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Addiction, Mental Health, Parenting

“Brains are unmentionable:” A father reflects on reactions to daughter’s mental illness

"Brains are unmentionable:" A father reflects on reactions to daughter’s mental illness

I’m a few days late to this, but I must draw readers’ attention to the beautifully written “No One Brings Dinner When Your Daughter Is An Addict.” In the piece, the author compares how friends reacted when his wife was treated with breast cancer with how they responded when his drug-addicted daughter was admitted to a psychiatric hospital and diagnosed with bipolar disorder. As he and his wife managed their daughter’s illness, there were “no warm casseroles… no scalloped potatoes in tinfoil pans” brought to them, he wrote, before explaining:

Friends talk about cancer and other physical maladies more easily than about psychological afflictions. Breasts might draw blushes, but brains are unmentionable. These questions are rarely heard: “How’s your depression these days?” “What improvements do you notice now that you have treatment for your ADD?” “Do you find your manic episodes are less intense now that you are on medication?” “What does depression feel like?” “Is the counseling helpful?” A much smaller circle of friends than those who’d fed us during cancer now asked guarded questions. No one ever showed up at our door with a meal.

The piece, which originally appeared on Slate, is powerful and thought-provoking – and a reminder of the need to better support those caring for the mentally ill.

Addiction, Health Policy, Public Health

Breaking Good: How to wipe out meth labs

Breaking Good: How to wipe out meth labs

methlabEarlier today I testified about methamphetamine laboratories to West Virginia Governor Earl Ray Tomblin’s Advisory Council on Substance Abuse. Like more than a dozen other states in the “meth belt,” my home state is suffering from a wave of explosions, fires, burns, poisonings and environmental destruction stemming from laboratories operated by small-time “meth cooks.”  Fortunately, as I told the Advisory Council, this is a problem that we already know how to solve.

Meth cooks make their drug using pseudoephedrine (PSE), which they extract from certain cold medicines such as Sudafed. The precise proportion of these cold medicines that are purchased to produce methamphetamine is not known, but it is clearly very large. A recent study published in JAMA found that per-capita consumption of PSE-containing medicines in counties with meth labs exceeds that of counties without labs by as much as 565-to-1.

In light of this connection, the states of Oregon and Mississippi returned PSE-containing products to prescription-only status, which was how they were regulated until 1976. Meth labs have virtually disappeared in both states.

Most state legislatures in the meth belt have introduced legislation to copy Oregon and Mississippi’s approach, but these bills have all failed. Part of the reason is intense lobbying by the companies that produce PSE-containing products, but another part is that some voters and legislators believe that cold and allergy sufferers will have a hard time getting relief if a prescription for PSE-containing medications is required.

This worry is not usually well-founded, as there are more than 100 over-the-counter cold medications available which provide relief to almost all people with stuffy noses, fevers and the like. However, in the rare case of an individual who truly needs a PSE-containing medication, innovative biochemistry has come to the rescue with the development of medications that contain PSE that is harder for meth cooks to extract.

These companies created cold medications (e.g., Zephrex-D) which use polymers or lipids to bond with PSE in a fashion that reduces the possibilities for conversions to meth. Even if the possibilities for PSE extraction are reduced by only two-thirds by these new medications, meth cooks would effectively be put out of business because their required materials would exceed the value of the drug they make. Meanwhile, consumers with chronic allergies do not suffer reduced access to PSE-containing products.

The public policy option available to meth belt states is thus something that should satisfy all parties. PSE-containing cold medications would be returned to prescription-status, with an exemption for such medications that independent laboratories prove yield only a de minimus amount of PSE for meth preparation.

It’s a rare opportunity for a clear win-win in public policy. That’s why I strongly encouraged Governor Tomblin’s advisors to pursue it with courage and enthusiasm.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. Dr. Humphreys has no financial or personal connections to any company that produces cold medications (extraction resistant or not).

Previously: Examining how addiction in the U.S. has changed over the last decade, Can an antidepressant help meth addicts stop using?, The Florida Governor’s questionable actions on drugs and Stanford Health Policy Forum focuses on America’s methamphetamine epidemic
Photo by 16 Miles of String

Addiction, Media, Research, Science

The disturbing trend of science by press release

The disturbing trend of science by press release

The Washington Post, Christian Science Monitor and Time were among the respected media outlets that recently covered the sensational alleged scientific finding that Oreos are as addictive as cocaine. Some journalists contacted me for my reaction, and I said I would get back to them after I read the study. I searched on PubMed and it wasn’t there. I looked through the “on line early” section of leading journals and it wasn’t there either. Neither could I find it in the published proceedings of any conferences.

Relapsing to a simpler approach, I Googled “Oreos and cocaine” and found the sole source of information available: A press release about an undergraduate research project at Connecticut College in New London, Connecticut. It is to the credit of the mentor on the project, Joseph Schroeder, PhD, that he’s teaching bright young people how to do science. I wish, however, he had also taught them something else: The role of peer-review in the promotion of scientific quality and credibility.

Putting out a sensational press release before experts in your field have had a chance to evaluate your scientific work is bad for science and bad for society

A leading scientist in the addiction field, Edythe London, PhD, of UCLA, was able to identify fatal flaws in the Oreo research even on the basis of the limited information in the press release. You can read Dr. London’s discussion of those problems if you wish, but my purpose here is to address a larger point: Putting out a sensational press release before experts in your field have had a chance to evaluate your scientific work is bad for science and bad for society.

The Oreo news stories were upsetting to people struggling with cocaine addiction as they trivialized the problem they face. Judging by the comments on many of the news websites covering the story, the study also fueled many people’s bias that taxpayer dollars are being wasted on studying silly topics. Granted, these harms are less serious than those that occurred when Andrew Wakefield, MD, intentionally deceived many journalists into reporting that the MMR vaccine caused autism, but that still doesn’t make it good practice to report initial findings as facts in the media before one’s work has been peer-reviewed.

Credibility-straining press releases are unfortunately becoming more common in science. And even when a finding is real, a press release can distort its meaning. For example, the recent Qesem cave discovery of fossils from homo sapiens was considered a genuine achievement by experts in physical anthropology and was published in a peer-reviewed journal, but the accompanying press release made wild claims about human evolution that were nowhere to be found in the article. When the shocking claims in that press release were disseminated by journalists, the public was misled and the science was cheapened.

Sensationalized press releases about scientific findings unfortunately can be much more widely disseminated today than in prior eras. Science journalists once had the time and resources to do more shoe leather reporting, conduct follow-up interviews with the scientific team, and interview independent scientists to obtain a careful critique of the findings. But today, as Paul Costello, chief communication officer for Stanford’s medical school, told the Columbia Journalism Review, the “shift to new media Web site traffic” is putting added pressure on reporters, leading some to cut corners in the name of more copy, “often writing right off press releases, even at the good papers.”

If science journalists can no longer be depended on to sort the wheat from the chaff, scientists are going to have to assume more responsibility for self-restraint when they release findings to the press. All of us would like to believe that we never make mistakes in our scientific work. All of us are capable of becoming overly enthusiastic about a pet theory before our colleagues have subjected it to criticism. And all of us can be tempted to hype our findings as a way to draw some gratifying attention to ourselves. But when we give in to those human frailties in our interactions with the media, we undermine our collective credibility and may also harm members of the public who act on the assumption that our claims have been rigorously evaluated.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: The influence of medical press releases on news coverage quality and The problem with “science by press conference”

Addiction, Pediatrics, Public Health, Research

Cigarettes’ harm that smoke alarms can’t detect

Cigarettes' harm that smoke alarms can't detect

Beyond the hazards of smoking or even inhaling second-hand smoke, residue from cigarette smoke lingering on fabrics and skin causes a quiet, yet pervasive, danger.

A new study has found that children from birth to 13 years of age who were exposed to third-hand smoke from parents who reported that they smoked outside the house showed double the risk of respiratory tract infections, and an even greater incidence of wheezing, than those with parents who didn’t smoke.

The findings, which stemmed from an analysis of survey responses by 1,899 families in a region of the Netherlands, were presented at the annual meeting of the European Respiratory Society.

In a MedPage Today article, Ambra Nicolai, MD, a researcher in pediatrics at Sapienza University in Rome, puts the numbers in context. “When people think about harm caused by tobacco they are generally aware of smoking and second-hand smoke. Only recently are we finding that third-hand smoke as well can cause problems,” Nicolai said.

Previously: Quitting smoking for the baby you plan to have together, Report shows African-American, low-income children in California at highest risk of secondhand smoke and Study shows smoking bans decrease kids’ exposure to secondhand smoke

Addiction, Health Policy, Public Health, Public Safety

How police officers are tackling drug overdose

police car

Drug overdose is now the most common cause of accidental death in the United States, primarily because of the vastly increased availability of pharmaceutical-grade opioids (e.g., Oxycodone, Vicodin). The size and impact of the epidemic can be lessened by a range of public policies, including one that the White House has been touting: Equipping first responders with naloxone hydrochloride.

In opioid overdose, breathing slows to a very low level or even stops completely, which deprives the brain of oxygen. Death or permanent organ damage can be the horrifying result. Enter naloxone, an old, off-patent (and hence inexpensive) medication with a powerful ability to force opioids out of brain receptors. Overdose is thus rapidly reversed.

Naloxone does not cure addiction. Nor does its effect last more than 30-90 minutes. However, that window of time can be used to get the overdosed person to a hospital and subsequently it is hoped into addiction treatment.

Police officers and fire fighters are often the people who discover people who have overdosed. They typically call for medical backup in such cases, but even if the EMTs take only 15 minutes to arrive, that can be too late. Training in how to recognize overdose and to then administer naloxone allows those first responders to save lives that would otherwise be lost.

Police in Quincy, Massachusetts began carrying naloxone in their cruisers in October of 2010, and have been reversing about one overdose every ten days since. Police and firefighters in other parts of the country are now copying Quincy’s successful approach.

The Obama Administration’s embrace of improving naloxone’s availability is one of many signs of how quickly U.S. drug policy has moved in a public health direction. Only a few years ago, drug policy officials in the G.W. Bush Administration condemned the use of naloxone. Today, Obama drug policy officials give out awards to successful naloxone access expansion programs. The result will be fewer overdose and more chances for people with addictions to receive the help they need to become healthy and productive.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington.

Previously: Do opium and opioids increase mortality risk?
Photo by Scott Davidson

Addiction, Pediatrics, Research

Menthol “sweetens the poison,” attracts more young smokers

5713002598_4af6e5f8d5Many Halloweens ago, a stranger in a dark house might have reached into a black caldron and handed a child a pack of candy cigarettes. While that practice is less socially acceptable now, tasty tricks can still turn the young into tobacco addicts.

A new study (subscription required) published in the journal Tobacco Control found an increase in menthol cigarette smoking among young adults even as non-menthol tobacco smoking in that population declined during 2004-10. Researchers used data from the National Surveys on Drug Use and Health, reaching nearly 390,000 people age 12 or older and including more than 84,000 smokers.

The study found that menthol cigarette use was more common among smokers ages 12-17 years (56.7 percent) and 18-25 years (45 percent) than among older persons (range 30.5 percent to 32.9 percent).

From a release:

[Lead researcher Gary Giovino, PhD, professor and chair of the University at Buffalo's Department of Community Health and Health Behavior] is particularly alarmed that the findings show youth are heavy consumers of mentholated cigarettes and the use of menthols is specifically associated with being younger, female and of non-white ethnicity.

“This finding indicates that mentholated cigarettes are a ‘starter product’ for kids in part because menthol makes it easier to inhale for beginners,” says Giovino. “Simply stated, menthol sweetens the poison, making it easier to smoke. Young people often think menthol cigarettes are safer, in part because they feel less harsh.”

Previously: Menthol cigarette marketing aimed at young African AmericansA conversation about the FDA’s new graphic health warnings for cigarettesPediatrics group calls for stricter limits on tobacco advertising and What’s being done about the way tobacco companies market and manufacture products
Photo by Jonna Michelle

Addiction, Behavioral Science, Research, Stanford News

Study shows belief in willpower’s potential more powerful than a boost of sugar

Study shows belief in willpower's potential more powerful than a boost of sugar

8114319143_1cf455d575A psychology study (subscription required) in the current issue of the Proceedings of the National Academy of Sciences struck down sugar’s power to rule over those struggling with self-control – so long as people believe that their willpower is greater than their glucose stores.

The study examined the role of glucose ingestion and attitudes about willpower in self-control and cognitive performance. Psychologists from Stanford and the University of Zurich conducted three experiments testing theories about willpower, including past research showing that taking in glucose increases self-control. From the study:

…following a demanding task, only people who view willpower as limited and easily depleted (a limited resource theory) exhibited improved self-control after sugar consumption. In contrast, people who view willpower as plentiful (a nonlimited resource theory) showed no benefits from glucose—they exhibited high levels of self-control performance with or without sugar boosts. Additionally, creating beliefs about glucose ingestion (experiment 3) did not have the same effect as ingesting glucose for those with a limited resource theory.

As Stanford psychologist and study author Carol Dweck, PhD, tells the Stanford Report:

“When you have a limited theory of willpower, you’re constantly on alert, constantly monitoring yourself. ‘Am I tired? Am I hungry? Do I need a break? How am I feeling?’ ” Dweck said. “And at the first sign that something is flagging, you think, I need a rest or a boost.”

She said people who have the more-abundant theory aren’t looking for those cues all of the time.

“We’re not saying people don’t need fuel for strenuous work, they just don’t need it constantly,” Dweck said. “People have many more resources at hand than they might think.”

Previously: Examining how stress affects good and bad habitsAsk Stanford Med: Answers to your questions about willpower and tools to reach our goalsAsk Stanford Med: Stanford health psychologist Kelly McGonigal taking questions on willpowerThe science of willpower and Addiction: All in the mind?
Photo by uıɐɾ ʞ ʇɐɯɐs

Addiction, Mental Health, Research, Stanford News

Stop-smoking program aids recovery of psychiatric patients, study finds

Stop-smoking program aids recovery of psychiatric patients, study finds

While smoking has been in decline in recent years in this country, one group where it remains endemic is among psychiatric patients, who often die prematurely of tobacco-related disease. Practitioners have long thought that smoking could be a useful tool in therapy, calming patients and helping them cope with stress. They also feared that if psychiatric patients were asked to quit, it could interfere with treatment.

But those assumptions are challenged by a new study led by a Stanford researcher, which shows that quitting smoking may be beneficial for these patients. Judith Prochaska, PhD, MPH, and her colleagues at University of California, San Francisco found that a stop-smoking program in hospitalized psychiatry patients aided their recoveries and reduced the chance that they would be hospitalized again for their psychiatric problems.

“This is a very low-cost, brief intervention that helped patients quit smoking and offers evidence that it may have helped their mental health recovery,” said Prochaska, associate professor of medicine with the Stanford Prevention Research Center.

Michael Fiore, MD, MPH, director of the University of Wisconsin Center for Tobacco Research and Intervention and a leader in national policy for tobacco treatment, said:

This paper by Dr. Prochaska and colleagues provides powerful evidence that evidence-based tobacco dependence treatments can substantially increase quit rates among psychiatric inpatients. We know that psychiatric patients smoke at very high rates and are at tremendous risk from their smoking. Thus, the findings hold promise to make an important, real-world contribution to the health of these patients.

The researchers offered stop-smoking treatment to 224 patients at UCSF’s Langley-Porter Psychiatric Institute, a smoke-free, locked unit for acute care. Half participated in a stop-smoking intervention that included a meeting with a counselor, written and electronic materials and the availability of a 10-week supply of nicotine patches. The other half received usual care – a pamphlet about the hazards of smoking and information on how to quit.

At the end of 18 months, 20 percent of those in the treatment group had quit smoking, compared to just 7.7 percent in the control group. Moreover, what was unexpected and striking is that 44 percent of those in the treatment group were rehospitalized, compared to 56 percent in the control group.

“I think some of the therapeutic contact that addressed tobacco dependence and supported participants with this major health goal may have generalized to feeling better about their mental health condition,” Prochaska said.

The study is published online today in the American Journal of Public Health.

Addiction, Cancer, Chronic Disease, Health Policy, Research, Stanford News

Stanford study: Higher tobacco taxes associated with reduced alcohol consumption

Stanford study: Higher tobacco taxes associated with reduced alcohol consumption

beer-cigaretteTobacco and alcohol are a troublesome pairing. Since smoking enhances the addictive effects of alcohol – and vice versa – people tend to drink and smoke more when these drugs are used together. But new research suggests that it may be possible to exploit the link between tobacco and alcohol to reduce their use.

A Stanford-led team of researchers found that increases in tobacco taxes were associated with lower alcohol consumption among certain groups of people. This finding suggests that an increased tobacco tax may simultaneously reduce smoking and alcohol consumption.

I corresponded with the study’s lead author, Stanford postdoctoral student Kelly Young-Wolff, PhD, to find out more about the recently published study and how the findings might be applied to efforts to control cigarette and alcohol use.

“Cigarette taxes have broad population reach and have been recognized as one of the most significant policy instruments to reduce smoking,” Young-Wolff told me. “Given the high co-occurrence of drinking and smoking, we hypothesized that the public health benefits of cigarette taxes would extend beyond smoking to reduce alcohol consumption.”

Using data from a prospective, longitudinal survey of U.S. adults, the team tested their theory by examining whether increases in cigarette taxes were associated with reductions in alcohol consumption across two periods of data collection (2001-2002 and 2004-2005). State tobacco taxes increased between the first and second time period for about half of the participants (10,936 of 21,473 people living in 31 of 46 states included in the study), which gave the researchers a way to assess whether or not higher tobacco taxes were associated with alcohol consumption.

In their study, published online last Friday in Alcoholism: Clinical and Experimental Research, the team found that smokers living in states with increased tobacco taxes tended to drink less. The result was most pronounced for male smokers – particularly among groups of males who drank heavily, were young, or had lower incomes.

Since tobacco and alcohol use is linked, it’s unsurprising that they rank first and third (respectively) on the list of most preventable causes of death, according to the Centers for Disease Control. “The co-occurrence of smoking and drinking is of particular clinical significance given evidence that health consequences increase with combined versus singular abuse of alcohol and tobacco,” explained Young-Wolff. Yet, despite the known link between tobacco and alcohol use, relatively few studies have explored ways a tougher tobacco tax could affect the use of these two addictive substances.

The new results suggest that the beneficial effects of increased tobacco taxes could spread beyond the sale, purchase and use of tobacco products. “Our finding that increases in cigarette taxes may have the added public health benefit of reducing alcohol consumption among vulnerable segments of the population is promising, and it highlights the importance of research that targets the interactions of tobacco and alcohol,” Young-Wolff explained.

This study could set the stage for researchers to investigate other possible second-hand benefits of increased tobacco taxes, such as reductions in alcohol-related violence, drunk driving, and alcohol-related illness and death, Young-Wolff continued. “Our results add to evidence of the public health benefits of cigarette taxes, which have already been shown to reduce smoking, and can be brought to the policy debates to more fully capture the public health effects of cigarette taxes for prevention and treatment.”

Holly MacCormick is a writing intern in the medical school’s Office of Communication & Public Affairs. She is a graduate student in ecology and evolutionary biology at University of California-Santa Cruz.

Previously: Stanford professor shares potential downside of an increased tobacco tax, Kicking the smoking habit for good and How have U.S. tobacco regulations affected smokers?
Photo by Office on Women’s Health

Addiction, Mental Health, Stanford News

Stanford humanities course helps counteract the “powerlessness and shame” of addiction

Stanford humanities course helps counteract the "powerlessness and shame" of addiction

More than a decade ago, two Stanford professors began teaching a humanities course to women at Hope House, a drug and alcohol treatment facility where a number of residents have recently been released from prison.

A story published earlier this week in the Stanford Report examines how the program has become an integral part of the addiction recovery process at the facility and how it benefits both residents and those teaching the course. Corrie Goldman writes:

A humanities education may not seem like an obvious component of addiction recovery, but Karen Marie Francone, the executive director of the Service League of San Mateo County, the nonprofit agency that runs Hope House, said there is a strong correlation between the two.

“Like the recovery process, the coursework seems insurmountable,” she said, but trusting the process of the course shows students that “you can do anything if you keep an open mind and are willing.”

Francone, who initiated the Hope House program with Stanford, also said that humanities subject matter, such as philosophical scenarios and ethical dilemmas, gives the students new perspectives “that help them make wise decisions that are actually good for them.”

Importantly, Francone noted, exposure to the humanities helps the women “expand their horizons and see themselves not just as an addict or alcoholic but as a whole person.”

Hundreds of women have completed the Hope House Scholars Program since it began. One recent student in the program commented, “For the first time in a long time I did something I was proud of.”

Previously: Alcoholism: Not just a man’s problem and Examining how addiction in the U.S. has changed over the last decade

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