What You Can Do to Help Fight Addiction

“Love, evidence & respect.”
Maia Szalavitz’s answer via Twitter to the question, “What fights addiction?”

When I talk with people about the state of addictions treatment in the Blacksburg, Virginia area, I am increasingly asked, “What can I do to help?”

Here are my suggestions:

1) If addiction is a problem right this moment, take yourself or your loved one to a doctor.

Addiction is a health condition that needs health care. In the Blacksburg, Virginia area, most medical care for addiction is offered by primary care physicians and emergency room personnel. These health care professionals can provide individualized initial care, make recommendations for follow-up care based on that person’s individual needs, and make appointments and connections for follow-up care. (Starting with a psychiatrist might be optimal but wait lists for psychiatric care in our rural area are 6 months or more.)

If challenging experiences with substance use and health care professionals have happened in the past, take someone with you/go with someone who needs help. We’re all still learning.

We can do this

2) Inform yourself.

Addiction is complex and the consequences of insufficient or incorrect information may be dire. Take matters into your own hands and learn as much as you can about addiction and its treatment. To help with getting started, I have compiled a simple list of evidence-based treatment options, reworded much of that page’s content as a personal recovery checklist, and compiled a list of local recovery resources. I also personally and professionally recommend Maia Szalavitz’s work on the science of addiction.

But don’t take my word for it. Start Googling, start asking those who are knowledgeable about addiction, use your powers of discernment, and join the growing numbers of people seeing the difference between evidence-based treatment and belief-based practices.

3) Understand the difference between treatment and  support.

Treatment is direct, personal, expert care for an individual’s unique presentation of symptoms. Support is help from volunteer survivors in adjusting to having those symptoms. To use Maia Szalavitz’s metaphor, going to a cancer support group is not equivalent to going to an oncologist. To use a business metaphor, attending a business networking event is not a “treatment” for a cash flow problem; selling something to a customer is.

Attending support groups can be hugely helpful in providing comfort, reassurance, and practical suggestions for handling having a condition. Attending support groups may be a component of an individual’s comprehensive treatment plan. Some people may find support group attendance all they need to attain their recovery goals. But attending support groups is not availing oneself of treatment.

“Families and loved ones can improve the odds for people with addiction by helping motivate them to get treatment; seeking evidence-based care; keeping naloxone on hand; and treating addicted people with the empathy, support and respect they’d offer if they faced any other life-threatening medical problem.”
Maia Szalavitz

4) Familiarize yourself with 12-step recovery.

Addictions treatment is currently dominated by 12-step recovery, although a recent article from the American Medical Association Journal of Ethics states, “TS [12-step] programs of recovery are a respectable modality to recommend to those seeking help with addiction; however, the effect is not sizeable enough for clinicians to insist on TS for everyone seeking treatment for addiction.” In addition, treatment programs and drug courts receiving federal funding that include 12-step components in their programs or require 12-step meeting attendance of their clients may be violating First Amendment rights. Nonetheless, 12-step recovery will be a direct or indirect component of local addictions treatment.

To begin to orient yourself to 12-step recovery support groups, ask someone you know who attends meetings if you can attend with him or her. If you don’t know someone, go by yourself or with a small group to an open 12-step recovery meeting. Respect those seeking help for this serious condition, observe silence, and, as a humanitarian, citizen and consumer, listen and observe.

If you or or a loved one is considering 12-step meeting attendance, perhaps you can find a way to make 12-step meetings work for you. If the content isn’t a fit, see if you can think about attending meetings for social support. In 1996, Blacksburg was designated “Most Wired Town in America.” My dream for our next accolade? “Most Recovered Town in America.” For now, however, options for addictions recovery support are limited. A SMART Recovery meeting is held in Blacksburg and on the Virginia Tech campus when classes are in session.

Addiction is a bully, very difficult to fight alone. Addictions treatment can feel that way when it mandates 12-step practices. Like the sun and the moon, for now, 12-step recovery will exist in addictions treatment. Try to find ways, personally helpful to you, to work with its existence.

5) Become aware of your feelings, thoughts, beliefs and words about people with addictions.

One of the most heartbreaking features of addiction is that it often manifests in inexplicable words and actions that hurt others. So many people have been emotionally, physically and financially harmed, abused, neglected, or injured by an addicted parent, partner, sibling, family member, community member or complete stranger. It’s understandable to feel hurt and baffled, even to want to hurt back.

To begin trying to see addiction as a health condition rather than a personal problem, try starting small. Maybe try saying “person with addiction” rather than “addict.” Try saying “person with alcoholism” rather than “alcoholic.” Even this small change in thinking about addiction can help others who have it.

6) Hold sober events.

Designate some events in your home, work place, community, and organizations as substance-free. Hold a sober holiday meal, a 5:00 PM alcohol-free business networking event, a gourmet street festival without brews or corks. (It’s just not Thanksgiving without wine, you say? Believe me, I hear you.) Help the 1 in 10 Americans and the 16,000+ in our area with substance use challenges to have something pleasant to do that doesn’t include environmental cues, the “people, places and things” notorious for triggering a return to active use.

7) Support doctors being doctors.

Did you know that in order for physicians to offer the top treatment for opioid use disorder – to prescribe medication for what’s considered a national health crisis – physicians must receive special training and approval and, once they receive it, are limited to treating 30 patients in the first year and must apply to treat a cap of 100 patients in the second and subsequent years? Did you know that wait lists to receive medication-assisted treatment for what’s been termed an epidemic – the supply of which is plentiful and often covered by health insurance – can be months long? It’s madness. More madness is ahead: that 100-patient limit is going to be extended to, wow, 275. Inform yourself, then talk to every influential person you know and ask them to help us get readily available medical care to people who need it.

8) Help watch over people who have what I have.

Having a condition that causes personal suffering, causes suffering for those I love, may cause me to do something that harms my fellow citizens – for me, driving while drinking or burdening the health care system with trips to the ER after falls – that has no cure, for which effective treatments are essentially unknown, of which so few of those uncertain treatments are available in my town, that makes me one of those people, has put me into a place of misery beyond words.

Help. Please help.

Thanks to Rosemary Sullivan, Kelly Shushok, Harry Sontheimer, Lara Hayward, my father, Robert Giles, and thousands of others for the conversations that helped me write this post.

Image credit: iStock

What else would help? Feel free to comment or to contact me and let me know.

If you are a resident of the Blacksburg, Virginia area and you or someone else is experiencing a substance use and/or mental health emergency, call 911 and/or ACCESS, 540-961-8400.

The opinions expressed here are mine and do not necessarily reflect the positions of my associates, clients, employers, friends or relatives.

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.

Last updated 8/5/16.

A version of this post originally appeared here.

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.

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

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

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

The opinions expressed here are the authors’ and do not necessarily reflect the positions of Handshake Media, Incorporated, its associates, clients, or vendors.

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.

DBT Improves Emotion Regulation Skills for Addictions Recovery Success

Emotions are powerful. From emotions come passions, wild and driving, which spur us to create or to destroy.
How Self-Regulation Builds Recovery Success

We define emotion regulation as “the ability to assess and change one’s emotional state, particularly in cases of extreme distress.” Emotion dysregulation – also termed “affect dysregulation” – can manifest as under- or over-regulation.

In our post a year ago, we cited the literature that links emotion dysregulation to substance use disorders:
Emotion regulation requires both-and thinking

“Substance use disorders are strongly linked to emotion dysregulation in the literature (Beckstead et al., 2015, Nikmanesh et al. 2014, Fox et al. 2008, Matthias et al. 2011, Axelrod et al. 2011, Dishion et al. 2011).  It has been proposed that substance use begins as an effort toward emotion regulation or self-regulation, but if use leads to addiction, it only worsens one’s ability to self-regulate.  This is known as the self-medication hypothesis of addiction, an older hypothesis which is still supported by scientific literature.

The perceived need to self-medicate begins when emotions become intolerable, and when an individual is unable to regulate those emotions. In fact, “negative affect,” or unregulated, negative moods such as anger, frustration, and depression, is the primary predictor of relapse for addicted individuals.”
How Self-Regulation Builds Recovery Success

In the year since that post was published, Dialectical Behavior Therapy (DBT) is showing increasing favor as the treatment of choice for those struggling with addictions. DBT is a behavioral therapy developed by Marsha Linehan to help individuals with Borderline Personality Disorder (BPD) begin to simultaneously accept themselves and accept that change is needed. The skills DBT teaches patients are applicable beyond BPD, however: mindfulness, interpersonal relations, emotion regulation, and distress tolerance.

While scientists recognize more research is needed to evaluate DBT’s effectiveness outside of BPD, studies have been promising in demonstrating that DBT may improve distress tolerance, reduce depression, anxiety, and other negative affect moods, and has promise for treatment of substance use disorders. As early as 1999, Linehan found that DBT was more effective than treatment as usual in reducing drug use for women with co-occurring BPD and substance use disorders (SUDs). The mindfulness component of DBT has been extensively researched, and shows the most promise for treatment of substance use disorders.

“It is important to note, areas of the brain that have been associated with craving, negative affect, and relapse have also been shown to be affected by mindfulness training.”
Witkiewitz et al., 2013

Mindfulness is essentially a meditation technique borrowed from Zen Buddhism. To practice mindfulness, one must simply become more aware of the present moment, without thought of past or future, and accept it without judgment. Scientists have studied Mindfulness-Based Relapse Prevention (MBRP), a repeatable mindfulness-based training program, and have found as recently as 2014 that those practicing MBRP report significantly fewer days of substance use and decreased heavy drinking, as well as significant decreases in craving, and fewer legal and medical problems.

Addictions treatment has historically been a field riddled with unsupported and even unconscionable “treatments.” With already such strong support in the literature, dialectical behavior therapy may be the very best behavioral therapy available to people in recovery.

This post was updated on 12/17/2016.

11 Facts on Women and Addiction

When we look around at the women in our world in the U.S., what are we likely to see with regard to women and addiction – her co-workers, her neighbors, the parents of her children’s friends, women in line at the grocery store? How many of these women abuse drugs or alcohol, how many have addictions, and what’s going on with them if they do have problems and/or addictions?

  1. flower by Nancy BrauerAccording to the National Institute on Alcohol Abuse and Alcoholism, to maintain “low-risk drinking,” women should have no more than 3 drinks on any single day and no more than 7 drinks per week. Over 48% of women in the U.S. are at that maximum level of a drink per day.
  2. In the U.S., 15.8 million women aged 18 or older, or 12.9 percent, have used illegal drugs in the past year.
  3. According to the World Health Organization, in developed countries like the U.S., 1 in 12 women develop alcohol dependence during their lives.
  4. Addiction occurs more often in men than in women, but this gap is closing. Also, once women start substance use, they are more likely to develop dependence than men are, a phenomenon known in the scientific community as telescoping.
  5. Women are more likely to experience negative social and physical effects of addiction, and faster, than men.
  6. Women encounter more barriers to treatment for addiction than men do, such as childcare difficulties, social stigma, financial difficulties, and relating to predominantly male staff.
  7. Female smokers have greater health risks than male smokers, including double the risk for heart attack. Research suggests that quitting smoking can be more difficult for women, particularly during the first 14 days of their menstrual cycle (the follicular phase) due to hormonal changes.
  8. Co-occurring disorders are prevalent in women with substance use disorders. 29.7% of women with substance use disorders in a particular study (24,575 individuals) were diagnosed with mood disorders, and 26.2% with anxiety disorders. Additionally, eating disorders co-occur in 40% of women with substance use disorders.
  9. Over 50% of women in the U.S. experience trauma in their lifetimes. Rates of physical or sexual abuse range from 55% to 99% of treatment-seeking women with substance abuse disorders. 20-25% of people who experience trauma develop PTSD, putting them at elevated risk for a substance use disorder, which in turn can exacerbate their PTSD symptoms. Up to 3/4 of people who survive violence or trauma have drinking problems. About 80% of women in treatment for addiction experienced sexual or physical assault in their lifetimes.
  10. Women are especially susceptible to developing alcohol substance use disorders due to lower levels of water in their bodies, higher fat content, and lower levels of the protein that metabolizes alcohol. Women are also, particularly due to slow metabolization of alcohol, more likely to develop health problems due to alcohol use, and faster, than men.
  11. Most of the women who enter substance abuse treatment are mothers. Mothers are more likely to complete and comply with treatment if they retain custody of their children. However, of the women who quit smoking during pregnancy, 65% relapse within 6 months of delivery. Between 2005 and 2009, 1,015 infant deaths per year were caused by smoking tobacco during pregnancy. Overall, risk of stillbirth is 2 to 3 times greater for pregnant women who smoke tobacco or marijuana, take prescription pain relievers, or use illegal drugs during pregnancy. Yet a pregnant woman who withdraws suddenly from alcohol or drug use, legal or illegal, without medical help, puts her baby at risk.

Women may become addicted to substances less often than men, but the consequences are potentially more severe for them when they do. On the whole, this information suggests that women may have better treatment outcomes in programs tailored to the specific challenges of their gender. Mindfulness of child care, menstrual cycles and menopause, treatment of co-occurring disorders, and a prevalence of female treatment providers are some ways in which addictions treatment could be improved to help women.

Photo credit: Nancy Brauer

Laurel Sindewald is Executive Director of Handshake Media, Incorporated, publishers of the free addictions recovery smartphone app, New2Recovery.

What the Opioid Epidemic Means in Virginia

In a nation where addiction is slow to be recognized as a disease, “opioid epidemic” sounds almost unbelievable. Surely we have more important diseases to worry about such as cancer, AIDS, and diabetes, right? Yet this year the Obama administration has proposed $1 billion in new funding for treatment and research on treatment to address the opioid epidemic in our country. An estimated 44 people die every day from prescription painkiller overdose in the United States. Since 2008, 115,000 Americans have died of overdose from opioid painkillers.

Named for the receptors on which they act in the brain, opioids are drugs that relieve physical and emotional pain. Opioids include opiates, which is an older term for drugs derived from opium, such as morphine. Common opioids include prescription painkillers such as OxyContin, hydrocodone, Percocet, methadone and Vicodin, as well as drugs like morphine and heroin. Opioids cause a rush of dopamine in the brain, conditioning the brain over time and altering pathways dealing with pleasure, memory, learning, and decision-making.

“The brain is not designed to handle it,” said Dr. Ruben Baler, a scientist with the National Institute on Drug Abuse. “It’s an engineering problem.”
Jason Cherkis, “Dying To Be Free,” The Huffington Post

The rise in opioid use in the United States is largely due to unregulated overprescription of painkillers beginning in 1999. Sales of painkillers quadrupled between 1999 and 2010. OxyContin, in particular, hit rural Appalachia hardSouthwest Virginia included. Recent evidence indicates that OxyContin’s effects wear off much faster than pharmaceutical companies claimed. This means that people will need to take the drug more frequently, which is more likely to cause addiction due to repeated behavior.

People in rural Virginia were also at higher risk for addiction in general, in part due to poverty, a known precursor for addiction. Poverty causes people extreme stress and hopelessness, which often results in mental illness. A new study has found that when unemployment rates rise 1%, fatal opioid overdose rates and emergency room visits rise by 3.6% and 7%, respectively.

As state and federal law enforcement began to crack down on prescription and distribution of painkillers, people who were now addicted to painkillers turned to heroin, which is cheaper and in some areas more readily available.
Video by Leah DickScreenshot from the YouTube video by Leah Dick, featured in her post This is what an addict looks like, 2/22/16.

The opioid epidemic is strongly affecting the Commonwealth of Virginia. In 2013 there were more drug-related deaths in Virginia per capita than motor vehicle deaths. Two people in Virginia die from prescription opioid and heroin overdose every day according to the 2016 policy brief for the Virginia Senate. Untreated substance challenges cost the state of Virginia more than $600 million annually in health care and public safety expenses. The policy brief also specified that, “Virginia’s Medicaid program spent $26 million on opioid use and misuse in 2013, with $10 million of this spending occurring in Southwest Virginia.” Eighty percent of the 986 drug overdose deaths in Virginia in 2014 were due to prescription opioids and heroin. The Virginia Department of Health syndromic surveillance October 2016 report shows that the rising trend of emergency room visits for opioid overdoses has continued, especially in Southwest Virginia where emergency room visits have risen 71% since September.

Statistics this dire may feel remote, but the opioid epidemic is far from being a distant problem or one isolated to pockets of the population. Opioids penetrate both low and high-income areas, affecting young people, older people (especially ages 55-64), and infants. The opioid epidemic has taken such a hold of Virginia and of America that we will need to address the issue at a community level in order to see much progress.

Latest science informs us that the best approach to treating opioid substance use disorders is medication-assisted therapy (MAT). Suboxone and methadone keep people stable enough in recovery to live more normal lives. Pregnant women who are addicted to opioids are advised to take buprenorphine (Subutex) to stabilize themselves and their babies until delivery. People with substance use disorders are more than twice as likely to stay in treatment and not relapse if they are receiving medication than if they are not. Furthermore, total healthcare costs for people with substance use disorders on methadone are 50 to 62% lower than people not on an MAT program. Unfortunately, access to MAT is currently very limited. Even if every slot available for MAT treatment in the US were filled, over 914,000 would be left without treatment.

Abstinence-based approaches to treating opioid addiction have failed, often resulting in fatal overdose due to lower tolerance following abstinence. Incarceration of people with opioid substance use disorders is also ineffective, and may even impair that person’s ability to recover by putting additional stress on the person. Addiction is known to be a chronic disease of the brain requiring long-term treatment. And to quote NIDA Director, Dr. Nora Volkow, “If we embrace the concept of addiction as a chronic disease…perhaps we will be able to feel empathy for a patient suffering from a disease we call addiction.”

Laurel Sindewald is Executive Director of Handshake Media, Incorporated, publishers of the free addictions recovery smartphone app, New2Recovery.

This post was updated on 5/4/17.