Addiction Management Blog

Posts Tagged ‘education’

The College on Problems of Drug Dependence 2013 – my update

Sunday, June 23rd, 2013

For the past half-dozen years, I have been attending The College on Problems of Drug Dependence, better known as CPDD. The conference has been in existence since 1929 and this year is celebrating 75 years! It is the longest running conference on drug addiction problems in the US and is attended by the brightest minds in the field from all over the world (it even has its own blog). This year it was held in San Diego and included poster sessions, oral presentations, and plenty of networking. Usually I go it alone, but this year decided to drag my family along to make up for the year I brought them to the same conference in Reno where, ironically, gambling, drinking and smoking permeated the hotel and conference (yuck!).

There was a lot of great stuff this year as usual, so I thought I would highlight just a few things that really caught my attention.

  • traumafiveAdverse childhood experiences predict later substance abuse and addiction. We have known for a long time that 80-90 percent of those who go down the path of addiction start their journey early in life – during teenage-age years – most often as an adaptive response to coping with one or more adverse childhood experiences. I have written about the ACE study on this site, but what is new are studies that continue to evolve these findings in more detail, and help us really understand just how complex, pervasive, and critical it is to evaluate and treat underlying traumas in those who struggle with addiction. Current stats on abuse and neglect are frightening, and sadly addiction is not the only outcome of these cases. The British Journal of Psychiatry recently published a paper linking childhood adversity to all classes of mental health disorders. At the conference Cathy Spatz Widom presented some of her work that has involved following 1,575 kids from childhood through adulthood. This amazing study included 908 substantiated cases of childhood abuse and neglect processed by the courts from 1967 through 1971, and then matched this group with a control group of 667 children with no official record of abuse/neglect. The results from interviews over multiple decades provides strong evidence that early life experiences make a difference in the trajectories of our lives. Bottom line for those who struggle with addiction: intervention must involve addressing unresolved issues from the past that perpetuate addictive behavior.
  • Legalization of marijuana. I have not written about this topic on this site before, largely because I continue to struggle with exactly how I feel about it. While it is now legal in two states (Colorado and Washington) many other states are moving to legalize recreational use as well. On many fronts I agree that legalization makes sense, as the drug war has been a miserable failure. At the same time, Nora Volkow, the Director of NIDA, in cannabisher keynote address pointed out that marijuana use among teens is at an all-time high, while research findings are absolutely clear about the dangers of THC in young developing brains. This year the public policy forum was dedicated to this topic, and two great speakers from the RAND Drug Policy Research Center – Beau Kilmer and Rosalie Pacula – provided a lot of food for thought. Beau reviewed his seven P’s and Rosalie addressed the four primary public health goals: 1) prevent youth access, 2) prevent drugged driving, 3) regulate product content and form (potency), and 4) minimize concurrent use with alcohol. The “how” of accomplishing these goals is beyond this post, but if you dig into the RAND site you will find a recent publication that provides all the details.
  • Abuse of prescription drugs. If the 80′s were about cocaine, the 90′s about meth, we are now deeply entrenched in a time where “the” object of addiction are prescription drugs. In the past decade there has been a five-fold increase in treatment admissions for abuse of opioids, and overdose deaths related to pills have tripled in the past two decades. In some states more people die of pill overdoses than motor vehicle accidents. It is a problem that has gained national attention by many government agencies (and non-government groups), and was a hot topic this year at CPDD. Much of the focus was on abuse-deterrent formulations, which studies have shown have reduced abuse and diversion. This is a good thing, but at the same time such formulations are not necessarily reducing the number of people who struggle with abuse/addiction – they are just pushing them in another direction to other more easily abusable products or illicit drugs (what we call the “balloon effect”). The key point goes back to my first bullet point. We need to invest far more resources into prevention and early intervention since this is really the origin of the problem for most who struggle.
  • psilocybinPsilocybin and quantum change. Of all the cool things I learned this year, the one that surprised me the most was a workshop focused on the treatment benefits of psilocybin, a hallucinogenic compound from mushrooms that operates mostly on 5-HT-2a/c serotonin receptors. The session, led by Roland Griffiths and Herb Kleber, reviewed studies where psilocybin produced some remarkable mystical experiences for participants that rated among the most important events in their life! Here is a video clip describing one of the studies. The hope for those who struggle with addiction is that psilocybin may be an accelerated way to induce spiritual experiences that result in profound and lasting behavioral changes. The compound, when used appropriately in controlled conditions, appears to be non-physically toxic and virtually non-addictive. While the early findings are intriguing, I am not so sure we will see it on the list of evidence-based practices any time soon.

If you want to read more about the conference, check out the CPDD Blog.

Lastly, I know many of you won’t believe this, but CPDD has workshops that go from 8pm until 10pm at night, even Sunday – on Father’s Day! My wife never believed me until she saw it for herself. This is a dedicated group of people! So, after one of these very long evenings, I ventured out into the evening and did a little picture taking. Here are two of my favorites:

SD-5sd-1-2

 

Hitting Rock Bottom: New docu-drama about addiction needs your help!

Monday, June 3rd, 2013

I don’t think I have ever done this before on a post, but here goes. I need your help.

Not long ago I was contacted by some folks who have been working hard on a show called Hitting Rock Bottom. It tells the real stories of people who have struggled with addiction, hit rock bottom, and found a way out. Unlike reality television that often turns tragic stories about addiction into entertainment, this show has a far more noble and broader reaching aim. The creater and Director, Corey Snyder, who has been in recovery for the past five years and also happens to be a very talented film maker, wants to instill hope (and action) in those who still struggle. He portrays challenges with addiction through docu-drama storytelling that utilizes actors to dramatize real stories. He and his team have already completed the first four episodes of season one which you can watch right now for free on the Hitting Rock Bottom homepage. Each episode is a few minutes, so watching them all will not take you that long.

HRBThe first season tells the story of Daryl Brown, a very likable young man who sets out in life with no idea of what is ahead for him. The show is more than engaging, and realistically captures the underlying risk factors that contribute to going down a path of addiction. It is real, scary, and unfortunately a story that plays out far too often.

Fortunately, the story of Daryl has a positive ending, but that is where I need your help!

The show is need of funding to finish filming the first season and complete the story of how Daryl overcomes addiction. It’s the best part of the story and has the potential to motivate many struggling souls to seek help. To complete the season, the crew are presently running a fund-raising campaign on Indiegogo. The goal is $57,500 which will cover all costs to finalize filming the remaining episodes. Even with these funds, many involved in this project are giving their time and energy to see this project to its successful completion. By contributing whatever you can, be assured that your donation will go towards a project that has the potential to transform how we understand, treat, and address addiction in this country. Also, there are only 13 days left in the campaign, so please contribute now. And be sure to check out some of the cool perks at various donation levels.

Thank you.

Ah-hah moments to move beyond addiction

Saturday, May 11th, 2013

Not long after my wife and I were married, we decided to proactively increase our chances of staying together by enrolling in one of Dr. John Gottman’s weekend couples workshops in Seattle. At the time I was deeply immersed in my graduate studies in counseling and was excited to spend some time with the world-famous marriage guru. What I had not realized was that 1000 other people would be crammed into the Seattle Center taking the workshop as well, so my chances of a little one-on-one time were not so good. Fortunately, he circulated around while we all were doing exercises and I told my wife that if he ever came within 200 yards we should wave our hands wildly and grab his attention.

The moment came and sure enough my plan worked. He sat down and we began talking about some martial issue that escapes me now. During our conversation I began challenging him a bit about how people really change behavior, at which point he brought up focusing. Because I had told him I was nearing completion of my graduate program he assumed I would know all about focusing, but my deer-in-the-headlights response gave me away. I had to admit that never in any of my classes had the word focusing ever been mentioned. I was clueless and a bit embarrassed. He said it was the key to behavior change and I needed to know about it.

focusing_book_2007_medCoincidentally, the relative I mentioned a couple of blog posts ago who had given me a bunch of psychology books, had included the book  Focusing! Written in the 1970s by Eugene Gendlin, the book is based on about two decades of research analyzing what happens in therapy sessions that explain good outcomes. What Gendlin found is that it has little to do with the therapist or the specific type of therapy one gets, and far more to do with what happens inside the client. In essence, he discovered that positive outcomes occur when clients have “ah-hah” moments during sessions that awaken them to deeper truths about themselves and life. These moments occur when we (and clients) go inside and connect with what he calls a felt sense – a pre-verbal inner knowledge or awareness that comes from paying attention to an integrated and holistic aspect of our being that we can access at any time. If this sounds a little new-agey it really is not, it is just hard to describe something that cannot be easily put into words.

Have you ever lost your keys and banged your head against a wall trying to remember where you left them? No matter how hard you try nothing seems to work. So you go on to something else and then, in the middle of folding laundry, it hits you. You remember exactly where you left them! That moment of remembering is what Gendlin would call a felt-sense, an ah-hah moment that awakened you to an answer that previously was outside your awareness. While focusing can help you find your keys, it really has the power to change your life.

Focusing is the name Gendlin uses to describe the six-step process he developed for helping people – both and in out of therapy – have felt-sense experiences to solve a multitude of life problems, including addiction! If you have never heard about it, I really encourage you to check out the focusing website and read one of the many books written on the topic. What started as a little research project in Chicago in the 1950s has evolved into one of the greatest tools we have for overcoming addiction.

Addiction treatment system 14 years later….still in need of an overhaul

Monday, July 9th, 2012

This past week The National Center on Addiction and Substance Abuse at Columbia University released a scathing report of our addiction treatment system: Addiction Medicine: Closing the Gap between Science and Practice. While the report says nothing new, it does a nice job of summarizing the fact that we have made little progress since the Institute of Medicine released Bridging the Gap Between Practice and Research: Forging Partnerships with Community-Based Drug and Alcohol Treatment on January 1, 1998. Here we are, 14 years later, and well, where are we now?

The new report points out these grim statistics:

  • 15.9% (40.3 million) of US age 12 and older struggle with addiction to alcohol and drugs (the number is higher if we factor in behavioral addictions such as gambling, sex, food, and online activities)
  • 31.7% (80.4 million) of US age 12 and older, while not addicted to anything, engages in risky use of substances that threaten health and safety (again, this number is higher if behavioral addictions are included)
  • 89.1% of those who meet criteria for addiction involving alcohol and drugs (not including nicotine) receive no treatment
  • Of those who do get treatment, about 50% come from criminal justice (only 5.7% are referred from primary care medicine)
  • Over 50% of those who go to treatment drop out
  • Addiction and risky substance use costs our society an estimated 468 billion each year

Not good! I will admit I was a bit depressed reading through the report, but not surprised. Addiction is a problem still very much misunderstood. Take for example this huge 573 page report, that constrains the definition of addiction to substances. How can we possibly make progress evolving our treatment system if we continue to narrowly define addiction. It is not just to substances that people become enslaved, but to food, gambling, sex, and many online behaviors. We now have neuroimaging studies providing empirical support that the brain is an equal opportunity organ that does not care what stimulates it, so long as dopamine provides a nice reward that keeps us coming back for more. In a great book on overeating, cleverly titled, The End of Overeating, by David Kessler (which I plan to blog about soon), he makes the point that animals will work almost as hard for food as they will for cocaine. So, back to my point. How can we make progress in this field when we continue to slice up the addiction problem, and fail to understand that it is not about the objects per se, but the relationships that a person has with these objects – all of these objects?

Accurately defining the problem would be a start, because we could then start building systems of care that leverage interventions for a wide range of chronic conditions, including addiction. But even agreement on a broad definition will likely not be enough. We need big system changes to make big progress. The CASA report provides a list of recommendations for improvement, including:

  • Increasing screening and referral in primary care medicine
  • Improve training on addiction in medical schools
  • Establish national accreditation standards for all addiction treatment facilities and programs
  • Educate non-health professionals about addiction, screening, and referral (dentists, teachers, legal staff, welfare, etc.)
  • Require adherence to use of evidence-based treatments
  • Expand addiction treatment workforce
  • Implement more national public health campaigns

It is a list, but hardly a gutsy one or even close to what needs to be done if we are to make big progress. What would my list look like? Here are my top four suggestions:

  • National Institute on Addiction (NIA): While integrating NIDA and NIAAA into one organization next year is progress, I would like to see an institute called the National Institute on Addiction that puts the emphasis on understanding the relationships people have with all objects of addiction, not just alcohol and drugs. While I know these agencies have invested resources in gambling and food, the money is scant compared to what is spent on substances. One of the primary goals of this organization would be to get all stakeholders (researchers, treatment providers, public) on the same page about how we should define addiction.
  • Leverage the Internet: Over 80 percent of the US population has access to high-speed internet, which means that we have the potential to reach the 90 percent who don’t get care. I am not saying this is easy, but there is a saying in marketing that you go where the customers are – and they are online.
  • Stop criminalizing addiction and treat those who do end up behind bars: The vast majority of folks behind bars suffer from addiction and most don’t get treatment. This needs to change. Because most will get out, why not use their time while in prison to treat their addiction, educate them, and provide them something to live for when they get out? I know, this costs too much money. See my last point.
  • Invest in families/prevention: Addiction is primarily a problem born out of adolescence. Most who develop addictions begin their journey before the age of 15. We need to devote significant resources to helping families flourish. We need programs that help people developmentally obtain the capacities they need for optimal mental health, for intimacy, parenting, and getting along with each other.

What would be on your list?

All you need is love, love, love is all you need.

Tuesday, August 30th, 2011

At a training not long ago on CRAFT, the presenter, Dr. Robert Meyers, told a story that I want to pass on to you. But first, if you have never heard of CRAFT, it stands for Community Reinforcement and Family Training which is an evidence-based approach that family members (or friends) can use to facilitate getting an unmotivated loved one struggling with addiction into treatment. I am most fond of this approach because, unlike traditional interventions that rely upon coercing a person into treatment through harsh group feedback, CRAFT relies upon using basic behavioral strategies to rearrange the world of the addict so he or she internally reaches the decision that treatment is necessary. We have known for a long time that external motivation gets the job done; interventions do often lead to treatment. But unfortunately, once there, the person we so badly care about does not engage in treatment, does not really want to be there, and often drops out. We are back to square one and saying that treatment does not work. It is a vicious cycle.

In these situations, treatment fails because of a lack of internal motivation. Those who need to change their behavior have to want to change their behavior, which is why CRAFT is so powerful. It works to increase internal motivation for change by eliminating the positive reinforcement for acting out in an addiction, and enhancing positive reinforcement for non-acting out behaviors. If you don’t understand basic behavioral approaches to change using reinforcement, then it is time for Dr. Meyers’ story.

A woman who had been admitted to a psychiatric ward was driving the staff crazy. From the time she woke up until the time she went to bed in the evening she would scream her head off. The staff tried everything they could think of to get her to stop screaming, but nothing worked. She had to be placed in a room alone, away from the other residents, and restrained at times. Although medications could have been used to sedate her (and probably were at times), they were not the answer. After many frustrating weeks of listening to her loud cries, a doctor was brought in to see if he could help. His name was Nathan Azrin.

Nate walked down the hall to the woman’s room as staff likely snickered about how he possibly could make a difference given all that had been tried. When he arrived, the woman was sitting on the edge of the bed rocking back and forth screaming like she did throughout the day. He stood at the doorway for quite some time. He may have thought about why she was screaming, but also knew that whatever the driving reason, she could not speak and exploring the why would likely be a long journey. Instead, being a behavioral psychologist, he considered her behavior and what he wanted her to do instead of screaming. Well, this was easy, he wanted her to stop screaming. Then, he considered the times when she was doing what he wanted her to do: eating, sleeping, and breathing. During these activities she did not scream. As he stood in the doorway, he began to focus more on the immediate moment to moment rhythm of her screaming and breathing. Then he got an idea…

Right at the moment when she stopped screaming to take a breath, he walked over to her and gently stroked her hair. After she inhaled and began screaming again, he slowly moved back to the door and waited until she had to take another breath. He then repeated the movements with every breath: move close to her, look her in the eyes, gently stroke her hair, and then move away as she screamed. Nate knew, that at our core, we all have one unifying need: love. And he believed that by reinforcing the moments when she was not screaming, even though they were just seconds, with loving touch, that just maybe…maybe, he could alter her behavior. While staff had isolated her, restrained her, and stayed clear of her, he moved closer to her. And his approach worked. By that evening, he was sitting next to her on the bed, gently stroking her hair, and the screaming had stopped. He told the staff that when she woke up the next morning and started to scream, someone was to sit next to her and gently comfort her. In fact, anytime she began to scream, the antidote was the same.

I love this story because so often when we are challenged in life we tend to overlook the obvious. We seek out expensive treatments, elaborate self-help strategies, or engage in complex change regiments only to become frustrated when change eludes us. Dr. Azrin is among the most cited psychologists of all time, and although he may go down in history for his popular read, Toilet Training in Less Than a Day, for me, he will go down as an individual who taught me about love.

Video, Video…and more Video!

Friday, April 15th, 2011

I learned recently that the number one online  activity is watching videos. My initial guess was email, but as I thought more about how we have grown-up watching television, and that the average American now spends more than five hours a day in front of a screen (TVs, computers and mobile devices, non-worked related), this outcome is hardly surprising. Email actually ranks third behind online banking. These statistics got me thinking about the most effective way to provide you science-based, easy-to-understand information about addiction and how to overcome it as a problem. Call me a little slow, but if watching videos is where all the action is online, then it seems to make sense that I go there as well. So I am excited to tell you that I have taken the leap and completely updated this site with lots of video! You will now find many short snippets, most just a few minutes long, on a wide range of addiction-related topics.

A few words about the clips. Last year I joined the Board of Shangri-La, a nonprofit organization dedicated to helping Oregon’s most vulnerable populations with housing, employment, and a multitude of other needed services. What an amazing group of people! I can’t say enough great things about how they are making a difference in the lives of so many people at a time when so many are struggling. One reason for my involvement has been the increasing prevalence of addiction among the populations they serve. To help out, I presented some material about addiction to about 80 of their managers and staff, and in return, they taped it so I could use it on this site. Thanks again guys!

The first set of clips I am posting are primarily aimed at helping you better understand addiction. Here is one of them focused on addiction being about relationships.


 

Race to Nowhere

Monday, April 11th, 2011

Last week I watched the independent film Race to Nowhere that has won numerous awards for its strong messages about our broken educational system. Through interviews with students, parents, teachers, and others, the movie illustrates the dark side of being a kid in school. The race to nowhere for students is paved with an over-scheduling of activities, too much homework, too little sleep, and increased stress that is resulting in health problems, drug abuse, eating disorders, and suicide. What is even more troubling, is that for all the effort kids are putting into their school work and extracurricular activities, many are being churned out of our educational system lacking some of the most important qualities of a good education, including:  the ability to reflect deeply on topics, handle difficult emotions in the face of stress, and successfully engage in a wide range of healthy relationships. The film points the finger at numerous perpetrators, but in the end, fails to hit home that no one individual person or group is to blame, but rather it is the entire educational system that we must examine more carefully if we are to find the truth behind the worrisome outcomes.

When I think about the fact that over 80 percent of those who end up struggling with addiction begin their behaviors prior to the age of 15, this film frightens me even more. When did school become so competitive and stressful? Much of the over-scheduling of extra-curricular activities and hours of homework is in response to the demands, both perceived and real, associated with getting accepting into a college or university. What is sad is that the stress and pressure begin long before high school. My wife and I spent a couple of years tearing our hair out (the little I have left) trying to identify and enroll our son in the best possible elementary school. I put more time and effort into researching options, attending open houses, completing enrollment packets that included writing lengthy essays, than I ever did applying to graduate school! The process was absolutely crazy, and I know we were not alone. And now I know it was just the beginning.

Race to Nowhere illustrates painfully many of the current antecedents to addiction, and why we absolutely must reexamine our understanding of what education means and how we are going about educating our children. Failure to do so will only lead to a new generation of addicts.