Tag Archives: Recovery

Thank you for coming back to my blog site.  In case you have missed any of the previous eight blogs on the Ten Reasons for the Current Heroin Epidemic, please do scroll down to check them out.  Today we will be discussing how Mental Health Treatment or actually the lack thereof has contributed to the overall increase in illicit drug and alcohol use, and opiate/heroin dependency.

Mental Health Parity Picture

 

It is well documented that patients with mental illness are still greatly underserved, and despite some positive movement to increase treatment funding and access, the drastic cuts from the distant and recent past have not been eliminated.  NAMI, the National Alliance on Mental Illness, released the report State Mental Health Cuts: A National Crisis which documented the drastic cuts implemented by states between 2009 and 2011 for spending for children and adults living with serious mental illness. These cuts led to significant reductions in community and hospital based mental health services, with a direct effect also on access to psychiatric medications and crisis services. The Medicaid funding issue is a complex analysis, but there is no question that too many patients are left without viable treatment options.  In an article by the Pew Charitable Trusts, Some States Retreat on Mental Health Funding, Medicaid expansion “may also have persuaded some states to pull back funding for community mental health centers and other mental health initiatives, including school and substance abuse programs.”

The lack of access is not limited to the Medicaid insured population, as many commercial insurers also do not cover mental health services in parity with medical and surgical illnesses. In addition to private insurance companies not abiding by parity laws, the federal and state governments, who are responsible for overseeing compliance, apparently are not doing a good job,  Despite Laws, Mental Health Coverage Often Falls Short.  It was also reported that “NAMI found that patients seeking mental health services from private insurers were denied coverage at a rate double that of those seeking medical services … [and] patients encountered more barriers in getting psychiatric and substance use medications.”

Enough with the statistics! How does this lead to the heroin epidemic?  Simply stated, patients with mental illness are no different than patients with a wide variety of complaints – they all want to feel better.  However, when there are roadblocks related to funding and access to treatment and medication for psychiatric illnesses, patients look elsewhere to feel better.  It is a well-known phenomenon that patients who cannot access care are more likely to self-medicate. So it should not surprise us that patients with depression, anxiety, bipolar illness and other psychiatric health issues reach for drugs that make them feel better: alcohol, stimulants such as cocaine, and opioids such as OxyContin or heroin are commonly used.

When I started this blog series, I promised that I would not only assign blame for the Heroin Epidemic, but also offer solutions.  So here is another solution:  Federal and State Governments must enforce parity laws and we must increase access and funding for mental illness. As they say in the Midas commercial, “You can pay now or you can pay later, but you are going to pay.”  Inadequate mental health treatment can lead to substance use, crime, dysfunctional family dynamics and an overall increase in financial costs to society.

Bad things can happen when mental illness goes untreated, and especially when drug use compounds the situation.  In Addiction On Trial  this is illustrated by Aunt Betty’s conversation with Jimmy’s father:

Adam continued, “Jimmy’s in jail. He was arrested for possession of drugs. But now they are trying to pin a murder on him, but there’s no proof, and well, it’s really a case of mistaken identity.” Adam tried to ground his runaway emotions, but with a trembling tone he blurted out what he so desperately wanted to believe. “Jimmy had nothing to do with it!”

Adam’s anxious moment gave Betty the opening she needed. “Adam, how can I help? And don’t lie to me. We both know that just because Jimmy may not have intended to do anything bad, well, you know what I am saying. When people are high on drugs, accidents happen and sometimes it looks like it wasn’t an accident.”

And during the trial, Venla Hujanen, the Finnish born District Attorney, also focuses on drugs and mental illness while cross examining Dr. Saul Tolson:

Dr. Tolson spoke softly while nodding affirmatively. The District Attorney proceeded, “So Dr. Tolson, it sounds like you do agree that if a person is addicted to drugs—even though he may have been ‘clean’ for a while, and even though when not using drugs he is able to process things better—if he returns to drug use and again becomes ‘high,’ his anger can resurface, poor choices can be made, and bad things can happen.”

 

Author : Meghan
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Welcome back to Ten Reasons for the Heroin Epidemic. This is the second and final primer to lay the foundation before launching into the ten reasons we currently have a heroin epidemic raging across our country.  But before I proceed, I hope you all will read the recent article published in the New York Times on April 17, 2015 entitled, Serving All Your Heroin Needs. Here are two quotes that are extremely revealing:

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“… selling heroin across the United States resembles pizza delivery.”

“… a new home for heroin is in rural and suburban Middle America …”

To better understand why pizza delivery of heroin works and how it found its way into suburban and rural America, there are three related terms that are essential to understand:

  • Tolerance
  • Dependency
  • Addiction

Tolerance refers to not getting as much bang for the buck.  In medical terms, it is the body’s adapting to a drug which then necessitates consuming more of the drug to achieve the same effect.

Dependency refers to the state of having symptoms in the absence of the drug. Examples of withdrawal symptoms are the “shakes” after a heavy drinker stops drinking; or the chills, nausea, vomiting, abdominal cramping, etc. when a heroin addict is deprived of his/her next “fix”.

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Addiction is the drug seeking behavior of an individual.  However, a person who is dependent may not necessarily be addicted.  Remembering from the last blog that the disease of addiction has bio-psycho-social aspects, a person may become dependent but not have the components of addiction.

For example, if sweet Aunt Tillie ends up in the hospital with severe intractable pain from a tumor pressing on her spinal column, she may be given an opiate such as morphine to reduce her pain until the tumor size can be minimized by radiation or chemotherapy or surgically removed.  A few weeks of medication may be needed and during that time Aunt Tillie develops tolerance and dependency to morphine.  After the tumor size is reduced and the pressure on the spinal nerves is diminished, the frequency and amount of morphine is gradually decreased to avoid withdrawal symptoms. After a week or so, Aunt Tillie will no longer require an opiate to eliminate her pain and will be showing no signs of withdrawal. After she is discharged home, she is happy taking an occasional non-narcotic pain medication like Tylenol or Ibuprofen. But how about the person who goes home and has some bio, psycho and/or social components of the disease of addiction. He/she may very well start looking for that euphoric “high” and start seeking drugs.  That is the essential difference between dependency and addiction!

We are now ready to delve into the 10 reasons we have a heroin epidemic. Next blog we will focus on the injudicious prescribing of opiates by doctors as reason #1. But first let’s get a look at Jimmy, Annette and Travis – they are dependent and also addicted.

Annette laid out several lines of cocaine, one definitively larger than the other two. Everyone knew the “fat line,” as they jokingly called it, was hers. Travis prepared the portions of heroin, which had already been processed to a fine powder for snorting. They were now ready to snort their speedballs, a combination of heroin and cocaine. Annette much preferred an amphetamine rush, so her drug cocktail was heavily weighted with the cocaine powder and contained only a small amount of heroin. The reverse was true for the boys….

Within an hour after the speedball, Annette craved more cocaine, but she wanted to set an example for Travis, who undoubtedly would soon be itching for more heroin. Her cocaine buzz was starting to dissipate and numbing herself with alcohol served as a distraction to the hollow depressed feeling as a result of the depleted levels of the chemical dopamine in her brain. Dopamine, a neurotransmitter, is an essential naturally occurring compound that is required to stimulate the portion of the brain that elicits the feeling of pleasure. The greater the frequency and amount of cocaine used, the greater the amount of dopamine is depleted. This results in longer lag times for the brain to produce sufficient quantities of dopamine and therefore progressively longer periods of pleasure deprivation and sadness. This vicious cycle encourages more use, which only partially rectifies the effects of the depleted dopamine stores. Annette did not need a course in neurochemistry to understand that doing more and more lines was a never-ending journey.

 

Author : Meghan
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September is National Recovery month, which is now in its 25th year!  "National Recovery Month is a national observance that educates Americans on the fact that addiction treatment and mental health services can enable those with a mental and/or substance use disorder to live a healthy and rewarding life. The observance’s main focus is to laud the gains made by those in recovery from these conditions, just as we would those who are managing other health conditions such as hypertension, diabetes, asthma, and heart disease.”

Recovery Month spreads the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover.  This year’s theme, ‘Join the Voices for Recovery: Speak Up, Reach Out,’ encourages people to openly speak up about mental and substance use disorders and the reality of recovery, and promotes ways individuals can use to recognize behavioral health issues and reach out for help.”

So this month, I wish to again focus my blog on further destigmatizing and demystifying the disease of addiction. This illness has no socio-economic barriers and two recent articles definitely reinforce this.  It is time to abandon any and all preconceived stereotypical notions we might have!  Give it up!  We are all affected, regardless of skin color, race, religion, education or employment status.

Please check out these two articles and be sure to let me know what you think!  Vermont Quits War on Drugs and Whites Account for Rise in Heroin Deaths

I hope you will consider reading my book “Addiction on Trial” and remember that its subtitle could just as easily read “Tragedy Anywhere USA”.  Please also consider checking out a previous blog: We Need More Doctors Like Saul Tolson to better understand the biological, psychological and sociological components of addiction.  And just imagine what it must be like to be the parent who gets a call that your son is A Heroin Addict in Jail

September is Recovery Month – Spread the word!!!

Author : skassels
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