Author Archives: txprn
Substance abuse continues to climb during the coronavirus pandemic
The Dangers of Opioids in the Workplace
Drug overdose is the number one cause of unintentional death in the U.S.
According to the CDC, in 2018, more than 67,000 people died from drug overdoses. The main culprit of the deaths being opioids, including: prescriptions, heroin and fentanyl.
The Biden administration released its first set of drug policy priorities after overdose deaths hit record numbers during the pandemic. The priorities provide a guide to ensure that the federal government promotes evidence-based public health and public safety interventions.
The priorities are:
- Expanding access to evidence-based treatment
- Advancing racial equity issues in our approach to drug policy
- Enhancing evidence-based harm reduction efforts
- Supporting evidence-based prevention efforts to reduce youth substance use
- Reducing the supply of illicit substances
- Advancing recovery-ready workplaces and expanding the addiction workforce
- Expanding access to recovery support services.
According to the National Safety Council, opioids are most often used to treat acute or chronic pain. Employees who are prescribed prescription opioids may be at risk for opioid impairment in the workplace or developing an opioid use disorder. Impaired employees pose a safety hazard to themselves, co-workers and the environment they’re in. This is important to note because there are very safety-sensitive industries that are dangerously affected, such as: construction, transportation and material moving operations that put employees at a higher risk for workplace injury.
Opioids can also impair thinking and reaction time, affecting performance and safety sensitive tasks. This can lead to serious mistakes when performing a job that requires focus, attention to detail and quick reaction time.
The NSC created a free toolkit to help address opioid use in the workplace and how it impacts it. The online toolkit includes sample policies, fact sheets, presentations and more.
Source: https://ohsonline.com/articles/2021/04/12/the-dangers-of-opioids-in-the-work-place.aspx
Overdose Deaths Have Surged During the Pandemic, C.D.C. Data Shows
The latest numbers surpass even the yearly tolls during the height of the opioid epidemic and mark a reversal of progress against addiction in recent years.
More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to preliminary federal data, eclipsing the toll from any year since the opioid epidemic began in the 1990s.
The surge represents an increasingly urgent public health crisis, one that has drawn less attention and fewer resources while the nation has battled the coronavirus pandemic.
Deaths from overdoses started rising again in the months leading up to the coronavirus pandemic — after dropping slightly in 2018 for the first time in decades — and it is hard to gauge just how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.
Many treatment programs closed during that time, at least temporarily, and “drop-in centers” that provide support, clean syringes and naloxone, the lifesaving medication that reverses overdoses, cut back services that in many cases have yet to be fully restored.
The preliminary data released Wednesday by the Centers for Disease Control and Prevention show a 29 percent rise in overdose deaths from October 2019 through September 2020 — the most recent data available — compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs, particularly methamphetamine.
And unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting Black Americans disproportionately.
“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse, said at a national addiction conference last week. “And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups.”
Dr. Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.
“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”
The surging death rate eclipses modest gains made during President Trump’s term against the nation’s entrenched addiction epidemic. During his administration, several billion dollars in grants to states allowed more drug users to get access to the three F.D.A.-approved medications for opioid addiction — methadone, buprenorphine and naltrexone — that work by suppressing cravings and symptoms of withdrawal. Naloxone, the overdose-reversing drug that has saved thousands of lives, also became widely distributed.
Brendan Saloner, an associate professor at the Johns Hopkins School of Public Health who studies access to addiction treatment, said surveys that he and a colleague, Susan Sherman, conducted of drug users and people in treatment in 11 states during the pandemic found that many had used drugs more often during that time — and used them alone more often, likely because of lockdowns and social distancing. Well over half the participants also said the drugs they used had been cut or mixed more than usual, another red flag.
“The data points corroborate something I believe, which is that people who were already using drugs started using in ways that were higher risk — especially using alone and from a less reliable supply,” Dr. Saloner said.
Although President Biden has yet to appoint a permanent “drug czar,” his Office of National Drug Control Policy released an outline last week of its priorities for addressing the addiction and overdose epidemic. They include measures the Trump administration also embraced, like expanding access to medication treatment for opioid addiction, but diverged from the Trump agenda by pledging to address “systemic inequities” in prevention, treatment and recovery.
And although the Biden plan embraced medications for addiction, shortly after his inauguration, Mr. Biden reversed a move by the Trump administration that would have made it easier for doctors to prescribe buprenorphine, a lifesaving anti-craving medication, for opioid addiction.
Members of the new administration said at the time that the plan was not legally sound, but one of the priorities listed in the new document is to “remove unnecessary barriers to prescribing buprenorphine.”
On Tuesday, several dozen organizations that work on addiction and other health issues asked Mr. Biden’s health and human services secretary, Xavier Becerra, to “act with urgency” and eliminate the rule that doctors go through a day of training before getting federal permission to prescribe buprenorphine. Many addiction experts are also calling for abolishing rules that had already been relaxed during the pandemic so that patients don’t have to come to clinics or doctors’ offices for addiction medications.
Although many programs offering treatment, naloxone and other services for drug users have reopened at least partly as the pandemic has dragged on, many others remain closed or severely curtailed, particularly if they operated on a shoestring budget to begin with.
Sara Glick, an assistant professor of medicine at the University of Washington, said a survey of about 30 syringe exchange programs that she conducted last spring found that many closed temporarily early in the pandemic. After reopening, she said, many programs cut back services or the number of people they could help.
“With health departments spending so much on Covid, some programs have really had to cut their budgets,” she said. “That can mean seeing fewer participants, or pausing their H.I.V. and hepatitis C testing.”
At the same time, increases in H.I.V. cases have been reported in several areas of the country with heavy injection drug use, including two cities in West Virginia, Charleston and Huntington, and Boston. West Virginia’s legislature passed a law last week placing new restrictions on syringe exchange programs, which advocates of the programs said would force many to close.
Mr. Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, as well as $30 million in funding for local services that benefit people with addiction, including syringe exchange programs. The latter is significant because while federal funds still largely cannot be spent on syringes for people who use drugs, the restriction does not apply to money from the stimulus package, according to the Office of Drug Control Policy. Last week, the administration announced that federal funding could now be used to buy rapid fentanyl test strips, which can be used to check whether drugs have been mixed or cut with fentanyl.
Fentanyl or its analogues have increasingly been detected in counterfeit pills being sold illegally as prescription opioids or benzodiazepines — sedatives like Xanax that are used as anti-anxiety medications — and particularly in meth.
Northeastern states that had been hit hardest by opioid deaths in recent years saw some of the smallest increases in deaths in the first half of the pandemic year, with the exception of Maine. The hardest-hit states included West Virginia and Kentucky, which have long ranked at the top in overdose deaths, but also western states like California and Arizona and southern ones like Louisiana, South Carolina and Tennessee.
Source: https://www.nytimes.com/2021/04/14/health/overdose-deaths-fentanyl-opiods-coronaviurs-pandemic.html
Covid-19 Increases Stress And Traumatic Stress Disorders Including Drug Abuse And Fatal Overdoses
A syndemic refers to multiple interrelated epidemics happening at the same time. Covid-19 has unleashed and amplified a number of simultaneous personal, social, medical, political, and economic crises. This article is part two of a series of articles exploring the impact of the Covid-19 syndemic. Read part one here.
Post-traumatic stress disorder (PTSD) is an anxiety disorder that is caused by a traumatic experience in a person’s life, such as military combat, sexual abuse, violence, disasters, or acts of terrorism. Symptoms often include flashbacks, nightmares, severe anxiety and depression as well as uncontrollable and intrusive thoughts surrounding the events that caused the PTSD. Covid-19 has created so many stressors from strained finances to grieving the death of loved ones to the moral trauma of global leaders mishandling or ignoring the crisis. It is likely that an unprecedented amount of people have and will experience PTSD related to the effects of Covid-19. A recent study demonstrated the prevalence of PTSD in 30.2% of patients after acute Covid-19 infection
This alone is a grave concern as our health systems are not currently equipped to care for and treat such an influx of patients and even access to mental health care remains a convoluted issue. Amplifying the crisis is that PTSD and substance abuse disorders are commonly linked as co-occurring disorders. Research consistently demonstrates that individuals who suffer from trauma or PTSD are more likely to have problems with substance dependence. The U.S. National Comorbidity Survey revealed that 34.5% of men and 26.9% of women who had PTSD at some point in their lifetime also had a problem with drug abuse or dependence. Based on this knowledge, substance abuse and addiction could even be seen as manifesting as a symptom of PTSD.
According to the CDC, as of June 2020, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. As the pandemic has continued, the crisis has only worsened. In Colorado, overdose deaths were up 20% through the end of last year, and those involving fentanyl doubled. 2020 proved to be the deadliest year of the opioid epidemic on record for Maine with 502 fatal drug overdoses reported.
The latest national data from the CDC shows there were more than 88,000 overdose deaths in the year through August 2020, up from nearly 70,000 in the same time period of 2019. According to a report from the Commonwealth Fund, the final 2020 total in the United States could exceed 90,000 overdose deaths, compared to 70,630 in 2019. That would not only be the highest annual number on record but the largest single-year percentage increase in the past 20 years.
There are many reasons that may explain why the pandemic has facilitated this steep rise in addiction, relapse, and overdoses. Americans have fewer coping and resilience-building strategies available to them in the pandemic, they can’t exercise at a gym or fitness center and they can’t socialize or see family regularly. Isolation makes it easier to hide the effects of addiction from family and friends who might otherwise intervene. People are also more likely to die when they are using drugs alone because there’s no one there to call emergency services or administer naloxone, an opioid-reversal agent. The impact of PTSD related to Covid-19 can also not be underestimated.
During the early stages of the pandemic and even currently, addiction treatment centers have shut down or reduced their in-person services. While clinics and services have shifted to telehealth services, many patients lack access to stable housing and/or the technology to access these services. Some patients feel the intimacy and impact of a group meeting are lost in a virtual setting and stop attending. That’s not to say telehealth can’t be effective in providing greater access to care, particularly in rural areas. But the choice to use telehealth in addiction treatment needs to be voluntary, not inflicted by a pandemic.
Despite the clear and desperate need, many states are cutting addiction programs due to the financial toll of the pandemic. The National Council on Behavioral Health conducted an online survey of 880 behavioral health organizations across the country in April 2020. 61.8% of organizations closed at least one program. Nearly all of the organizations (92.6%) have reduced their operations. 46.7% of behavioral health organizations have had to, or plan to, lay off or furlough employees as a result of Covid-19.
One option to address this disparity in care is Medicaid expansion, which has been associated with positive insurance coverage, treatment access, and mortality outcomes for substance-use patients. With the federal government funding 90 percent of the cost, Medicaid expansion can be a key source of external funding for states to sustain substance abuse care providers and facilitate better access for patients. Florida, South Carolina, and Tennessee, which have high overdose rates, have yet to expand Medicaid. Utilizing Medicaid also decreases the reliance on annual discretionary funding to support siloed treatment programs.
On April 1st, 2021, the Biden administration announced its drug policy priorities for the first year. These priorities included expanding access to quality treatment, enhancing harm reduction services to engage and build trust with people who use drugs, and working to reduce the lethal supply of illegal substances in the U.S, advancing recovery-ready workplaces, expanding the addiction workforce, and increasing access to recovery support services such as safe and stable housing.
While these are critical and long-overdue reforms, there also needs to be a greater focus on preventive mental health screenings and care due to their link with substance abuse disorders. Childhood trauma is also linked with future substance use disorders and will likely be exacerbated by the increase in child poverty during the pandemic. Creating integrated healthcare systems that treat the physical, mental and social health of patients will be critical in fighting the syndemics such as PTSD and addiction that accompany the Covid-19 pandemic.
Sober Brown Girls Is A Rare Safe Space For Women Of Color Looking To Overcome Addiction
A particularly grueling January morning which followed another night of binge drinking led Sober Brown Girls founder Kirstin Walker to find her way toward sobriety.
In hindsight, she realizes it was shame that had kept sending her back to the bottle.
“Guilt shows up in so many different ways in addiction, I would wake up every morning with this heavy — like a whole body was laying on me — sense of guilt, because I couldn’t control myself,” Walker told Blavity. “What in the world is that all about? You can control yourself. You have power here. But there was that profound sense of guilt of letting my family down.”
Walker, 39, says her problematic relationship with wine dominated her weekends until, one day — the morning of her mother’s doctor’s appointment — it left her helpless.
“That fear is what changed the tables for me, because then I did start to think ‘What if something happens to the kids and I can’t get out of bed, or I’m stuck on the toilet, or I’m sick? What would really happen? This is out of control. If you can’t get out of bed to take your mom to a scheduled appointment, what would happen during an emergency?'” she said.
The mom of two said she founded Sober Brown Girls last February as both a safe space for other women of color who may be struggling with addiction, as well as a means to hold herself accountable as she documented her own journey towards recovery.
In fact, Walker told Blavity, she launched the Instagram page before she even shared her sobriety with her husband.
But Sober Brown Girls encapsulates a more nuanced mission than sobriety alone. For Black women, Walker says, the road to recovery is paved with microaggressions.
“Our traumas are very unique as Black women. When I’m in a group of white women — and they do dominate the sober space — there are certain topics, certain nuances of my addiction that they won’t understand,” Walker said. “But I know if I get in a room with Black women, or I have a Black counselor or a Black lead, it makes a world of difference to me.”
Indeed, sober spaces are not exempt from the harmful, dark-cloud stereotypes that often trail Black women. In conversation with Joy Sutton at American Addiction Centers (AAC), Walker explained that Black women are oftentimes preceded by a singular stereotype in sober spaces: crack addicts.
“What really hit me in speaking with Kirstin, was when she spoke about going to a meeting and people touching her hair,” Sutton, the Director of Corporate Communications at AAC told Blavity. “Even in everyday life being a Black woman, you have to explain yourself. So not only coming into a space where you have to explain yourself and deal with what you’re going through, Kirstin talked about going to meetings and having to explain that it was alcohol and not crack. Just all of the stereotypes.”
The crack epidemic of the 1980s encapsulates a criminalized way of thinking about addiction now considered archaic by the sober community, which generally approaches addiction as a chronic illness today. With the adoption of supervised injection sites and the expansion of emergency responders’ training on how to reverse an overdose, the U.S. response to the opioid crisis is marked by a measure of compassion and support that was not extended to Black Americans victimized by the crack epidemic.
“Well, it was Black people who were doing it,” Walker said. “The messaging was: ‘Control yourself, get yourself together, pull yourselves up by your bootstraps.’ But now we get it. This is a huge chronic illness that needs treatment. This isn’t just because I’m a bad person and I just want to feel this way. I didn’t want to throw up three to four times a week. That didn’t feel good. I would start having fears, knowing the vertigo is coming. What if we had the conversations we had around opioids, with crack?”
Sutton says the science-informed approach to addiction treatment as a chronic illness, rather than an issue of crime or morality is the result of society’s evolved way of thinking — and that we’re better for it.
“We’ve learned more about addiction, and it’s unfortunate because so many people in the Black community suffered, and were stigmatized and shamed,” she said. “It’s sad that it took the opioid crisis, it’s sad that it took an epidemic happening within another community for us to have a wake up call, but I’m glad we’re here now so that people like Kirstin can understand that they’re not alone, and they’re not bad people.”
Today, more than ever, Sutton says it’s crucial for those battling addiction to remember that they are not alone. AAC chose to keep its doors open throughout the pandemic as people across the nation found themselves isolated from their coping mechanisms, and tempted by their former vices, Sutton told Blavity. The center has started an online support program, with membership reaching over 1,000 online users.
The group’s virtual Alcoholics Anonymous and Narcotics Anonymous meetings are intended to provide a sense of safety and support. They’re offered in place of the conventional 12-step meetings that the pandemic has left so many feeling isolated and vulnerable without, the AAC Facebook page explains.
“Anxiety, stress and isolation are triggers for relapse. So in this pandemic we have had the perfect storm,” she explained. “People are losing their jobs, are isolated in their homes, so people that had that supportive community, could go to Alcoholics Anonymous meetings and be around other people, now all of a sudden found themselves in isolation. When you had that, coupled with the stress, it led people to start drinking again, to start doing drugs again.”
Walker’s own struggles with alcoholism speak to the power of isolation. She says her addiction was marred by feelings of shame, and maintained by secrets: tools she picked up in a household governed by a code of silence.
“When I was growing up, not only was it ‘What happens in this house, stays in this house,’ but when you were vulnerable, there was a possibility that someone else would find out this information that you’ve entrusted in confidence,” Walker told Blavity. “This environment makes you scared to be vulnerable and come out and say what you’re feeling. It’s hard to feel that you’re in a safe space.”
Walker says this aspect of her upbringing has guided her in her own motherhood, as she remains fiercely committed to fostering feelings of openness and transparency with her children. What’s more: it’s informed her approach to supporting others in sobriety.
“Just trusting people is something that is still very new for me. As far as everything being secretive, that wasn’t gonna be a part of my household, no way,” Walker said. “With Sober Brown Girls, I want people to know when they come here, it’s safe. I’m very honest on the page when I’m having a rough day — or what a craving is like — when I’m having a good day, what tools I’m using. We laugh, we cry. I want them to know this space is real and it’s safe, and you’re welcome here.”
While Walker arms her fellow sober brown girls with the tools to cope with life and chronic illness, at AAC, the path to recovery is pronged by other avenues of wellness and self discovery. Untreated mental illness is often an unidentified companion to addiction, Sutton told Blavity.
“With the majority of people who come into our treatment centers, we’re not just treating them for addiction. It’s also anxiety, PTSD,” she explained. “There is a strong correlation between mental health disorders and addiction. But it’s no wonder because when you’re struggling, you’re trying to find a way to just feel normal. What you’ll find people often say when they’re dealing with addiction is ‘I wasn’t even drinking for pleasure, I just wanted to feel normal.’”
For Walker, this pursuit of “normalcy” amid anxiety and depression came without context or explanation. Yet again, the answers she needed lay hidden behind the veil of secrecy.
“Who knows who in my family could have suffered from anxiety, depression, postpartum depression, the way I have?” Walker posited. “It could have been generations and generations, but because we don’t talk about these things, we don’t know. I couldn’t turn to a family member because we never had those discussions. They may have thought it was something completely foreign or wrong with me. I didn’t want that judgement. Therapy is not a bad word. I love my therapist. I love my medication, that’s not bad either. It was actually what I needed instead of the alcohol.”
Still, Americans’ problematic relationship with alcohol is not driven by feelings of secrecy and shame alone.
In her sobriety, Walker says she has become aware of the predatory nature of industry advertisements — especially in their targeting of women consumers.
“Alcohol is the only drug that you’re judged for not using. That just comes from our mindset and the role that it plays when we celebrate, when we’re down, the way we see it on TV,” Walker said. “The alcohol industry is kicking out these commercials, most recently a Tropicana one, where they target moms: ‘Go hide in the bathrooms and make a mimosa.’ That is not what she needs. She needs support and compassion. She needs some self care, some me time, she needs to delegate and get the rest of the family involved so she doesn’t feel like she has so much on her back. Those are the tools.”
What’s more insidious, Walker finds, is the chasm between her own experience with the painful consequences of overconsumption, and that which is portrayed in the media.
“It’s pretty irritating to watch a movie and see the amount of alcohol they are drinking, and then in the morning see they’re bright eyed and bushy tailed,” Walker admitted. “In what world? How are you binge drinking and just getting up and living your life? Show us what it really looks like to be hungover.”
The Alcohol Rehab Guide reported that the portrayal of alcohol in television programming and advertisements does in fact have an impact on viewers, as this portrayal is intended by alcohol companies to trigger cravings for certain alcohol brands as well as deepen social acceptance.
The impact, Sutton finds, is further normalization.
“This culture of binge drinking allows people to continue to be in denial. If society is telling you that over drinking is fine, people end up thinking: ‘I don’t have a problem, everyone does this,’” she explained. “When we have an industry that normalizes excessive drinking, it’s hard for people with an addiction to come to the point of realizing ‘I have a problem and I need help,’ because people are telling them ‘You need this, you deserve this.’”
But the media’s propagandic depiction of binge drinking is not limited to romanticizing the morning after. The general understanding of alcohol’s potential deadliness is also largely lost on Americans, Sutton finds.
“People think opiates like heroin are the deadliest to come off of. The truth of the matter is, it’s alcohol. We tell people to be careful if you’re trying to detox at home, because depending on how long you have had this toxic relationship with alcohol, you may find yourself having withdrawal symptoms and even seizures. If that happens, you need to get yourself to the emergency room. I think because we’re in a culture where it’s kind of like ‘Oh alcohol is safe, you can drink’ people aren’t fully aware that dependency and detox can be deadly.”
While the general public remains blissfully unaware of the true dangers of detoxing from alcohol, a hurricane of fear stood in the eye of Walker’s unchecked addiction — fear of not drinking, that is.
“What was I gonna do with all that time? What was I gonna do on the weekends? How were my friends gonna take this, when our whole interaction, before Corona, was centered on alcohol?” the questions buzzed through Walker’s mind, a steady and discouraging taunt.
Today, Walker is one year sober and enjoys the long stretch of weekends that reach for miles, unclouded by the haze of alcohol and hangovers.
“I’m crafty now, who knew at 39 that I’d be crafting?” Walker said. “There are so many different tools and hobbies that I’ve started to lean on. I love reading now. I have so much time on the weekends, which is crazy because i used to always feel like my weekends just flew, because i was sick half of the time. Now it’s like my weekends are forever. I can get into my coloring, I can get into my crafts, it’s been really fun. It’s taken a while to get to this point, to find these different tools, because my only tool used to be alcohol. It’s really an awakening.”
For more resources on the path to recovery, visit Sober Brown Girls and American Addiction Centers.
As Overdoses Reach New Highs, Messaging on Addiction Needs More Nuance
The other is politicians who have the power to invest more in treatment, along with the public who, ideally, will pressure them to use it. The problem is that the two audiences would seem to require different messages. Getting this right is essential if we want to help addicts and their families.
Here’s the issue: Anti-stigma efforts tend to use medicalized language in their appeals, describing addiction as a “brain disease.”
This could be a problem, however, according to research done by one of us (John Kelly), because such rhetoric may stoke, rather than soften, negative feelings about people who are addicted to drugs.
The impetus to medicalize addiction messaging can be traced to the National Institute on Drug Abuse, NIDA. In the late 1990s, it declared addiction a “chronic and relapsing brain disease.”
That assertion was usually accompanied by a technicolor scan of a brain, a computer-generated map of neural activity that said, in effect, “This is your brain on drugs.” The tactic was well-intended and intuitively appealing: make addiction look like any other disease, and support will follow.
Indeed, over the years, “brain disease” language and imagery have been adopted by scores of advocacy groups. “The science is indisputable: addiction is a chronic disease that changes the brain,” says Shatterproof, an organization devoted to improving treatment quality.
You won’t find this approach—addiction as serious brain disease —in anti-drug TV ads. But it is a staple of PowerPoint presentations and advocacy messaging seen by politicians and health care stakeholders and the public. You can see some of it here in an educational video from the Addiction Policy Forum.
Similar “brain disease” messaging comes from the Partnership to End Addiction, (related to the former Partnership for A Drug Free America, which gave us the actual this-is-your-brain-on-drugs ad). Presidents Obama’s and Trump’s Surgeon Generals have called addiction a “chronic brain disease” and NIDA reliably incorporates the message into congressional testimonies.
In view of the need for more treatment funding, Kelly wanted to know what kind of language worked best to prime the general public to help addicted people. Was featuring the brain always the best approach? Probably not.
His study, published in Addiction, involved more than 3,500 adults from a nationally representative sample of volunteers who enrolled in an online ‘KnowledgePanel.’ All of the participants read a vignette about “Alex,” who was in a treatment program for opioid use.
The study’s aim was to test exposure to a variety of commonly used medical and nonmedical descriptions.
In general, Alex was seen as least blame-worthy when the opioid addiction was described using the biomedically loaded term (“chronically relapsing brain disease”)—this is indeed the objective that advocates of medical terminology hope to achieve—and most blame-worthy when described as having an “opioid problem.”
Between those two poles, study participants attributed less and less blame to Alex as they encountered the other terms (“brain disease” to “disease” to “illness” to “disorder”).
The problem is that the use of medical terminology led to a lower perceived likelihood that Alex could recover, greater opposition to social inclusion, and a greater perception that Alex was dangerous. In effect, a brain-on-drugs message promoted empathy for Alex, but it didn’t help the Alex’s prospects for higher education or employment.
The findings of the “Alex” experiment aren’t outliers. They’re consistent with findings of studies of mental illness. Although medical, biological, genetic, or neurobiological understandings of mental disorders, such as schizophrenia, reduce the blame attached to sufferers, they increase aversion, perceptions of dangerousness, and pessimism about their chances of recovery.
This phenomenon, which psychologists Nick Haslam and Erlend Kvaale of the University of Melbourne have called the “mixed-blessings” model of stigma, accords with the theory of ascription, or, how we attach causes to conditions and events.
Under this theory, explanations of errant behavior that implicate the brain—the physical, embodied seat of personal agency—suggest that affected people cannot control their actions. In contrast, psychological explanations that invoke conscious decision-making may engender more blame by making a person seem more responsible for what they do, but also induce hope that they can change their mind and their behavior.
Kelly’s work shows that “stigma” is not a unitary phenomenon. Rather, it encompasses several dimensions. Thus, the term “chronically relapsing brain disease” may reduce one aspect of stigma while increasing others.
This means the campaigns aimed at politicians and the public should rethink and likely tailor their message to match the audience.
Thus, for example, to temper feelings of blame, treatment providers might use the term “chronically relapsing brain disease” to ensure that shame does not keep drug-using individuals and their families from seeking help. This is the approach taken by the famed Hazelden/Betty Ford.
Alternatively, presenting addiction as a “problem” might enhance policy makers’ optimism about prospects for recovery and encourage more funding for treatment programs. Employers, housing or school administrators, too, might view someone being treated for a “problem” as less dangerous than someone with a “brain disease.”
It might seem sly to treat different audiences differently, but this happens all the time in the private sector. You might tout an automobile’s performance to one audience and its safety to another. This kind of nuance would help when it comes to addiction.
Now is a good time to do some rethinking. Soon there will be new directors of key federal agencies with major public outreach responsibilities — the Substance Abuse and Mental Health Services Administration the Office of National Drug Control Policy (aka the office of the Drug Czar). We urge them and the Biden Administration to heed this insight on shaping public opinion about addiction and its treatment.
The authors have no relevant financial relationships.
Maintaining Mental Health During Today’s New Normal
Assistant Professor and licensed psychologist Katherine Daly shares some suggestions to keep in mind to help maintain mental health during this challenging time.
If your stress is impacting the quality of your life, seek professional help. It’s important to remember that you are not alone, says licensed psychologist Katherine Daly.
If today’s new normal is increasing your feelings of stress, anxiety and even depression, you’re not alone. In this week’s health tip, we turn to Katherine Daly, a licensed psychologist who leads counseling and wellness services for UCF medical students, on ways to maintain your mental health during this challenging time:
- Be intentional about your emotional health right now. Be honest with yourself – what are you feeling? Irritable? Sluggish? Panicked? Unmotivated? Angry? These emotions are normal given all the changes we’ve seen in our daily lives over the past few months. So give yourself permission to feel as you feel. The important step is to identify the things that add to your stress and set out to find things that bring you more peace.
- For example, we all want to stay informed, but overexposure to the news and social media can add to some people’s stress. If 24/7 news on the pandemic hits an emotional nerve, access more data-driven sites like the CDC’s COVID-19 website. Instead of being glued to social media, pick up the phone and call a friend. Write a letter to a relative. Find safer ways to connect.
- Make sure you are maintaining the pillars of physical health. Eat nutritious foods – preparing a healthy meal can be a relaxing experience for some people. Be sure you are getting enough sleep and exercise. Because many of us are working from home, our daily physical activities have changed. We’re not hustling down the hall for a meeting or taking the stairs to get to our offices. Those simple changes can make you feel sluggish. So take a break from your home office every hour for a quick walk outside or around the house. Walk around during a phone meeting. Find ways to move.
If you’re working from home, you don’t have a daily commute. So use that time to focus on your mental health in a place that feels safe and secure.
- Create a sanctuary. If you’re working from home, you don’t have a daily commute. So use that time to focus on your mental health in a place that feels safe and secure. Have your morning coffee or tea on the porch or outside. Listen to the birds or some soothing music or nature sounds on tape. Meditate. Go outside and notice the trees and flowers. Spend some uninterrupted time with your pet.
- Give yourself a break. It’s OK right now to rest and reflect. Use your physical distancing time to invest in your wellness. Pick up a self-growth book. Take up a hobby you never had time to do before. Read for enjoyment. Start online yoga. Journal. Sketch.
- Remember the things that bring you joy and be grateful. It’s easy to focus on all the things that are going wrong in the world and in your life. At the end of each day, take time to reflect on what happened that was good. Get a jar and each day write on a slip of paper something for which you are grateful. On a bad day, reach into the jar, grab one of the slips and read it. End each day by counting your blessings.
- Focus on what you can control. During stressful times, it’s easy to think you are powerless. Focus on the actions you can take to exert some control over your life. You can’t change how other people react to COVID-19. But you can be sure you always wear a mask in public. If it gives you more comfort to have groceries delivered to your home rather than venture out, then do it. Be sure you are following up with your healthcare provider on screenings and management of chronic diseases. Be sure you are filling your prescriptions. Have ibuprofen, fluids and recommended over-the-counter medications if you become sick as a way to feel more empowered by being prepared.
If your stress is impacting the quality of your life, seek professional help. It’s important to remember that you are not alone.
BY DEBORAH GERMAN, VICE PRESIDENT FOR HEALTH AFFAIRS AND DEAN OF COLLEGE OF MEDICINE AND AND KATHERINE DALY, COUNSELING AND WELLNESS DIRECTOR, UCF COLLEGE OF MEDICINE JULY 2, 2020
The authors have no relevant financial relationships.
Source: /https://www.ucf.edu/news/maintaining-mental-health-during-todays-new-normal/
The Art of Saying “No” (March 20, 2018)
I don’t know about you, but I often find myself struggling to set boundaries with others. The idea of saying “no” to a request instead of automatically saying “yes” can be a challenge, sometimes even heartbreaking.
Most people in recovery find that they had the “disease of saying ‘yes’” before entering recovery. “Yes” to that drug. “Yes” to that purchase. “Yes” to that extra appointment on the schedule. The problem with this is that when you say “yes” all the time, it begins to lose value. Additionally, we begin to lose sight of ourselves and our journey. When we say “yes” to everything we tend to travel the journey that others push us towards.