NCADD News Service

Finding Your Place in Mutual Help Groups

Finding Your Place in Mutual Help Groups

In the United States and elsewhere, addiction treatment programs routinely recommend that patients make use of mutual support groups, also known as “self-help” groups.  Twelve-Step programs, particularly Alcoholics Anonymous (AA) and programs modeled after it such as Narcotics Anonymous (NA), are recommended most often.  They are widely available and have been central to the recoveries of many individuals with addiction, some having achieved success with 12-Step or other mutual help programs as their sole support.

Most often, however, peer assistance by itself is not sufficient.  To stabilize and emerge from active addiction, many individuals require formal addiction treatment programs that feature professional counseling in individual and group settings.  These programs may be brief or long-term and some provide residential separation from common relapse triggers.  Medications may be necessary for detoxification, medical or psychiatric problems, and/or relapse prevention.  Medications often are needed beyond the initial treatment episode, some indefinitely.

Formal treatment is far more comprehensive than mutual help—and far more expensive.  Participants in mutual help programs generally pay nothing, though they may make voluntary contributions.  Many individuals are introduced to mutual help meetings as an adjunct to formal treatment, then later rely on them as the primary support for long-term recovery.

AA and NA are the largest and most well established mutual help programs and are the ones best known to addiction treatment professionals and the public.  A recent article in this series highlighted issues for professionals and prospective participants to consider prior to referrals to 12-Step meetings.

The purpose of this article is to increase familiarity with lesser known mutual help programs, which can supplement or serve as alternatives to 12-Step programs.  These programs include:  SMART Recovery, LifeRing Secular Recovery, Women for Sobriety, Secular Organization for Sobriety (SOS), and Refuge Recovery.  I invited some of those involved in the leadership of these programs to share information on their programs, aimed at both individuals who can benefit from them and health professionals who may refer to them.

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"Prescribing” Mutual-Help Meetings: A Primer

"Prescribing” Mutual-Help Meetings: A Primer

All physician recommendations to patients are, in a sense, prescriptions. Obvious prescriptions are written or electronic orders for treatments or procedures, including medications, diagnostic tests, and physical therapy.

Prior to executing these orders for particular patients, physicians typically weigh the relevance of the medication or procedure to the individual based on factors such as cost, availability, accessibility, and patients’ physical and mental abilities. Prescribers routinely order a medication only if there are no special precautions or contraindications for that patient, and they educate the patient regarding potential adverse effects.

Less obvious as prescriptions, but no less deserving of foresight and care, are the recommendations to patients receiving addiction treatment that they attend and gain support from mutual-help meetings, particularly 12-step programs.

Providers make these recommendations often, but unfortunately make them without reflecting on their relevance to individuals and without educating patients regarding potential adverse effects. These omissions occur in primary care, addiction medicine, psychiatry, and other disciplines—regardless of whether the providers are in recovery themselves or have explored recovery by attending open meetings, reading 12-step literature, and attending lectures or seminars.

Some providers, particularly those treating patients with methadone and buprenorphine (Suboxone® and others), actually require patients to attend 12-step meetings. They may even ask for a signed note from the meeting chairperson. Drug courts frequently do the same.

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All About Medications for Opioid Use Disorder—In One Place

All About Medications for Opioid Use Disorder—In One Place

In the face of our national opioid crisis communities across the United States are taking notice and taking action. They’re proactively addressing opioid misuse, opioid addiction, and overdose deaths by distributing naloxone nasal injectors to counteract overdoses, contriving ways to move individuals treated for overdoses directly into treatment, and making treatment for opioid use disorder (OUD) more accessible.

Treatment for OUD has several potential components, one of which is use of three FDA-approved OUD medications: Methadone, buprenorphine, and naltrexone. Use of medication to treat opioid addiction has been controversial since the 1960s when methadone was first shown to help individuals addicted to heroin.

But controversy is being replaced with acceptance as OUD medications are increasingly recognized as a potent tool to combat the opioid crisis. Treatment Improvement Protocol (TIP) 63 released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in February 2018, Medications for Opioid Use Disorder, is an authoritative summary of where we stand that follows the established TIP formula of balancing scientific research with input from a consensus panel.

Here are some statements from TIP 63 (with selected page numbers):

OUD medications reduce illicit opioid use, retain people in treatment, and reduce risk of opioid overdose death better than treatment with placebo or no medication. (ES-13)This doesn’t mean that remission and recovery occur only through medication. (ES-2)Patients taking medication for OUD are considered to be in recovery. (ES-3, 1-2)Discussing medications that can treat OUD with patients who have this disorder is the clinical standard of care. (3-5)Doses and schedules of pharmacotherapy must be individualized. (ES-5, 3-i)Patients should decide whether to taper off or discontinue pharmacotherapy with the support of their healthcare professional and, if applicable, their addiction or mental health counselor, family, and peer recovery supports. (3-88)Medical management should not end when patients taper off of medication. (3-89)

Medication suits the needs of many individuals with OUD but not all. Research demonstrates that the odds of sustained recovery are higher with medication and that medications are underutilized; so medication should be a routine consideration, just not a mandate.

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FDA Calls on Online Companies to Police Opioid Sales

FDA Calls on Online Companies to Police Opioid Sales

Food and Drug Administration (FDA) Commissioner Scott Gottlieb this week called on Internet service providers and social media companies to more carefully monitor online sales of opioids.

“We find offers to purchase opioids all over social media and the Internet, including Twitter, Facebook, Instagram, Reddit, Google, Yahoo and Bing,” Gottlieb said at the National Rx Drug Abuse and Heroin Summit in Atlanta.

Many illicit drugs that enter the U.S. are bought and sold online, including drugs laced with fentanyl, he said.

Gottlieb plans to meet with leaders of Internet companies and advocacy groups “to identify technology gaps and new solutions,” The Wall Street Journal reports. Such solutions might include search algorithms to alert potential buyers about treatment programs and the deadly risks of opioids.

Original linkOriginal author: Ezra
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FDA to Host Meeting on Patient-Focused Drug Development for Opioid Use Disorder

FDA to Host Meeting on Patient-Focused Drug Development for Opioid Use Disorder

The Food and Drug Administration (FDA) will host a public meeting April 17 on patient-focused drug development for opioid use disorder (OUD), in collaboration with the National Institute on Drug Abuse.

The FDA is also working closely with patient advocacy and community organizations to encourage participation from people with OUD.

The FDA is interested in learning patients’ perspectives on OUD, including the effects on their health and well-being that have the greatest impact on daily life, their experience using prescription medical treatments and other treatments or therapies for OUD, and challenges or barriers to accessing or using medical treatments for the disorder.

The meeting will take place at FDA White Oak Campus, 10903 New Hampshire Ave., Building 31, Room 1503A (Great Room), Silver Spring, Maryland, from 10 a.m. to 4 p.m.

Original linkOriginal author: Ezra
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Schools Confront Sudden Increase in Easily Concealed Vaping Devices

Schools Confront Sudden Increase in Easily Concealed Vaping Devices

Middle schools and high schools are struggling to cope with a sudden increase in students using easily concealed vaping devices called Juul, which resembles a flash drive.

Officials at schools across the country say they are concerned these devices are creating a new generation of young people addicted to nicotine, The New York Times reports.

Pods in vaping devices have a higher concentration of nicotine than do individual cigarettes, the article notes.

Vaping devices come in flavors such as fruit or mint. Because they don’t produce a noticeable plume of smoke, some students use them in class.

“I’m afraid that we’re going to be hooking a new generation of kids on nicotine, with potentially unknown risks,” said Dr. Mark L. Rubinstein, a professor of pediatrics at the University of California, San Francisco. “With cigarettes, we’ve been studying them for many years, we have a pretty good idea of what the risks are. We just don’t know what the risks of inhaling all these flavorings and dyes are, and what we do know is already pretty scary.”

Original linkOriginal author: Ezra
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Nerve Pain Medication Gabapentin Linked With Increasing Overdose Deaths

Nerve Pain Medication Gabapentin Linked With Increasing Overdose Deaths

Public health officials say the nerve pain medication gabapentin is being found in an increasing number of overdose deaths, according to CBS News.

Gabapentin is a non-narcotic drug used to treat seizures and pain associated with shingles.

Doctors have been prescribing it for a growing number of other conditions, as a way to offer pain relief without opioids.

A study published last year found that for people who use heroin, the combination of opioids with gabapentin potentially increases the risk of overdose death.

“Unfortunately, we now need to worry about it because people are abusing it,” Dr. James Patrick Murphy, a pain and addiction specialist in Kentucky, told the Louisville Courier-Journal. “Alone, it’s not something that will stop your breathing or your heart,” he said. “But if you take it along with a drug like heroin or fentanyl, together it might be enough to make you stop breathing and put you over the edge.

Original linkOriginal author: Ezra
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More Americans Should Carry Naloxone: Surgeon General

More Americans Should Carry Naloxone: Surgeon General

U.S. Surgeon General Jerome Adams released a public health advisory Thursday urging more Americans to carry the opioid overdose antidote naloxone, NPR reports.

Naloxone is already carried by many first responders, such as EMTs and police officers. The Surgeon General is recommending that more people, including people at risk for an opioid overdose, as well as their family and friends, also keep naloxone nearby.

“For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids, individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life,” he said in a statement.

Original linkOriginal author: Ezra
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NIH Announces the HEAL Initiative

NIH Announces the HEAL Initiative

In April 2018, NIH launched the HEAL (Helping to End Addiction Long-term) Initiative, an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis.

This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment (MAT) for opioid use disorder (OUD).

Successes from this research include the development of the nasal form of naloxone, the most commonly used nasal spray for reversing opioid overdose, the development of buprenorphine for the treatment of opioid use disorder, and evidence for the use of nondrug and mind/body techniques such as yoga, tai chi, acupuncture, and mindfulness meditation to help patients control and manage pain.

Over the past year, NIH has worked with experts from public and private organizations to identify the areas that would benefit from focused efforts by NIH alone or in partnerships with outside organizations.

The NIH HEAL Initiative will bolster research across NIH to:

Prevent Addiction through Enhanced Pain ManagementMore than 25 million Americans suffer from daily chronic pain. NIH will support research to understand how chronic pain develops, making patients susceptible to risks associated with opioid use. NIH will work with partners from the biopharmaceutical industry to develop a data sharing collaborative, new biomarkers for pain, and a clinical trials network for testing new pain therapies. NIH will also enhance the pipeline of treatments for pain and enhance clinical practice for pain management.Improve Treatments for Opioid Misuse Disorder and AddictionMore than 2 million Americans have OUD. Millions more misuse opioids, taking opioid medications longer or in higher doses than prescribed. NIH will support research that can prevent and treat opioid misuse and addiction, and that will help people with OUDs achieve and maintain a meaningful and sustained recovery.Original linkOriginal author: Ezra
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Opioid Overdoses Clustered in Poor Areas With Few Job Opportunities

Opioid Overdoses Clustered in Poor Areas With Few Job Opportunities

Opioid overdoses are clustered in poor areas with few job opportunities, according to a new study.

Researchers found the opioid overdose death rate varied widely by county.

Rates were highest in poorer counties and those with high levels of family distress, as well as areas dependent on mining.

Some rural counties, especially in Appalachia, have the highest opioid overdose death rates in the nation, the study found.

“The drug epidemic is a pressing concern among policymakers, but the media portrayal of the drug overdose epidemic has largely been that it is a national crisis, with the common refrain that ‘addiction does not discriminate,'” lead author Shannon Monnat of Syracuse University in New York told HealthDay. “Failure to consider the substantial geographic variation in drug-related mortality rates may lead to failure to target the hardest-hit areas.”

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National Prevention Week is May 13 – 19, 2018

National Prevention Week is May 13 – 19, 2018

National Prevention Week is an annual health observance dedicated to increasing public awareness of, and action around, substance abuse and mental health issues.

The three primary goals of National Prevention Week are to:

Involve communities in raising awareness about behavioral health issues and implementing prevention strategies;Foster partnerships and collaboration with federal agencies and national organizations dedicated to behavioral and public health; andPromote and disseminate quality behavioral health resources and publications.

National Prevention Week is held each year during the third week of May—near the start of summer, an important time for school, communities, and prevention professionals to re-focus on prevention!

Adolescents and full-time college students most often use substances for the first time during June or July, according to SAMHSA National Survey on Drug Use and Health (NSDUH) data on adolescents – 2012 and NSDUH data on full-time college students – 2015.

The timing of National Prevention Week provides an opportunity for schools and organizations to host prevention-themed events before the school year ends, raising awareness about this important issue among students and their families. These are key periods of social transitions, a risk factor for youth substance use, and an opportunity to develop or strengthen the community, school, and family bonds that protect young people from substance use.

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Large Percentage of Deaths by Drug Overdose May be Suicides

Large Percentage of Deaths by Drug Overdose May be Suicides

Between 25 and 45 percent of deaths by overdose may be suicides, according to the immediate past president of the American Psychiatric Association.

Dr. Maria Oquendo told NBC News the opioid epidemic is occurring at the same time suicides have risen to a 30-year high. One study of overdoses from prescription opioids found almost 54 percent were unintentional. The rest were either suicide attempts or undetermined, the article notes.

Few doctors are looking for a connection between opioid addiction and suicides, Dr. Oquendo said. “They are not monitoring it,” she said. “They are probably not assessing it in the kinds of depths they would need to prevent some of the deaths.”

Original linkOriginal author: Ezra
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Cocaine Laced With Fentanyl Causing Growing Number of Deaths

Cocaine Laced With Fentanyl Causing Growing Number of Deaths

A growing number of drug overdose deaths are due to cocaine laced with fentanyl, NPR reports.

According to the Drug Enforcement Administration (DEA), 7 percent of cocaine seized in New England in 2017 included fentanyl, up from 4 percent the previous year.

In Connecticut, the number of deaths involving fentanyl-laced cocaine has increased 420 percent in the last three years.

Massachusetts officials say an increasing amount of fentanyl-laced cocaine is changing hands on the streets.

The DEA, in its National Drug Threat Assessment, says people typically add fentanyl to cocaine for the purpose of “speedballing,” which combines the rush of cocaine with a drug that depresses the nervous system, such as heroin. Some experts told NPR fentanyl may be mixed with cocaine accidentally during packaging. Others say drug cartels are adding fentanyl to cocaine to expand the market of people who are addicted to opioids.

Original linkOriginal author: Ezra
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Cocaine Deaths on the Rise Among Black Americans

Cocaine Deaths on the Rise Among Black Americans

Cocaine deaths are increasing, particularly among non-Hispanic black Americans, The New York Times reports.

Cocaine, the number-two killer among illegal drugs, claims the lives of more black Americans than heroin does, the article notes.

A recent study in the Annals of Internal Medicine found between 2012 and 2015, the death rate from cocaine overdoses was 7.6 per 100,000 among black men, compared with 5.45 per 100,000 for heroin. Cocaine overdoses exceeded those from heroin among black women as well.

“We have multiple drug problems in the U.S.,” said Keith Humphreys, a professor at Stanford University School of Medicine who advises governments on drug prevention and treatment policies. “We need to focus on more than one drug at a time.”

Original linkOriginal author: Ezra
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Growing Number of Children End Up in ICU After Overdosing on Opioids

Growing Number of Children End Up in ICU After Overdosing on Opioids

A new study finds a significant and steady increase in the number of children in the United States who are admitted to pediatric intensive care units (PICUs) after swallowing opioids.

The increase occurred across all age groups, researchers report in the journal Pediatrics.

The opioid-related PICU admission rate increased 39 percent from 2004 to 2015, HealthDay reports.

The majority of these patients were ages 12 to 17, but a third of patients were younger than 6.

“What concerns us is the rate that PICU admissions are increasing over time, which is in contrast to adult data that suggest we have reached a plateau in hospitalization for opioid overdose,” lead researcher Dr. Jason Kane of the University of Chicago Comer Children’s Hospital said in a news release. “As more opioids are being prescribed in the community, children are becoming ‘second victims’ of the opioid epidemic.”

Original linkOriginal author: Ezra
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ERs Report Opioid Overdoses Jumped 30 Percent in One Year

ERs Report Opioid Overdoses Jumped 30 Percent in One Year

Hospital emergency rooms reported a 30 percent jump in opioid overdoses between the third quarter of 2016 and the third quarter of 2017, according to NPR.

The largest increase in overdoses occurred in the Midwest, which saw a 69.7 percent increase. In Wisconsin, opioid overdoses increased 109 percent.

The smallest increase occurred in the Southeast, which saw a 14 percent increase. The findings come from a new report by the Centers for Disease Control and Prevention (CDC).

“We have an emergency on our hands,” said acting CDC Director Anne Schuchat. “The fast-moving opioid overdose epidemic continues and is accelerating. We saw, sadly, that in every region, in every age group of adults, in both men and women, overdoses from opioids are increasing.” Schuchat noted the report could underestimate the total number of overdoses, because many people who overdose do not end up in the emergency room.

Original linkOriginal author: Ezra
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What Influences Transition from Prescription Opioid Misuse to Injection Drug Use?

What Influences Transition from Prescription Opioid Misuse to Injection Drug Use?

A new study finds there are no significant differences between young adults who misuse prescription opioids and those who inject heroin, except for the amount of time they have used drugs.

The study of young adults in rural upstate New York found on average, it took four to five years between the time a young person started using prescription opioids and the time they started to inject drugs. “Unless they receive treatment, in another year or two it’s likely those who are misusing prescription opioids are on a trajectory to start injecting,” said lead researcher Holly Hagan PhD, MPH, RN, Professor at the NYU Rory Meyers College of Nursing and co-director of the Center for Drug Use and HIV/HCV Research. “We have to figure out how to intervene now to help these young people with their substance use problem.”

Most of the young adults in the study who were in treatment were in 12-step programs and were not receiving medication-assisted treatment. “There are few programs for methadone and buprenorphine in this area,” Dr. Hagan said. “More office-based buprenorphine treatment is needed to prevent young adults from transitioning to injection drug use. We want to reverse this cycle of drug use before it becomes too entrenched.”

Dr. Hagan found that of the 198 young adults in the study, ages 18 to 29, about half had experienced at least one overdose.

Before starting the study, Dr. Hagan thought that severe adverse childhood experiences might explain the difference between young adults who misused prescription opioids and those who injected heroin. “Adverse childhood experiences – both physical and emotional abuse – were strongly associated with having a substance use disorder,” she said.

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Americans Urged to Dispose of Unused Rx This Weekend

Americans Urged to Dispose of Unused Rx This Weekend

With 174 Americans dying every day from drug overdoses, Addiction Policy Forum is urging everyone to clean out their medicine cabinets when they turn the clocks ahead this Sunday. The organization is promoting the safe disposal of unused prescription drugs by giving away disposal kits at events across the country and online. For a list of events and to order a free disposal kit, visit www.addictionpolicy.org/order.

According to the National Survey on Drug Use and Health (NSDUH), nearly one-third of people ages 12 and over who used drugs for the first time began by using a prescription drug for non-medical reasons. Over 11.5 million Americans misused prescription painkillers in the last year1 and every day 2,000 teenagers misuse prescription drugs for the first time.2 

The addiction epidemic is currently impacting more than 21 million American families. "Everyone can do their part by getting rid of unused prescription drugs in a safe way. We are urging anyone who has old, unused medications sitting around their home to order a free online disposal kit," said Jessica Hulsey Nickel, President of Addiction Policy Forum. "It's an easy way for everyone to do their part to solve the addiction crisis by ensuring these drugs stay out of the hands of children, teenagers, or anyone they were not intended for."

Studies suggest that a majority of patients use only some or none opioid medications prescribed to them, and more than 90 percent failed to dispose of the leftovers in recommended ways, which can harm the environment.3  

"We want to encourage everyone to dispose of their unused prescription drugs twice a year, whenever we change our clocks," said Hulsey Nickel. "Our hope is that this is as ingrained in people's minds as changing their smoke detector batteries, because just like a working smoke detector, getting rid of prescription drugs can save lives."

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Deaths From Benzodiazepine Overdoses on the Rise

Deaths From Benzodiazepine Overdoses on the Rise

Deaths from overdoses of prescription sedatives known as benzodiazepines—including Xanax and Valium—are on the rise, according to a report in the New England Journal of Medicine.

According to data from the National Institute on Drug Abuse, overdose deaths involving benzodiazepines increased from 1,135 in 1999, to 8,791 in 2015.

Benzodiazepines are prescribed to treat conditions including anxiety, insomnia and seizures. Overdoses have increased in the past decade, as the number of prescriptions for these drugs has increased, HealthDay reports. Prescriptions for benzodiazepines rose by 67 percent between 1996 and 2013, from 8.1 million to 13.5 million.

“These are highly addictive and potentially lethal drugs, and many people don’t know that,” lead author Dr. Anna Lembke of the Stanford University School of Medicine said. “Sadly, most physicians are also unaware of this and blithely prescribe them without educating their patients about the risk of addiction.”

 

Original linkOriginal author: Ezra
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Creating Healthy Habits

Creating Healthy Habits

We know that making healthy choices can help us feel better and live longer. Maybe you’ve already tried to eat better, get more exercise or sleep, quit smoking, or reduce stress. It’s not easy. But research shows how you can boost your ability to create and sustain a healthy lifestyle.

“It’s frustrating to experience setbacks when you’re trying to make healthy changes and reach a goal,” says NIH behavior change expert Dr. Susan Czajkowski. “The good news is that decades of research show that change is possible, and there are proven strategies you can use to set yourself up for success.”

Lots of things you do impact your health and quality of life, now and in the future. You can reduce your risk for the most common, costly, and preventable health problems—such as heart disease, stroke, cancer, type 2 diabetes, and obesity—by making healthy choices.

Know Your Habits

Regular things you do—from brushing your teeth to having a few drinks every night—can become habits. Repetitive behaviors that make you feel good can affect your brain in ways that create habits that may be hard to change. Habits often become automatic—they happen without much thought.

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