Archives for June 2016

What Happens at a SMART Recovery Meeting?

A SMART Recovery meeting offers people who want to stop doing something – but find themselves still doing it – an opportunity to meet together with others with similar challenges. The free meeting is chaired by a volunteer trained as either a host or as a facilitator.

A facilitator has completed a 30-hour training. A host has completed a self-paced, online training that takes 4-6 hours.

Circle of welcome at a SMART Recovery meeting

I am trained as a host, not as a facilitator. At the facilitated SMART Recovery meetings I have attended, the facilitator warmly and skillfully guides participants to deeper understanding using what’s termed SMART Recovery “tools.”

At a hosted discussion meeting – the type of SMART Recovery meeting available to the community in my hometown of Blacksburg, Virginia and for which I am trained – prior to the meeting, the host has chosen a SMART Recovery activity that the attendees might find helpful or meaningful. Given that people thrive when they feel safe, the host doesn’t divide his or her attention by participating but focuses on the needs of the group and its members. To foster safety and continutity, the meeting is held using a script and the meeting proceeds in this order: check-in, discussion, activity, discussion, check-out.

In the above description, I meticulously did not use any of these terms: support, group, support group, mutual aid, mutual aid group, addiction, recovery, illness, disease, disorder, science, evidence, or research. As, happily, discussions about addiction and recovery become more frequent and these terms are used variously in multiple contexts, without meticulous definitions, they’re pretty meaningless.

And none of those terms describes my primary experience of a SMART Recovery meeting: kindness.

Maybe it’s the hope-filled discussion topics: building and maintaining motivation, coping with urges, managing thoughts, feelings and behaviors, and living a balanced life.

Maybe it’s the guidelines for discussion read at the beginning of the meeting, including “We don’t give advice. SMART Recovery encourages participants to make their own choices,” and “We don’t debate issues about addiction and recovery. We are free to speak in the language we want to, and to view addiction and recovery however we want to.”

Maybe it’s the tools and the activities that primarily ask what’s working and what might work better, rather than pointing out how bad and wrong everything is – including the individual.

Maybe it’s the use of “I-statements” rather than boundary-violating “you-statements” or “we-statements.”

Maybe it’s the time and space to speak without being interrupted or corrected.

Whatever it is that results in prevailing kindness, I sense participants’ best wishes for themselves and for others. I sense an intentional effort to bring forth the best of their hearts and minds for the time we’re together.

In her letter to the New York Times, author Maia Szalavitz wrote, “Shame and stigma are the exact opposite of what fights addiction.” In response to my Twitter tweet asking her what does fight addiction, Maia Szalavitz replied, “Love, evidence & respect.”

At a SMART Recovery meeting, I give and receive love – as much as people who may not know each other or know each other well may offer – I work together with others in ways for which there is enough evidence to support it might be helpful, and I feel respected by, and I feel respect for, people who are willing to come together to talk. 

I chortle with joy thinking that, in our kind little well-intentioned circle, we’re “fighting” addiction.

  • A hosted SMART Recovery discussion meeting is held on Sundays, 4:00-5:00 PM,  at New River Valley Community Services, 700 University City Boulevard, in Blacksburg, Virginia. Directions
  • A facilitated SMART Recovery meeting for Virginia Tech students is held when classes are in session on Thursdays, 6:30 PM – 7:45 PM at Squires Student Center, Virginia Tech, Blacksburg, Virginia. For more information, please contact: [email protected] or call 540-231-2233.
  • Recovery resources in the Blacksburg and New River Valley areas
  • Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, will be speaking in Blacksburg, Virginia on August 3, 2016. Read more

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

A Personal and Professional Look at the Evidence for SMART Recovery

SMART Recovery’s statement of purpose is to “help individuals gain independence from addictive behavior and lead meaningful and satisfying lives’ and “to support the availability of choices in recovery.” Its stated mission is to “offer no-fee, self-empowering, science-based, face-to-face and online support groups for abstaining from any substance or activity addiction.”

SMART Recovery group protocols, tools and activities are based primarily on cognitive behavior therapy (CBT), rational emotive behavior therapy (REBT), which is a form of CBT, and motivational interviewing (MI).

While earning a master’s degree in counseling and subsequent work in the field, I was trained in CBT. As one of the many people hit with addiction who has also been hit with mental illness and trauma, I have been treated with CBT. CBT is an evidence-based practice for treating addiction. Reports like this one and this one question the primacy of CBT over medication-assisted treatment (MAT). However, I am a counselor, not a medical professional. To help people with addictions, I can offer CBT and the increasingly promising dialectical behavior therapy (DBT). That SMART Recovery employs CBT works for me personally and professionally.

I had the remarkable experience of serving as a “client” for Albert Ellis himself, founder of REBT, at a conference in Tampa, Florida in 2003. My name was selected from a fish bowl and I proceeded to the front of the room and learned first-hand from him, directly but gently, about my awfulizing and catastrophizing. What I remember most is not what he said, but the fully involved and kind look in his eyes when he said it.

While the tie between REBT and measures of addictions treatment efficacy – such as days abstinent, for example – hasn’t been studied extensively, REBT is well-documented as a useful therapy for emotional, mental and psychological problems. As with CBT, the inclusion of REBT as a basis of SMART Recovery is a fit for me.

Since I discovered in the late 80s I would be unable to conceive a child, I have frequently received individual counseling, weekly in the hard years since 2007. If my counselors used motivational interviewing with me, I didn’t notice. That’s the beauty of this extensively studied, powerful therapeutic method – it helps the client discover herself, rather than conform to some kind of “rightness” with a particular methodology’s paradigm. I have been trained in motivational interviewing and treasure the counselor’s paradoxical imperative to, as my latest instructor Gerard Lawson put it, “Be like water.”

SMART Recovery does not claim to be a treatment, nor does it claim to be an evidence-based treatment. Rather, it claims its components are evidence-based which, according to my careful, informed assessment, seems true. Further, it welcomes study of its efficacy, stating on its home page, “Our approach…evolves as scientific knowledge in addiction recovery evolves.” While reports on SMART Recovery like this one and this one are primarily descriptive, a meta analysis was begun this year and this study moves closer to measuring the efficacy of the program as a whole. A study published in 2016 found that patients participating in SMART Recovery showed “highly significant” improvements in percent days abstinent and a reduction in drinks per drinking day.

2017 study by Zemore et al. found that participants of SMART Recovery and other 12-step alternatives were more satisfied, with more group cohesion than the participants of 12-step groups. Zemore et al.’s findings mean that, despite the prevalence and cultural emphasis on 12-step groups, alternative groups are equally or more effective than 12-step groups at providing social support for people in recovery. Given that 12-step approaches have been studied for decades, with no causal link emerging between 12-steps and abstinence, a support group that is informed by and responsive to latest science is a welcome addition to the field of addictions treatment.

SMART Recovery was named as a recovery support service (RSS) in Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, released in November, 2016.

I feel personally and professionally confident in both participating in, and serving as a volunteer in, SMART Recovery.

Laurel Sindewald contributed to researching this post.

Last updated 4/4/17.

The content of this post is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.

7 Science-Savvy Ways to Evaluate Research

Popular interpretations of science often oversimplify research and lead us astray. Some people have thrown up their hands and declared, “Research can be twisted any way to say anything anyone wants it to say.” The statement is not wrong, but it is also not grounds for dismissing science entirely. We can respond to bad science and misinterpretations of science with caution and discrimination. Fortunately, science professionals have been obsessing over how to do this for decades now, and we can approach the problem with some useful techniques.

Scientist in field by Risa Pesapane
Epistemology, the discipline that attempts to answer, “How can we know anything?” is not reducible to science. Many questions can be answered outside of science. Sometimes we can use deductive reasoning, personal experience, or trust an authority on the topic. The last of these, trusting an authority, does not seem very rigorous, but can be reasonable if the person has developed a reputation for high epistemological standards.

Some epistemological methods are good for some questions but not for others. I wouldn’t ask an authority on any subject to tell me my preference for slippers, and I wouldn’t trust someone who is not an expert on a topic to give an accurate opinion about it. Almost always, with epistemology, people are working with degrees of certainty rather than with perfect and absolute Truth. (Our culture tends to seek closure and absolutes when these are actually quite rare.) Still, carefully researched hypotheses are better than a shot in the dark – a delicious espresso drink but a poor epistemological practice.

It may be true that anyone can twist a single scientific study to seem to say something it doesn’t. It’s much harder to twist many controlled, randomized, and blinded studies with large sample sizes.

Scientific rigor refers to a number of scientific attitudes and practices demonstrating an unswerving loyalty to finding truth, setting aside any opinions or biases the researcher might have. It is a term referring to how close a statement or the results of a study are likely to be to the truth. The intentions of scientific rigor is disciplined accuracy.

Good scientists design studies using scientific rigor, report degrees of probability, indications rather than certainties, and always follow up with a call for more research. They welcome peer review – evaluation of their work by experts. Relying solely on the peer review process has its risks and limitations, however. While people conducting peer reviews are trained, experienced, scientific professionals, they are not infallible.

Armed with understanding the limits of “knowing” – epistemology – and the intention of research to seek truth beyond the personal – scientific rigor – we can use the following criteria to examine the research meaningfully on our own.

1. Sample sizes must be sufficiently large. Each scientific study, if it is to be of any use, must have a sufficiently large and representative sample. “Sufficiently large,” or meaningful sample size, can be evaluated with statistics, but as a rule the larger the sample size the better. Typically, sample sizes are limited to the amount of funding a study has.

In the field of addiction, people have asserted that one must have experienced addiction in order to understand it. In some ways this is true; the personal experience of having an addiction is not replaceable by science and is immensely valuable for helping others relate to the condition. Personal experience may even provide insight for the initial formation of scientific hypotheses. However, personal experience is a sample size of one. Science is used to evaluate things about a condition beyond the individual and personal.

2. One or more controls must be used for each experimental variable. Science attempts to break a large question down into a series of studies, each addressing very few, measurable variables. Human studies are notoriously difficult to engineer because of the number of variables potentially influencing the outcome. The tension is between the usefulness of a study general enough to apply to many people, and a study specific enough to be rigorous.

First, scientists attempt to narrow the focus of the study to a limited population, for example, to people with heroin substance use disorders in prison. Next scientists must determine what variables still remain. Ideally, they will make all relevant variables consistent, except for the ones being tested. The more potential, unaccounted-for variables, the less useful the results. Statistics allows scientists to sort out some of this complexity, but as a general rule, fewer confounding variables are better.

For each experimental variable – for each variable being measured – scientists come up with one or more controls. In the case of addiction, if the treatment is 12-step attendance, scientists may compare it to no treatment at all. If multiple treatments are being evaluated, scientists may compare 12-step attendance with cognitive behavior therapy,  dialectical behavior therapy, and no treatment. A new treatment may be compared to “treatment as usual,” or “TAU,” which must be explicitly defined.

3. Placebos are a particularly useful control for evaluating medical treatments. Using this type of experimental control, scientists will compare new treatments to false treatments, or placebos. The placebo effect refers to the ability of the human mind to fabricate some kind of change even if the treatment was a sugar pill with no effect. Scientists investigate whether treatments can physiologically improve a condition more than the brain can on its own with sufficient belief.

4. Randomization is a key part of most experimental designs to prevent bias. Randomization involves using a computer program to select test subjects or experimental plots, match test subjects with treatments, and etc. It is a technique that attempts to make samples representative of whatever is being studied. Randomization is an important precaution against bias, i.e. it prevents the scientist from engineering the results of an experiment.

Especially with human studies, scientists often try to overcome some of the potential effects of human diversity (i.e. gender, race, income level, etc.) by randomizing which test subjects are assigned to which experimental group. For example, in a study on Medication-Assisted Treatment (MAT), scientists may use a computer program to determine which person receives buprenorphine, methadone, or no medication at all.

5. Double-blind experiments are a gold standard. In addition to randomization, scientists will use double-blind experiments, where possible, to assess new treatments. Not only are the patients unaware of whether they are receiving treatment or placebo, but the experimenters are, too. After randomizing which patients receive a placebo and which receive the experimental treatment, the people administering the treatments are not told which is placebo and which is not so that they can’t give the patients any unintentional hints. Double-blind trials are not always possible, especially with behavioral therapies.

6. Minimal extrapolation from results is preferred. Even a well-conducted study can be followed by fairly wild speculation on the part of the researcher. Scientists are sometimes guilty of drawing conclusions that are not supported by their research design or by their results. Usually, due to experimental limitations, the conclusions drawn should be modest. After reading the results of a study, reading the conclusion should feel like a “duh” moment.

7. Regardless of a study’s level of rigor, one study is never enough to draw a strong conclusion. As a secondary researcher, I need to use a large sample size, too. Just as my personal experience is limited as a sample size of one, each scientific study has limits to its usefulness. One of the most important aspects of the scientific method is the repeatability of experiments. Until we repeat experiments or approach a problem with multiple experiments, our ability to draw conclusions from the results is very limited. So, when I see a news article making a sensational claim that only cites a single study, I’m going to recognize that even if that study is as rigorous as it could possibly be, its results have limited value until it has been repeated.

Science is accessible to anyone and is extremely useful, though its expense, the limitations of each study, the number of repeat studies, and the work required to understand it may make it seem like an epistemological tortoise. It may be true that anyone can twist a single scientific study to seem to say something it doesn’t. It’s much harder to twist many controlled, randomized, and blinded studies with large sample sizes. Science-savvy readers, at least, will be harder to fool and will be looking for more modest, nuanced conclusions.

Photo credit: Risa Pesapane

5 Addiction Myths Challenged by Maia Szalavitz in Unbroken Brain

Unbroken Brain: A Revolutionary New Way of Understanding Addiction braids together three narratives: Maia Szalavitz’s personal story, what the science reports about addiction, and a call to action to change belief-based addictions treatment to evidence-based treatment.

Prior to the release of Unbroken Brain, Maia Szalavitz shared these images about the myths surrounding addiction and the science that refutes them through her Twitter stream.

Unbroken Brain Myth #1: There is an "addictive personality" that all people with addiction share.

Myth #1: There is an “addictive personality” that all people with addiction share.

People with addictions are more likely to have higher levels of certain traits like impulsivity or anxiety, however, not all addicted people have all of these traits and no single “addictive personality” has ever been found. Further, extremes on either end of the personality spectrum – like fearfulness and recklessness – can both increase risk.

Unbroken Brain Myth #2: Once an addict, always an addict.

Myth #2: Once an addict, always an addict.

Conventional wisdom has it that addictions are always a lifelong struggle. But in fact, half of people with illegal drug addictions overcome their problems by age 30 – and many do so by cutting down, rather than quitting entirely.

Unbroken Brain Myth #3: Addiction is an "equal opportunity" disease.

Myth #3: Addiction is an “equal opportunity” disease.

Not everyone is equally at risk. Addiction typically kicks people who are already down or who have unstructured or otherwise difficult lives. It is far more likely to affect people who have mental illness, those who have suffered severe childhood trauma, people with personality disorders and those who are poor and marginalized (although it is probably more common in the extremely rich who have more unstructured time than the middle class, as well).

Unbroken Brain Myth #4: Babies can be "born addicted" to drugs.

Myth #4: Babies can be “born addicted” to drugs.

Infants can be born with physical dependence on drugs like heroin or pain relievers if their mothers take them daily during pregnancy. But newborns cannot be addicted, even though they can suffer withdrawal. Addiction requires knowing that the drug is what you need to fix your symptoms, as well as being able to obtain it repeatedly and then taking it despite negative consequences.

Unbroken Brain Myth #5: Addicts have "hijacked brains" and are powerless over their behavior and unable to learn until they stop taking drugs.

Myth #5: Addicts have “hijacked brains” and are powerless over their behavior and unable to learn until they stop taking drugs.

While much of addictive behavior seems irrational, no one deliberately shoots up in front of the police or in court – and people with addiction clearly plan and work hard to ensure their drug supply and avoid detection. On the other hand, they do all this hiding and planning in order to gain access to something that is harmful for them.

This means that people with addiction can have impaired decision-making abilities, but they are not zombies without free will. While addicted, they can and do take important steps to protect their health like learning to use clean needles and how to reverse overdose.

Here’s a transcription of the text in these images (.pdf).

Maia Szalavitz has written extensively in multiple publications on how addiction myths are contradicted by the science of addiction.

Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, has graciously agreed to speak in Blacksburg, Virginia on Wednesday, August 3, 2016.

Learn more about Maia Szalavitz’s visit to Blacksburg, Virginia

Author Maia Szalavitz to Speak in Blacksburg, VA on August 3

Maia SzalavitzHandshake Media, Incorporated is honored to present “What’s a Town to Do About Addiction? A Conversation with Maia Szalavitz, Author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction” at 7:00 PM EST on Wednesday, August 3, 2016, in Blacksburg, Virginia.

UPDATE: Video and transcript are here.

Thanks to its generous donation of meeting space, the event will be held in the New River Room at New River Valley Community Services, 700 University City Boulevard, Blacksburg, Virginia.

Directions to New River Valley Community Services (NRVCS) in Blacksburg, Virginia

The event is free and open to the public and will include time for Q & A with author Maia Szalavitz.

No time to read Unbroken Brain prior to the event?

Here are our top picks from her most recent publications.

Read Author to lead conversation on the science behind addiction by Luanne Rife for The Roanoke Times.

Unbroken Brain braids together three narratives: Maia Szalavitz’s personal story, what the science reports about addiction, and a call to action to change belief-based addictions treatment to evidence-based treatment.

The author will be available to sign audience members’ previously purchased copies of Unbroken Brain after the conversation. Here’s a link to multiple ways to buy Unbroken Brain prior to the event.

Can’t attend? NRVCS will be livestreaming the event on its Facebook page on Wednesday, August 3, 7:00 PM EST.

To learn more about why Maia Szalavitz was invited to Blacksburg:

If you would like more information about Maia Salavitz’s visit to Blacksburg, Virginia, please contact Anne Giles.

. . . . .

Maia Szalavitz will give a public lecture on drug addiction at The University of Virginia’s College at Wise in Wise, Virginia on Thursday, August 4, 2016, 6:00 PM at the Banquet Room in Cantrell Hall. The lecture is free of charge and open to the public. Persons with family members or loved ones with addiction are especially invited to attend. For additional information, contact Hugh O’Donnell, 540-395-3926 or 540-762-0590.

Directions to Cantrell Hall in Wise, Virginia

. . . . .

Community Discussion of Unbroken Brain on August 31

Let’s continue the conversation after Maia Szalavitz’s visit to Blacksburg!

We’ll Unbroken Brain by Maia Szalavitzgather for a community book discussion of Unbroken Brain on Wednesday, August 31, 2016 at 7:00 PM in the Community Room at Blacksburg Library, 200 Miller Street, in Blacksburg, Virginia.

The book discussion is free and open to the public.

We invite you to prepare for a lively discussion by considering these questions.

No time to read the book?

If you’ll sign up on the Unbroken Brain discussion Facebook event page we’ll know how many chairs to set up!

To learn more about author Maia Szalavitz:

If you would like more information, please contact Anne Giles.

Last updated 7/28/16

What’s a Town to Do About Addiction? A Conversation with Maia Szalavitz

In 1996, Blacksburg, Virginia was deemed the Most Wired Town in America. In the 20 years since, the Town of Blacksburg has made dozens of “best of” lists for business, retirement, living and learning.

My dream for Blacksburg’s next accolade?

Most Recovered Town in America.

Why in the world would we want or need such a designation?! We have our street festival, Steppin’ Out, just around the corner! We’re fine! Right? We’re fine. Aren’t we?

Over 16,000 people 18 and older in the New River Valley area have alcohol and other drug problems. According to local officials I’ve interviewed, the majority of local criminal and traffic cases involve substance use. These numbers include a larger trend in Virginia, considered epidemic in the U.S., involving opioid addiction.

We, like other towns in the U.S., are not fine. The state hardest hit by the opioid crisis, West Virginia, is right next door.

Stephen Covey urged leaders, “Begin with the end in mind.”

What would be the “end in mind” for the “Most Recovered Town in America”? How would we know if we had achieved that end?

Maia SzalavitzTo begin to answer those questions, Handshake Media, Incorporated is honored to present “What’s a Town to Do About Addiction? A Conversation with Maia Szalavitz, Author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction” at 7:00 PM on Wednesday, August 3, 2016.

Thanks to its generous donation of meeting space, the event will be held in the New River Room at New River Valley Community Services, 700 University City Boulevard, Blacksburg, Virginia.

Read more about Maia Szalavitiz’s August 3 talk in Blacksburg, VA

. . . . .

In Blacksburg, Virginia, we’ve been reading Maia Szalavitz’s Unbroken Brain: A Revolutionary New Way of Understanding Addictionsince it was released two months ago on April 6, 2016.

To prepare for Maia Szalavitz’s visit to Blacksburg, we’ll Unbroken Brain by Maia Szalavitzgather for a community book discussion of Unbroken Brain on Wednesday, June 22, 2016 at 7:00 PM in the Community Room at Blacksburg Library, 200 Miller Street, in Blacksburg, Virginia.

The event is free and open to the public!

We invite you to prepare for a lively discussion by considering these questions.

If you’ll sign up on the June 22 Facebook event page, we’ll know how many chairs to set up!

For more information about Maia Szalavitz’s visit to Blacksburg, Virginia, please contact Anne Giles.

Last updated 6/18/16

Signing Off on Podcast Production Services

At Handshake Media, our vision was to share the voices of our community through our own podcast channel and to help members of the “who can podcast” list below to set up their own podcast channels. We offered podcast production services for about 3 months with no takers, however. We’ve learned from previous ventures that if our labor force is small and our budget minimal, if we don’t have early adopters very early, we won’t be able to sustain a “wait and see” approach.

Who can podcast?

  • Authors of self-published books whose readers want to hear the author’s passion for the subject
  • Busy experts who don’t have enough time to speak with all the people who want to talk with them
  • Motivational and inspirational speakers
  • People who can voice opinions
  • Comedians and funny joke tellers
  • Singers and musicians
  • Poets and short story writers
  • Storytellers, and people who would like to preserve family stories for other family members
  • Political, business, and community leaders

Anyone with a message, in other words, can podcast that message to the world.
Why Would You Podcast?

Zoom-H1 by Handshake Media, Inc.

I have a feeling that local interest in podcast channels may follow a similar pattern to that of blogs. When I started Handshake Media in 2008 and pitched blogs and sharing blog posts through social media, the return on investment of sharing the story of an organization or business – not just descriptions of its products or services – was hard to sell.

Will blogs and social media really be used for marketing? That was the question I was asked in 2008.

Do people really listen to podcasts? Will podcasts be used for marketing? That’s the question we’re being asked in 2016.

We shall see what the answer is.

In the meantime, we’ll need to stop offering podcast production services. We appreciate everyone who met with us and considered our services.

We’d like to, however, offer up our extensive market research and thoughtful business model conception on podcast production services for anyone interested. Perhaps our work can help others move this idea forward in ways we weren’t able to.

Because we think members of our community have voices and ideas the world needs to hear.

Feel free to follow the links below and to study, copy and paste as you would like. Feel free to contact us if we can answer any questions or be of service in any way.

Why Would You Podcast?

by Laurel Sindewald and Anne Giles

If Charles Dickens were alive today, this pioneer of the “serial publication of narrative fiction” would be podcasting and we’d be waiting to listen to each installment of his story like we do for the next Harry Potter book.

Anne recording a podcast episode

The Oxford Dictionary tells us “podcast” is a blend of “iPod” + “broadcast.” It’s a “digital audio file made available on the Internet for downloading to a computer or portable media player, typically available as a series, new installments of which can be received by subscribers automatically.”

Why would you podcast?

Because you’ve got a story to tell and you can tell it with your own voice.

BBC’s podcast, The Forum, published an episode just last year titled The Power of the Human Voice, discussing and demonstrating the influence of the human voice in communication and identification. In this episode, The Forum interviews three guests. Peter French, a professor and an internationally recognized expert in voice and acoustic forensics, speaks to the qualities and components of voices that can be isolated to track down and identify criminals. He also agrees with Anna Devin, an opera singer who shares how the human voice provides a spiritual connection, an almost primal, emotional connection in a way that is not yet measurable, and therefore unstudied by science. Diana Deutsch, their third guest, speaks to the importance of intonation in public speakers, and that intonation alone can affect an audience just as much as the content.

As a listener, I was struck by how personal their accounts felt, and marveled that the format of their conversation felt far more interesting, inclusive, and engaging than it would have had I merely read their interview. In interviewing Peter French, Anna Devin, and Diana Deutsch in a podcast, The Forum demonstrated the power of the human voice even as they discussed the topic. Podcasts have taught me that I would rather listen, in many cases, than read.

In fact, many people learn best by listening, and these people will be more likely to remember your message if you deliver your content as recorded audio. Other people struggle to see, with either full or partial blindness, and these members of your audience may appreciate audio content even more.

Podcasts also extend your reach by making your content accessible to people who are too busy to sit down and read. Podcasts and audiobooks are gaining in popularity, because they leave their audience free to drive, exercise, or do chores while listening.

Podcasts, like other forms of content marketing, allow you to build rapport with your target market as a company or professional who provides value, even before people buy in as customers. Unlike other forms of online marketing, podcasts allow you to reach your market even after they leave their online devices behind. Listeners will often download podcast episodes to listen to later, on iPods or other mobile devices.

Who can podcast?

  • Authors of self-published books whose readers want to hear the author’s passion for the subject
  • Busy experts who don’t have enough time to speak with all the people who want to talk with them
  • Motivational and inspirational speakers
  • People who can voice opinions
  • Comedians and funny joke tellers
  • Singers and musicians
  • Poets and short story writers
  • Storytellers, and people who would like to preserve family stories for other family members
  • Political, business, and community leaders

Anyone with a message, in other words, can podcast that message to the world.

Understanding Why We Have Wait Lists for Opioid Addictions Treatment

by Laurel Sindewald and Anne Giles

Wait lists for medication-assisted treatment (MAT) for opioid addictions treatment can be months long, especially in rural areas. While opioid addiction is considered an epidemic in the U.S, patients struggle to access and then to pay for medications known to support opioid addictions recovery.

Buprenorphine is a partial opioid agonist used in maintenance therapy for opioid use disorders. As is methadone, buprenorphine is an evidence-based treatment for opioid use disorder. Buprenorphine has been shown repeatedly to improve treatment outcomes more than behavior therapies (Clark et al., 2015; Bart, 2012) and more than abstinence-based treatment.

Wait lists for buprenorphine can be months long

Yet federal and state governments have intervened to impose a number of strict regulations, effectively limiting patient access to buprenorphine, beginning with the federal Drug Addiction Treatment Act of 2000 (DATA 2000):

  • DATA 2000 mandates that only physicians may prescribe buprenorphine. This is unusual, because nurse practitioners, as well as physicians, are typically given clearance to prescribe a number of schedule II opiates, including Oxycodone. Source
  • Physicians are required to complete DATA 2000 Certification. The government usually allows doctors discretion in determining what techniques and medications require what training. Source
  • DATA 2000 imposed 30-patient limits on physicians prescribing buprenorphine. Due to the Office of National Drug Control Policy Reauthorization Act of 2006, physicians must apply, after one year, to raise their patient limit to 100. Patient limits were imposed to reduce diversion of medication for street sale. However, the abuse potential for buprenorphine has been found to be less than that of full opioid agonists such as heroin or oxycodone. Diversion for illicit use has been limited in the US, and has typically been used therapeutically when diverted. There are no patient limits for prescription of other opiates, including oxycodone. Source
  • On July 8, 2016, Substance Abuse and Mental Health Services Administration (SAMHSA) and the US Department of Health and Human Services (HHS) published new regulations for MAT in the Federal Register, allowing doctors to prescribe up to 275 patients at a time. In order to do so, doctors must have credentials in addiction medicine or addiction psychiatry from a specialty medical board or professional society, or work in a qualified practice setting providing comprehensive MAT treatment. These regulations will be effective on August 7, 2016.
  • Some states, including Virginia, require physicians to refer patients to counseling in order to prescribe buprenorphine. Counseling has not been shown to improve treatment outcomes for MAT patients. Source from 2016 / Source from 2015 / Source from 2011
  • While the Mental Health Parity and Addiction Equity Act of 2008 requires health insurers to cover behavioral health services, this does not extend to MAT. Not all insurance plans cover buprenorphine, and in some cases doctors insist on payment in cash. If a patient has no insurance, the requirement to comply with counseling adds an extra expense that may be prohibitive.
  • Some states set limits on how long patients may be treated with buprenorphine. The SAMHSA guidelines for treatment with buprenorphine state that some patients may require many years, or even life-long maintenance.
  • Some states set age restrictions on who can receive buprenorphine. In Virginia, no one under the age of 16 is allowed to take the medication. This is clearly not because people under 16 never develop substance use disorders. The 2014 SAMHSA National Survey on Drug Use and Health reports that 1.3 million adolescents aged 12-17 had substance use disorders. This means 5% of adolescents, or 1 in 20, met the criteria for a substance use disorder in 2014. 168,000 of these adolescents were addicted to pain relievers, and 18,000 were addicted to heroin.

Opioids produce tolerance in people over time, which means their bodies no longer respond to the drug as strongly as before. As tolerance develops, people take higher and higher doses of opioids to get increasingly lessened effects. If people with opioid use disorders are abstinent, their tolerance drops. This means if they relapse, they may try to take the kinds of high doses they had been used to, and so are likely to overdose and die.

As only a partial agonist, buprenorphine and methadone do not produce highs in patients who have, already, developed tolerance to opioids. Rather, these medications are designed to stabilize opioid levels while patients rebuild their lives, staving off withdrawal symptoms as well as cravings, and reducing the risk of lethal overdose.

“[T]he treatment delivery strategies that are often used and that can produce excellent patient outcomes (eg, frequent clinic visits, observed dosing, provision of intensive psychosocial services, limited take-home doses) may simultaneously decrease treatment availability, practicality, acceptability, enrollment, and retention for some patients. Alternatively, treatment paradigms that may be most convenient for patients and physicians (eg, infrequent clinic visits, reduced oversight, and providing longer-duration supplies of medication) may increase the risk of medication diversion and abuse and undermine treatment outcomes. This paradox poses significant barriers to the widespread therapeutic delivery of effective medications to opioid-dependent patients, particularly in rural areas with few services and significant unmet need for treatment.”
– Stacey C. Sigmon, Ph.D., Access to Treatment for Opioid Dependence in Rural America, 2014

When talking about MAT, we must be clear about our values and objectives. Above all, MAT is a non-punitive approach to opioid addiction recovery. Abstinence may be wished for, but in the meantime, treatment providers are hoping to reduce disease risk, crime, and death. Lessons from the AIDS epidemic may be helpful in understanding and implementing best practices quickly.

A recent pilot study indicates that buprenorphine dosing while patients are waiting for comprehensive addictions treatment significantly reduced illicit opioid use, including intravenous use, compared to patients on wait lists who did not receive buprenorphine. Even without additional addictions treatment, buprenorphine seems to be effective. The authors suggest that their findings could be especially useful for treating people with opioid use disorders in rural areas where treatment is hard to access due to limited transportation.

Latest science indicates that incarceration and punishment are ineffective, even harmful. Yet this did not prevent drug courts from lobbying against Human Health Services’s efforts to increase patient limits to 200. Fortunately, their efforts were not successful, and we may see patient limits increased in the near future.

The question remains whether patient limits should be imposed at all. In other areas of medicine, we trust doctors to limit their patient load to what they can effectively handle. We still trust doctors to prescribe painkillers, like hydrocodone and oxycodone, without restriction of dose or patients. Not that we should begin imposing arbitrary restrictions on other aspects of medicine. It is simply time for government to recognize addiction as an illness requiring treatment, not punishment, and that sometimes treatment includes medications such as buprenorphine.

With millions of Americans addicted to opiates and close to a  million still left without treatment, a 200 patient limit may not go far enough to ensure people get the treatment they need. Meanwhile, people are dying while they wait.

Updated 12/28/16

Image: iStock

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