by Justin Mckibben | Apr 15, 2019 | Addiction Stigma, Big Pharma, Celebrity, John Oliver, Opioids, Prescription Drugs
John Oliver VS Big Pharma
This is definitely not the first time John Oliver has taken on Big Pharma and the issues with the opioid crisis in America. In fact, at the start of this recent segment, he acknowledges his previous episode before setting his focus on the changes since then, or lack thereof. On another hard-hitting episode of Last Week Tonight the well-known English comedic commentator takes on the Sackler Family, Mckesson Corporation, and the failed attempts to curb the influx of prescription opioids into an already volatile environment.
A Comedian on a Mission
As a writer for The Daily Show With Jon Stewart John Oliver won an Emmy for his work with taking a comedic yet impactful look into important political and social issues. As a host on his own HBO series, Last Week Tonight, Oliver has made a name for himself by taking deeper dives into the details of certain issues. Each moment of troubling truth or eye-opening examination is balanced with jokes that are either intensely ironic or ridiculously abstract. For instance, in this latest episode, Oliver steps off the serious discussion of Big Pharma corruption to deliver a few bits about the true nature of bears, with comical and cartoon-ish visual aids.
Moreover, Oliver tends to deliver some relatively detailed arguments, regardless of the topic at hand. While some may consider him a more liberal voice in the media, with open criticism of the Trump administration and other prominent conservative voices, he also criticizes other media outlets also considered to be more liberal. Recently, we questioned CNN for their coverage on the arrest of Julian Assange.
Needless to say, his take on the opioid crisis is a sound and even hilarious dissection of everything wrong with Big Pharma and the policies that allowed them to flourish.
Taking on Distributors
First, Oliver took on companies that are responsible for dispensing drugs from manufacturers to hospitals and pharmacies. These companies are supposed to alert authorities in the event that they notice suspicious quantities of control substances being ordered. However, several have been called out in recent years for failure to fulfill that responsibility.
John Oliver begins his take on distributors by talking about the story of Kermit, West Virginia. In the year 2016, more than 3 million doses of hydrocodone were ordered in one year, by just one pharmacist, in a city of only 400 people. That is around 7,500 doses for every resident!
For some background, McKesson Corporation is an American pharmaceutical distributor based out of San Francisco. In 2018, the company revenues were counted at $208.4 billion. In 2008, the DEA claimed that McKesson had failed to properly control their controlled substances. At the time, the Big Pharma distributor was allowed to avoid any admittance of wrongdoing as long as they agreed to pay a fine of $13,250,000. They were also required to develop and implement a controlled drug monitoring program.
However, by many accounts, McKesson failed to live up to that pledge. Oliver points out that one DEA agent wrote of the company:
“Their bad acts continued and escalated to a level of egregiousness not seen before.”
John Oliver points out how the strategy of expecting pharmaceutical companies to monitor themselves seems to consistently fall short of effective. In the case of Kermit, the McKesson Corp was responsible for distributing over 5 million doses of opioids in only two years.
In 2017, McKesson ended up having to make another settlement of $150 million. However, as Oliver points out,
“Which yes, sounds like a lot… until you realize that it is less than 1/1,000th of their revenue for one year.”
Which brings around Oliver’s point about how companies who profit from the opioid crisis are dealt with. He notes that for Big Pharma giants like McKesson, paying a fine is “just the cost of doing business.”
Trouble for Purdue Pharma
Kicking off the piece of the segment about the infamous opioid empire of Purdue Pharma, Oliver notes the history of Purdue’s aggressive and egregious marketing tactics for OxyContin. The company faced massive backlash after years of marketing the opioid painkiller as a less addictive painkiller that was safe to use for the treatment of common conditions like backaches.
Here, Oliver hits us with one of the clever comparisons, reminding us that once upon a time companies used to marketing cocaine for toothaches.
Next, Oliver takes on the Sackler Family, citing a 2017 article from The New Yorker stating the family has a collective net worth of $13 billion. As the battle against corporations tied to the opioid crisis intensifies, this family name has been pulled into the fray with protests and lawsuits calling out their involvement in Purdue Pharma’s business plan. On Last Week Tonight, Oliver also takes a look at one individual from the Sackler Family in particular.
Actors Try on Richard Sackler
Richard served as President of Purdue Pharmaceuticals from 1999 to 2003 and spent several years on the board with seven other members of the family. Overall, he was with the company throughout the opioid crisis. Richard Sackler is named in several lawsuits brought by different states.
In Massachusetts, one lawsuit asserts that Richard demanded to be sent into the field with sales reps on visits to doctors. This is something John Oliver believes is in correlation with a very specific purpose. He cites statements made by Richard at a company event that the launch of OxyContin would be followed by “a blizzard of prescriptions that will bury the competition.”
Even as the imminent threat presented by OxyContin became apparent, Oliver adds that Richard Sackler pushed forward with this attitude of selling more opioids, with very little concern for the impact. In an attempt to make the points of this segment feel more meaningful, John Oliver even enlists the help of several actors to deliver quotes attributed to Richard Sackler.
First, there is the American actor and 1989 Batman, Michael Keaton. Oliver points out that when evidence was mounting that OxyContin was causing widespread addiction, Sackler urged the company to blame people suffering from addiction to take the focus off of their product. When quoting the actual words of Sackler, the amazing Michael Keaton states:
“We have to hammer on the abusers in every way possible. They are the culprits and the problem. They are reckless criminals.”
Here John Oliver acknowledges that the Sacklers and Purdue vigorously deny these claims. They insist that these quotes are being taken out of context and that they did not cause the opioid crisis.
Probably one of the most troubling revelations to come from the segment is Oliver’s argument that the Sackler family has fought hard to avoid true transparency regarding their involvement in the opioid crisis. More specifically, how the company has settled many of the lawsuits against them by demanding the stipulation that evidence is sealed and unavailable to the public. For instance, one lawsuit against Kentucky was settled on the condition that the states Attorney General destroy 17 million pages of documents pertaining to the allegations against Purdue.
A leak from this case actually included the transcript from a video deposition with Richard Sackler. While the video itself is unavailable, John Oliver again found a way to make a powerful statement by having Breaking Bad star Bryan Cranston get in on the action. Suffice it to say, the dramatization of that interview does not play very well for the Sackler in question. One part they highlight was a speech given by Sackler supposedly bragging about how quickly they had gotten the DEA to approve OxyContin. And as Oliver says, Cranston goes “full Walter White” on this video.
The segment also enlists Michael K. Williams, who famously portrayed Omar Devone Little on The Wire, to give an intense reading of the transcript. And finally, Richard Kind from Spin City and A Bug’s Life gave some goofy “I don’t know” answers from the over 100 times it was mentioned in the real deposition.
At the end of the day, John Oliver and Last Week Tonight make a call for transparency with Big Pharma companies. He acknowledges that while his show tries to find some way to laugh through the pain of the opioid crisis, it is important that more be done to hold opioid makers and distributors accountable. This seems to be a growing sentiment, as the Sacklers prepare to face numerous lawsuits. More lawmakers, public health officials, and advocacy groups are calling for transparency and culpability for any business that profited from the opioid crisis. Meanwhile, the fight against addiction and overdose death rates continues.
For those who are struggling, comprehensive addiction treatment is a vital resource to overcoming opioid addiction. If you or someone you love is suffering, please call toll-free now. We want to help.
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by Justin Mckibben | Apr 9, 2019 | Addiction, Alcohol, Alcohol Addiction, Alcoholism, Binge Drinking, Underage Drinking
Help for Today, Hope for Tomorrow
While the first of April is typically reserved for pranks and practical jokes, the rest of the month is also for some more serious observances. One of those being Alcohol Awareness Month. For the year 2019, the focus is underage drinking, and reports show the theme is “Help for Today, Hope for Tomorrow.” The hope is that we can take this chance to spread education to young people about the dangers of alcohol abuse, and share ways to get help.
Despite the fact that most of the headlines these days focus on the opioid crisis, alcohol abuse and addiction continue to rise all over the country. While alcohol may not be as notorious today as fentanyl or heroin, death rates relating to alcohol are still staggering, and the health problems associated with excessive alcohol use are steadily growing.
Risks of Underage Drinking
Underage drinking is one of the most important issues we face when talking about alcohol abuse. Despite the fact the is it illegal for people under 21 years old to consume alcohol, people aged 12 to 20 years actually drink 11% of all alcohol consumed in the United States.
Not to mention, underage drinkers on average consume more drinks per occasion than adult drinkers. So it is no surprise that 90% of alcohol consumed by underage drinkers meets the criteria of binge-drinking.
According to a 2017 Youth Risk Behavior Survey of high school students, during the past 30 days:
- 30% report drinking some amount of alcohol
- 14% binge drank
- 6% admit to driving after drinking alcohol
- 17% admit to riding with a driver who had been drinking
Every year, approximately 6,500 people age 21 and under die due to alcohol-related accidents. Many of these young people are not even drinking themselves. Another nationwide survey in 2017, the Monitoring the Future Survey, shows that:
- 8% of 8th graders admit to drinking in the past 30 days
- 2% of 8th graders admit to binge-drinking in the past 30 days
- 33% of 12th graders admit to drinking in the past 30 days
- 19% of 12th graders admit to binge-drinking in the past 30 days
For parents, these statistics can be unsettling, to say the least. While most parents want to believe that their kids are the exception to the rule, it is still vital that families talk about the risks of alcohol use, binge-drinking, and drunk driving.
According to the Center for Disease Control and Prevention (CDC), there is a range of severe side-effects relating to underage drinking, including:
- Memory problems
- Changes in brain development
- Trouble at school, such as poor grades or increased absences
- Social problems, like fighting or lack of participation in youth activities
- Legal issues relating to drinking
- Hangovers and other physical illnesses
- Disruption of normal growth and sexual development
- Unwanted, unplanned, and unprotected sexual activity
- Physical and sexual assault
- Higher risk of depression and suicide
- Abusing other drugs
- Death due to alcohol poisoning
For underage drinkers, the risk of experiencing these issues is far greater for those who participate in binge-drinking. Additionally, those who engage in excessive drinking earlier in life are more likely to develop alcohol use disorder later on.
History of Alcohol Awareness Month
Firstly, we believe it is important to acknowledge the history of Alcohol Awareness Month. The annual observance was first established back in 1987, created to reduce the stigma of alcoholism and support local communities in their efforts to address alcohol-related issues.
The program began with the intention of targeting college-age students. Many young people at the point in life tend to drink too much as part of their independence. Meanwhile, many parents mistakenly shrug excessive alcohol use off as a ‘rite of passage’ for young people. However, the true nature of their drinking can be far more dangerous.
Over the last several decades, alcohol abuse among teens has not gone away. That is why Alcohol Awareness Month is just as important today as it was the day it began.
Defining Alcohol Use Disorder
Since the conversation around alcohol awareness will frequently reference alcohol use disorder, it is also important to establish a clear definition of AUD. The National Institute on Alcohol Abuse and Alcoholism (NIDAA) defines alcohol use disorder as:
“A chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.”
Furthermore, the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published in May of 2013 made some updates to the diagnostic criteria. Some of the symptoms of Alcohol Use Disorder listed in the DSM-5 include, but are not limited to:
- Periods of drinking more, or longer, than you intended
- More than once wanted to cut down or stop drinking, or tried to, but couldn’t
- Spend a lot of time drinking, being sick, or getting over the aftereffects
- Wanting to drink so badly you could not think of anything else
- Drinking, or being sick from drinking, often interferes with taking care of responsibilities
- Continued drinking despite causing problems with family or friends
- Needing to drink more than usual for the same effects
- Giving up important or pleasurable activities in order to drink
It also categorizes AUD with different levels of severity, including:
- Mild– the presence of 2 to 3 symptoms
- Moderate– the presence of 4 to 5 symptoms
- Severe– the presence of 6 or more symptoms
Alcohol use disorder is incredibly dangerous, and the withdrawals can range from uncomfortable to life-threatening for those with severe physical dependence. That is why it is critical for those who struggle with alcohol use disorder to seek out a safe medical detox when trying to quit drinking.
It is true that one of the most devastating drug epidemics in America is the opioid crisis. However, one could argue that an alcohol epidemic just as pervasive and devastating has been happening in the background. While it may be different because it is legal and far more socially acceptable, alcohol is behind staggering numbers of deaths across the country. Likewise, alcohol use and abuse are far more prominent than most people realize.
Needless to say, one of those ever-important alcohol-related issues is the prevalence of underage drinking. Just a few years ago in 2015, the National Survey on Drug Use and Health (NSDUH) conducted a number of studies. According to the data:
- 623,000 adolescents between 12 and 17 years old fit the criteria for alcohol use disorder (AUD)
- Over 15 million adults age 18 and older suffered from AUD
- 8 million of them were men
- 3 million were women
Overall, approximately 88,000 people die from alcohol-related causes every single year. To put that in perspective, 70,200 people died due to drug overdose deaths in 2017.
The alcohol epidemic also contributes to other serious issues around the world, including:
- Domestic abuse
- Sexual assault
- Violent crimes
- Driving fatalities
Needless to say, if we look at alcohol the way we look at most drugs, we’d probably see these statistics a lot differently. The alcohol epidemic is all around us. Every year tens of thousands of people are losing their lives, but because we see beer commercials on television and drive past liquor stores every day we don’t realize how serious it is.
Alcohol Awareness Month is also about shedding some light on this tragic reality in hopes that we can turn it around.
Increases in Alcohol Illness and Death
In addition to alcohol abuse and AUD, there are a number of health concerns that arise from excessive and prolonged alcohol use. In fact, some researchers have noticed an influx of alcohol-related health programs, including:
- A 40% spike in alcohol-related liver disease
- 60% spike in drinking-related emergency room visits
Some have even attributed these new rates to an increase in the potency of some alcoholic beverages. During Alcohol Awareness Month, we should also bring attention to the multitude of serious health risks associated with the substance. Some of the most common health problems associated with alcohol use include:
Excessive drinking can cause lower numbers of oxygen-carrying red blood cells. This condition, commonly known as anemia, can create a variety of symptoms, including:
- Shortness of breath
Heavy drinking, especially binge-drinking, can cause blood pressure to surge. Over time, this effect can become chronic and lead to other serious health issues, such as:
- Kidney disease
- Heart disease
According to the American Heart Association, 1 in every 3 deaths is related to cardiovascular disease. The AHA states that on average, 1 American dies every 40 seconds from cardiovascular disease. Furthermore, excessive alcohol use is one common factor that leads to an elevated risk of heart disease.
Physicians and scientists agree that habitual drinking increases the risk of cancer. Most believe this risk comes from the body converting alcohol into acetaldehyde. Cancer sites frequently attributed to alcohol use include:
Cancer risk is only further exacerbated by tobacco use.
Alcohol is toxic to liver cells. As a result, heavy drinkers often develop cirrhosis. With this condition, the liver is so heavily scarred that it is unable to function, which can be lethal.
On one hand, heavy alcohol consumption can actually cause epilepsy. Conversely, it can also trigger seizures in people who don’t have epilepsy or interfere with medications used to treat convulsions.
Addressing Underage Drinking
In order to address underage drinking, families, and communities have to work together to spread education and prevention. Alcohol Awareness Month helps highlight these efforts and bring the conversation to the forefront. Not only does this mean promoting prevention for young people, but also offering treatment opportunities for those in need.
Reducing underage drinking means community-based efforts to monitor the activities of youth and decrease youth access to alcohol. Alcohol Awareness Month also promotes additional prevention strategies, such as:
- Enforcement of minimum legal drinking age laws
- National media campaigns targeting youth and adults
- Increasing alcohol excise taxes
- Reducing youth exposure to alcohol advertising
- Development of comprehensive community-based programs
With alcohol use disorder being such a significant aspect of this issue, it is crucial that young adults and their families understand the importance of comprehensive alcohol addiction treatment. Not only is it the safest and most effective way to safely discontinue alcohol use, but a personalized treatment program can help an individual establish a strong foundation for continued recovery. Long-term sobriety is about more than just surviving the physical withdrawals and health problems. Recovery is also about developing the life skills and coping mechanisms that support a healthy lifestyle beyond addiction.
For over 20 years, Palm Healthcare Company facilities have provided the best in comprehensive treatment opportunities for those struggling with alcohol use disorder. If you or someone you love is struggling, do not wait. Please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
by Justin Mckibben | Apr 4, 2019 | Addiction, Cannabidiol, Marijuana, Marijuana Reform, Medical Marijuana, News
The Cannabidiol and CVS Collaboration
Cannabidiol (CBD) and other cannabis-based products continue to become more mainstream as time goes on, and more conventional franchises seem to be embracing this wave of merchandising. Recently, the CEO of Whole Foods, the only USDA Certified Organic grocer in the United States, said he would be happy to sell cannabis supplements in his stores. Across America, legalization movements continue to build momentum. Meanwhile, commercial industries are starting to take advantage of the new market. So, of course, it was only a matter of time before a nationwide pharmacy chain like CVS got in on the action. Soon, a line of topical products derived from cannabis will be available for purchase in eight states in 800 CVS locations.
Working with Curaleaf Holdings
CVS is the largest pharmacy chain in the country, with over 9,900 locations all over the nation. Now, the company well-known for providing convenience store services while filling prescriptions will also carry cannabis-derived CBD products. The company has entered a deal with a cannabis retailer Curaleaf Holdings. For some background, Curaleaf operates 40 cannabis dispensaries in 12 states. As a result, reports indicate stock for Curaleaf spiked as high as 20% the day this deal was announced.
Joseph Lusardi, the CEO of Curaleaf, tells investors he hopes to see the number of CVS stores carrying these products to increase even more. For now, Curaleaf’s CBD products will be sold in CVS stores in:
Out of these states, only California and Colorado have legalized recreational cannabis. Maryland and Illinois have medical marijuana laws, but the other four states still prohibit both. Lusardi adds that Curaleaf is also in the process of establishing similar deals with other large consumer states around the country.
Larry Merlo, CVS Health CEO, made comments about the decision during an interview with CNBC. Merlo explained that for a while, the company has been receiving requests for CBD products. It seems not the pharmacy chain is willing to take a step toward meeting that demand. In the interview Merlo said,
“Anecdotally, we’ve heard from our customers that have used those products that, gee, it’s helped with pain relief for arthritis and other ailments.”
Mike DeAngelis, a spokesman for CVS Health, said in a statement that the stores will not carry any CBD-infused edibles, as it is illegal to introduce ingredients like CBD into the food supply or to market them as dietary supplements. For now, the Food and Drug Administration (FDA) still regards CBD as an illegal substance under federal law. Therefore, it remains banned from use in foods and beverages.
Still, the retailer maintains that it will be selling CBD products in accordance with the law. In a recent statement, the company said that it has “partnered with CBD product manufacturers that are complying with applicable laws and that meet CVS’s high standards for quality.”
It seems that CVS is taking that commitment to quality CBD products very seriously. In order to assure accurate labeling and safety for customers, CVS found a partner in Eurofins, a third-party laboratory that tests CBD topical products for:
- Tetrahydrocannabinol (THC)
- CBD content
- Other contaminants
CVS also saw a significant jump in stock prices following the announcement.
Ironically, the rival drug store chain Walgreens announced the following week that is will also be carrying CBD products. Not one to be outdone, Walgreens seemed to one-up CVS, saying nearly 1,500 of their stores will be selling similar products.
CBD Products Becoming More Popular
From a business perspective, capitalizing on the growing popularity of CBD products seems like a no-brainer. New projections for the CBD market size are becoming increasingly more optimistic. According to a new analysis by Cowen & Co., the global CBD market could reach up to $16 billion by the year 2025. With all these new deals going through, the budding industry seems well on its way.
Back in January, Cowen’s survey of approximately 2,500 adults determined:
- Nearly 7% of Americans are using CBD as a supplement
- CBD use is most common among people aged 18 to 34
- 44% of the CBD market is from CBD tinctures
- 26% of the CBD market is topical products
- 22% of the CBD market is attributed to capsules
- 19% of CBD market is beverages
Furthermore, Cowen says the use of CBD products will likely continue to grow. Yet, in the face of growing popularity, CBD still faces mild controversy. Many argue that cannabidiol is still in the legal grey area that makes it hard for the market to reach its potential.
Is the Cannabidiol Industry Good or Bad?
Meanwhile, two very different schools of thought battle over the safety of such a position on CBD. Some still believe that allowing CBD products to become acceptable in society will only encourage further drug use. On the other hand, advocates think that CBD could even be used to treat substance use disorder and other underlying conditions that lead to drug abuse. In the midst of the opioid crisis, some even assert that CBD could be used to treat opioid addiction.
For now, many experts believe there is still a need for more data to determine what CBD products can actually help treat. While some retailers make a lot of claims about their products, others argue that there is not enough evidence to support a lot of these claims. In order for the cannabidiol industry to become legitimate, it might still need to go through a period of growth and exploration.
Therefore, for now, there is still more to learn about how CBD could impact individuals struggling with addiction, for better or for worse.
Despite the fact that CBD and cannabis products are becoming increasingly accepted, it is still possible there are risks for those who struggle with substance use disorder. As with most medications, what is appropriate for some may not be appropriate for everyone. Those who continue to struggle with substance abuse have better chances of building a foundation for lasting recovery through comprehensive addiction treatment. Palm Healthcare Company believes in providing quality treatment options at all levels of care, and we want to help you or your loved one create a life worth being clean and sober for. If your or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
by Justin Mckibben | Mar 28, 2019 | Addiction Medicine, Detox, Recovery, Sobriety
Physical Health is Important to Lasting Recovery
There is no doubt that substance use disorder has a dramatic impact on health. Physical, mental and emotional well-being always suffer when an individual becomes dangerously dependent on harmful substances. Drugs and alcohol have a variety of adverse effects on the body, ranging from painful withdrawal symptoms to lasting impairment of vital organs. Therefore, it should not come as a surprise that patients recovering from addiction often suffer from chronic health conditions.
Now, a new study published in the Journal of Addiction Medicine suggests that more than one-third of people recovering from addiction continue to suffer from a physical disease.
Studying Chronic Health Conditions in Addiction Recovery
Researchers from the Massachusetts General Hospital (MGH) Recovery Research Institute are the first to examine the national prevalence of medical conditions typically created or magnified by chronic and excessive use of drugs or alcohol. The data in the study comes from a nationally representative sample of more than 2,000 American adults. Each of these individuals described themselves as recovering from a range of substance issues, including:
Researchers then looked for the presence of diseases known to be exacerbated by drugs and alcohol, such as:
- Liver disease
- Heart disease
- Sexually transmitted infections (STIs)
- Hepatitis C
- Chronic obstructive pulmonary disease (COPD)
What they found was that out of all the adults recovering from substance abuse issues, 37% of them had been diagnosed with one or more of these nine conditions.
Additionally, researchers conclude that significant reductions in the participants’ quality of life connect to these conditions. Not to mention, researchers note that each of these health problems is known to reduce life expectancy.
Trends Relating to Different Drugs
When looking at the details of the data, there are a few trends that stand out. For instance, when compared to the general population, individuals in recovery have much higher levels of:
- Hepatitis C
- Heart disease
And in many cases, certain diseases more often correlate with certain substances. For example:
Rates of this condition were significantly higher for those recovering from opioids or stimulants than those recovering from alcohol.
HIV/AIDS and STIs
Lifetime prevalence of these health conditions was significantly higher in the group of people recovering from stimulant abuse than in the alcohol group.
The lowest rates of this condition were actually found in individuals recovering from opioid addiction.
This health problem was discovered to be least common for those reporting cannabis as their primary substance issue
Multiple Chronic Conditions
The odds of experiencing two or more chronic physical diseases were increased by 4%- 7% due to certain factors, such as:
- Each additional substance used 10 times or more
- Older age at onset of diseases
- Resolving alcohol or drug problems later in life
Reduced Rates of Disease
Researchers also note a few elements that appear to coincide with reduced rates of physical diseases. In general, such factors include being:
There were also social stability and economic factors linked to lower rates of physical disease for those recovering from substance abuse, including:
- Having a household income greater than $50,000
- Higher education
- Being Employed
- Married or living with a partner
Some of these may be a bit of a surprise, especially considering that women are typically considered more susceptible to serious health problems associated with substance abuse.
Highlighting the Importance of Health in Recovery
According to the researchers, this study is important to a larger conversation about the quality of life for those in recovery from addiction. The lead and corresponding author David Eddie, Ph.D., research scientist at the Recovery Research Institute is an MGH clinical psychologist and an instructor in Psychology at Harvard Medical School. He states,
“We’ve known for a long time that chronic and heavy substance use can cause a multitude of diseases directly and indirectly – The extent to which these diseases and health conditions continue to persist for the millions of Americans who achieve recovery remains to be clarified, but this study highlights the fact that these negative impacts may continue to affect quality of life even when people achieve addiction recovery.”
Eddie believes it is important to appreciate that even those who overcome their issues with substance use disorder and drug dependence still face real physical diseases. In some cases, men and women who manage to finally make progress away from abusing drugs or alcohol still have to live the rest of their lives with other life-altering conditions. If the evidence points toward a better chance at young people and those with a shorter history of drug use being able to avoid chronic illness, then, of course, more effort should be put toward early intervention. Eddie adds,
“In addition, addiction treatment needs to be more seamlessly integrated with primary health care, and more research is needed to explore the complex relationships between alcohol and other drug use and physical disease.”
Moreover, this would further support the idea that we must address addiction as a public health issue. If we want to effectively address not only substance abuse but the long-term adverse effects of drugs and alcohol, we have to offer more comprehensive treatment options.
Part of building a healthy and effective foundation for recovery is a personalized treatment plan. Every individual is unique, and each person struggling with substance use disorder faces different challenges. That is why Palm Healthcare Company believes in providing customized and comprehensive care to every client. From medical detox resources to medication management and nutrition, we believe better health and well-being make lasting recovery possible. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
by Justin Mckibben | Mar 19, 2019 | Addiction Treatment, Depression, Detox, Inpatient Treatment, Mental Health, News, Outpatient Treatment
Discrimination Through Denial of Coverage
Health insurance is probably going to be one of the great debates of this period in American history. There is already plenty of contention about how to properly provide coverage for those who need it. Some claim the changes made in the last decade have gone too far. Others argue it has not gone nearly far enough. Healthcare reform is a hot button issue in our world today. Needless to say, a big part of this conversation has to do with parity coverage for mental health. Now a new landmark court ruling is going to make a monumental difference for mental health and addiction treatment insurance coverage.
Simply put, the largest behavioral health care company in America has been denying coverage to some of its most vulnerable members to save money. And now, a federal court decision may put more of a spotlight on insurance companies.
Wit v. United Behavioral Health
The case was brought in front of a federal court in Northern California against United Behavioral Health (UBH). UBH is a company that manages behavioral health services for UnitedHealthcare and other health insurers. The court found that UBH denied claims of tens of thousands of people seeking mental health and substance use disorder treatment. The company was using defective medical review criteria in order to reject claims.
In Wit v. UBH, over 50,000 individuals were reportedly denied coverage based on the flawed review criteria. 11 plaintiffs sued UBH on the behalf of these victims. One victim, in particular, is Natasha Wit. Natasha had been seeking treatment for several chronic conditions, including:
Wit was repeatedly denied coverage for her treatment, despite the fact she did have healthcare benefits that should have offered coverage. Her family ended up paying out nearly $30,000 for treatment. And they are just one of the thousands of families to face the same discrimination.
Looking at the Marks Against UBH
According to recent reports, United Behavioral Health has been failing its members in more ways than one.
Federal courts determined that UBH developed internal guidelines that were “unreasonable and an abuse of discretion” and “infected” by financial incentives designed to restrict access to care for those who should qualify for coverage. Essentially, UBH was manipulating internal guidelines to avoid providing coverage that members had every right to under the law.
For many of those struggling with substance use disorder, defective criteria for coverage can equate to a death sentence. When looking over the requirements set by UBH, it is no wonder why the courts say they are illegitimate.
Firstly, their medical-necessity criteria fail to provide coverage to those chronic and comorbid conditions. Generally accepted standards of care state these conditions should be effectively treated, even when those conditions:
- Respond slowly to treatment
- Require extended or intensive levels of care
However, UBH set guidelines that only approve coverage for what they labeled “acute” episodes or crises. For example, only individuals who were actively suicidal or suffering from severe withdrawal could be considered for coverage.
In other words, for someone who struggled with substance use disorder or mental illness, you had to be knocking on death’s door to get a chance at treatment. The court found that these guidelines were not acceptable.
Furthermore, UBH fails to use national evidence-based guidelines for covering different levels of care for mental health and substance abuse treatment, such as:
These are guidelines that have been developed by clinical specialty nonprofit organizations.
Additionally, UBH’s guidelines improperly required reducing the level of care, even if the providers who were treating them recommended maintaining a higher level of care. So patients would be removed from more intensive residential treatment programs and pushing into some form of outpatient therapy, even if the specialists argued that they were not ready.
This is a big deal. Most recovery advocates and healthcare providers agree that insurance companies should not be the ones telling treatment providers how to care for their patients.
State Mandated Guidelines
Furthermore, some states have mandated specific guidelines for evaluating the medical necessity for behavioral health services. UBH was also found to have violated these requirements for reviewing substance use disorder claims as well.
The case against United Behavioral Health was filed under the Employee Retirement Income Security Act of 1974 (ERISA). This is a federal mandate that governs group health insurance policies through private employers. More specifically, ERISA requires insurance plan administrators to function in a fiduciary capacity when overseeing employee benefit plans. This includes coverage for mental health and substance use disorder treatment.
In Wit v. UBH, the court determined that UBH was in breach of its fiduciary duties by developing and employing faulty medical necessity criteria for behavioral health services. Therefore, the court alleges that UBH is in violation of its obligations under this federal law.
What Does this Mean for Addiction Treatment Insurance Coverage?
This case is exposing insurers for refusing care to people at serious risk of death by overdose or suicide. It is important to remember that UBH is not the only insurance provider trying to find ways around federal and state coverage guidelines. Given the nature of these violations, advocates believe that regulators should immediately start examining the market conduct of all healthcare plans across the country.
Judge Joseph C. Spero in Wit v. UBH also points out that the company was circumventing the Mental Health Parity and Addiction Equity Act of 2008, also known as the Federal Parity Law.
Parity law actually requires insurers to cover illnesses of the brain, such as depression or addiction, the same as illnesses of the body, such as diabetes or cancer. In his ruling on Wit v. United Behavioral Health, Judge Spero highlights an abundance of evidence that guidelines created by the UBH were designed to diminish the impact of the 2008 Parity Act in order to keep benefit costs down. In other words, it is clear that the company was actively trying to work around federal law in order to avoid providing coverage to people with mental illnesses and addictions.
For those in the mental health and addiction communities, this brings new awareness to the discriminatory practices of treating mental health conditions differently than physical conditions. The new hope is that insurance providers will understand the consequences of discrimination against those who need help. With so much going on in healthcare, the Federal Parity Law must be protected.
Far too many people suffering from mental health and substance use disorders never get the help that they need. The last thing we need in a country devastated by an opioid crisis and rising overdose death rates is to create more roadblocks to treatment resources.
Palm Healthcare Company believes that if our country is ever going to overcome the damage of the opioid epidemic, we have to offer more comprehensive treatment options to those who still suffer. Insurance companies should not be keeping people from the care they deserve. Prevention is important, but we also believe in taking care of those who are already in the grips of substance use disorder by offering compassionate and effective care. If you or someone you love is struggling, please call toll-free now. We want to help.
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by Justin Mckibben | Mar 8, 2019 | Alcohol, Death, Drug Abuse, Harm Reduction, News
Two non-profit organizations recently analyzed updated data from the Center for Disease Control and Prevention (CDC) and found that deaths caused by suicide, drug overdose and alcohol rose by 6% in the year 2017, leading to an all-time high in the United States.
Altogether, drugs, alcohol, and suicide killed more than 150,000 people.
Ever since federal data collection started in 1999, the non-profit’s report claims there has never been a death rate this high attributed to these causes. A spike was observed in the national rate for deaths from alcohol, drugs, and suicide:
- Start of 2017- 9 deaths per 100,000 people
- End of 2017- 6 deaths per 100,000 people
On one hand, this is actually a slower increase than the previous two years. However, the difference was a lot over the average annual increase of 4% since 1999.
Opioid Death Rates
Probably the most obvious reasoning behind this increase would be the ongoing opioid crisis. One of the major contributing factors to the rising rates of overdose death in America is dangerous synthetic drugs making their way to the illicit market.
For one thing, deaths due to synthetic opioids like fentanyl, rose 45 % in that time. In the past five years, these deaths have actually increased tenfold. Needless to say, lawmakers and public health officials have been scrambling for years to try and solve the overdose issue in the United States.
Suicide Death Rates
Since 1999, deaths from suicide have increased by 33%. The data for 2017 indicates a significant rise in death rates:
- Start of 2017- 9 deaths per 100,000
- End of 2017- 5 deaths per 100,000
This is an increase of 4%, which is double the average annual pace over the previous decade. More specifically, from 2008 to 2017:
- Suicide by suffocation increased by 42%
- Suicide by firearm increased by 22%
The highest suicide rates are typically in rural areas, including:
- West Virginia
- New Mexico
- New Hampshire
One thing to point out is that some researchers believe that suicides are actually under-reported. This may be in part due to the stigma surrounding mental disorders, but also largely due to mislabeling the cause of death. For instance, some cases may be recorded as overdoses or accidents that are actually intentional.
Alcohol Death Rates
As far as alcohol-related death rates are concerned, some suspect that higher proof alcohols becoming increasingly popular in the last decade has also contributed to health issues and deaths. In fact, between 2002 and 2013:
- The amount of how much alcohol Americans consumed only increased by 6%.
- Estimates to determine how much alcohol is typically drunk have remained the same.
- Health problems as a result of drinking spiked in the same time frame.
Meanwhile, some drinks have a dramatically higher alcohol-by-volume (ABV) percentage. Between 2002 and 2016, the average alcohol by volume grew across the board:
- Beer ABV increased an average of 2%
- Wine ABV increased an average of 6%
- Liquor ABV increased an average of 4%
According to another analysis by the Institute for Health Metrics and Evaluation at the University of Washington, from 2007 to 2017:
- The number of deaths attributable to alcohol increased by 35%
- Deaths among women rose 85%
- Deaths among men rose 29%
One positive piece of data is that the study suggests teen drinking deaths actually decreased by 16%. Still, alcohol has contributed plenty to the rising death rates.
Addressing Underlying Issues
With the highest death rates due to drugs, alcohol, and suicide in recorded history, it goes without saying that a lot more needs to be done to promote treatment resources and prevention. With the failed War on Drugs has taught us what is not working, many have turned to strategies that focus on the preservation of life more than punishing those struggling with addiction. Harm reduction efforts like naloxone expansion and needle exchange programs have made some real progress. Some have even begun exploring the possibility of establishing safe injection sites.
Additionally, there needs to be more put into comprehensive treatment. Most experts agree there is a need for broader efforts to address the underlying causes of alcohol and drug use, and suicide. Having access to effective mental health care and addiction treatment resources can significantly impact the well-being of those most at risk. Long-term recovery offers those most likely to die as a result of drug use or suicide a way out.
This would also include more funding and support for programs that reduce risk factors. A major aspect of prevention when it comes to substance abuse and mental health has to do with trauma and adverse childhood experiences. Research has suggested there is a notable connection between the risk of drug and alcohol abuse and suicide and childhood trauma.
There were five states where death rates due to drugs, alcohol, and suicide decreased:
- Rhode Island
Hopefully, as new initiatives push forward to save lives and offer prevention, we will see more states with decreasing death rates. Overall, we can hope that better opportunities for treatment and support will lead to an improvement in public health. Meanwhile, raising awareness and education are crucial to turning this trend around.
With their highest death rates in history, substance abuse and suicide are some of the most important public health issues facing Americans today. If you or someone you love is struggling, please call toll-free now.
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by Justin Mckibben | Feb 22, 2019 | Addiction, Maintenance Drugs, Marijuana, Medical Marijuana, News
Every time you turn around, there is another story about marijuana reform in America. Regardless of which side of the argument you stand, you consistently read new headlines to ponder regarding how cannabis is making its way into the mainstream. In many states, reform has been embraced with open arms and surprising public support. However, there are also cases where marijuana reform is being faced with strong opposition. Now, you can consider New Hampshire as one of these instances. This week, a House committee voted to approve a new marijuana legalization bill.
Due to the notably high rates of opioid overdoses in the state of New Hampshire, many are contesting marijuana legalization. The Granite State has been hit pretty hard by the ongoing epidemic, and many officials feel that pushing for legal cannabis will only make the drug problem worse.
Government Officials Pushing Back
Governor Chris Sununu is just one of many officials in New Hampshire trying to put a stop the marijuana legalization. They insist that the issue isn’t only concerning cannabis, but also opioids and other drugs.
It is understandable that people are hesitant to embrace drug reform policies in an area that has one of the highest per capita death rates due to opioid overdose in the country. Citizens and communities all over the state have suffered, while money and resources have been pouring into efforts to combat overdose deaths. Therefore, opponents of marijuana legalization are insisting it is too risky to consider easy access to any drug at this point.
Governor Sununu states,
“When we are dealing with opioids as the single biggest health crisis this state has ever had, you are going to tell me legalizing more drugs is the answer? Absolutely not.”
Many still argue that marijuana is a gateway drug and that by allowing recreational access to cannabis they will be effectively increasing the rate of opioid abuse. This is instigating a further national discussion about whether or not marijuana use is a gateway to opioid abuse.
Sununu may be a Republican, but the opposition to legalization is not exclusively partisan. In fact, both New Hampshire Senators, Senator Jeanne Shaheen, and Senator Maggie Hassan, are Democrats that express their own opposition to marijuana legalization. Sununu even has the state commission on alcohol and drug abuse against the legislation.
Additionally, plenty of residents also support the push back. Many believe New Hampshire should focus on addressing the opioid crisis before considering cannabis reform. Ronald G. Shaiko, who is studying public policy and social sciences at Dartmouth College in Hanover, New Hampshire, says that many residents feel that the government hasn’t responded well enough to the opioid epidemic. Therefore, most are skeptical about adding more drugs into the mix.
Marijuana Legalization VS Opioid Addiction
Proponents of cannabis reform do not dismiss the opioid crisis, but instead, argue that increasing access to marijuana could actually reduce rates of opioid overdose. This is a movement that has also begun gaining ground in recent years. State Representative Renny Cushing, who is sponsoring the legalization bill, stated:
“What we’ve come to understand is that marijuana in many instances is an exit drug, not a gateway drug.”
Legalization supports point to a 2018 study that shows an association between daily marijuana use and remaining in medication-assisted treatment (MAT) programs. Additionally, a 2014 study found that states with medical marijuana had lower death rates from opioid overdoses. Some states are now encouraging marijuana use instead of opioids or making opioid addiction a qualifying condition to receive a medical marijuana prescription.
New Bill Barely Passes
Even with a bipartisan message of caution, the new legislation to establish recreational marijuana in New Hampshire appears to be moving forward. Advocates for the new bill believe that Governor Sununu is fear mongering and using the opioid crisis to block the Democratic-controlled state legislature.
The New England area is known for embracing more liberal policies on social issues. Following the other states in the New England area, New Hampshire legalized medical marijuana in 2013. Then during Sununu’s administration, the state decriminalized marijuana possession in small amounts in 2017.
This new bill will make it legal for people over the age of 21 years old to possess, consume, buy and grow small amounts of marijuana. The bill also makes an effort to establish a commission responsible for licensing and regulating:
- Retail establishments
One state commission states that the tax revenue from a new cannabis industry could give New Hampshire between $15.3 million and $57.8 million a year. The financial benefits of cannabis reform have been a real selling point in many states. To put it in perspective, California:
- Taxes all sales of recreational and medical marijuana by 15%
- Made over $2.75 billion on recreational sales
- Added over 80,000 new jobs with cannabis sales
Needless to say, that is a lot of money. Some estimate the legal cannabis industry could grow to a whopping $25 billion in 2025.
Another huge selling point of the bill for many people is that it would expunge prior convictions for offenses relating to cannabis that are made legal under the new law.
The New Hampshire House Criminal Justice and Public Safety Committee approved the bill on Thursday, February 21, 2019, in a 10-9 vote, cutting it incredibly close. However, Governor Sununu has reportedly vowed to veto the bill if it reaches his desk. Meanwhile, House Speaker Steve Shurtleff believes there are enough votes in his chamber, and maybe in the Senate as well, to override a veto from the Governor.
There does not seem to be one easy answer for the cannabis debate going on in New Hampshire. For the moment, both sides seem confident in their stance. Even experts who believe cannabis may be useful in helping fight opioid addiction say that more research is necessary. Therefore, many experts insist marijuana should not be used as a substitute for other methods of MAT.
Tym Rourke, a member of the state commission on alcohol and drug abuse who oversees addiction-related programs for the New Hampshire Charitable Foundation, makes a good case for proceeding with caution. Rourke points out that while marijuana could be more or less safe for the average person, that doesn’t mean it is safe for everyone. Rourke states,
“For some people, it’s unsafe. And as we are grappling with a high volume of individuals struggling with the consequences of substance misuse, do we really want to create a system that puts another substance more into the marketplace or more into their presence?”
This is a sentiment echoed by many addiction recovery advocates. There are those who believe in studying the benefits, but many holds with the idea that even if some are able to safely use cannabis, the same may not be true for many of those with substance use disorders. Therefore, as the movement for marijuana legalization continues, we should still be aware of those who could be at risk of relapse or prolonged drug use.
Even if marijuana is legal in certain areas, there should still be support for resources that treat people suffering due to substance abuse. Even if you don’t believe marijuana is a gateway drug, it can still be risky for those in recovery. Furthermore, marijuana addiction is possible for some, even if it is not as life-threatening as heroin addiction. If you or someone you love is struggling, please call toll-free now.
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by Justin Mckibben | Oct 1, 2018 | Alcohol, Alcohol Addiction, Alcoholics Anonymous, Alcoholism, Binge Drinking, Detox, Dual Diagnosis, Inpatient Treatment
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
“Alcoholic” is the kind of term that a lot of people jokily use to describe their friend who has a few too many drinks one night, or something they say dismissively to make light of their own drinking binges. But does the average person truly understand what it means to be an alcoholic? Alcohol addiction might not seem as serious to some people, but alcoholism is truly devastating and far more complicated than you may think. Partly because people often assume that all alcoholics are the same.
So first, let us look at how alcoholism is commonly defined. Then, let us look at 4 different problem drinkers to see how alcoholics can be quite different.
Alcohol use disorder (AUD) has been more commonly known for decades as alcoholism. Alcoholism is frequently used as a more broad term for any drinking of alcohol that results in physical and/or mental health problems. At one point, the Diagnostic and Statistical Manual of Mental Disorders (DSM) divided alcoholism into two types of disorders:
- Alcohol abuse
- Alcohol dependence
The most recent version is DMS-5, which integrates these two disorders into one definition of alcohol use disorder. That DSM-5 also identifies levels of mild, moderate and severe sub-classifications. According to the DSM-5, anyone meeting two of the 11 criteria for AUD in the same 12-month period would receive a diagnosis of AUD.
These 11 criteria include:
- Had times when you ended up drinking more, or longer, than you intended
- More than once unable to stop drinking when you wanted to or tried to stop
- Spent a lot of time drinking, being sick from drinking, or recovering from the aftereffects of drinking
- Wanting a drink so badly you cannot think of anything else
- Drinking or being sick from drinking often interferes with taking care of your home, family, job, school responsibilities
- Continuing to drink even though it causes trouble with family and friends
- Giving up or cutting back on interests and activities in order to drink
- Getting into situations that increase your chances of getting hurt while or after drinking
- Continuing to drink despite feeling depressed or anxious, adding to another health problem, or having memory blackouts
- Needing to drink much more for the same effect
- Experiencing alcohol withdrawal symptoms when the effects of alcohol wear off
Then the severity of the AUD is defined as:
Mild alcoholism is the presence of 2 to 3 of these symptoms.
Presence of 4 to 5 of these symptoms suggests moderate alcoholism.
The presence of 6 or more of these symptoms is an indication of severe alcohol use disorder.
5 Subtypes of Alcoholism
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is part of the National Institutes of Health (NIH). This organization has actually identified what it believes are 5 subtypes of alcoholism to help expand on our understanding of this complex disease. By looking at how alcoholism can manifest in different forms, a person can learn how to identify warning signs, and how to look for a personalized treatment program that fits their needs.
According to the NIAAA, the largest percentage of alcoholics actually falls into this category, with 31.5% of alcoholics in America. Nearly 1/3 of all alcoholics fit into this subtype.
This group is typically late teens and early 20s. Often these young adults are likely college students. The Centers for Disease Control and Prevention (CDC) reports:
- Underage drinkers between the ages of 12 and 20 regularly consume more alcohol at a time than older drinkers
- 90 percent of the alcohol consumed by this group is through binge drinking
Binge drinking is often perpetuated by underage and young adult drinkers. People who fall into the young adult alcoholic subtype rarely have alcoholism in their family history, and they may also be less likely to seek help for their excessive drinking as it is often considered “normal” as a “phase of life” that family members and adults may not take seriously.
This type of alcoholic is typically someone in their mid-20s who started drinking alcohol at an early age. With anyone, alcohol impacts brain chemistry, and regular exposure can actually change the way the brain’s circuitry works.
Young brains do not have a fully developed prefrontal cortex, meaning young people can have more difficulties controlling emotions and impulses. They are also more likely to take bigger risks. So excessive drinking may interfere with normal brain development, and increase the odds of substance abuse and addiction.
Unlike the young adult subtype, more than half of the young antisocial alcoholics have a family history of alcoholism.
Many people in this category suffer from a mental health disorder. Around half of the young antisocial subtype also struggle with an antisocial personality disorder. If someone is struggling with a co-occurring mental health disorder, the risk of developing alcoholism or a substance use disorder (SUD) is elevated. Other co-occurring disorders frequently found in this category include:
Around 3/4 of this subtype will also use tobacco and/or marijuana. They may also struggle with opioids or cocaine addictions.
Around 19.5% of the alcoholic population in the country will fall into the category of the functional alcoholic. These are typically middle-aged, well-educated, and seemingly well put together individuals. They may have a seemingly stable home life with a loving family. Functional alcoholics probably have a steady job and appear to have their lives together. They do not fit into the common stereotype of alcoholism.
Around 1/4 of this subtype of alcoholics have at least one major depressive episode in their lives. However, functional alcoholics are also often good at hiding emotional distress and issues with drinking.
Usually, a functional alcoholic will consistently fulfill most of their regular obligations. In fact, their family may even enable their drinking by making excuses for them when issues related to alcohol abuse do come up. The fact that they are able to appear successful will make it much harder to convince them that they have a drinking problem. Thus, many functional alcoholics will not seek help.
This subtype is also typically made up of middle-aged alcoholics. Around half of these individuals come from families with multigenerational alcoholism. Close to 1 out of every 5 intermediate familial alcoholics also struggles with marijuana and cocaine abuse. Many of these individuals also have co-occurring mental health disorders.
- Nearly half of all intermediate familial alcoholics have struggled with clinical depression
- 20% have battled bipolar disorder
- Many others struggle with obsessive-compulsive disorder and generalized anxiety disorder
A lot of intermediate familial alcoholics may use alcohol as a way to self-medicate the difficult emotional symptoms of their mental health disorders.
When people use the term alcoholic, this is the subtype they most commonly associate with it. Surprisingly though, chronic severe alcoholics only make up 9% of the entire alcoholic population of America.
So really, that stereotype of alcoholism actually represents the minority of alcoholic drinkers.
Chronic severe alcoholics are comprised mostly of middle-aged individuals who had early onset of problem drinking. This subtype experiences high rates of Antisocial Personality Disorder and criminality. Furthermore, nearly 80% of the chronic severe alcoholics come from families with multigenerational alcoholism. This group has the highest rates of other psychiatric disorders, including:
- Bipolar disorder
- Anxiety disorders
Chronic severe types also experience high rates of dependence with:
This is alcoholism to an extreme. Thankfully, this is the subtype with the highest rates of admission to alcohol addiction treatment.
Why Alcohol Addiction Treatment Matters
According to the NIAAA, in 2015 over 6% of American Adults met the criteria for AUD. Sadly, less than 10% of those people struggling with alcoholism received professional treatment. Those numbers alone show how much having alcohol addiction treatment matters. Each subtype will have unique experiences, which means they can greatly benefit from a recovery plan that is custom made for their unique needs. A functional alcoholic may want a treatment plan that incorporates their family. A chronic severe alcoholic may be suffering from a serious health condition that requires more of a focus on medical care.
The truth is, for how devastating alcoholism can be, it is troubling that so few people actually get the help they desperately need. Alcohol withdrawal symptoms are not just uncomfortable, but they can be dangerous and even life-threatening depending on the severity. That is why safe medical detox for alcohol is such a key component of a treatment program.
With all of those subtypes who experience co-occurring mental health disorders, it is critical that they have access to dual diagnosis treatment opportunities. For these individuals, it is important that treatment is not exclusively focused on alcoholism, but also addresses their mental health. Dual diagnosis treatment is designed to simultaneously treat co-occurring conditions while also providing comprehensive care and support for recovering from alcohol addiction. For those with co-occurring disorders, only treating one while ignoring the other can be counterproductive. An untreated mental health disorder can ultimately lead an individual to self-medicate. Dual diagnosis treatment isn’t just a better level of care- it is a crucial aspect of relapse prevention.
Regardless of what subtype someone may fit into, it is important that anyone who fits the criteria for alcohol use disorder seek professional addiction treatment. If you or someone you love is struggling, please call toll-free now. We want to help.
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by Justin Mckibben | Sep 17, 2018 | Addiction, Addiction Treatment, Dual Diagnosis, Mental Health, Relationships, Sex Addiction
When they hear the words “sex addiction” most people probably have a similar, simplistic assumption of what that means. They will picture someone who has sex a lot throughout the day, or maybe someone who has a lot of sexual partners. Some people associate it with over-indulging in pornography or engage in an inappropriate sexual behavior.
However, these are not necessarily the defining features of sex addiction. Not everyone who suffers from it will have multiple partners, and they most certainly don’t all act out inappropriately. While some of these scenarios may be present in those who experience sex addiction, many advocates believe the vital element of sex addiction has to do with the consequences of their behaviors and their inability to control them. Other terms for sexual addiction include:
- Hypersexual Behavior Disorder
- Sexual dependency
- Compulsive sexual behavior
It is also known as nymphomania in females and satyriasis in men. So what is sex addiction, and can it be treated?
The DSM Debate
The most difficult part of the conversation is trying to talk about what sex addiction actually means when it is not officially recognized as a mental health disorder.
One of the most essential tools we use for understanding and treating mental health is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a widely recognized compendium of mental health diagnostics. This crucial resource receives regular updates from the American Psychiatric Association (APA).
At this point in time, the DSM does not include criteria for sex addiction. Among mental health professionals in the APA, this is the cause of a great deal of debate. For a quick timeline:
(DSM-III-R), referred to “distress about a pattern of repeated sexual conquests or other forms of non-paraphilic sexual addiction, involving a succession of people who exist only as things to be used.” The reference to sexual addiction was subsequently removed.
The DSM-IV-TR did not include sexual addiction as a mental disorder.
Some authors suggested that sexual addiction should be re-introduced into the DSM system; however, sexual addiction was rejected for inclusion in the DSM-5, which was published in 2013.
Darrel Regier, the vice-chair of the DSM-5 task force, stated:
“Although ‘hypersexuality’ is a proposed new addition… [the phenomenon] was not at the point where we were ready to call it an addiction.”
The proposed diagnosis does not make the cut as an official diagnosis due to a lack of research into diagnostic criteria for compulsive sexual behavior, according to the APA.
As of 2017, none of the official regulatory bodies for Psychosexual Counselling or Sex and Relationship therapy, have accepted sex addiction as a distinct entity with associated treatment protocols.
The World Health Organization produces the International Classification of Diseases (ICD), which is not limited to mental disorders. The ICD-10 includes “excessive sexual drive” as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).
However, the ICD categorizes these diagnoses as “compulsive behaviors” or “impulse control disorders” and not specifically addiction.
The most recent version of that document, ICD-11, includes only “compulsive sexual behavior disorder” as a diagnosis, but does not use the addiction model.
Opposing Expert Opinions
Some opposing it believe that it is an agenda put forth by “sex-negative” clinicians trying to control the private behaviors of their patients. Indeed, some practitioners regard sex addiction as a potentially harmful diagnosis. Some even draw parallels with controversial gay conversion therapy that has caused a great deal of outrage over the years.
Of course, this is an understandable reservation to have. No one should be made to feel that their sexual preferences are an illness. So the debate is not an easy one to solve. When does one draw the line and say what should be considered “healthy” sexuality? In the end, some do fear that having a sexual addiction classification will make problems out of nonproblematic experiences.
However, there are still many experts and mental health professionals advocating for the inclusion of sex addiction as an official psychiatric condition. Many therapists and psychiatrists say that excluding sex addiction from the DSM completely disregards the pain, confusion, trauma, fear, and hopelessness of sex addicts and their families.
What Advocates Consider Sex Addiction
Even though there are no official DSM criteria for sexual addiction, provisional diagnostic criteria for sexual addiction that follow DSM format have been derived from DSM-IV-TR criteria for substance dependence.
According to Aviel Goodman, MD, sexual addiction is a maladaptive pattern of sexual behavior that leads to clinically significant impairment or distress, as manifested by at least 3 of the following within a 12 month period.
- A distinctly increased amount or intensity of the sexual behavior to achieve the desired effect or markedly diminished effect with continued involvement in the sexual behavior at the same level of intensity.
In other words, needing more in order to feel something. This is often seen in relation to substance abuse when people develop a tolerance to a drug over time.
- Characteristic psychophysiological withdrawal syndrome. When someone discontinues a sexual behavior and experiences
- Physiologically described changes
- Psychologically described changes
- The sexual behavior is often engaged in over a longer period, in greater quantity, or at a higher level of intensity than was intended.
- Persistent desire to engage in sexual behavior and being unable to control the sexual behavior.
- Excessive time is spent on activities necessary to prepare for the sexual behavior, to engage in the behavior, or to recover from its effects.
- People reduce or discontinue important social, occupational, or recreational activities because of the sexual behavior.
- The sexual behavior continues despite knowledge of the harmful consequences of the behavior.
This outline is not the final word on sex addiction. It is possible that our understanding of sex addiction will evolve as research grows. For now, this is a starting point to better understanding how sex addiction impacts people.
What Sex Addiction Is NOT
Due to there being no clear-cut definition of sex addiction, there are also those who mislabel certain behaviors. While everyone may not agree on sexual addiction as a condition, those who do typically agree on what is NOT sex addiction. Most notable examples are the controversies surrounding allegations of sexual misconduct and how certain individuals have used sex addiction as an alibi for inappropriate sexual activity.
Also, some people may be mislabeled by others as sex addicts because of their preferences. However, this is also incorrect. It is significant to point out that no form of sexual behavior in itself constitutes sexual addiction. A pattern of sexual behavior does not qualify as sexual addiction based on things like:
- The type of behavior
- The object of the behavior
- Social acceptability
Sexual addiction is determined by how it impacts the individual’s life. Essentially, any sexual behavior has the potential to be engaged in addictively. That does not make the behavior itself inherently wrong. Again, we reiterate that the key features distinguishing sexual addiction from other patterns of sexual behavior are:
- The inability to control the sexual behavior reliably
- Continuation of the sexual behavior despite significant harmful consequences
There are plenty of situations where people find it very difficult to determine what constitutes a sexual addiction and what does not.
A great example of a circumstance that isn’t so black and white is paraphilia.
Paraphilia is a condition where people have sexual desires that typically involve extreme or dangerous activities. Again- this is another term that causes contention because some people label the behavior as abnormal, while others say it is simply a fetish. The symptoms of sex addiction and paraphilia overlap to some extent, but they are not identical. Some sex addicts are not paraphiliacs, and some paraphiliacs are not sex addicts.
A similar distinction exists between a sex addict and sex offender, where the area of overlap is considerably smaller. However, this does not mean the behaviors of a sex offender are justified by sex addiction.
Sex Addiction Treatment
After all that, we have to ask- can sex addiction be treated? According to an article published on healthresearchfunding.org, an estimated 12 to 30 million people in America experience sexual addiction. So do they have opportunities to get help?
This is why it is important to have more research on sex addiction so that more can be done to create better opportunities for treatment. For now, some people find a great deal of help utilizing the same concepts presented in substance abuse treatment. Most people who do get help for sex addiction receive help from addiction professionals.
Current treatment options aim to reduce any excessive urges and to encourage the nurturing of healthful relationships. An important element in treating sexual addiction is not to shame people for their preferences or their experiences and try to help them design a personalized recovery plan that will help them have a happier and healthier life. A lot of people who get treatment for sex addiction do find help with options such as:
Residential treatment programs
Residential treatment programs exist to help individuals struggling with various addictive disorders. These are in-patient programs where individuals live on-site at a facility while receiving direct care from specialized therapists in a safe and controlled environment.
Cognitive behavioral therapy (CBT)
Many programs that work to treat sexual addiction provide cognitive behavioral therapy. This comprehensive approach gives people a variety of techniques that help the individual change their behavior. CBT can equip a person to avoid relapses and reprogram harmful sexual behaviors by helping them recognize patterns and develop healthier coping skills.
Beyond traditional addiction treatment options, there are always self-help organizations and support groups. Numerous 12-step programs offer to help the individual in self-managing their sexual addiction, including:
- Sex Addicts Anonymous
- Sexaholics Anonymous
- Sexual Compulsives Anonymous
- Sex and Love Addicts Anonymous
For some, sex addiction goes hand-in-hand with a substance use disorder, such as alcoholism. In cases like this, medical detox is always a good idea in order to get professional support through the initial process of withdrawal. Also, it is important for those struggling with co-occurring disorders to consider dual diagnosis treatment in order to address both issues for a stronger foundation for recovery.
Despite the debate about how sexual addiction should be classified, the reality is that a lot of people have seen the damage done to their lives as a result of their behaviors. So without trying to punish the sexuality of an individual, there should be resources available for those who want help. If you or someone you love is struggling with an addiction, please call toll-free now.
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by Justin Mckibben | Sep 13, 2018 | Coping Skills, Drug Abuse, Family, Mental Health, Parenting, Relationships
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Most people in the world would say that nothing is more important than family. They say that you can choose your friends, but family is forever. If you subscribe to the philosophy of blood being thicker than water, then it makes sense that when those closest to you suffer, you suffer right along with them. For many, this concept is never more painfully clear than when living with an addict in the family. Even though plenty of people struggling with addiction say they are only hurting themselves, most of us know that addiction is a family disease.
While there are many obvious ways that addiction affects a family, like domestic violence, financial troubles or death, there are also some more subtle consequences. When someone is suffering, their loved ones will often develop specific family roles for dealing with addiction. Depending on the household, and how the addiction manifests itself, some people may take on multiple roles in order to try and create a balance at home. However, many of these family roles can cause adverse effects of personal development over time.
Here are 6 family roles people use when coping with addicted loved ones.
Addiction and its effects draw a lot of attention, so it may seem to the addict that the world revolves around them. They take on a victim mentality, often causing others in the family to feel the need to save them, or at least to avoid disturbing them.
The victim is central to all the other family roles that develop around it. As the roles are defined, the victims loved ones unconsciously take on other family roles to complete the balance after the problem has been introduced.
Although this person’s actions are the key to their own recovery and overcoming the victim mentality, it is important to remember they are not necessarily vital for a family to recover on its own.
In the family, there will be someone who tries to be the champion for the victim and the family. This is someone who needs the family to look good, and they will work hard to make it so. The problem with the Hero is that they try to ignore the addiction and its effects. Instead, they want to dress everything up and act as if all is well.
The Hero will present things in a positive manner as if the family roles don’t actually exist. They are often perfectionists and overachievers, who seek to unite the family and offer hope through their own accomplishments. But taking on all this pressure can cause a lot of stress and anxiety for this family member. Very often this is the child of an addict or alcoholic.
If the Hero is able to finally overcome this role, they can ultimately play a crucial part in the addiction recovery process, both for the individual and for the family.
The Mascot’s is often thought of as the comic relief. This is the member of the family who uses humor as a defense mechanism and a distraction tactic. They try to soften the impact of an addicts behavior or ease tensions between family roles through laughter.
On the bright side, the Mascot does bring humor to the family roles people use for coping with addicted loved ones. They have a talent for making others feel better, even in the worst situations. But ultimately, they are also people-pleasers to a fault, which can foster feelings of anxiety.
However, Mascots sometimes make inappropriate jokes about other family members or situations, which can causes friction. They also run the risk of avoiding their own feelings or being inconsiderate of the feelings of others. Sometimes their harmful humor can hinder addiction recovery.
Also, the Mascot is likely to self-medicate as they grow up, perpetuating the cycle of addiction.
The Lost Child
In every family that deals with an addicted loved one, there is usually someone who tries their best to disappear. They are silent, withdrawn, and avoid drawing much attention to themselves from other members of the family. This is the Lost Child.
The Lost Child is typically careful to not make problems. They avoid any kind of conflict, along with conversations regarding the addiction or the underlying family roles that take shape around the victim.
The Lost Child will spend as much time as possible in isolation or away from their family. They are the child who sits in their room playing video games or watching TV for hours without any interaction. The Lost Child will often develop feelings of neglect and resentment, which can lead to depression. They often grow up to have a very difficult time developing healthy relationships later in life.
The Scapegoat is a problem child. Usually, this is the black sheep of the family who often acts out in front of others. They take on this role, knowingly or subconsciously, to divert attention from the person who is addicted. They rebel home, get in trouble at school, make a lot of noise to mask the underlying issues in the family. Male scapegoats are often prone to violence, while female scapegoats frequently act out sexually.
This person may even adopt substance use in order to run interference for a parent or sibling. They may develop other issues as well, such as eating disorders or a tendency to self-harm.
The Scapegoat covers or draws attention away from the real problem. They grapple with feelings or anger and shame, and they often offer the other family roles a sense of purpose- being someone to watch out for or try to fix.
The Enabler is also commonly referred to as the Caretaker but is always the person who makes all the other family roles possible. Most often this is a spouse, but it can also be a child of an addict.
Caretakers will take it upon themselves to keep everyone happy, believing it is the best way to protect the family. Their mission is to maintain balance in order to make the family look good on the outside. They are notorious for minimizing the addiction, making excuses for all behaviors and actions. They have a knack for blaming everything on something else, without acknowledging the real problem.
This person protects the addict from consequences, while constantly cleaning up after their messes.
Additionally, the Enabler frequently embraces the other family roles when they are convenient for maintaining the family balance. They will laugh at the Mascots harmful jokes, or adamantly put the focus on the Hero’s achievements. They will support the Lost Child’s “independence”, and run interference for the Scapegoat, all while catering to and caring for the needs of the victim.
At the end of the day, the family roles people adopt as part of coping with an addicted loved one are a kind of functional dysfunction. It is a system that people create in order to survive situations at home that can be toxic and unpredictable. Human beings by nature will behave in accordance with their surroundings. Out of self-preservation, we will get used to unhealthy strategies for dealing with unhealthy relationships. Even if they are not effective, if they help us get by there is a lot of damaging stuff we will get used to.
All of these family roles demonstrate how important it is for families to be supported and involved in a loved one’s recovery from addiction. Because we can see how addiction impacts the family, we know that the family also needs help in overcoming those adversities. Having a recovery program designed specifically for family members and loved ones of people with addiction can make all the difference. Not only does it help the family support their loved one, but it helps the family recover on its own. Family can also play a very important role in relapse prevention. It teaches them what their loved ones may experience during the medical detox phase of treatment. It helps them better understand the science of addiction and the process of recovery, while also showing them how their own behaviors have an impact.
The Palm Healthcare Family Program is all about helping the family come together to face addiction and overcome all the unique challenges that come with it. If you or someone you love is struggling with addiction, please call toll-free now. You are not alone. We want to help your family be stronger together.
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