Category: Addiction

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Biased Publication Standards Hinder Schizophrenia Research

00Addiction, Bias, Deception, Education, Ethics and Morality, Featured news, Psychopharmacology, Therapy September, 16

Source: Erin on Flickr

The effects of schizophrenia are profound. Characterized by delusions, hallucinations, and social withdrawal, the disorder has no known cure. The introduction of antipsychotic medications in the 1950s has helped many sufferers cope. Following diagnosis, patients usually take antipsychotics for the rest of their lives.

But recently, a 20-year study by professor emeritus Martin Harrow and colleagues at the University of Illinois found evidence to support alternative treatment methods. In fact, non-medicated patients in the study reported better community functioning and fewer hospitalizations than patients who stayed on antipsychotics.

So why do medications continue to be the most commonly prescribed treatment for schizophrenia?

Antipsychotic drugs are the largest grossing category of prescription medication in the United States, with a revenue of over $16 billion in 2010. And much of the research that exists on treatment of schizophrenia is directly funded by pharmaceutical companies, making it challenging for independent researchers like Harrow and his team to get studies published. A bias exists towards silencing unfavourable research.

An analysis looking into possible publications biases surrounding antipsychotic drug trials in the U.S. found that, of the trials that did not get published, 75% were negative, meaning that the drug was no better than placebo. On the other hand, 75% of the trials that did get published found positive results for the antipsychotics being tested.

The Washington Post wrote an article in 2012 claiming that four different studies conducted on a new antipsychotic drug called Iloperidone were never published. Each of the studies pointed to the ineffectiveness of the drug, finding that it was no more effective than a sugar pill for the treatment of schizophrenia. A publication bias like this is worrisome.

Research has also shown that staying on antipsychotic drugs for long periods of time negatively impacts brain functioning and could potentially lead to a worsening of some of the initial symptoms of the illness, including social withdrawal and flat affect.

A growing body of research is focusing on cognitive therapy and community based treatments for schizophrenia, as either a replacement for or in combination with traditional pharmacological treatments. So far, outcomes have been promising.

A study by Anthony Morrison, a professor at the University of Manchester found that patients undergoing cognitive therapy showed the same reduction in psychotic symptoms as patients receiving drug treatment. Likewise, research by psychiatristLoren Mosher, an advocate for non-drug treatments for schizophrenia, showed that antipsychotic medication is often far less effective without added psychotherapy. Onestudy by Mosher showed that patients receiving alternative community based treatment had far fewer symptoms of schizophrenia than patients who received traditional treatment in a hospital setting.

When antipsychotic medication was introduced, many hoped it would represent themagic pill for an illness previously thought to be incurable. But little was known about the long-term effects, and even today, many claims of medication efficacy or lack of side effects remain questionable.

Research in schizophrenia is burgeoning and whether a safer, more effective treatment can be developed remains to be seen. Yet for such developments to be possible, it is important for the scientific and medical communities to open themselves up to the possibility of alternative treatments instead of limiting research that challenges the status quo. While antipsychotic medications offer great benefits in terms of reducing acute positive symptoms like hallucinations or delusions, they are by no means a cure.

–Essi Numminen, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Semicolon Punctuates Mental Health Awareness

00Addiction, Featured news, Health, Resilience, Self-Harm, Suicide, Trauma September, 16

Source: Brittany Inskeep on Flickr

Sure, writers dismiss it. But the semicolon—the otherwise underwhelming punctuation mark—has had its share of fans like American physician and poet Lewis Thomas, who said the semicolon leaves “a pleasant little feeling of expectancy; there is more to come; read on; it will get clearer.”

Amy Bleuel echoed this sentiment when she founded Project Semicolon on April 16, 2013. This global non-profit movement is dedicated to providing support for those struggling with mental illness, suicide, addiction, and self-injury.

In a recent interview with the Trauma and Mental Health Report, Amy shared the meaning behind the semicolon:

“It represents continuance. Authors usually use the semicolon when they choose not to end the sentence. You are the author and the sentence is your life, and you’re choosing to continue.”

In 2003, Amy lost her father to suicide.

“I’m kind of continuing his story by telling it to raise awareness. It took 10 years for me to do it but I was able to use his story to bring hope to others and that was my inspiration.”

Since the project’s humble beginnings, the semicolon has evolved into something much bigger. After one of Amy’s blog posts went viral, many decided to get inked with the symbol. What’s more: they started sharing their stories online and creating awareness around mental illness.

But according to Amy, Project Semicolon was not intended to become a tattoo phenomenon:

“It was not meant at all to be a tattoo campaign. It was just picked up as that. I got a tattoo. People started getting a tattoo. It became something people apparently wanted to say.”

It also became something people were willing to stand behind. As a registered charity, Project Semicolon raises funds to help fight stigma and present hope and love to those in need. Dusk Till Dawn Ink, a tattoo shop in Calgary, even donates a portion of the proceeds from semicolon tattoos to the Canadian Mental Health Association.

But the semicolon isn’t the only mental health tattoo out there. Casidhe Gardiner, 20, has an eating disorder recovery symbol tattooed on the inside of her arm, alongside the words “take care.” To her, the tattoo serves as a reminder to look after herself and to avoid relapse:

“If I branded myself with a recovery symbol in a place that I could see all the time, it would remind me in a hard time when I’m spiraling down again that I’ve recovered. I’ve done all this hard work to get there. Why go through the negative parts of the disorder when I have all these amazing parts of recovery?”

What is it about mental health tattoos that help in the healing process?

According to Casidhe, the tattoo works as a conversation piece—sparking discussion when it might not happen otherwise. When asked about the role the semicolon tattoo plays in her healing process, Amy felt the concept was more opaque:

“You know I’m not really sure how that works. I have a lot of people say they look at the semicolon and it gives them inspiration. It’s a reminder that says you get to keep writing. Yeah it sucks sometimes but you get to keep going and choosing how you write that story.”

Supporters of the project have declared April 16th ‘National Semicolon Day.’ On this day, everyone is invited to post their semicolon tattoo on social media platforms like Twitter and Pinterest with the hashtag #ProjectSemicolon, raising awareness and celebrating the network of people who believe in moving forward despite their challenges.

On their website, the project states that they are not a helpline, nor are they trained mental health professionals. But what makes Project Semicolon special, according to Amy, is that it emphasizes the importance of community and non-judgmental support in recovery:

“These people need somebody who cares, who understands them. Not just people who say everything will get better. I wanna be open and honest about my own struggles, I don’t want them to think I’m a person who doesn’t struggle. I want people to be able to come up and say, ‘I struggle too.’ Why do we need to hide?”

A simple punctuation mark; a tattoo; a network of support. Perhaps by wearing a symbol that represents the struggles and victories of the human spirit, the invisible becomes visible. And visibility is important when striving for universal acceptance.

 “Stay strong; love endlessly; change lives.” The phrase appears on the mission statement on the project’s website. It was borne of a phrase close to Amy’s heart:

“I use the phrase “love endlessly” and I truly believe that it’s love that can save a life. And my father showed me that in the short time I had with him.”

–Marjan Khanjani, Contributing Writer, The Trauma and Mental Health Report

–Chief Editor: Robert T. MullerThe Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Plastic Surgery to Cope With Bullying?

00Addiction, Bullying, Child Development, Depression, Featured news, Health, Self-Esteem June, 16

Source: Aimee Heart on Flickr

Looks matter. Focusing on appearance is nothing new. And the growing popularity of plastic surgery has, to some extent, normalized changing our bodies to fit our ideals.

But how do we understand the limits, especially where children are concerned?

In 2014, fifteen-year-old Renata underwent nose and chin surgery to put an end to the constant bullying she was facing at school.

The teasing had become so bad that Renata was homeschooled for three years. And while she says that she is happy with the end results, there was great concern raised at the time by parents, health professionals, and the public over the surgeries.

Experts are split on whether children can benefit from undergoing plastic surgery to avoid bullying. But it should be acknowledged that Renata’s story is not that uncommon.

Fourteen-year-old Nadia Ilse, as well as 7-year-old Samantha Shaw, both had surgery to pin back their ears in response to bullying. They had the operations done for free by the Little Baby Face Foundation, a non-profit organization dedicated to correcting facial deformities of children from low-income families. Founder Thomas Romo tells NBC News that such procedures can have a positive impact on a child’s functioning:

“You take a child, and you change the way they look. To anybody who sees them, they’re good looking. That gives the child strength. We can’t go after the bully. But we can try and empower the children.”

A study by the Department of Psychology at the University of the West of England supports the idea of this kind of surgery, which can have a positive impact on mental health. In a pre- and post-operation comparison of 51 plastic surgery patients and 105 general surgery patients, the plastic surgery group experienced a greater decrease in their depression and anxiety.

But the extent of these positive results is questionable.

Over the course of 13 years, the Norwegian Social Research Institute studied body satisfaction in over 1,000 adolescent females, 78 of whom underwent cosmetic surgery. They found that although satisfaction with the specific body parts that were operated on increased, overall body satisfaction did not improve. Furthermore, participants who underwent cosmetic surgery had an increase in depression, anxiety, and substance abuse compared to those who had no surgery, suggesting that the positive mental effects of plastic surgery are localized and short-lived.

Child psychologist Nava Silton also tells Fox 9 News that plastic surgery could be covering up underlying emotional or mental health issues that a child might have, such as low self-esteem. Unaddressed emotional issues could lead to a plastic surgery addiction in adulthood.

Currently, there is no pre-surgery screening process for mental health issues. The American Board of Plastic Surgery (ASPS) recommends children only have plastic surgery if they understand the benefits and drawbacks, do not have unrealistic expectations, and initially requested the plastic surgery themselves. Yet media personality Laura Schlessinger questions a child’s ability to demonstrate such qualities, noting the importance of parents in guiding their children towards better decisions:

“Children, by virtue of their lack of maturity, may have exaggerated notions of how these procedures will improve their lives.”

Still, Renata insists that surgery was the right choice for her—one that she says boosted her confidence enough to return to school.

Children of different ages and different cognitive abilities vary in their ability to appreciate what they are getting themselves into, but wherever possible, it’s important to help them be realistic about the anticipated consequences of a surgical procedure that will change them permanently.

– Anjali Wisnarama, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Documentary Film Tells Story of Race, Drugs and Baseball

00Addiction, Featured news, Personality, Psychopharmacology, Race and Ethnicity, Resilience, Therapy April, 16

Source: baseball971 on Flickr

Narratives surrounding professional sport often make stories about performance-enhancing drugs as common a spectacle as the sports themselves. As the story often goes, pressure to succeed and maintain peak physical form drives many professional athletes to substance abuse.

We hear this tale again in Jeffrey Radice’s biographical film, “No No: A Dockumentary,” titled as a play on the name of the story’s subject, Dock Ellis, a black Major League Baseball (MLB) pitcher famous for using drugs while on the mound. In the film, Radice examines Ellis’ struggle with drug abuse, digging deep into his life story and the environment in which he played.

Beginning his major league career in the late 1960s with the Pittsburgh Pirates, Ellis was no stranger to the racial stigmatization faced by many black Americans during this time. Through interviews with former teammates, family members, and childhood friends, Radice shows the pride Ellis had for his culture’s acceptance into MLB. In his time as a professional athlete, he became known for his strong verbosity – he was expressive, opinionated, and willing to disobey MLB rules.

He also established himself as an elite pitcher in the league. His success did not come easily or without a price. Of this experience, Ellis says:

“When you get to the major leagues, it’s easier coming up the ladder, but it’s hell to stay there.”

Ellis’ initial drug of choice was a stimulant called “dexamyl,” popularly known as “greenies” in the MLB. This type of drug is classified as an amphetamine; side effects include alertness, a decreased sense of fatigue, mood elevation, and increased self-confidence. According to Ellis, “greenies” made him feel sharper and allowed him to throw with pinpoint accuracy.

On the eve of June 12th, 1970, Ellis took LSD, a hallucinogen, which lead to his most memorable performance: throwing a perfect game.

In the first half of the documentary, Ellis’ life is described as erratic but exciting, colourful, and Hollywood-like. Radice depicts Ellis’ drug-abuse in a surprisingly lighthearted manner. Ellis chuckles as he reminisces about his high-flying lifestyle when he was at the top of his game. He is portrayed as a baseball superstar, his drug abuse merely a stepping-stone to his success.

In the second half of his film however, Radice shifts his perspective to view the film’s subject through the lens of mental health. While portraying Ellis as good at what he did, Radice asks whether his success in the MLB justified his drug and alcohol abuse.

At one point, Ellis is shown coming off drugs and tearfully admitting his dependence on them. After his retirement and an unfortunate drug-fueled spousal assault, he entered rehab and spent the rest of his life mentoring and counseling other drug-dependent individuals. He stayed sober up until his death in 2008.

The juxtaposition in the documentary – between an outlandish and erratic drug-using icon and a recovered, empathic individual – is moving and effective. It represents the highs and the lows drug users face when coming to terms with their addiction, and the fight to stay sober and live a more fulfilling life.

Toward the end of the film, Ellis reads a letter sent to him by Jackie Robinson, the first African American to play in the MLB:

“There will be times when you will ask yourself if it’s worth it all. I can only say, ‘Dock, it is’ and even though you will want to yield, in the long run your own feeling about yourself will be most important. Try not to be left alone.”

Although Robinson is referring to Ellis’ determination to gain equality in the MLB, his words also relate to the issue of drug-use and addiction in professional sports. The way “No No: A Dockumentary” approaches Ellis’ biography is unique: it idolizes a great baseball player, but also highlights his dark side and shows what Ellis ultimately lost because of drug dependence.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

1 A blood test to diagnose depression-118138414119886042cd33f08a35cf742e1cc5c5

A Blood Test to Diagnose Depression?

00Addiction, Depression, Featured news, Neuroscience, Psychiatry, SSRIs March, 16

Source: Andrew Mason on Flickr

Researchers at the Feinberg School of Medicine at Northwestern believe it may be possible to diagnose depression using a blood test. According to Eva Redei, a professor of psychiatry at the university, previous studies with lab animals have identified 26 markers in the blood (called biomarkers) that are associated with depression.

With human subjects, Redei identified nine biomarkers that differed between depressed and non-depressed individuals. The biomarkers signify a difference in gene expression associated with depression and allowed Redei to identify all those suffering from Major Depressive Disorder (MDD) in a sample of 66 adults.

Further, Redei was able to use biomarkers to identify adults with MDD who benefited from Cognitive Behavioural Therapy (CBT).  When depression symptoms were improving, some of the original biomarkers that helped to identify depressed individuals disappeared in blood samples.

If replicable, these findings would have major implications for the future of mental health diagnosis. Patients sometimes seek the attention of a primary care physician when they have concerns about depression. Unfortunately, such physicians are not as equipped or experienced as psychiatrists and psychologists in diagnosing and treating depression. This increases the time between when individuals begin to experience symptoms and when they are able to receive treatment. On average, an official depression diagnosis can take between 2 to 40 months.

At the same time, untreated depression has severe risks. “The longer depression is not treated, the more difficult it is to treat,” says Redei. “There’s also a higher chance of suicide, and adverse effects in the person’s work environment, home environment, [and] social structure.”

Untreated depression usually worsens over time, and to cope, patients may succumb to addiction, self-injury, and reckless behaviors such as having unprotected sex and drunk driving. Risk of suicide also goes up the longer depression remains untreated.

Using a test such as this to identify depression could reduce some of the stigma tied to the disorder and bridge the gap between mental and physical health. Depression affects the whole person, body and mind. A test such as this underscores that connection.

Does it all sound too easy?

Perhaps.  New biological findings in mental illness have a way of promising a whole lot more than they deliver.

Nowhere is this seen more than in the area of depression (Anyone out there remember Peter Kramer’s 1993 classic, Listening to Prozac?)  Decades of research on SSRI’s, once hailed as revolutionary, are increasingly showing just how modest, indeed disappointing, the medication’s effects actually are.

So a healthy dose of skepticism is in order.

This study is one of the first in its category. Depression is an exceptionally complex disorder that can only be partially understood in terms of biology. For the above implications to be substantiated, many studies with larger sample sizes must replicate the findings.

In fact, a much larger study that looked for genetic associations with MDD in over 6,000 individuals (of whom 2,000 were diagnosed with MDD) found little to no genetic links.

Further, even if blood sampling were used to diagnose depression, it would not account for the social and environmental components of the disorder. It is possible that increased reliance on biological factors could lead to increased numbers of people being misdiagnosed and forced to suffer alone due to the narrow diagnostic scope that blood tests would provide.

Still, Redei’s research does show promise. She hopes that using blood tests to diagnose depression will help expedite the otherwise lengthy process. But she does not feel that current diagnostic practices should be replaced. Instead, the combination of blood tests and self-report evaluations of symptoms may be key to early diagnosis in the future.

Although further research is needed, the hope is that blood tests may eventually help clinicians with the question of which treatment may be most effective for which client. “I think this opens the possibility to begin to look at whether there are biomarkers that may be able to predict response to a behavioral treatment like cognitive behavioral therapy, pharmacotherapy and other forms of treatment,” says co-author David Mohr.

Redei’s research responds to the very real need for more efficient and effective methods of diagnosing depression.  And it opens doors to new ways of understanding the disorder and its identifying characteristics.

– Alessandro Perri, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

Laughing at Mental Illness?

Laughing at Mental Illness?

10Addiction, Bias, Creativity, Depression, Embarrassment, Featured news, Health, Humor, Laughter, Self-Esteem December, 15

Source: Fractured-Ray on DeviantArt

Whether chuckling at a New Yorker cartoon or an episode of South Park, there is nothing wrong with a bit of laughter. But certain topics are off limits.

Depression, anxiety, psychosis. Is it ever okay to laugh at mental illness?

Many mental health advocates say that mental illness is never a laughing matter. This view was reflected in public outcry after a2013 McDonald’s ad showed an apparently depressed woman with the caption, “You’re Not Alone. Millions of people love the Big Mac.” The helpline under the ad connected callers to the McDonald’s head office. The fast-food giant faced tremendous backlash and quickly pulled the ad, apologizing to those they offended.

Psychologist Howard Samuels, founder of The Hills Treatment Centre in Los Angeles, says that when we laugh at mental health issues, we lessen the seriousness of the condition and dehumanize sufferers. He cites the example of former Toronto Mayor Rob Ford, whose substance abuse made for numerous jokes, ridicule that may have delayed his decision to seek treatment.

But Janine Hobson (name changed), a stand-up comedian for Vancouver’s Stand Up For Mental Health (SMH) and Toronto’s Laughing Like Crazy (LLC) disagrees. To her, the acceptability of finding humour in mental illness depends on who is making the joke and why. Does the person have a mental illness, and is the humour playing down the condition or helping that person connect to others?

According to Janine, a sufferer of bipolar disorder, SMH and LLC help people with mental illness overcome their conditions. As part of the two programs, participants come up with a comedy routine based on their experience with mental illness and the mental health system, performing their sketches in front of live audiences.

David Granirer, the founder of SMH and Janine’s trainer, thinks that comedy gives people with mental illness a powerful voice and helps reduce stigma and discrimination around these issues.

“People with mental illness suffer from the effects of misplaced public perceptions,” states Janine. “What do people think of the mentally ill? They’re dangerous, they’ll fly off the handle and kill you.People are afraid. The other myth is that mental illness is a symptom of a weak personality. When you have mental illness there’s a lot of shame.”

Proponents say that comedy diffuses shame and fights stereotypes. Addressing mental health issues through humour improves communication and creates a meaningful and memorable dialogue about the impact of mental illness on individuals and communities. At the same time, people with severe mental illness performing stand-up comedy—a daunting prospect for most—empowers sufferers and shows that mental illness does not have to be a handicap.

Although not a substitute for treatment, laughter can be a way for people to feel better about themselves and embrace their conditions while educating others.

“It’s a way of giving power and hope back to people like myself who are going through the system and have felt so disempowered over the years, which is so important to keeping someone spirited against the obstacles they face related to their illness,” claims Janine.

Research studies on laughter appear to support these views, showing that humour is related to the development of a positive and realistic self-concept, higher self-esteem and self-worth, and more positive emotional responses to stress. Humour that is good-natured, integrating, and non-hostile is associated with higher self-esteem and competence in interpersonal settings, and more positive feelings.

Janine emphasizes that participants of the SMH and LLC programs focus on their own experiences and make light of their ownproblems (as opposed to belittling or sensationalizing mental illness).

So, can we laugh about the frightening symptoms of schizophrenia? Hard to know, the answer depends on context. At its best, humour creates partnership, hope, and open-mindedness. At its worst, it triggers ridicule and bullying.

The difference is as thin as the line separating comedy and tragedy.

– Veerpal Bambrah, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

The Changing Face of the Heroin Addict

The Changing Face of the Heroin Addict

00Addiction, Featured news, Health, Law and Crime May, 15

Source: Jonathan Silverberg / Flickr

Hollywood and much of the Western world was shocked by the sudden passing of actor Philip Seymour Hoffman in February of 2014.  Reports rapidly circulated that Hoffman, 46, was found dead from an overdose, with a needle in his arm and multiple bags of heroin nearby.  Described by the New York Times as “one of the most ambitious and widely admired stars of his generation,” Hoffman did not fit the stereotypical profile of a heroin user.

His death has brought an alarming pattern to light.  New heroin users are not necessarily troubled or poverty stricken persons from inner city environments.  Many are younger, “middle class,” and from rural or suburban areas.

Governor of Vermont, Peter Shumlin, gave an unprecedented “State of the State” address that focused exclusively on the massive surge of heroin abuse in his state.  Calling it a “full-blown heroin crisis,” Shumlin explained that heroin use in Vermont has increased over 770% in the past decade, with 4300 new addicts in 2012 alone.

Vermont is a small state known for its idyllic cottage country and rural areas.  Unlike neighbouring states New York and Massachusetts, it lacks the large urban sprawl usually associated with drug addiction.  Its unemployment rate is the seventh lowest in the country, and nearly everyone has some form of health insurance.

Fifteen years ago, Vermont saw a massive jump in the amount of OxyContin addictions across the state.  OxyContin is a powerful and highly addictive narcotic painkiller.  Its opiate effects quickly build a tolerance and produce a powerful, euphoria-inducing high.

Many of those who became addicted were middle and working class individuals who sought pain relief for a variety of injuries –some legitimate, others not.  Many now claim that doctors were over-prescribing and setting patients up for destructive drug addictions.

In 2010, North American pharmaceutical companies, in reaction to a strong push from anti-drug groups and legislators, replaced OxyContin with a new version that was supposed todeter drug abuse.  The newer drug, OxyNeo, is much harder to break up and becomes a gel-like substance in water, making it difficult for users to crush and snort or “cook” and inject.

Around the same time, new legislation was drafted to make access to OxyContin more difficult to obtain.  In Canada, the Narcotics Safety Act requires patients to show photo ID to both their prescribing doctors and pharmacists before they can have prescriptions written and filled.  This new legislation combined with OxyContin’s reformulation has made it increasingly difficult to get enough of the drug to feed an addiction.

OxyContin addicts are now turning to its cheaper and more easily accessible cousin, heroin.

Heroin is similar to OxyContin in that it’s part of the “opioid” family of drugs.  Both narcotics produce euphoria-like highs and many users seek its effects to temporarily numb both physical and emotional pain.  But the effects of heroin are much stronger and more destructive.

The initial “rush” felt by new heroin users is a more powerful high than that produced by OxyContin.  The user is often propelled to consume increasingly larger quantities of the drug in an attempt to replicate that high, placing them at risk of overdose.  It’s this pursuit that makes heroin so dangerous.  And when the drug is not available, the accompanying withdrawal symptoms are intense and can drastically alter mood and behaviour.

Street value and availability of heroin has also changed considerably.  Ten years ago, heroin was a very different product.  It was more expensive ($50-$150 a bag), less pure and difficult to find.  Now we are seeing a steady supply being sold, at a fraction of the cost, that is 3-4 times more pure –the current street price for a bag is $10-$30.

Not only has the drastic drop in street value made it more accessible, but its purity has made it more attractive.  Ten years ago, a bag of 2-3% heroin had to be cooked and injected to attain a powerful high.  New supplies with 7-10% purity can be smoked or snorted – similar to cocaine. This opens up a much wider group of users who shy away from using a needle.

While well intentioned, the steps taken by Canadian and American drug companies and legislators likely played a part in creating a potential heroin crisis affecting populations in ways and numbers like never before.

The new user is often young, educated, and for many readers of this article, more like you than you think.

– Magdelena Belanger, Contributing Writer, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

This article was originally published on Psychology Today

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Methadone Treatment May Prolong Addiction

00Addiction, Diet, Environment, Fear, Featured news, Health, Motivation, Psychopharmacology, Resilience, Sleep, Spirituality, Stress, Trauma January, 15

The conventional treatment for opioid dependence is to prescribe methadone.

Similar to morphine, methadone is a synthetic opioid sometimes referred to as a narcotic. It is useful at preventing opioid withdrawal, minimizing drug cravings, and is said to reduce the risk of HIV, Hepatitis C and other diseases associated with intravenous drug usage. Methadone is also cheap, and best of all legal.

Despite the advantages, methadone is highly addictive, and has many side effects such as dry mouth, fatigue, and weight gain.

Treatment involving methadone requires a weekly medical visit to renew the prescription, sometimes leading those who are addicted back to the very environment and people that they need to avoid to stay clean.

The Trauma & Mental Health Report recently spoke with Leslie (name changed for anonymity), a patient who has been receiving methadone maintenance treatment (MMT), who says, “Sometimes I wait all day to see the doctor. During that time, you can’t help but associate with other users, hear “drug talk”, or even see drugs being passed around. The methadone doctor doesn’t push counseling and is not there for support. I’m only going to get my prescription.”

Toward the end of treatment, methadone dose is slowly tapered to prevent withdrawal. But most users don’t wean off completely. Leslie says she didn’t have the motivation or tools to do so until she started seeing her drug addictions counselor:

“I’ve been trying to get off of methadone for 18 months now. It has helped with the withdrawal symptoms, and life is easier to manage since I’m not running the street 24/7 looking for my next fix. And I have more time to get my life on track. But, In order to ‘knock’ the addiction you need to figure out what your personal triggers are. My counselor has helped me with this. She also provides a safe place for me to go and discuss my problems and any issues I have with MMT.”

The greatest fear is relapse. Although part of the recovery process, relapse can have physical and emotional consequences. But it helps to identify personal triggers: cues that provoke drug-seeking behavior, the most common of which are stress, environmental factors such as certain people or places, and re-exposure to drugs.

The most important missing link in MMT is drug counseling. Meeting with a counselor is not mandated and patients seldom see one. Those who seek counseling benefit from help determining personal triggers, and preparing for potential relapse. A counselor may help create a healthy living plan that focuses on improving mental health with nutrition, exercise, sleep, building healthy relationships, and spiritual development.

Better family relationships also help with recovery. Including family members in treatment increases commitment to counseling and also helps family members understand what the person is going though.

Opioid addiction is more than physical dependence. Initial detox is a start. Methadone helps with the physical aspects of withdrawal, and helps users lead a more normal life. But without the help of a drug counselor, MMT isn’t enough.

Without counseling, social support, a drug free environment, and the desire to change, we lead the patient only part way there. And part way isn’t enough.

– Contributing Writer: Jenna Ulrich, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: www.123rf.com/stock-photo/lonely_man.html

This article was originally published on Psychology Today

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State of Emergency: Suicide in First Nations Communities

00Addiction, Anger, Depression, Education, Featured news, Grief, Health, Identity, Politics, Post-Traumatic Stress Disorder, Spirituality, Suicide, Trauma December, 14

On April 17th 2013, Chief Peter Moonias declared a state of emergency in the community of Neskantaga. Two suicides within days of each other are only the most recent in a string of sudden deaths that have ravaged the group. 

In the four months prior, seven people died, four of them from suicide, and twenty more made suicide attempts. In a community as small and remote as Neskantaga (the reserve is home to 300 people and is only accessible by plane), the residents are tight-knit. And the losses of their family members, friends and neighbours have left many struggling to cope.

Suicide is disturbingly common among some Inuit and First Nations groups, with the rate in some communities eleven times higher than the Canadian average. Overall, First Nations peoples have a suicide rate twice the norm in Canada, a statistic that has been stable for at least three decades.

Colonization of the Americas has had a profound effect on Indigenous populations. In the centuries since first contact, 90% of the American Indigenous population has been wiped out due to plagues, warfare, and forced relocations. The legacy of land seizures and residential schools still haunts these groups.

The immediate survivors of these incidents would undoubtedly be traumatized, but many of the people who have committed suicide in recent years were not personally exposed. How can trauma inflicted centuries ago have an impact on current suicide rates?

The answer lies in the concept of historical or collective trauma, which Maria Yellow Horse Brave Heart, Associate Professor at the University of New Mexico, defines as “cumulative emotional and psychological wounding over the lifespan, and across generations, emanating from massive group trauma experiences.”

Also known as generational grief, the trauma results from suffering profound losses in areas such as culture and identity, without resolution. Unresolved, deep seated emotions like sadness, anger and grief are passed on from generation to generation through parental practices, relations with others and culture-wide belief systems.

In everyday life, the trauma manifests itself through social problems like drug use, familial abuse and violence. These events can cause traumas of their own and result in depression and PTSD, both of which increase suicide attempts.

Young people are especially at risk. In the cohort of 15-24, the rate of completed suicides is five to seven times the national (Canadian) average, and suicide attempts are even more frequent 

Chris Moonias (no relation to Chief Peter Moonias), an emergency response worker in Neskantaga, told the CBC that since the end of 2012, “We average about ten suicide attempts per month, and at one time we surpassed thirty attempts in one month.”

In addition to unresolved grief, Cynthia Howard of Laurentian University identifies several factors that contribute to suicides in Aboriginal communities. These include: attendance at residential schools and abuse experiences there, forced assimilation, displacement, and adoptions. These experiences have left legitimate feelings of distrust towards dominant American and Canadian cultures and feelings of loss of culture.

Some people also feel strung between two cultures (dominant culture and their own band’s culture) while essentially belonging to neither. Feeling alienated and lacking a sense of belonging can leave many people depressed and feeling that their lives lack a sense of purpose.

Other issues such as low socioeconomic status and extreme poverty, along with low levels of education and lack of opportunity have lead to feelings of hopelessness and helplessness.

“Learned helplessness” occurs when a group or individual, usually after a series of disastrous events, believes they have no control over the outcome of any situation, and that perceived failures in the present will likely continue into the future. Without hope, people sometimes feel that living is worse than not living. This feeling is only exacerbated by a shared history of trauma and its consequences, and can culminate in suicide.

Unfortunately, many people suffering do not receive adequate help. Their families and friends are also left without professional support, continuing the cycle of unresolved grief.

Perhaps it is fitting that Chief Moonias of Neskantaga called a state of emergency. His community has reached a tipping point and must be healed in order to move forward. 

As of now, the federal Canadian government has offered some monetary and human aid, but unless we go beyond band-aid solutions, frequent suicides and their consequences will continue to haunt Neskantaga.

– Contributing Writer: Jennifer Parlee, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

 Photo Credit: https://www.flickr.com/photos/kittysfotos/6235090832/”>Kitty Terwolbeck</a

This article was originally published on Psychology Today

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Book Review: Becoming Trauma Informed

00Addiction, Anxiety, Child Development, Cognition, Empathy, Environment, Featured news, Health, Leadership, Parenting, Psychopharmacology, Race and Ethnicity, Stress, Therapy, Trauma, Treatment December, 14

Red, and your heart starts to race. Red, and your palms sweat. Red, and the sounds around you blur together. Imagine becoming emotionally aroused or distressed at the sight of simple stimuli, like the colour red, without knowing why.

Because triggers like this can take the form of harmless, everyday stimuli, trauma survivors are often unaware of them and the distress they cause in their lives. And clinicians who practice without the benefit of a trauma-informed lens are less able to help clients make the connection.

To address this and other concerns, researchers Nancy Poole and Lorraine Greaves in conjunction with the Centre for Addiction and Mental Health (CAMH) in Toronto recently published Becoming Trauma Informed, a book focused on the need for service providers working in the substance abuse and mental health fields to practice using a trauma informed lens.

Becoming Trauma Informed provides insight into the experiences, effects, and complexity of treating individuals who have a history of trauma. Without a clear understanding of the effect traumatic experiences have on development, it is challenging for practitioners to make important connections in diagnosis and treatment.

The authors describe how someone who self-harms may be diagnosed with bipolar disorder, possibly insufficiently treated with only medication and behaviour management. But using a trauma informed lens, the practitioner would more likely identify the self-harming patient as using a coping mechanism common to trauma survivors, giving rise to trauma informed care.

Such care involves helping survivors recognize their emotions as reactions to trauma. And helping clients discover the connection between their traumatic experiences and their emotional reactions can reduce feelings of distress. 

Throughout the text, the authors describe an array of treatment options, pointing to ways they can be put into practice; for example, motivational interviewing to provide guidance during sensitive conversations, cognitive behavioural therapy for trauma and psychosis, and body centred interventions to allow clients to make connections between the mind and body, an approach that has become increasingly popular in recent years. 

Importantly, the authors emphasize that a single approach to trauma-informed care is unrealistic and insufficient. While all treatments should include sensitivity, compassion, and a trusting relationship between therapist and client, specific groups require unique approaches. 

The authors devote chapters to specific groups, including men, women, parents and children involved with child welfare, those with developmental disabilities, and refugees. They outline different approaches necessary for trauma informed care in various contexts, such as when working in outpatient treatment settings, in the treatment of families, and when working with women on inpatient units, where treatment requires sensitivity to both the individual’s lived experiences and environment

A unique and compelling feature of this book is the focus on reducing risk of re-traumatization, an often neglected topic. Responding to the need for trauma survivors to feel safe, the authors outline how trauma informed care minimizes the use of restraints and seclusion (practices that can be re-traumatizing), and they offer ways to reduce the risk of re-traumatization by placing trauma survivors in less threatening situations, where they are less likely to feel dominated. This may involve matching female clients to female therapists or support groups comprised of only females. 

The numerous case studies help illustrate specific scenarios, challenges, and outcomes of trauma informed care and highlight the growing recognition of the link between substance abuse, mental illness and traumatic experiences.

While the text is theoretically grounded, the authors convey information in a way that is accessible to wider audiences. It provides critical information for those working in the field by underscoring the relationship between past experiences and current functioning.

Becoming Trauma Informed delivers a deeply informative look into the field of trauma therapy.

– Contributing Writer: Janany Jayanthikumar, The Trauma and Mental Health Report

– Chief Editor: Robert T. Muller, The Trauma and Mental Health Report

Copyright Robert T. Muller

Photo Credit: https://www.flickr.com/photos/auntiep/4450279893/

This article was originally published on Psychology Today