patients with both conditions should feel empowered to have both PTSD symptoms and problematic drinking behavior as treatment targets that can be addressed in tandem rather than in parallel. This is comparable to other studies that find integrated approaches to be successful in cases of co-occurring substance use and other neuropsychiatric disorders such as depression and ADHD
  • For treatment professionals and treatment systemsPatients with PTSD and alcohol use disorder benefitted from integrated treatment approaches. Findings suggest that individuals with comorbid PTSD and alcohol use disorder should not be excluded from receiving front-line PTSD treatment on account of their untreated alcohol use. Rather, alcohol use should be identified as a core treatment target and addressed in tandem with PTSD. Further work is needed, though, to determine the most effective treatment modality for addressing problematic alcohol use in the context of PTSD.  
  • For scientists: Findings point to the efficacy of prolonged exposure therapy, even in the presence of co-occurring alcohol use, in mitigating symptoms of PTSD. While findings suggest a reduction in heavy drinking days, this effect was not specific to the therapeutic approach of prolonged exposure therapy. This finding does not align with “self-medication” as a maintaining condition for alcohol use disorder, at least for some. While more work is needed to determine the most effective approach for reducing alcohol use among PTSD patients, this study represents an important first step in decreasing barriers to access to empirically-validated and integrated treatments. Additionally, while prolonged exposure therapy is commonly viewed as a gold standard approach for trauma treatment, retention particularly in real-world settings is often low. Co-occurring substance use has been found to be one patient factor robustly associated with dropout. Therefore, future studies aimed at enhancing engagement and retention, especially among patients with co-occurring disorders, is critical for the widespread dissemination of this approach. 
  • For policy makersFindings lend preliminary support for the efficacy of integrated treatment approaches, which runs contrary to the outdated, yet still pervasively present notion, that substance use disorders need to be fully remitted prior to the treatment of co-occurring other mental health concerns (e.g., PTSD, depression, anxiety disorders). Integrated treatment approaches that allow for substance use disorders and other mental health disorders to be addressed simultaneously will undoubtedly decrease barriers to treatment access for the large proportion of patients seeking recovery from multiple conditions. Therefore, it is imperative that clinician trainees and all patient-facing staff in mental health facilities receive proper education and training in issues related to substance use disorders. Such training may involve early identification of problematic substance use and management of acute signs of overdose. Additionally, as demonstrated in this study, it remains unknown which integrated treatments are optimally effective in treating substance use disorders in the context of PTSD and other co-occurring mental health conditions. Therefore, the field would benefit from continued funding to support research on novel treatment development and evaluation.  

CITATIONS

Norman, S. B., Trim, R., Haller, M., Davis, B. C., Myers, U. S., . . . Mayes, T. (2019). Efficacy of integrated exposure therapy vs integrated coping skills therapy for comorbid posttraumatic stress disorder and alcohol use disorder: A randomized clinical trial. JAMA Psychiatry, (Epub ahead of print). doi: 10.1001/jamapsychiatry.2019.0638 

The Council on Recovery is the leader in providing a wide range of prevention and education resources aimed reducing alcohol use, especially among adolescents and young adults. We also offer therapeutic counseling and an intensive outpatient treatment program (IOP) for those affected by alcoholism. For more information, please call 713-942-4100 or contact us online.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 59

Guest Blogger and long-time Council friend, Bob W. presents Part 59 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

For those of us who have achieved a certain level of committed sobriety, i.e., multiple years of living and working actively in the Fellowships of AA and its sister programs, we begin to find ourselves moving into a realm of peace and serenity that seems other worldly. We still must face the normal struggles of life and we experience crises and trauma with friends and family that challenge our sense of presence, but there is a growing calm in all of it.  We have learned that staying in the here and now of today, avoiding the tendency to obsess about outcomes, gives us an inner peace and a power to face the world with grace and resolution.

The journey to this state, for each of us, was as mythic as all the great stories of literature and history. At the depths of our bottoms, we may have felt like Edmund Dantes in the dungeons of Chateau d’If, in The Count of Monte Cristo…alone, cold and dissolute in the deep recesses of that dreaded island prison in the Bay of Marseilles.  The feeling of hopelessness, doom and isolation was overwhelming.  As in the story, fellows like Abbe Faria, a fellow prisoner for Dantes, may have given us a process to begin the journey of relief.  Also like Dantes, the journey may have been long; our own “rocketing into the Fourth Dimension” may have progressed much less like a rocket than a speed akin to the Lexington Avenue Local.

The working of the Steps, the constant renewal of self-examination, a continual reinforcement of the focus on a Higher Power, and an untiring commitment to service elevate our personal psyches to an unusual extent.  We begin to feel, slowly and purposefully, a deep need to focus on service, service to all things and to all people, service that is an unflinching, almost unconscious, process attending each and everyone one of our daily waking moments.

I have come to see this evolving state of consciousness to be an unusual spiritual presence, one that speaks to a new and enlightened way of being in the world, for all of us, individually and collectively.  To have come from those terribly dark and hopeless places of our disease, to work along a journey of love and commitment, to and from our fellows in the programs, in our journey to sobriety, and then to arrive at a point where uncompromising and selfless service becomes the primary focus of our lives, is truly mythic…and maybe it is so deeply mythic that it begins to defy imagination.

Our alcoholism may have provided us with a “dark portal” to a life that will take generations for all of us to fully understand.

As Addiction Boils Over, Expert Advice for Saving Your Kids’ Lives

The opioid epidemic is boiling over. Addiction, including alcoholism, is killing hundreds of thousands and destroying millions of lives. Especially tragic is addiction’s ravaging effects on teenagers and young adults. Their developing brains are being chemically altered by drugs and alcohol. That’s creating a whole new generation who will suffer from addiction. Many will die. Parents everywhere are looking for solutions to save their kids. They are desperately seeking an understanding of how and why addiction occurs. But more importantly, what can be done right now to save their children’s lives? We take you inside the problem and shine light on immediate and effective solutions. We talk with Lori Fiester, a highly-regarded clinical therapist and well-known mental health and addiction expert. She has helped thousands through her knowledge, compassion, and commitment in the field of recovery. By the end of this podcast, you will have the information, ideas, and inspiration you need to help save the lives of people you love….Or maybe your own.