Friday, July 20, 2018

Good New About American Teens!

HealthDay

More U.S. Teens Shunning Drugs, Alcohol

By  Alan Mozes
HealthDay Reporter


THURSDAY, July 19, 2018 (HealthDay News) -- Over the last four decades, more American teenagers have decided to say no to drugs and alcohol, a new report shows.

"There has been a steady increase in the proportion of students graduating high school who report never having tried alcohol, marijuana, tobacco or any other drugs," said study author Dr. Sharon Levy. She directs the adolescent substance use and addiction program at Boston Children's Hospital.

For example, while about 5 percent of high school seniors had embraced abstinence in 1976, that figure had risen to 25 percent in 2014, according to the most recent poll of nearly 12,000 students.

Surveys conducted among 8th and 10th graders between 1991 and 2014 unearthed a similar trend, with abstinence jumping from roughly 10 percent to almost 40 percent among the former, and from 25 percent to more than 60 percent among the latter.

There was also a jump in total abstinence during the month leading up to each survey, rising from just over 20 percent among high school seniors in 1976 to more than 50 percent by 2014. Among 8th graders, that jump was from about 50 to about 65 percent, while among 10th graders month-long abstinence rose from about 65 to roughly 85 percent, the findings showed.

Levy said the downward trends didn't catch her off-guard, even if "the findings may surprise people because we constantly hear bad news about drug use and the opioid epidemic."

She explained that both drinking and smoking -- the number one and number three most common substance use habits -- have been sliding in popularity across the board for a while now, even though pot use has held steady.

But why? That remains "the million dollar question," said Levy, "and for sure it doesn't have one simple answer."

Overall, she credited public health efforts for giving rise to a new cultural climate that encourages teens to shun substance use because it's dangerous and unhealthy, rather than because it's immoral or forbidden.

Dr. Eric Sigel, an adolescent medicine specialist at Children's Hospital Colorado in Aurora, said the results of those efforts are "encouraging."

Sigel, who was not part of the study team, attributed the trend to successful grassroots campaigns such as Mothers Against Drunk Driving (MADD), the increased availability of mental health and substance use programs, better parental role-modeling and an emphasis on the harsh health risks posed, particularly by cigarettes.

Still, Levy warned that the good news "is quite precarious."

For example, "while fewer teens overall are using substances, those who do face a landscape of more dangerous substances [like opioids] compared to their parents' generation," Levy said.

Investigators also found that white and Hispanic teens were less likely to choose abstinence, compared with their black peers. And because girls are more likely than boys to "misuse" prescription drugs -- particularly pain medications -- they were also less likely to be fully abstinent, despite less frequent alcohol, marijuana and tobacco use.

"This is a good reminder that parents, primary care providers and other trusted adults should be talking to kids about avoiding prescription medications, knowing how addictive they can be," Levy said.

What's more, she stressed that "there are always lurking threats to our progress." In particular, Levy pointed to the soaring popularity of e-cigarettes and the steadfast appeal of marijuana, both of which are increasingly perceived as safe.

Those threats were also highlighted by Sigel.

"Society has not as yet focused those [education] efforts on marijuana being detrimental to youth," he said. "Nor have we had the opportunity to combat the whole vaping/electronic use of tobacco products."

Both habits are on the rise, Sigel said, a "foreboding" development that "could influence these [abstinence] trends for years to come."

The study findings were published online July 19 in the journal Pediatrics. http://pediatrics.aappublications.org/content/early/2018/07/17/peds.2017-3498

More information

There's more on substance use and teens at the U.S. National Institute on Drug Abuse.

SOURCES: Sharon Levy, M.D., MPH, director, adolescent substance use and addiction program, division of developmental medicine, Boston Children's Hospital; Eric Sigel, M.D., adolescent medicine specialist, Children's Hospital Colorado, Aurora; July 19, 2018, Pediatrics, online

Friday, June 15, 2018

Opening in Los Angeles!

Opening in California!

I’m pleased to announce the opening of Alltyr Addiction and Mental Health Services in Los Angeles, CA! In order to establish a footprint there, we’ve rented an office at 10886 Wilshire Blvd, Los Angeles, CA 90024. It’s on the corner of Wilshire and Westwood, near UCLA.

I’ll be coming out for the first time next week. I’ll be arriving Thursday night, and I’ll be in the office all day Friday and possibly Sat AM. Phone number is the same. I’ll be out monthly at first, and do the rest via telehealth. As business picks up, I’ll be coming out more often and/or for longer time periods.

I’m really looking forward to bringing Alltyr’s brand of 21st Century addiction and mental health treatment to California!

Mark

Wednesday, March 21, 2018

More Evidence Chantix May Reduce Heavy Drinking(*)

A newly published study suggests varenicline (Chantix) may have role in the treatment of co-occurring alcohol use disorder and smoking.  Results from the Phase 2, randomized placebo-controlled trial, published in last month's JAMA Psychiatry, showed a reduction in the percentage of heavy drinking days among some of its participants.  These results, however, came with a big asterisk: the improvements were only seen among the men enrolled in the study, while the women in the placebo group showed more improvement than those in the medication group.

Chantix has been FDA-approved for smoking cessation since 2006.  As a partial nicotinic acetylcholine receptor agonist, it has been called the "Suboxone of nicotine addiction."  As researchers gained insights into the converging role this receptor system plays in both smoking and alcohol reward, the idea that it could have value in alcohol use disorder (AUD) treatment gained momentum.  Preclinical studies in 2007, 2009, and 2011 showed some promising results, indicating rodents taking the medicine drank less alcohol than those who weren't.  This led to several small human trials of Chantix for heavy drinking, though with mixed results.  The February study was the first to show such divergent results between the two genders, and it is unclear why men fared so much better than the women enrolled in the study.

Nevertheless, these results contribute a little more data to the search for new addiction medications and suggest prescribers may want to consider Chantix for their male patients who both smoke and drink heavily.  Here at Alltyr Clinic, we have seen some of our AUD patients respond quite well to Chantix.  Since our clinicians routinely screen our patients who smoke for their desire to quit, it has been a logical option to consider as a firstline treatment. Despite the less-than-blockbuster results of this study, we are glad to hear about any new research on potential medication options.

Friday, March 2, 2018

Researchers: Supervised Methadone and Buprenorphine Dosing Adds Little Therapeutic Benefit

Methadone, the full agonist synthetic opioid, is one of the most tightly regulated medications on the planet - at least, that is, when it's being used to treat opioid addiction.  Here in Minnesota, no fewer than 5 regulatory bodies oversee the clinics that provide methadone maintenance treatment (MMT).  One of the core federal requirements of "opiate treatment programs" is daily supervised dosing, requiring patients to come daily to the clinic to receive their dose, observed by trained nursing staff for at least the first 3 months.  After that, patients earn one additional day of "take-home" doses at a time until they've earned 1 week (after the 8th month of treatment), then 2 weeks (after the first year in treatment), and finally 4 weeks of take-home doses (after 2 years of sustained participation in the program).  The rationale for these highly restrictive federal rules, ostensibly, has been that it will protect patient safety, decrease diversion, and will improve outcomes among MMT patients.

A recent review of the literature throws these assumptions into question.  The review, analyzed and shared by the folks at Drug and Alcohol Findings, found "no evidence that supervising consumption meant patients were better safeguarded or that the treatment more effectively reduced illegal drug use."  Instead, these policies tend to be quite costly to programs and burdensome to patients.  They reinforce negative stereotypes about MMT patients and have prevented people from seeking potentially lifesaving treatment. 

Here at Alltyr Clinic, we routinely hear from patients that the ability to receive a monthly prescription of Suboxone has meant they could keep their job or maintain their role within the family.  With all the national attention being given to the recent spike in overdose statistics, maybe it's time the feds re-visit these burdensome regulations and increase access to the highly effective treatments. 

From the Findings UK article:

Supervised dosing with a long-acting opioid medication in the management of opioid dependence
http://findings.org.uk/PHP/dl.php?file=Saulle_R_1.txt&s=eb&sf=sfnos

Key points
From summary and commentary

Guidelines recommend making opioid-dependent patients take their methadone or other opioid substitutes at the clinic or pharmacy to safeguard the patient and prevent medication being ‘diverted’ to other people.
Randomised trials and studies study which monitored patients in routine treatment afforded no evidence that supervising consumption meant patients were better safeguarded or that the treatment more effectively reduced illegal drug use.
However, introduction of supervision to UK treatment services was associated with fewer methadone-related overdose deaths.
Findings and expert opinion support initial supervised consumption and its relaxation on an individual basis, depending on assessment of the patient.

Wednesday, February 28, 2018

The Language We Use in Addiction Treatment



The language we use related to alcohol and drug use disorders is often stigmatizing and misguided. Alltyr’s mission is to transform addiction treatment in America. Changing language is a necessary step in that process.

Here’s is Alltyr’s guide to addiction language for the 21st Century.

Instead of saying:
Say:
alcoholic
person with an alcohol use disorder (AUD)
addict
person with a substance use disorder (SUD)
alcohol /drug abuse
risky use, heavy drinking, risky drinking
sober
abstaining, in remission
betrayer, liar, cheat, thief, selfish
addicted person, sick, ill
enabler
loved one  
enabling
unhelpful or unskillful behavior
tough love
self-care, setting reasonable limits and expectations
unmotivated, denial
ambivalent about change, non-adherent, not yet able to overcome barriers to change, demoralized
dry drunk
irritable, moody, troubled, erratic, struggling
slip, lapse, relapse
use episode, recurrence, set-back
recovery (abstinence + spiritual growth)
remission (absence of illness once present)
relapse
recurrence, set-back
relapse prevention
recovery skills training
treatment program
rehab
Treatment (meaning rehab)
treatment (includes all levels of care)
MAT (medication assisted treatment)
treatment, pharmacotherapy, anti-relapse meds
compliance
adherence
non-compliant
non-adherent
harm reduction
treatment, chronic care management, partial response

Want to learn more about The Alltyr Model of Care™? Visit our website: www.alltyr.com 

Thursday, January 11, 2018

Substance Matters Blog is Back!

Hi Everyone,

The blog is back! In 2014, I stopped blogging because I was too busy to keep it interesting. With growth and other recent changes, we'll be starting to post again. A link to the blog is always available on www.Alltyr.com, so you don't have to worry about bookmarking this URL.

A lot has changed since 2014. Alltyr Clinic has grown, and development of the Alltyr Model of Care is complete. We are still located in downtown St. Paul, MN, but plan to expand into the west metro Twin Cities area. We are also looking at expansion in other states. The most likely new location is the Los Angeles area. Ian McLoone, who came aboard very early, helped me with the blog before, and will be posting as well.

I'm looking forward to continuing to do everything possible to disrupt the current corrupt and antiquated rehab system, and replace it with accessible, affordable, attractive and effective professional treatment.

Thanks for reading. Please comment on the posts.

And visit www.Alltyr.com to learn more about how far Alltyr Clinic has come!

Wednesday, September 17, 2014

The Myth of "Cross-Addiction" Debunked

For decades, the conventional wisdom and clinical lore in rehab facilities and recovery communities has warned against the risks of so-called "cross-addiction". "Be careful," they say, "you're at-risk of picking up a new addiction now that you've kicked one habit." Heroin addicts are warned against developing an addiction to alcohol, and cocaine addicts are warned against developing an addiction to opiates, Cross-addiction can even occur to things like exercise or sugar, according to pamphlets and even therapists who have worked in the field for years and years.

But is it even true? Is the notion of cross-addiction supported by empirical evidence - or does it fall on its face under scientific scrutiny?

According to a new report, published September 10 in JAMA Psychiatry, the answer is a resounding, "No."

The study, "Testing the Drug Substitution Switching-Addictions Hypothesis," analyzed data from the National Epidemiological Study on Alcohol and Related Conditions (NESARC) to investigate whether participants developed new-onset substance use disorders (SUD) after remission from a previous SUD. These data were then compared against people with a SUD who did not achieve remission but also developed a new-onset SUD.

The authors discovered that, "As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets."

This is probably the best evidence to-date that addresses the concept of cross-addiction. Will counselors and agencies begin to pull back from this concept - or will clients still be subjected to homework assignments and lectures warning against it?

Here's the abstract from JAMA Psychiatry (found here: http://archpsyc.jamanetwork.com/article.aspx?articleid=1901525):

Importance  Adults who remit from a substance use disorder (SUD) are often thought to be at increased risk for developing another SUD. A greater understanding of the prevalence and risk factors for drug substitution would inform clinical monitoring and management.
Objective  To determine whether remission from an SUD increases the risk of onset of a new SUD after a 3-year follow-up compared with lack of remission from an SUD and whether sociodemographic characteristics and psychiatric disorders, including personality disorders, independently predict a new-onset SUD.
Design, Setting, and Participants  A prospective cohort study where data were drawn from a nationally representative sample of 34 653 adults from the National Epidemiologic Survey on Alcohol and Related Conditions. Participants were interviewed twice, 3 years apart (wave 1, 2001–2002; wave 2, 2004–2005).
Main Outcomes and Measures  We compared new-onset SUDs among individuals with at least 1 current SUD at wave 1 who did not remit from any SUDs at wave 2 (n = 3275) and among individuals with at least 1 current SUD at wave 1 who remitted at wave 2 (n = 2741).
Results  Approximately one-fifth (n = 2741) of the total sample had developed a new-onset SUD at the wave 2 assessment. Individuals who remitted from 1 SUD during this period were significantly less likely than those who did not remit to develop a new SUD (13.1% vs 27.2%, P < .001). Results were robust to sample specification. An exception was that remission from a drug use disorder increased the odds of a new SUD (odds ratio [OR] = 1.46; 95% CI, 1.11-1.92). However, after adjusting for the number of SUDs at baseline, remission from drug use disorders decreased the odds of a new-onset SUD (OR = 0.66; 95% CI, 0.46-0.95) whereas the number of baseline SUDs increased those odds (OR=1.68; 95% CI, 1.43-1.98). Being male, younger in age, never married, having an earlier age at substance use onset, and psychiatric comorbidity significantly increased the odds of a new-onset SUD during the follow-up period.
Conclusions and Relevance  As compared with those who do not remit from an SUD, remitters have less than half the risk of developing a new SUD. Contrary to clinical lore, achieving remission does not typically lead to drug substitution but rather is associated with a lower risk of new SUD onsets.