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Addiction, Ask Stanford Med, Health Policy, Public Health, Stanford News

Is a proposed ban on smoking in public housing fair?

Is a proposed ban on smoking in public housing fair?

smoking ban sign - 560

Cigarette smoking kills nearly half a million Americans each year, making it the leading preventable cause of death in the United States.

So the Department of Housing and Urban Development thinks it’s time to ban cigarette smoking from some 1.2 million subsidized households across the nation.

HUD Secretary Julián Castro unveiled a proposal last week intended to protect residents from secondhand smoke in their homes, common areas and administrative offices on public housing property.

“We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke, especially the elderly and children who suffer from asthma and other respiratory diseases,” Castro said, adding the proposed rule would help public housing agencies save $153 million every year in health-care, repairs and preventable fires.

Stanford Law School professor Michelle Mello, PhD, JD, who is a core faculty member with Stanford Health Policy, has researched and written about this issue extensively, including in a 2010 article in The New England Journal of Medicine.

In a piece published yesterday, I asked Mello about her views on the federal smoking ban proposal. A sampling of the Q&A:

What would be the greatest benefit to banning smoking in public housing?

There are lots of benefits, but to me the greatest benefit is to the 760,000 children living in public housing. Although everyone knows that secondhand smoke exposure is extremely toxic, not everyone knows how much children in multiunit housing are exposed — even when no one in their household smokes. Research shows that smoke travels along ducts, hallways, elevator shafts, and other passages, undercutting parents’ efforts to maintain smoke-free homes. Also, chemicals from cigarette smoke linger in carpets and curtains, creating hazardous “third-hand smoke” exposure that especially affects babies and small children.

Beth Duff-Brown is communications manager for Stanford Health Policy.

Photo by Getty Images iStock

Addiction, Behavioral Science, Neuroscience

Decisions, decisions: How evolution shaped our decision-making

Decisions, decisions: How evolution shaped our decision-making

Research in neuroscience, psychology, business and economics tells us that a plethora of influences can alter the decisions we make. The author explored some of these factors in a Worldview Stanford course and wrote about them in a Stanford story package, Decisions, Decisions. This post is the last in a series on what she learned. 


Our brains evolved to get the reward now and worry about consequences later. That, according to Stanford’s Keith Humphreys, PhD, is in part why addiction treatment programs so often fail.

“An alcoholic person will always choose the swift and certain rewards of a drink now over the possible threat of punishment at some future time,” he says.

In my story about how evolution shaped our decisions, I describe a program that allows people with drunken driving arrests to keep driving as long as they prove twice a day that they are sober:

Punishment is mild – a night in jail – but swift and certain if they are caught with alcohol in their bloodstream. And, according to a 2013 study, repeat offenses were down 12 percent where that policy was in effect.

Humphreys said he’d written about this program, to some skepticism. But when he explained evolutionary theory to an assembled group of law enforcement and lawyers he was surprised at how receptive they were.

“The rest of the conference everyone kept telling me that they had never thought about the neurological basis of why addicted offenders do what they do and why criminal justice systems which ignore this reality fail over and over again,” he said.

The story has more about a new initiative within the Stanford Neurosciences Institute in which Humphries and other faculty members are hoping to use neuroscience to influence addiction policies.

Previously: Decisions, decisions: How group dynamics alters decisionsKeith Humphreys: Drug-addiction treatment programs for military families are outdated and “24/7 Sobriety” program may offer a simple fix for drunken driving
Photo from Shutterstock

Addiction, Cancer, Events, Health Policy, Medicine and Society, Public Health

The devil you know: Experts discuss the public-health consequences of e-cigarettes

The devil you know: Experts discuss the public-health consequences of e-cigarettes

e-cigarettesHow do we reduce health risk in the face of harm that can’t be eradicated completely? That’s the question that the medical school’s dean, Lloyd Minor, MD, presented to the audience at Monday’s Health Policy Forum on e-cigarettes — a topic about which he said “intelligent and reasonable people can disagree.”

E-cigarettes are a heavily contested subject in the public-health community. Panelists at this event debated whether the recently developed devices hold promise to help long-time smokers move away from combustible cigarettes, or whether they carry the worrisome potential to re-normalize smoking.

All panelists agreed that those under 21 shouldn’t be using any nicotine delivery devices, and they shared a goal of minimizing general use of harmful health products. They disagreed, however, on what the advent of e-cigarettes means to the accomplishment of those goals.

David Abrams, PhD, a Johns Hopkins clinical psychologist specializing in health psychology, addictions, and tobacco-use behavior, described himself as a harm reductionist. He argued that as an alternative mode of nicotine delivery, e-cigarettes pave the way for saving lives by helping addicted smokers not use traditional cigarettes.

“I do think the evidence is very solid that they are dramatically less harmful than cigarettes…because they absolutely have very low, almost undetectable levels or trace amounts of the top eight carcinogens that are found in cigarettes and they have no carbon monoxide,” he explained.

But a lack of extensive research makes Stanford’s Robert Jackler, MD, and Bonnie Halpern-Felsher, PhD, question whether vaping is actually safe — and a prevalence of candy-flavored e-liquids leaves them concerned for the potential for harm to youth.

“Let me point out that you can smoke [combustible cigarettes] for many years before you get chronic destructive lung disease,” said Jackler, who leads a Stanford research team studying the impact of tobacco advertising, marketing, and promotion. “So while I agree… that they are safer, the presumption that they are safe for teenagers to adopt as opposed to combustible tobacco, we won’t know that for decades.”

In the meantime, he worries that “we’re experimenting with the lungs of teens.”

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Addiction, Health Policy, In the News

Stanford addiction expert: “The country needs to spring into action” on heroin epidemic

Stanford addiction expert: "The country needs to spring into action" on heroin epidemic

What’s underlying today’s heroin epidemic and what can be done about it? That was the focus of the opening hour of KQED’s Forum yesterday morning, and Stanford addiction expert Keith Humphreys, PhD, was one of the panelists who weighed in on the issues. He talked about the connection between painkiller addiction and heroin use, the differences between heroin addicts these days versus those in the 1970s, and the use of Naloxone, which can reverse the effects of opioids. Noting that California recently passed a bill that makes this medication available at pharmacies, he said, “I would encourage anyone who is at risk for overdose, or loves someone who is at risk for overdose to get Naloxone.”

Humphreys also referenced the relative lack of resources that goes into studying the heroin epidemic: “We don’t seem to have the will to take this problem on the way we need to… The country really needs to spring into action. We did on AIDS, and we are not doing it here.”

Previously: Heroin: The national epidemic and A focus on addiction, the country’s leading cause of accidental deathIncreasing access to an anti-overdose drug and A reminder that addiction is a chronic disease

Addiction, Behavioral Science, Genetics, Neuroscience, Research, Stanford News

Found: a novel assembly line in brain whose product may prevent alcoholism

Found: a novel assembly line in brain whose product may prevent alcoholism

alcohol silhouette

High-functioning binge drinkers can seem charming and stylish. The ultimate case in point: Nick and Nora of the famed Thirties/Forties “Thin Man” film series (you can skip the ad after the first few seconds).

But alcoholism’s terrific toll is better sighted on city streets than in celluloid skyscraper scenarios. At least half of all homeless people suffer from dependence on one or another addictive drug. (My Stanford Medicine article “The Neuroscience of Need” explores the physiology of addiction.) Alcohol, the most commonly abused of them all (not counting nicotine), has proved to be a particularly hard one to shake.

Alcoholism is an immense national and international health problem,” I wrote the other day in a news release explaining an exciting step toward a possible cure:

More than 200 million people globally, including 18 million Americans, suffer from it. Binge drinking [roughly four drinks in a single session for a man, five for a woman] substantially increases the likelihood of developing alcoholism. As many as one in four American adults report having engaged in binge drinking in the past month.

While there are a few approved drugs that induce great discomfort when a person uses them drinks alcohol, reduce its pleasant effects, or alleviate some of its unpleasant ones, there’s as of yet no “magic bullet” medication that eliminates the powerful cravings driving the addictive behavior to begin with.

But a study, just published in Science, by Stanford neuroscientist Jun Ding, PhD, and his associates, may be holding the ticket to such a medication. In the study, Ding’s team identified a previously unknown biochemical assembly line, in a network of nerve cells strongly tied to addiction, that produces a substance whose effect appears to prevent pleasurable activity from becoming addictive. The substance, known as GABA, acts as a brake on downstream nerve-cell transmission.

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Addiction, Anesthesiology, Chronic Disease, Pain, Stanford News, Videos

“People are looking for better answers”: A conversation about chronic pain

"People are looking for better answers": A conversation about chronic pain

2048px-Low_back_painChronic pain limits the lives of an estimated 100 million people in one way or another and costs our country half a trillion dollars per year, according to Sean Mackey, MD, PhD, chief of the Division of Pain Medicine. To address the needs of the many people suffering from back pain, the most common kind of chronic pain, Mackey and other doctors and researchers in the division recently held a free Back Pain Education Day.

The event was popular enough that all seats were filled more than a week ahead of time, and a video stream of the day’s speakers was viewed by almost 1,500 people during the conference and in the week following. Recordings of the day’s talks can now be viewed on the Division of Pain’s YouTube channel.

We don’t have a cure for chronic pain. What we have are exceptional ways [to help] people get back their lives

During a recent conversation, Mackey told me the big turn-out reflects the keen interest people living with back pain have in finding solutions. “People are looking for better answers: why they have what they have and what they can do about it,” he said. “We wanted to provide them with real-world tools that they can use to control their pain.”

Speakers at the event covered varied ground, including physical therapy approaches to pain management, new research in using acupuncture to treat pain, self-management strategies, mindfulness-based pain reduction and the important role of sleep in pain. (Recent research has shown that poor sleep can intensify and prolong pain.) One over-riding theme was the role of the brain, Mackey said, not just in terms how people experience pain, but also how it can help turn down or turn up pain.

Mackey cautions that a quick fix often isn’t possible, so people living with chronic pain need to think about long-term management. “It’s a chronic disease, like diabetes. We don’t have cures for diabetes, and we don’t have a cure for chronic pain,” he said. “What we have are exceptional ways to control the disease and ways [to help] people get back their lives.” Speaker Beth Darnall, PhD, the event co-chair, emphasized that pain psychology techniques can empower people to lessen distress and pain, and begin moving toward meaningful life goals.

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Addiction, Podcasts, Public Health

Heroin: The national epidemic

Heroin: The national epidemic

4132006028_1fbf0b4076_zWhen I think of New England, I don’t naturally conjure up an image of heroin. Yet today, many cities and towns in the bucolic northeast are facing a heroin epidemic. Clearly at odds with the image of the Atlantic Ocean lapping at seaside resorts, Maine, Vermont, New Hampshire and Massachusetts are each seeing disturbing trends. Illustrating the magnitude of the problem engulfing his state, Vermont’s Governor Pete Shumlin devoted his entire 2014 State of the State address to what he called “a full blown heroin crisis.”

Across the country too, heroin death are skyrocketing: According to the Centers for Disease Control, more than 8,000 Americans died of heroin-related overdoses in 2013 – nearly three times as many as those who died in 2010.

So what’s fueling the explosion of heroin use? Stanford addiction expert Keith Humphreys, PhD, told me in this 1:2:1 podcast that it’s largely propelled by the huge number of prescriptions for opioid pain killers. According to the National Institute on Drug Abuse, more than 2 million Americans abuse prescription pain killers – and Humphreys says when the pills run out, many turn to heroin as a cheaper alternative and an equivalent high.

Recognizing the rippling toll on communities and families across the nation, the Obama administration announced a new program in August to combat the trafficking and use of the drug.  The Washington Post first reported the plan, saying that the initiative will pair public health officials and law enforcement in an effort to shift the emphasis from punishment to the treatment of addicts.

After hearing the heroin crisis also popping up in conversations from several presidential candidates during their jaunts to New Hampshire, I turned to Humphreys to dig deeper into the issue. In addition to being a professor of psychiatry and behavioral sciences at Stanford, Humpreys also spent a year in the White House Office of Drug Policy as a senior policy advisor during the first year of the Obama administration.

Previously: Assessing the opioid overdose epidemicA focus on addiction, the country’s leading cause of accidental deathWhy doctors prescribe opioids to patients they know are abusing them and Do opium and opioids increase mortality risk?
Photo by Lauri Rantala

Addiction, In the News, Myths, Patient Care, Public Health, Public Safety

“24/7 Sobriety” program may offer a simple fix for drunken driving

"24/7 Sobriety" program may offer a simple fix for drunken driving

8684229367_2826035583_zEvery now and then I read a story that takes what I think I know about a certain topic and turns it upside down. Today, my understanding of programs to reduce drunk driving were upended by an article written by Keith Humphreys, PhD, professor of psychiatry and behavioral science at Stanford.

As Humphreys explains, many people mistakenly believe that no one can overcome a drinking problem without treatment involving a professional’s help. This, he says, is a myth, and the success of the “24/7 Sobriety” program highlights the importance of exploring and adopting new ways to combat drunken driving. From the Wall Street Journal article:

Offenders in 24/7 Sobriety can drive all they want to, but they are under a court order not to drink. Every morning and evening, for an average of five months, they visit a police facility to take a breathalyzer test. Unlike most consequences imposed by the criminal justice system, the penalties for noncompliance are swift, certain and modest. Drinking results in mandatory arrest, with a night or two in jail as the typical penalty.

The results have been stunning. Since 2005, the program has administered more than 7 million breathalyzer tests to over 30,000 participants. Offenders have both showed up and passed the test at a rate of over 99%.

Counties that used the 24/7 Sobriety program also had a 12% decrease in repeat drunken-driving arrests and a 9% drop in domestic-violence arrests, according to a 2013 study.

A possible reason why this program works — when attempts to help people with drinking problems often fail — is that the twice daily breathalyzer tests have immediate consequences, Humphreys explains. “It turns out that people with drug and alcohol problems are just like the rest of us. Their behavior is affected much more by what is definitely going to happen today than by what might or might not happen far in the future, even if the potential future consequences are more serious.”

Previously: Can the “24/7 sobriety” model reduce drunken disorderly conduct and violence in London?Alcoholism: Not just a man’s problem and Stopping criminal men from drinking reduces domestic violence
Photo by: KOMUnews

Addiction, Aging, Chronic Disease, Pain

National survey reveals extent of Americans living with pain

National survey reveals extent of Americans living with pain


Yesterday, the NIH announced a new analysis of data that examined how much pain people in America suffer. The findings, published in The Journal of Pain, were based on data from the 2012 National Health Interview Survey (NHIS), an annual survey that asks a random sample of U.S. residents a wide variety of questions about their health.

The survey results are staggering: More than half of the adults in the country (126 million) had some kind of pain, minor to severe, in the three months before the survey. About 25 million had pain every day for that time frame and about 40 million suffer from severe pain. Those with the worst pain were also most likely to have worse health in general, use more health services and have more disabilities.

The survey also looked at complementary medicine approaches people take to dealing with their pain. Natural dietary supplements topped the list, followed by deep breathing and physical exercise such as yoga, tai chi or qi gong.

Joseph Briggs, director of the National Center for Complementary and Integrative Health was quoted in an article about the new study in the Washington Post:

The number of people who suffer from severe and lasting pain is striking. . . This analysis adds valuable new scope to our understanding of pain … It may help shape future research, development and targeting of effective pain interventions, including complementary health approaches.

Another topic the WaPo article touched on, which we’ve written about here at Scope, is the link between chronic pain and prescription painkiller abuse:

The prevalence of chronic pain in America also lies at the root of an ongoing epidemic of prescription painkiller abuse. Since 1999, according to the Centers for Disease Control and Prevention, the amount of painkillers such as oxycodone and hydrocodone sold in the United States has nearly quadrupled.

Here at Stanford, the Division of Pain Medicine is sponsoring a free back pain education day on Saturday September 13. You can find out more details here.

Previously: Assessing the opioid overdose epidemicChronic pain: Getting your head around itFinding relief from lower back pain and Stanford researchers address the complexities of chronic pain
Photo by Steven Depolo

Addiction, Emergency Medicine, Health Costs, Patient Care, Research

Questionnaire bests blood test at identifying patients with risky drinking behaviors

Questionnaire bests blood test at identifying patients with risky drinking behaviors

3144132736_9de39a590d_zAs many as half of the patients who visit the emergency room with traumatic injuries have alcohol in their bloodstream, and roughly 10 percent of these patients will return to the ER within a year. Today, many emergency rooms use blood alcohol tests to screen for patients with risky drinking behaviors. Yet a new study by researchers from Loyola University Medical Center suggests that a questionnaire may be a better way to identify at-risk patients.

In the study, researchers reviewed 222 records from patients 18 years of age and older that were admitted to Loyola University Medical Center’s level I trauma center between May 2013 and June 2014. Each of the patients in the study had a blood alcohol test and had answered the World Health Organization‘s 10-point questionnaire, called the Alcohol Use Disorders Identification Test (AUDIT). The research team compared the results of the blood test to that of the AUDIT test and found that the questionnaire was 20 percent more effective at identifying at-risk patients with dangerous drinking habits than the blood test.

As the researchers explain in their study, blood alcohol tests only provide “a snapshot of the patient’s recent drinking behaviors” by measuring of the amount of alcohol in the patient’s system at the instant the test is taken. In contrast, the questionnaire assesses the patient’s overall drinking behaviors by asking questions such as, how often they drink, how much they drink per day and if they have feelings of guilt or remorse after drinking.

These findings are significant because blood alcohol tests are often the only tool used to assess at-risk drinking behavior in ER patients. Their findings call this common practice into question and suggest that the AUDIT questionnaire may be a better way to identify, and ultimately prevent, potentially dangerous drinking behaviors.

Previously: Alcohol-use disorder can be inherited: But why?Could better alcohol screening during doctor visits reduce underage drinking? and How to make alcoholics in recovery feel welcome this holiday season
Via: Business Wire
Photo by: Julie °_°

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