3 Surprising (and Dangerous) Truths About Opiate Addiction

By Eric Schmidt

MedsIt’s been almost a month since the U.S. Centers for Disease Control hosted the National Rx Drug Abuse Summit in Atlanta, GA. There, some surprising truths about opiate addiction were unveiled. For instance, deaths due to prescription opiate overdoses have quintupled since 1980. In the previous decade, there were 125,000 deaths due to painkiller overdose. And, according to the CDC, for every overdose death, there are 115 people addicted to prescription painkillers, 26 emergency room visits, and $4.35million in healthcare costs. Still, every day at New Roads Behavioral Health, we see misconceptions and, frankly, minimizations about exactly what these prescription drugs are, how they are used, and what consequences are experienced.

Let’s set the record straight. Here are 3 truths about opiates and opiate addiction:

1. Long-Release Pills Offer Extra Overdose Opportunity

The FDA recently approved the controversial drug Zohydro, an extended-release opiate pain medication. In theory, it would allow a patient to take one big pill that would slowly release enough medication to mask pain for many hours. In practice, there may be a different story. We, as a field, have known for years that long-acting medications, like Methadone and in this case Zohydro, increase the chances of accidental overdose. It comes down to the half-lives of the drugs. They stay in our system for longer periods of time than what addicted people are used to. An addicted person is used to a very quick physical response, a “high” that dwindles rather quickly. When that euphoria dissipates, the addicted brain begins to crave, leading to immediate use. Unfortunately, in the case of these longer-acting drugs, there is still a significant amount in the person’s system, though the person does not recognize it. They then use another opiate to achieve the euphoria, which increases the risk of overdose. This led more than 40 health care and addiction groups to pen a letter pointing out that Zohydro is a “whopping dose of hydrocodone packed in an easy-to-crush capsule.” By crushing and snorting or injecting the pill, it’s all too easy to transform an extended release of low-dose medication into an immediate overdose. Again, the effects of a drug when used properly should not only consider drug approval, but also its potential for misuse. This is a big one: pills that are meant to dissolve over 8 hours can be snorted or injected in less than 8 seconds.

2. Dependence is a Multifaceted Disease

Dependence, as it’s described in the Diagnostic and Statistic Manual, affects multiple aspects of a person. It is physiological at its core. But the physiological or biological components of the disease drive compulsive addict behaviors. Physically, your body wants to feel “normal”. It constantly strives for homeostasis — that’s why your temperature stays at 98.6 degrees. It is also why, after extended opiate use, more of the drug is needed to achieve the same effect. Over time, the body adapts to the drug hanging out in its system and a new “normal” is created. When the amount of drug needed for this new normal is stopped, the body goes through the withdrawal process. The addicted person not only experiences withdrawal symptoms in the absence of the drug, but also compulsively seeks the drug in order to avoid these symptoms.

3. Prescription Drugs Cause More Deaths than Heroin and Cocaine Combined

The truth is that a pill synthesized in a laboratory and provided by a doctor can kill someone just like someone injecting a drug with a dirty needle in a back alley. The National Institute on Drug Abuse reports that accidental overdose deaths due to prescription opioids now outnumber the deaths due to heroin and cocaine combined. One reason prescription drugs are so dangerous is that users don’t respect them the way they might respect heroin or a drug with an uglier reputation. For example, users may combine prescriptions with alcohol or other drugs, which can lead to dangerous depression of body function like respiration. Heroin may kill by its impurity, but prescription drugs kill by their assumed safety.

 

Prescription drug abuse is up. As parents, treatment providers, patients and those experimenting and therefore at risk of addiction, it’s time we knew the truth about these dangerous drugs. I hope you’ll join me in adding what you know to the comments below.

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Eric Schmidt is the CEO of New Roads Treatment Centers, affordable drug treatment programs for young adults.

Image: Charles Williams via Compfight



How Teen Social Life Affects Drug Abuse (And How Drug Abuse Affects Social Life)

By Eric Schmidt

237/365 Bittersweet [explored]What do you picture when you think of teen drug abuse? Is it parties at the home of an out-of-town parent, or sneaking drinks from the family liquor cabinet, or hiding in a bedroom with a “no parents allowed” sign on the door while slipping deeper and deeper into addiction? The fact is all of these are models of adolescent use, and a study published in the journal Psychopharmacology shows a common denominator: when a teen’s social life turns south, drug abuse can follow. The opposite is also true, that drug abuse itself can destroy a teen’s otherwise successful social life.

In many cases a socially awkward teen uses drugs in the mistaken hope that substances can fill the hole left by an unfulfilling social life. Unfortunately, this is true for many teens dissatisfied with their social group or lack thereof. They find acceptance in the group of kids using drugs.

Conversely, there are many teens who enjoy a healthy social life, but derail when they begin using. These teens often turn to drug use to feel better about something in their lives, such as dealing with anxiety, depression, grief, etc. Typically, this strategy only makes a teen feel worse, which leads to ever-increasing drug use. Like the above group these teens will eventually gravitate towards others that are using, leaving them in a social group that creates now further stress and disappointment compared to their previous group.

The study starts by pointing out that animals from mice to humans define themselves by social interactions – good social interactions reinforce our sense of self-worth and bad social interaction undermine this sense of self-worth. So we seek out positive social interactions: mice will choose the arm of a maze that lets them interact with a playful rather than drugged peer and the authors point out that teenagers’ “social play” helps them form opinions about themselves.

Drugs change teens’ desire and ability to be social up to a certain point and depending upon the drug of abuse. Opiods and alcohol make teens more social and cannabinoids and stimulants make teens less social.

First, all flavors of disruptive behavior disorders, including anti-social personality disorder, conduct disorder and oppositional-defiant disorder, go hand-in-hand with addiction. All of these disorders can decrease confidence and the ability to assess social cues. Subsequently, children and teens who struggle these disorders (and the disorder’s affect on the ways they relate to others) are more than twice as likely as their peers to develop substance abuse problems, and tend to start earlier and use more aggressively.

Social isolation is also a major risk factor for teen drug abuse. In fact, the authors write that isolation “changes the neural substrate of reward and motivation.” The brain of a socially isolated teen measures risk and reward differently than a social teen, making isolated teens more sensitive to the rewards of drugs. The researchers even show that socialization and drugs work on the same pathways within the brain: drugs are literally a way to attempt to get the neurobiological feeling of social connection.

But not all socialization is good. The authors put it this way: “Social insults in early life increase later drug taking.” So be careful when pushing an isolated teen into socialization: healthy socialization may be one of the most protective factors against teen drug use, but negative socialization (i.e. being bullied or socializing with a drug-using peer) is a major risk factor.

Here are the takeaways: If you are a teen, explore what motivates your drug use – substances are no substitute for social connection. If you’re the parent of an experimenting teen, know that isolation and negative social interactions may be your biggest enemies. But also know that encouraging or designing positive social experiences for your teen is one of the best ways to protect against drug abuse.

Eric Schmidt is the CEO of New Roads Treatment Centers, affordable drug treatment programs for young adults.

Image courtesy of martinak15 via Compfight



Study Shows That Knowing Why You Drink Can Help You Pick the Best Strategy to Stop

By Eric Schmidt

Sad.DrinkingDo you drink to have fun or do you drink to cope? In other words, do you drink because you want something positive or because you’re trying to avoid something negative? A recent article in the journal Addictive Behaviors shows that successful quitting strategies are very different for drinkers motivated by “approach” than for drinkers motivated by “avoidance”.  The article also asserts that knowing the reason you drink can help you quit.

On the other end of this spectrum is something the article calls “alcohol protective behaviors” – the strategies many people prone to problem drinking use to keep themselves in check, or at least attempt to. Just like drinking motivations come in two major types, there are two major categories of alcohol protective behaviors: strategies to guard against over-consumption and strategies that find alternatives to drinking. For example, you might limit your consumption by self-imposing a three-drink maximum, or your might find an alternative to drinking by going to a movie instead of a bar.

Picture the “approach” and “avoidance” drinking motivations as your car’s gas pedal.  They are the things in your life that get you moving towards drinking.  Conversely, keeping with the analogy, consider the alcohol protective behaviors as the brakes.  These behaviors create self-imposed limits so that you do not over-indulge or indulge at all.

Now here’s the important and scary part: drinkers motivated by avoidance are terrible at respecting the boundaries of consumption-limiting alcohol protective behaviors. Partly because these drinkers consume to avoid unwanted feelings.  They are more motivated by reducing the discomfort or using the alcohol to create a delusion the feelings are not there.  They are more likely to drink alone so, without social pressure they might find in a bar, they tend to blow right past the limits they set for themselves.

The study shows that avoidance-motivated drinkers, unfortunately, are most likely to specifically use the first type of alcohol protective behaviors – those doomed-to-fail consumption-limiting alcohol protective strategies.  Instead, the study shows that avoidance-motivated drinkers (again: people who drink to cope) are most successful when they use the second protective strategy: choosing alternative activities to drinking.

Now you see the problem: avoidance-motivated drinkers try to limit consumption, it doesn’t work, and they specifically avoid the strategy that would work, namely choosing alternative activities. Remember, these people are highly attracted to numbing unwanted feelings.  This trumps the desire to embrace alternative activities.

This finding is especially important in the context of the many early intervention programs that teach the use of alcohol protective behaviors. Which protections should these centers recommend? It seems the answer depends on the individual reasons people struggling with addiction choose to drink. Specifically, for people who drink to cope, it may be best to focus on alternative activities rather than strategies to limit high-risk drinking.  Thus, it is imperative that early-intervention programs help people discover their motivations to take that first drink – avoidance or approach.

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Eric Schmidt is the CEO of New Roads Treatment Centers, affordable drug treatment programs for young adults.



Study Shows Drinking is Even More Contagious Than You Thought

By Eric Schmidt

Beer.BottlesIt’s no secret that drinking is contagious: if your friends are binging or abstaining, there’s a good chance you’ll follow suit. But a fascinating study on early view at the journal Alcoholism: Clinical and Experimental Research shows just how far this influence goes – and also shows that the social effect on alcohol consumption happens largely outside of our awareness.

Continue reading… »



Mindfulness Offers Young Adults the Same Protection Against Substance Abuse as Positive Parenting

By Eric Schmidt

MindfulnessNobel-Prize-winning economist Daniel Kahneman considers your decisions a balance of two brain systems – system one is fast and intuitive; system two is slow and logical. In addiction, think of this like “want” and “should”. System one wants a substance and system two knows you shouldn’t. A study on early view at the Journal of Counseling Psychology shows how young adults can override system one so that you or your loved one can stay sober. Specifically, there are two ways: a strong connection with a parent and/or a young adult’s mindfulness. Mindfulness, at its essence, connects or synthesizes the two systems described above so that the person practicing the mindfulness makes more wise decisions.

Continue reading… »



JAMA: Mindfulness-Based Relapse Prevention Beats CBT and 12-Step

By Eric Schmidt

GandTHave you ever tried counting to ten? Not in a superficial way in which numbers spool through your mind like a stock market ticker, but really counting to ten – slowly and without letting other thoughts creep in?  Try it. It’s surprisingly hard. If you made it to double-digits without thinking about everything else you have to do today or whether there might be another splash of coffee still in the pot in the kitchen, you’re farther along the path of mindfulness than I am.

Simply, mindfulness means attending to experiences in the moment in a non-judgmental state of awareness; it means recognizing, processing and managing your experiences. And a study published in the March issue of the Journal of the American Medical Association (JAMA) shows that mindfulness-based training may be the best way to avoid relapse after substance abuse treatment.

But before we get to mindfulness, let’s take a quick look the two major models of relapse prevention currently in use. First, the strategy referred to in the study as “treatment as usual” uses 12-step programming and educational materials. And second, approaches based on cognitive-behavioral therapy (CBT) teach people in recovery from addiction to recognize and avoid cues that could trigger relapse.

But the study points out that “Shortcomings of [CBT] have been identified, including focus on avoidance-based goals vs. approach-based goals and on controlling causes of negative affect or craving vs. learning to tolerate these states.” In other words, CBT teaches people recovering from addiction what not to do and provides little resilience if impulse happens to sneak through this wall of avoidance.

So maybe there’s room for improvement? To find out, let’s take a look at what this randomized clinical trial of 286 people published in the United States’ top medical journal has to say about these three relapse-prevention strategies.

First, both CBT and mindfulness beat treatment-as-usual at the 6-month mark – both new-ish strategies delayed the time between the end of treatment and first drug use (i.e. relapse), and also resulted in fewer heavy drinking days in people recovering from alcohol addiction.  But at the 12-month mark, the benefits of the mindfulness-based training remained, whereas the protection of the CBT training sank back into the range of treatment-as-usual. By the numbers, people who received mindfulness-based training had “31 percent fewer drug use days and a significantly higher probability of not engaging in any heavy drinking,” a year removed from the end of inpatient treatment, the authors write.

The researchers from the University of Washington Center for the Study of Health and Risk Behaviors point out that the difference may be in the distinction between trained reactions and real, long-term behavior change. CBT teaches people to recognize and manage external cues. For example, you’ve probably heard about the famous experiment in which a dog is trained to drool at the sound of a bell; CBT relapse prevention strategies teach people in recovery to avoid the bell. But mindfulness teaches people to recognize and manage internal cues – it teaches you to hear the bell but to manage the impulse to drool.

The researchers say it this way: “Mindfulness-based treatments teach patients to remain in contact with and relate differently to challenging affective or physical states, use alternatives to avoidant-based coping, recognize underlying reasons for maladaptive behaviors, and identify and increase contact with natural contingencies.”

Again, the major difference is avoiding cues that could create relapse (CBT) vs. managing the internal states that crave relapse (mindfulness). And in this important study, it seems as if recovery is most effective when people learn to listen to, respect and consciously manage their impulses rather than avoiding or blunting these impulses.

After addiction, recovery requires a new way of being. And according to this research, “exposure to and acceptance of [impulses] may be mechanisms of behavioral change.”

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Eric Schmidt is the CEO of New Roads Treatment Centers, affordable drug treatment programs for young adults.

 



Welcome to Addiction Under 30

By John M. Grohol, Psy.D.

Addiction is a hard thing to overcome, and people from all walks and ages in life struggle with it. But in some ways, it’s especially tragic when a young adult or teenager is dealing with addiction. A teenager’s brain is still under development, and battling addiction can impact their neurological growth and stunt brain connections.

We’re still learning about addiction every day, and so the science of addiction is especially important to consider.

That’s why I’m pleased to introduce Addiction Under 30 with Eric Schmidt. This blog will explore what it means to be addicted and the process by which addicted young adults can become well. Eric has worked in the behavioral health and substance abuse field for the past 20 years. You can learn more about him here.

Please join me in giving Eric a warm Psych Central welcome!



 
 

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