Category Archives: addiction treatment

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Dual studies highlight ketamine’s potential to treat anxiety and addiction

New evidence suggests ketamine can reduce anxiety related to major depression, and substance abuse depression
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Two new studies suggest the psychiatric benefits of ketamine treatment may extend beyond just the targeting of depression. The research demonstrates ketamine may be helpful in targeting both anxiety- and substance abuse-related depression.

Although ketamine is a relatively old drug, originally developed in the 1950s as an anesthetic, over the last decade a growing body of research has affirmed its unique, and rapid, antidepressant effects. The anecdotal effects of the drug on depression have raced ahead of scientific research so quickly that ketamine clinics have popped up all across the United States, where the drug can be administered for up to US$1,000 a dose.

Much is still unknown about how efficacious ketamine actually is for depression. We don’t know ideal dosages, how long the treatments last, or how safe long-term usage is. Two newly published studies are adding to our knowledge about ketamine’s psychiatric uses, adding weight to the drug’s burgeoning new potential.

The first study, led by a team from Massachusetts General Hospital and Harvard Medical School, set out to study how effective ketamine is at treating patients with anxiety-based treatment-resistant depression. This is an important question to resolve, as many traditional antidepressants do not consistently improve anxiety-based symptoms in cases of major depression.

The study took 99 subjects with treatment-resistant depression, half of whom suffered from high anxiety and half of whom displayed no anxious symptoms. The study randomly administered subjects either one of four different intravenous ketamine doses, or midazolam, a general sedative that could serve as a control.

As well as demonstrating ketamine’s novel antidepressant qualities, the study revealed the drug worked equally well in both anxious and non-anxious subjects. This suggests that ketamine’s antidepressant effects are uniquely effective across different types of treatment-resistant depression, something that cannot be said for many major antidepressant drugs.

“In contrast to reports from monoaminergic antidepressants, our data suggest that patients with anxious depression respond equally as well to ketamine compared to those with non-anxious depression,” write the researchers in the published study.

The second new study comes from a team at Yale University School of Medicine. This research investigated whether ketamine could be effective in treating addiction-related depression when administered in tandem with naltrexone.

A study in 2018 offered a small but significant finding, revealing that ketamine was ineffective in treating depression when administered alongside naltrexone. These results were important because they suggested that part of ketamine’s antidepressant effects may be related to the activation of opioid receptors, which would mean long-term ketamine use may potentially result in problems with addiction, something that many researchers have long argued against.

Naltrexone, an opioid receptor blocker, is often administered effectively to combat serious substance abuse problems, so if it rendered ketamine ineffective then that would cast doubt on much research into how ketamine actually works to reduce symptoms of depression. The new Yale research was small, with a sample of only five patients, but its results strongly suggest ketamine and naltrexone do not cancel each other out.

All five subjects suffering from alcohol use disorder and depression displayed significant depressive relief from ketamine dosages despite long-term naltrexone consumption. Senior author on the study, John Krystal, says although larger studies still need to be completed the research does suggest ketamine and naltrexone may be a complimentary combination that helps treat substance abuse and its related depression.

“[The results] raise the possibility that for people who have depression complicated by substance abuse disorders, the combination of ketamine and naltrexone may be a strategy to explore in the effort to optimally treat both conditions,” says Krystal.

Although this new study only consisted of five subjects, the prior research linking ketamine to the opioid system was generated from just 12 subjects. So we are still in uncharted territory regarding ketamine’s mechanistic effects of the brain. But the Yale research should assuage some fears that ketamine may be, “merely another opioid in a novel form.”

The ketamine anxiety study was published in the journal Depress Anxiety.

The ketamine naltrexone study was published in the journalJAMA Psychiatry.

Source: Yale News

Efficacy of intravenous ketamine treatment in anxious versus nonanxious unipolar treatment‐resistant depression

Abstract

Objective

To examine the effect of high baseline anxiety on response to ketamine versus midazolam (active placebo) in treatment‐resistant depression (TRD).

Methods

In a multisite, double‐blind, placebo‐controlled trial, 99 subjects with TRD were randomized to one of five arms: a single dose of intravenous ketamine 0.1, 0.2, 0.5, 1.0 mg/kg, or midazolam 0.045 mg/kg. The primary outcome measure was change in the six‐item Hamilton Rating Scale for Depression (HAMD6). A linear mixed effects model was used to examine the effect of anxious depression baseline status (defined by a Hamilton Depression Rating Scale Anxiety‐Somatization score ≥7) on response to ketamine versus midazolam at 1 and 3 days postinfusion.

Results

N = 45 subjects had anxious TRD, compared to N = 54 subjects without high anxiety at baseline. No statistically significant interaction effect was found between treatment group assignment (combined ketamine treatment groups versus midazolam) and anxious/nonanxious status on HAMD6 score at either days 1 or 3 postinfusion (Day 1: F(1, 84) = 0.02, P = 0.88; Day 3: F(1, 82) = 0.12, P = 0.73).

Conclusion

In contrast with what is observed with traditional antidepressants, response to ketamine may be similar in both anxious and nonanxious TRD subjects. These pilot results suggest the potential utility of ketamine in the treatment of anxious TRD.

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New Drug Combo Shows Promise for Treatment of Depression and Addiction

Drug Combo Shows Promise for Depression and Addiction
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The combination of naltrexone and ketamine can help treat both symptoms of addiction and depression, a preliminary study by Yale University researchers suggests.

Substance abuse and depression are common in many patients, and efforts to treat both conditions simultaneously have had limited success. One recent study suggested that the antidepressant effects of ketamine might blunted by administration of naltrexone, used to limit cravings of those addicted to opioid drugs and alcohol.

A preliminary study of five patients suffering from both depression and substance abuse disorders suggest that isn’t the case. The study was published Jan. 9 in the journal JAMA Psychiatry.

The results “raise the possibility that for people who have depression complicated by substance abuse disorders, the combination of ketamine and naltrexone may be a strategy to explore in the effort to optimally treat both conditions,” said senior author John Krystal, Yale’s Robert L. McNeil Jr. Professor of Translational Research; professor of psychiatry, neuroscience, and psychology; and chair of the Department of Psychiatry.

Krystal and lead author Gihyun Yoon, assistant professor of psychiatry, treated the five patients suffering from depression and alcohol use disorder with a long-lasting form of naltrexone and then administered ketamine. Four of the five responded to the first ketamine dose and all five found relief from depression after multiple doses.

The study also challenges the idea that ketamine might produce antidepressant effects by stimulating opiate receptors.

Krystal cautioned that larger studies are needed to confirm beneficial effects of the combination treatment.

Krystal and Yoon have provisional patents on the use of ketamine and naltrexone to treat comorbid depression and substance abuse.

The study was primarily funded by the U.S. Department of Veterans Affairs.

Publication: Gihyun Yoon, et al., “Association of Combined Naltrexone and Ketamine With Depressive Symptoms in a Case series of Patients With Depression and Alcohol Use Disorder,” JAMA Psychiatry, 2019; doi:10.1001/jamapsychiatry.2018.3990

At NOVA Health Recovery, we do use Ketamine and other combinations to treat Alcoholism and Opioid and Pain pill addiction using Ketamine Treatment. Dr. Sendi is Board Certified in Addiction Medicine. Call 703-844-0184 Today. Fairfax, Va 22304.



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Addiction on PBS | 703-844-0184 | Opiate Addiction Treatment | Fairfax, Va 22304 | Addiction treatment Center

https://www.pbs.org/wgbh/nova/video/addiction

A new documentary premiering Wednesday on PBS takes a deep look at how opioid addiction affects the brain.

The film, “Addiction,” created by the team at Boston-based Nova, weaves the stories of impacted families alongside the work being done by scientists to understand and treat the nationwide epidemic, which killed more than 63,600 people in 2016 alone.

Sarah Holt, the film’s writer, director, and producer, told Boston.com she hopes the documentary will help to shed light on the stigma associated with addiction as well as help those seeking ways to assist loved ones struggling with dependance on drugs.

The most challenging aspect of making the documentary was finding people willing to share their stories on camera, she said. Even those who had years of recovery behind them were unwilling to speak about their struggles, fearful of what would happen once others found out.

“I think the stigma is huge, even in the language we use,” Holt said. “We call people ‘clean’ or ‘dirty.’ You’d never say, if somebody had diabetes and had high blood sugar, that they were dirty.”

In making the film, Holt, whose previous work includes “Can Alzheimer’s be Stopped?”, said she wanted to cover how people fall into addiction, why the disease is considered a brain disorder and chronic condition, and what effective treatment looks like. Helpingpeople who are addicted should be part of the medical system, she said, and what those struggling with dependency on opioids need is support and compassion.

“People would say to me, ‘Oh it must be so depressing, working on a film about addiction,’” Holt said. “And I really think the most important point is that it wasn’t depressing because I could see that once people get the right treatment, they get better. I want people to know that addiction is a treatable medical condition — it’s not a hopeless diagnosis. And we really need to be stepping up to the plate and trying to help people get the help they need.”

“Addiction,” which is narrated by Joe Morton, premieres at 9 p.m. on PBS. Watch a clip from the film below:

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5 Common Signs of Drug Misuse in Its Early Stages

There is a point between casual drug usage and troubling drug misuse that happens before addiction fully sets in that needs to be addressed. Recreational drug use has been a facet of society for as long as history has existed. Drugs of all kinds, from opioids to alcohol, have always found their way into the lifestyles of the upper-class, as well as those who are stricken by poverty. Just like addiction, drug misuse doesn’t belong to a particular “type” of person or demographic, even though some people may be predisposed to addiction or drug use based on genetics and their surrounding environment. The focus of drug misuse is the bridge between experimentation and continued use into eventual dependency and addiction. Recognizing troublesome misuse early on can potentially stop cases of addiction in their tracks which is why it’s important to be aware of the signs.

 What Is Drug Misuse?

There are many different phrases when talking about the use of drugs but what is “misuse”?

  • The use of illicit drugs: Experimentation can quickly go from a one-time use to habitual use, even if it doesn’t occur every day. The recreational use of illicit substances is always a risk since there is no way to fully know what a person is ingesting when a drug is acquired “off the street.”
  • Incorrect use of medication: Even legal, prescription drugs can be a part of drug misuse, especially when the person taking these drugs is using them outside of medical reasons without a doctor’s discretion or in dosage amounts that exceed the doctor’s instruction. This also occurs when someone is taking medication that does not belong to them.
  • Overuse of legal drugs: For example, just because caffeine and alcohol are legal doesn’t mean they cannot be misused. Regular or binge use of these substances can pose serious health concerns and result in potentially fatal consequences once a level of dependency is reached.

Drug misuse is a willful act which, when done continuously, can lead directly to dependency and unintended addiction. When someone habitually disregards the negative effects of drug misuse it’s likely they have crossed from misuse into addiction. The following are signs that someone has reached the stage of drug misuse:

1) Making Drugs A Priority

When someone starts planning their days, evenings, or entire weekends about obtaining and consuming drugs, misuse is likely a factor. Typically this begins shortly after the first or second experimental experiences they’ve had with a drug and become curious to try more. This can also become somewhat of a ritual. Leisure time is no longer to relax; it begins to focus solely on using the drug of choice in excess until there is no more left or more needs to be acquired. When social outings or gatherings seem to be exclusively dependent on having the drug available, misuse is in play.

2) Drastic Changes in Social Circle

Sometimes people are exposed to drugs and begin to experiment as a way to get acquainted with new friends. Usually, this involves someone new entering a social circle that opens members to a particular drug where its use becomes more and more prevalent. When someone drastically changes their social habits and social circle to include only other people who participate in the use of that drug, it’s more than likely they are misusing the drug regularly. They are most likely associating with people who can give them access to more of the drug.

3) Decline in Health or Appearance

When someone misuses drugs, their body typically experiences neglect or  mistreatment. If someone is showing signs of:

  • constant fatigue
  • confusion
  • lethargy
  • Other unusual outward behavior due to their excessive “partying”

it’s likely they are misusing drugs in their free time. People who are usually ‘put together’ may come stumbling into work or class looking disheveled or ill to hide a hangover or may be struggling through the “come down” from a high from the night before. Mysterious “illnesses” will also be a common excuse as to why they are frequently feeling sick from the misuse of drugs, or the effects that follow after a large dose.

4) Normalizing Drug Use

While some circles may treat recreational drug use lightly, the complete normalization of drug use every time someone goes out or socializes could be a sure sign of drug use. When people no longer attempt to hide the frequency of their consumption of drugs and begin to use them freely around other people, they have completely normalized the misuse of these drugs. Speaking fondly of the drug and their many adventures while using the drug can also be a sign that their use is has moved past the experimental or recreational phase into more serious use. If someone grew up in a household where drug misuse was frequent, this puts them at a much higher risk of drug misuse.

5) Facing Negative Consequences

When wild, drug-fueled events or nights out start leading to unwanted ramifications like constantly being late for work, receiving bad grades, or ruining close relationships, misuse is likely at the source. When people begin to take bigger and bigger risks to consume their drug of choice, it’s likely that their misuse has become full-fledged and they are now starting to see consequences of their decision-making. When someone starts dealing with constant social problems that are a direct result of their drug use, it may lead them to rethink their actions, but those who are misusing drugs at a constant rate may be lacking the self-awareness to correct their behavior.

Without addressing misuse, we cannot effectively make efforts stop addiction in its early phases. There is a period between experimentation and addiction that is the cornerstone of how people develop a substance use disorder. No matter what drug is being misused, the behaviors and subsequent consequences that result in misuse are what can turn a healthy, vibrant person into a shell of their former selves. We cannot ignore the fact that the attitude towards recreational drug misuse in society is troubling and sending the wrong message. While we fail to address misuse, people who fall victim to substance use disorders that once started as occasional misuse will still have to deal with the awful stigma attached to addiction. We can’t ignore something until it becomes an uncontrollable problem while blaming those who have succumbed to it. Prevention can and will help many if the message is clear. Discussing topics like misuse could potentially save many lives before they ever begin to experiment with addictive substances.Explore the links below for more information, resources and support:Addiction Forum Treatmenthttp://atforum.comMethadone Pregnancy Informationhttp://www.methadoneandpregnancy.com/Narcotics Anonymoushttps://na.org/NAMA Resourcehttp://methadone.orgNational Institute on Drug Abusehttps://www.drugabuse.gov/Substance Abuse and Mental Health Services Administrationhttps://www.samhsa.gov/Center for Substance Abuse Treatmenthttps://www.samhsa.gov/about-us/who-we-are/offices-centers/csatAmerican Association for the Treatment of Opioid Dependencehttp://www.aatod.org/Faces and Voices of Recoveryhttps://facesandvoicesofrecovery.org/Decisions in Recovery: Treatment for Opioid Use Disorderhttps://archive.samhsa.gov/MAT-Decisions-in-Recovery/Make the Connection: Resources for Veteranshttps://maketheconnection.net/___________________________________________________________________________________

What Makes Recreational Drug Use Dangerous?

According to SAMHSA, in 2016, 28.6 million people aged 12 or older used an illicit drug in the past 30 days, which corresponds to about 1 in 10 Americans overall (10.6%) but ranges as high as 1 in 4 for young adults aged 18 to 25. An estimated 11.8 million people misused opioids in the past year, including 11.5 million pain reliever misusers and 948,000 heroin users. Additional information is gathered in NSDUH for the misuse of pain relievers in the past year. Among people aged 12 or older who misused pain relievers in the past year, about 6 out of 10 people indicated that the main reason they misused pain relievers the last time was to relieve physical pain (62.3%), and about half (53.%) indicated that they obtained the last pain relievers they misused from a friend or relative.

With recreational drug use in America on the rise, it’s important to understand the risks involved with drugs that can lead to addiction. There is a very short amount of time between the experimental phase of recreational drug use and the next steps towards losing control. Based on statistics, recreational drug use is common among a wide range of ages and socioeconomic classes because addiction does not discriminate. Knowing the potential dangers of drug misuse can help educate others to prevent them from using drugs that could lead them down a dark path.

Drug Use that Leads to Addiction

While growing up, many of us are exposed to scare tactics that are used by school programs to help steer us away from drugs and alcohol. While their intentions are good, curiosity, peer pressure, and underlying risk factors that make people prone to addiction tend to override these measures.  According to the National Institute on Drug Abuse (NIDA), about 24% of 12th graders have used illicit drugs in the last month. While the general attitude towards teenagers is that we expect them to rebel, drug misuse at an early age can severely affect young developing brains. The prefrontal cortex controls the flow of dopamine in their brains, helping with logical decision making. This area doesn’t fully develop until mid-to-late 20s. When a young person has access to drugs during these developmental stages, it can acutely increase their risk of drug use disorder. The most common drugs teenagers are using that can quickly lead to addiction are opioids, methamphetamines, cocaine, and various forms of ecstasy.

From Recreational Use to Addiction

Most commonly, people who consume drugs recreationally do so when they want to let loose and party, whether it be at special events, concerts, or other social situations. Under these circumstances, it’s important to closely consider when use has become a problem, like when they can no longer enjoy themselves if they are not under the influence. Red flags are raised when they begin to consume much more than their friends or even begin to use when alone, outside of social situations. When personal responsibilities fall by the wayside, and drug use becomes the focus, it’s time to seek treatment. Once the line has been crossed, and the addiction has taken over, it’s very difficult to successfully recover without the help of a drug treatment program that can help assist with many different levels of care.

Phases of Misuse

Typically, the steps from recreational use to addiction are gradual. The typical process stems from early curiosity and can potentially lead to something much more serious.

  1. Experimental: Usually this step occurs while still young. Peer pressure builds, and they want to fit in with friends who are doing it too. It can affect adults too. Some people experiment with drugs for a change of pace. It can also appear to help ease social anxiety or negative emotions surrounding an event or incident.
  2. Recreational: Consumption of drugs becomes more frequent during this phase. Every month there’s an occasion where drugs are consumed socially. Usually, there is thrill-seeking involved. There usually aren’t many negative consequences at this phase other than feeling worn out and depleted after using.
  3. Regular Misuse: Drugs have become commonplace every weekend and sometimes on weekdays. Things are dull when not experienced while high and using and obtaining more of the drug becomes a focus. Their social circle begins to mostly include people who use as well, and former friends have slowly pushed
  4. Risky Use: Higher doses become the norm. There are consequences at stake, yet drug use trumps them all. Financial problems start to set in as most funds are used towards obtaining drugs. Usually, run-ins with the law like DWIs or worse are involved at this level.
  5. Dependence: Drugs have taken control over their life, and most relationships have deteriorated with loved ones and close friends. Their body has become physically dependent and needs a constant stream of drugs to function normally.
  6. Addiction: A high is no longer achievable, but the main purpose of ingesting drugs is to simply ward off withdrawal symptoms. Most significant areas of life have been heavily impacted by drug use, and they are holding onto life by a single thread, whether it is blatantly obvious or not from the outside.

Taking drugs recreationally may seem harmless, but it’s one step towards addiction. While some people can experiment with substances without losing control, there are many other factors involved in what makes someone more prone to addiction. Once the wheels towards addiction are set in motion, it’s hard to stop them.

If you find yourself questioning whether or not your drug use is truly recreational, or whether or not you have reached the level of addiction with your drug use, consider taking an assessment at a treatment center to help stop addiction in its tracks with the help of trained professionals.

Medmark

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Prazosin for Harm Reduction in Alcohol Use Disorder?

 

 

Double-Blind Randomized Clinical Trial of Prazosin for Alcohol Use Disorder

 

Increasing doses of prazosin reduced heavy drinking, but adverse effects were common.

In some patients with post-traumatic stress disorder (PTSD), the alpha-1 noradrenergic blocker prazosin has been helpful for nightmares and, in open-label studies, has decreased stress reactivity, alcohol craving, and alcohol use. The alpha-1 noradrenergic blocker doxazosin has also been found to be useful for alcohol and other substance use disorders. These investigators conducted a randomized, placebo-controlled, double-blind, 12-week study of prazosin for alcohol use disorder in 92 outpatients without PTSD (mean age, 48; 79% men).

Participants averaged >67% heavy drinking days and 12 drinks per drinking day in the prior 90 days. After two 1-mg bedtime test doses, prazosin and placebo were up-titrated, depending on adverse effects, over 2 weeks; prazosin targets were 4 mg in the morning, 4 mg in the afternoon, and 8 mg at bedtime. Twelve patients dropped out during titration; of the 80 completers, 70 reached the target dose. The prazosin group took ≥1 dose on a mean of 65% of days and all 3 doses on 55% of days.

Prazosin was associated with self-reported fewer heavy drinking days and fewer drinks per week (–8 vs. –1.5 with placebo); differences in drinks per week accelerated after 8 weeks. Drinking days per week and craving showed no group differences. Mean systolic blood pressure decreased by 3.5 mm Hg with prazosin. Frequent adverse effects with prazosin were drowsiness (64% vs. 31% with placebo) and edema (20% vs. 4%). Symptomatic (1 patient in each group) and asymptomatic orthostatic hypotension did not differ between groups.

 

 

Evidence suggests that elevated brain noradrenergic activity
appears to be involved in the initiation and maintenance of
alcohol use disorder (1, 2). A clinically feasible approach to
reducing brain noradrenergic activity is to reduce activation
by norepinephrine at the postsynaptic a-1 adrenoceptor.
Prazosin is a clinically available lipid-soluble a-1 adrenoceptor
antagonist that reduces brain a-1 adrenoceptor–
mediated signaling when administered peripherally (3). In
rodents, prazosin has been shown to decrease withdrawalinduced
alcohol intake (4), alcohol drinking by alcoholpreferring
(P) rats (2), and stress-induced alcohol seeking
(5), and it has been shown to block yohimbine-induced reinstatement
of alcohol seeking (6). In human alcohol use disorder
studies, prazosin has been shown to reduce reactivity
to stress and to result in reduced craving (7), reduced drinks
per week (8, 9), and reduced drinking days per week (8). In
persons with DSM-IV alcohol dependence and comorbid
posttraumatic stress disorder (PTSD), one study found that
prazosin reduced drinking but not PTSD outcomes (10), and
another study found no prazosin effect on either outcome (11).
Doxazosin, another a-1 adrenoceptor antagonist, did
not outperform placebo on drinking outcomes in a study of alcohol treatment seekers, but among those with a high family
history density of alcohol problems, the active medication
was associated with improved drinking outcomes (12). Across
the entire sample, alcohol treatment seekers with higher
standing diastolic blood pressure receiving active medication
had better outcomes than those receiving placebo (13).
After obtaining positive results in a pilot study (8), we
conducted a 12-week randomized controlled trial comparing
prazosin and matched placebo in 92 participants who met
diagnostic criteria for alcohol use disorder but not PTSD.
Individuals with PTSD were excluded because there is evidence
that prazosin reduces symptoms of PTSD (14), and we
were interested in isolating the effects of prazosin on drinking
alone in light of evidence linking excessive drinking to
stress and the adrenergic system. Both treatment arms included
medical management (15), and daily symptoms were
monitored via a telephone-based interactive voice response
system to obtain close to real-time data regarding alcohol
consumption. Our primary hypotheses were that prazosin
would lead to a decreased likelihood over time of any drinking
and of heavy drinking (i.e., $4 drinks for women, $5 drinks
for men) as well as a decrease in number of drinks consumed.

 

 

These results indicate that prazosin has the potential to
reduce the likelihood of heavy drinking and number of
drinks per week over time but not the number of drinking
days per week. They suggest that prazosin may be most
useful in reducing heavy drinking associated with negative
consequences (29), which is consistent with a harm reduction
approach characterized by safer consumption rather
than full abstinence.

 In addition to reducing rodent self-administration of
alcohol (33), prazosin compared with vehicle has also been
shown to reduce self-administration of cocaine (34), heroin
(35), and nicotine (36). In humans, the previous positive pilot
studies of prazosin for alcohol use disorder (8, 10) and the
present study provide preliminary support for an effect of
prazosin on heavy drinking and number of drinks per week.
Another a-1 antagonist, doxazosin, has shown a signal for
reducing drinking in alcohol-dependent individuals who
have a positive family history of alcohol problems (12).
Doxazosin has also been found to reduce cocaine use in
cocaine-dependent individuals compared with placebo (37)

 

Link

 

Link

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High-intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

 

Link High‐intensity cannabis use is associated with retention in opioid agonist treatment a longitudinal analysis

ABSTRACT

Background and Aims Cannabis use is common among people on opioid agonist treatment (OAT), causing concern for
some care providers. However, there is limited and conflicting evidence on the impact of cannabis use on OAT outcomes.
Given the critical role of retention in OAT in reducing opioid-related morbidity and mortality, we aimed to estimate the association
of at least daily cannabis use on the likelihood of retention in treatment among people initiating OAT. As a secondary
aim we tested the impacts of less frequent cannabis use. Design Data were drawn from two community-recruited
prospective cohorts of people who use illicit drugs (PWUD). Participants were followed for a median of 81 months (interquartile
range = 37–130). Setting Vancouver, Canada. Participants This study comprised a total of 820 PWUD
(57.8% men, 59.4% of Caucasian ethnicity, 32.2% HIV-positive) initiating OAT between December 1996 and May
2016. The proportion of women was higher among HIV-negative participants, with no other significant differences.
Measurements The primary outcome was retention in OAT, defined as remaining in OAT (methadone or
buprenorphine/naloxone-based) for two consecutive 6-month follow-up periods. The primary explanatory variable was
cannabis use (at least daily versus less than daily) during the same 6-month period. Confounders assessed included:
socio-demographic characteristics, substance use patterns and social–structural exposures. Findings In adjusted analysis,
at least daily cannabis use was positively associated with retention in OAT [adjusted odds ratio (aOR) = 1.21, 95% confidence
interval (CI) = 1.04–1.41]. Our secondary analysis showed that compared with non-cannabis users, at least daily
users had increased odds of retention in OAT (aOR = 1.20, 95% CI = 1.02–1.43), but not less than daily users (aOR = 1.00,
95% CI = 0.87–1.14).

Conclusions

Among people who use illicit drugs initiating opioid agonist treatment in Vancouver,
at least daily cannabis use was associated with approximately 21% greater odds of retention in treatment compared with
less than daily consumption.

 

Heavy Cannabis Use Might Affect Recovery from Opiate Use Disorder

 

Using cannabis at least daily is associated with better 6-month retention in a program of opioid replacement therapy.

Greater retention during treatment for opiate use disorder (OUD) reduces morbidity and mortality and predicts better outcomes. According to preclinical and clinical data, both tetrahydrocannabinol (THC) and cannabidiol (CBD) might reduce opioid withdrawal and pain. CBD is safe in humans and might reduce anxiety and craving for opioids. However, results have been mixed in several large observational studies of the relationship between cannabis use and OUD treatment retention. In another observational study, researchers followed 820 Canadian patients with OUD for a median of 81 months after initiation of opioid replacement therapy (methadone, 99%).

At baseline, daily heroin injections were reported by 44%, daily prescription opioids by 8%, and cannabis use by 49% (17% used cannabis daily). In two semiannual follow-ups, daily use (but not less than daily) was associated with a 20% greater odds of 6-month treatment retention than no cannabis use. Various analyses yielded similar results.

COMMENT

Despite these provocative findings, providers should not recommend cannabis to patients with OUD for several reasons: Of several large observational studies, this is the only one supporting a benefit for retention with cannabis use; in two others, cannabis users had worse outcomes. As an observational study, it may have unmeasured confounders. Cannabis use has several potential associated risks and harms, including psychotic disorder, cognitive impairment, and cannabis use disorder. Finally, the findings might be relevant only to patients on methadone; almost no participant received buprenorphine. That said, cannabis use is unlikely to be excessively detrimental to recovery from OUD. In light of the recent FDA approval of a cannabidiol-containing compound and its classification to Schedule 5, more studies should be performed soon to investigate the utility of CBD for treating substance use disorders.

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Opioid Epidemic Burdening Grandparents, Foster Homes

 

Image result for child holding hand of grandparent

 

 

Once a month, Kim Hudson, 51, knocks on the door of her own home in Warren, Michigan.Eleven-year-old Ava answers the door and Hudson gets to “play grandma for the day.”On the surface, this ritual isn’t that unusual. Hudson is actually Ava’s grandmother.But ever since Ava’s mother, Katelin, died from a heroin overdose three years ago, Hudson has had a much larger role.

“I was robbed of being a grandma,” Hudson told Healthline. “Now I’m the full-time parent. I never really got to play the grandma role.”

Hudson never expected her daughter — who had Ava when she was 17 and was a “good mom” — to struggle with opioid addiction.

But after Katelin had her wisdom teeth pulled when she was 21, everything changed.

“They gave her some strong pain killers, and after that her life just unraveled,” said Hudson.

Katelin was in and out of rehab. When she started using heroin, she was in and out of jail.

While Katelin was in jail in 2011, Hudson and her husband — who has since passed away — applied for temporary full guardianship of their granddaughter.

They did it for one simple reason — Ava.

“My intention was never to take away Katelin’s role as a parent,” said Hudson, “but I had to protect that little girl.”

As the opioid epidemic forces more children out of their parents’ custody, grandparents like Hudson are stepping in to fill the gap.

But as they become the primary caregiver for their grandchild — or grandchildren, in some cases — older adults are seeing their lives turned upside down.

“They thought this was a time they were going to get to go to the movies and play cards with their friends. Instead, they are being a full-time parent,” Jaia Peterson Lent of Generations United, a Washington-D.C.-based nonprofit, told Healthline.

Grandparents who do the right thing also face many obstacles.

These range from navigating child welfare systems to caring for grandchildren that may have special medical or therapy needs — all while dealing with the effects of their own child’s addiction.

Grandparents face many challenges

After years of decline, the number of children in foster care is once again on the rise, reports Generations United.

There were more than 415,000 children in foster care in 2014, up from about 398,000 in 2011.

Experts point to the opioid epidemic.

Children may be removed from their home when their parents are jailed or forced into treatment due to opioid use, or when the parents die from an opioid overdose.

In 2014, more than 40 percent of children in foster care with relatives were there because of their parents’ opioid, alcohol, or other drug use, according to Generations United.

Dr. Lawrence S. Brown, Jr., chief executive officer of START Treatment & Recovery Centers in Brooklyn, New York, told Healthline that he has “seen an increasing number of patients bringing their children or grandchildren to our treatment programs while they are receiving their treatment. We believe that has a lot to do with the opiate epidemic.”

These are people who are trying to get clean so they can maintain custody of their child or grandchild.

But Brown said that START has also seen a jump in requests from children and family services about whether people in treatment are still able to take care of their child.

When addiction treatment — whether it is medication-assisted treatment or individual or group counseling — doesn’t work, foster care may be the next step.

States hardest hit by the opioid crisis have seen dramatic increases in foster care.

In Ohio, drug overdose deaths rose 21 percent between 2014 and 2015, according to the Centers for Disease Control and Prevention (CDC).

Since 2010, the number of Ohio children placed with relatives in foster care has risen 62 percent, according to Generations United.

Overall, about 2.6 million American children are being raised by grandparents or other relatives, according to the nonprofit.

Often without enough help.

“There is a real need for more supports and services, and also more information about the existing supports and services that are available to grandparents and other relatives,” said Peterson Lent.

Many grandparents expected they would be enjoying the freedom of retirement, not raising another child.

“They were not planning for this,” said Peterson Lent. “They may have gotten a call in the middle of the night saying ‘Take this child or they’re going to end up in foster care.’”

The financial burden is overwhelming for many grandparents.

There are the routine costs of daycare, clothing, and food. But there are also adoption and legal fees.

“I had to get a lawyer and I had to file court papers,” said Hudson. “I had to pay money to get full custody, which was silly, because I was getting full custody of my own grandchild.”

Children who witnessed their parents’ substance abuse, or who were exposed to opioids before birth, may also need ongoing medical care and therapy in order to live healthy lives.

Some grandparents raising grandchildren are also living on a fixed income. And nearly one in five live below the poverty line, according to Generations United.

Older adults may even be dealing with their own health issues. This can make it hard to keep up with the go-go-go pace of a child. Some grandparents may even forgo their own medical care.

“We find that often the children are the priority,” said Peterson Lent. “If the grandparent has a doctor’s appointment but something comes up with the child, they’re often going to neglect their own health needs and prioritize the needs of the children.”

They may even cut back on their medication in order to put food on the table or pay for other necessities for their grandchild.

Not enough support for grandfamilies

Some resources and financial assistance are available to grandparents who step in. These vary from state to state and depend on many factors, including their income and whether they are a licensed foster care parent.

The monthly stipends for fostering can help.

But according to Generations United, for every child in foster care with relatives, there are 20 children being raised by relatives outside the foster care system.

“That means that they are going to have access to much less support and services — and certainly less financial support — than if they become a licensed foster parent,” said Peterson Lent.

Ironically, when grandparents step in before their grandchild ends up in the foster care system, they are missing out on support that can help them take care of the child.

Hudson was one of those grandparents.

“I never went the foster care route at all, because my husband was here and we were providing for her,” she said.

But now that her husband is gone, she wonders if she could have gotten more support.

“But it’s always worked up to this point,” she added. “And it’s still working. I make it work.”

Her older children — age 25, 21 and 20 — all moved back home, which helps.

“We split the household into four,” said Hudson, “and we all take care of each other — and Ava.”

But even for grandparents who are registered foster parents, the small monthly stipend they receive from the foster care system may not cover the added legal and medical expenses.

And in some states, if they adopt their grandchild, the financial support dries up.

Hudson and her husband did apply for legal guardianship of their granddaughter. Without this formality, grandparents would have a hard time doing things like enrolling their grandchildren in school or taking them to the doctor.

Experts say that there are good reasons for providing more support for grandparents and other relatives to take in these children.

“The research is really pretty clear that you should prioritize relatives for children when you can,” said Peterson Lent “Children do better with relatives, compared to nonrelatives, when we have an appropriate relative to place them with.”

There are other benefits, as well.

“Those relatives who step in to care for the children, and keep them out of the formal foster care system, they’re not only doing the right thing for kids — by reducing trauma and keeping them with family,” said Peterson Lent. “They’re also saving taxpayers $4 billion each year by keeping kids out of foster care.”

Already, state foster care budgets are stretched thin, social workers are overloaded, and there is a shortage of families willing to provide temporary homes for children.

Relatives play an important role in helping children left behind by the opioid epidemic — and in helping an overburdened foster care system.

“As we see the uptick in foster care placements with the opioid epidemic,” said Peterson Lent, “we’re also seeing child welfare systems increasingly rely on relatives to meet that increasing need.”

Generations United reports that, in 2014, more than a third of all children who were removed from their home because of drug or alcohol use were placed with relatives.

Some progress in helping grandparents

The opioid epidemic is not the first time that grandparents and other relatives have had to step up to take of children affected by their parent’s drug addiction.

But some progress to the system has been made since the crack epidemic in the 1980s and 1990s, or the earlier opioid epidemic in the 1970s.

One step forward is The Fostering Connections to Success and Increasing Adoptions Act of 2008, which promoted placement of children with relatives. This includes giving relatives financial support similar to what other foster parents receive.

“As a result of that law, we are seeing that relatives are also being identified and reached out to more regularly,” said Peterson Lent. “Not every child welfare agency is doing that in the way that they should be, but we’ve certainly seen progress.”

Peterson Lent added that one thing the child welfare system doesn’t do well is provide earlier support for families, so foster care isn’t the only option.

“We need to turn child welfare financing on its head so that states can use some dollars for proven programs that help prevent that tragedy, that help prevent a need for children to enter foster care,” said Peterson Lent.

Brown said there is also a need for more support for the children of parents with an opioid addiction, to keep them from ending up on the same path.

Although there is a lack of real data, said Brown, “what we are seeing is an increase in generational addiction.”

This is why START developed a program, called Teen START, which focuses on helping adolescents stay clear of the cycle of drug addiction.

Like many other grandparents caring for their grandchildren, Hudson turned to a support group — in her case, the Grandparent2Grandparent Facebook group.

She is thankful that she has not had to deal with as many “horror stories” as other parents.

She is also thankful for her unexpected life with Ava, her fifth “child.”

“She is my hero and my rock,” said Hudson. “She’s very upbeat and positive.”

“Does she miss her mom? Yes, she misses her mom,” she added. “But I don’t think she misses the situation that she was in.”

 

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Opioid Deaths in The U.S.| trends and Risk Factors 2003-2014

Rates of opioid overdose hospitalizations increased between 2003 and 2014 in the United States, primarily for Caucasians in the South; factors associated with a higher mortality from opioid overdose also include younger age and male gender, according to a study to be presented at the 2018 World Congress on Pain, held September 12-16 in Boston, Massachusetts.

Considering the prevalence of opioid overdose and poisoning in the United States, and the accompanying high rates of addiction and death, researchers analyzed Nationwide Inpatient Sample data on opioid overdose from 2003 to 2014 to identify predictors of mortality, regional disparities, cost of inpatient hospital stay, and yearly trends. The data showed 149,483 patients who were discharged with a primary or secondary opioid poisoning diagnosis (ICD-9 Code 965.xx) in the United States during this time period. Binary logistic regression was used to study region, race, sex, and age as independent predictors of mortality.

Trends and Predictors of Mortality for US Opioid Overdoses from 2003 to 2014

Most opioid overdose patients were male and lived in the Southern United States (39.3%).Most opioid overdose patients were male and lived in the Southern United States (39.3%).
The following article is part of conference coverage from the IASP 2018 conference in Boston, Massachusetts.Clinical Pain Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in pain medicine. Check back for the latest news from IASP 2018.

Rates of opioid overdose hospitalizations increased between 2003 and 2014 in the United States, primarily for Caucasians in the South; factors associated with a higher mortality from opioid overdose also include younger age and male gender, according to a study to be presented at the 2018 World Congress on Pain, held September 12-16 in Boston, Massachusetts.

Considering the prevalence of opioid overdose and poisoning in the United States, and the accompanying high rates of addiction and death, researchers analyzed Nationwide Inpatient Sample data on opioid overdose from 2003 to 2014 to identify predictors of mortality, regional disparities, cost of inpatient hospital stay, and yearly trends. The data showed 149,483 patients who were discharged with a primary or secondary opioid poisoning diagnosis (ICD-9 Code 965.xx) in the United States during this time period. Binary logistic regression was used to study region, race, sex, and age as independent predictors of mortality.

 

Of the 149,220 patients admitted for opioid overdose, 2.6% died. The median age of these overdose patients was 47 years old, and 81.1% were Caucasian. Most opioid overdose patients were male and lived in the Southern United States (39.3%). The Northeast had 17.5% of opioid overdose cases, compared with 21.3% in the West and 21.9% in the Midwest. Yearly hospital admissions for opioid overdose have increased over the study timespan, from 7864 overdoses in 2003 to 15,165 overdoses in 2014. The total cost per inpatient admission also increased to $37,281 in 2014 compared with $17,156 in 2003.

Study investigators concluded that “further prospective studies are warranted to better understand the increasing [opioid overdose] admission rates, and an effective, targeted approach should be developed for [use] within the higher mortality demographic.”

Reference

Gupta S, Sung V. Hospitalizations for opioid overdoses in the United States from 2003-2014. Trends from the Nationwide Inpatient Sample and Predictors of Mortality. Presented at the World Congress on Pain 2018; September 12-16, 2018; Boston, MA. Poster 65409.

Predictors of Opioid overdose in users

Having a hepatitis C virus (HCV) infection, witnessing a friend or others experiencing a drug overdose, and having a history of frequent buprenorphine treatment are factors that may predict the risk for opioid drug overdose in high-risk opioid users, according to a study published in Addictive Behaviors.

Participants were recruited from an ongoing study in which the efficacy of distributing naloxone kits for reducing opioid overdose was assessed (N=247). Heroin and prescription opioid use were reported by 86.5% of participants, and all patients had reported current or past opioid misuse within 6 months of enrollment. The researchers sought to identify medical, psychosocial, and opioid use characteristics that were predictive of opioid overdose.

Patient characteristics data were obtained from responses on the baseline 30-item Opioid Use Questionnaire, which assessed chronic medical conditions, past and current opioid misuse, sexually transmitted infections (STIs), buprenorphine treatment frequency, and intensive outpatient and rehabilitation treatment history. Participants and family members or friends attended a baseline appointment and naloxone training.

Individuals who were white comprised a significant majority of individuals reporting a past opioid overdose when compared with blacks (96.2% vs 3.8%, respectively; =.005). More participants who had experienced an opioid overdose in the past 6 months reported using heroin vs prescription opioids only (95.2% vs 4.8%, respectively; P =.001). Participants with a friend who had died from an overdose were also more likely to experience an overdose themselves (89.6% vs 10.4%; P=.001).

In the adjusted analysis, the patient characteristic most associated with experiencing a nonfatal opioid overdose was witnessing a friend overdose (odds ratio [OR] 4.21; 95% CI, 1.99-8.89). Witnessing others overdose (OR 1.42; 95% CI, 1.11-1.82) and having a chronic HCV infection (OR 2.44; 95% CI, 1.20-4.97) were also associated with a higher risk of reporting a prior opioid overdose. Reporting a higher buprenorphine treatment frequency was associated with a greater odds of opioid overdose (OR 1.55; 95% CI, 1.17-2.07), and reporting a high frequency of methadone treatments was associated with a reduction in overdose odds (OR 0.67; 95% CI, 0.49-0.91).

The study was limited by its potential for recall and social desirability bias because of the self-reported nature of the collected participant data.

“Given the high rates of nonfatal opioid overdose, this suggests the need for expanded overdose training and distribution of naloxone,” concluded the study authors.

 

Reference

Schiavon S, Hodgin K, Sellers A, et al. Medical, psychosocial, and treatment predictors of opioid overdose among high risk opioid users [published online May 30, 2018]. Addict Behav. doi: 10.1016/j.addbeh.2018.05.029

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Emergency Department-Initiated Buprenorphine/Naloxone Beneficial When Prolonged

Buprenorphine/naloxone treatment initiated in the emergency department (ED) and prolonged for 10 weeks in primary care improved treatment engagement and reduced opioid use compared with referral or brief intervention.1

“This study represents a new paradigm for ED-initiated treatment of opioid use disorder with referral for ongoing care,” stated lead investigator Gail D’Onofrio, MD, in an interview with Clinical Pain Advisor. She noted that the approach tested in the study, in which an ED clinician initiates treatment and refers patients for follow-up, is similar to that used in other chronic disorders such as hypertension or hyperglycemia. Opiate use disorder was found to be more prevalent in patients who had presented to emergency departments than in the general population.2

The study presented a long-term follow-up of outcomes from the investigators’ previous work published in JAMA.3 The JAMA study randomly assigned 329 opioid-dependent patients to 1 of 3 interventions: screening and referral to treatment (referral); screening, brief intervention, and facilitated referral to community-based treatment services (brief intervention); or screening, brief intervention, ED-initiated treatment with buprenorphine/naloxone, and referral to primary care for 10 weeks of continued buprenorphine/naloxone treatment (buprenorphine).

Results of this study showed that at 30 days after treatment randomization, patients in the buprenorphine group were more likely to be involved in addiction treatment than those who received the other interventions. In addition, self-reported illicit opioid use and use of inpatient addiction treatment services were less prevalent in patients who had been prescribed buprenorphine than in patients in the other 2 groups.

The current study involved 88% of the same patients (n=329) who contributed data at a minimum of 1 follow-up assessment conducted at 2, 6, and/or 12 months after the ED intervention. Results showed that at 2 months, engagement in addiction treatment was more common in the buprenorphine group (68/92 [74%]; 95% CI, 65-83) than in those who received referral (42/79 [53%]; 95% CI, 42-64) or brief intervention (39/83 [47%]; 95% CI, 37-58; P <.001). Patients randomly assigned to buprenorphine had fewer self-reported days of illicit opioid use (1.1; 95% CI, 0.6-1.6) compared with the referral group (1.8; 95% CI, 1.2-2.3) or the brief intervention group (2.0; 95% CI, 1.5-2.6; P =.04]. No statistically significant differences for those outcomes were present at 6- or 12-month follow-ups.

Dr D’Onofrio told Clinical Pain Advisor that her research group hoped to offer alternative best practices to emergency physicians, who are not typically involved with continued care of patients with opioid use disorders. “Most EDs observe patients after recovery from overdose, but discharge them with at best a list of programs in the community for help. They do not make direct linkages to treatment programs or providers and do not initiate buprenorphine, similar to when patients present with any other problem related to opioid use disorder,” she said.

Summary and Clinical Applicability

The researchers noted that despite its limitations, the study indicates that ED-initiated buprenorphine/naloxone treatment combined with referral for ongoing treatment in primary care is effective at increasing participation in addiction treatment and reducing self-reported illicit opioid use while treatment is continued. “For 27% of the enrolled ED patients, the index ED visit represented their first treatment contact,” they wrote. “Thus, the ED visit is an opportunity to engage patients with opioid use disorder in effective medication-assisted treatment.”

Limitations

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How Boredom Can Lead to Addiction

How Boredom leads to addictionn

In this session I am re-posting on BOREDOM – I think it is a centerpiece in our society’s misfortunes. Having too much is becoming a regular problem and reinforces addiction and bad choices.

 

Aug 08, 2018

How Boredom Can Lead to Addiction

Every person who has a substance use disorder has a unique experience and path that lead them to their addiction. Some people are dealing with unresolved mental health issues or trauma, while others have genetic and environmental factors that have lead them to drug use. Another interesting factor that can sometimes contribute to someone’s addiction is boredom. Boredom isn’t just for people who “have nothing to do”. Plenty of very busy people can also experience boredom from their everyday responsibilities. Often we think of teenagers being bored with school or being grounded, but adults with careers and families can experience boredom as well, which can lead some to seek out ways to entertain themselves with substance use.

Redefining Boredom

It’s hard to think that anyone could get bored with all of the interactive apps, social media, and streaming content they can access online at the reach of their fingertips on smartphones, tablets, and smart TVs. Boredom isn’t so simple, however, it’s more than not having anything to do. Some may reach for drugs and alcohol due to peer pressure, but what about when they feel isolated or “stuck” in their home or family environment and are looking for ways to escape? The same goes for stay-at-home parents who spend their days at home, looking after their small children, often stretched thin with childcare and household responsibilities. Businessmen and women who spend long hours at the office, sometimes dealing with monotonous meetings and long commutes, can also experience everyday boredom that drives them towards substance use.

After people begin to use substances as a “mental escape” from boredom on a regular basis, it becomes difficult to face that boredom again sober. This is how easily an addiction can begin and also the reason why people in recovery often have to deal with the risk of boredom leading them to relapse. Once drugs have taken a person away from their boredom for so long, it can be difficult to return to “real life”, making addiction such a complex disease that requires a lot of strength and work to rehabilitate.

Boredom and Addiction

Doing drugs or drinking can provide somewhat of a mental vacation from people’s current situation. When someone feels trapped and doesn’t know what to do with themselves, getting high or drinking can provide the same kind of mental stimulation as doing a fun  activity. Many of these people are also dealing with profound loneliness, anxiety, or are suffering from other situations that prevent them from being involved with hobbies or activities. People with anxiety and depression may feel that leaving their homes to engage in social activities is too stressful, and instead, prefer to stay home and numb themselves.

Most people who are in recovery report that their greatest fear is facing the boredom they once felt while they were still using. Unfortunately, boredom is reported as one of the biggest reasons many people who are in recovery experience relapse. For people who were using drugs regularly, the drugs eventually became the center of their world. Those who are trying to stay sober will avoid old friends they used to do drugs with, causing many people in recovery to feel like they have no friend, or need to take on the overwhelming task of creating an entirely new social circle. Since drugs used to take up so much of their time, former drug users need to find ways to fill their lives with activities and hobbies to avoid boredom at all costs in order to prevent the risk of relapse.

Beating Boredom

For people who think that their boredom is leading them to misuse substances more frequently than their previous “recreational” use and want to avoid the slippery slope of addiction, beating boredom is essential. The same advice can be applied to people who are in recovery and are finding their motivation and confidence in their sobriety starting to slip. The main issue that can lead to boredom is being stuck in a familiar environment where substance use has most frequently occurred in the past. For some people, it’s a recliner in the living room, and for others, it’s a familiar setting like a long train ride or sitting on a lawn chair on a hot summer’s day. Pinpointing these trigger environments that can evoke cravings due to boredom or monotony need to be avoided as much as possible.

Boredom can also be avoided with the start of new interests and hobbies. Many people in recovery discover their love for fitness and outdoor activities which are healthier ways to keep boredom at bay. Others may require a quieter, mentally stimulating activity like learning to play chess, painting, or knitting. The main goal is to stimulate the brain to be engaged instead of being left to find its way back to using drugs or alcohol.

When mindfully avoiding boredom, people have succeeded in creating entirely new lives for themselves. Something that starts off as a hobby while in recovery can be great for abstaining from drug use, but can also blossom into a new career or passion. When people discover how much of their time they had previously spent on drugs and getting high, they realize how much their time is worth and how it can be better spent. Recovery is a time for rediscovery. Avoiding boredom can lead to things beyond just staying sober. No matter a person’s age or experience with addiction, new hobbies and volunteer work are just some of the ways to begin avoiding the feeling of complacency in life.

Boredom should not be taken lightly. It’s a real issue that is leading people from all walks of life into potential substance use disorders. Making time for activities that stimulate the mind outside of life’s everyday activities is healthy for the body and mind, especially when avoiding addiction and relapse.

 

Sources:

https://www.addiction.com/3462/boredom-and-relapse/

https://www.cbsnews.com/news/teen-boredom-breeds-drug-use/

https://www.psychologytoday.com/us/blog/heartache-hope/201304/boredom-very-real-road-addiction

by Holly Holloway

Three Sure-Fire Ways To Avoid Boredom And Relapse

Tedium sounds like such a minor emotion, lacking the passion of anger or fear. Yet it can be a major trigger for alcohol and drug abuse, smoking, emotional eating and problem gambling.If you’re working to change one of those behaviors, you need healthy ways to handle boredom and relapse risks.Beyond helping with recovery, handing boredom may also boost your overall longevity. As part of a large study detailed in the International Journal of Epidemiology, more than 7,500 British civil servants answered questions about how often they felt bored. Over the next 20-plus years, those who said they were bored a lot were more likely to die than those with a zest for life.

Bored to distraction

The first step toward vanquishing boredom is understanding what you’re up against. Imagine how you might feel after waiting in the DMV line for an hour. Time drags when you’re having a dull time, and all you can think about is how much you wish you were doing something—anything—more exciting.

But have you ever considered why you feel this way? John Eastwood, a psychology professor at York University in Toronto, has given it a lot of thought. After scouring the scientific literature on boredom, his abstract in Perspective on Psychological Science identified three core characteristics of the emotion:

  1. You’re unable to engage your mind in a satisfying way
  2. You’re aware of the situation and consider it a problem
  3. You blame the environment (“this is so boring” or “there’s nothing to do”)

Never a dull moment

Based on these characteristics, there are three sure-fire ways to beat boredom:

1. Learn how to engage your mind in a more satisfying way — When you’re bored, you aren’t able to focus your mind on something that interests you, and that leaves you feeling dissatisfied.

Regaining your focus can help. Here’s how:

  • Practice mindfulness. In a nutshell, mindfulness involves being fully aware of your moment-to-moment experience. You notice sensations, thoughts and feelings without judging or resisting them, and then you let them go as your focus moves on to the next moment. With this mindset, you’ll feel more engaged in whatever you’re doing — even a mundane chore such as folding laundry — and less preoccupied with wishing you were doing something else.
  • Turn off the screens. Your smartphone, tablet, computer and TV provide nonstop access to texts, tweets, shows, news and games, not to mention hilarious cat videos. So why are you still getting bored? Being bombarded with rapid-fire images and information can overload your capacity to pay attention, and constantly switching from one app or screen to another just magnifies the problem. Soon, your ability to focus on anything for long is shot. To prevent this, try to do just one e-task, such as answering emails or searching the Web, at a time. At home, spend at least an hour every day unplugged from your devices.

2. Redefine the situation so it doesn’t seem like such a problem – From time to time, everyone has to do routine or repetitive tasks, from entering data to washing dishes.

Putting a positive spin on the situation helps keep boredom at bay. Here’s how:

  • Make it meaningful. Remind yourself of the value in what you’re doing. For example, if you’re raking and weeding in your backyard, remember the fun times you’ve spent there in the past, or imagine the good times to come in the future.
  • Call it an opportunity. Rather than describing a less-than-thrilling activity as “monotonous,” tell yourself it is “meditative.” Think of it as your chance to take a mental break — a welcome respite from any pressure to make tough decisions or come up with clever ideas. (Ironically, I find that some of my most creative ideas bubble up unbidden at times such as these.)

3. Stop blaming the environment, and start taking charge — The interesting thing about boredom is that it comes from within. Taking the steps outlined above won’t rescue you from sitting through a dull meeting or standing in a long line, but it can help you feel less bored while you do so. If you still feel your eyes glazing over, shake off the sluggishness in a healthy way.

Depending on the situation, you could:

  • Imagine that you’re a detective, journalist or anthropologist who is investigating the situation, noting every detail with great interest
  • Entertain yourself by daydreaming or doodling
  • Go for a quick walk or climb a flight of stairs
  • Call a friend who’s a good conversationalist
  • Listen to a song that makes you feel energized
  • Make a list of fun things to do this weekend

Watch out for the urge to reach for a beer, cigarette or candy bar when you’re bored. Dulling the pain of dullness never works for long, and it can set back your recovery from addiction or your progress toward healthy goals. Instead, be ready with strategies for managing boredom effectively and constructively.

Boredom is associated with an early death!!

We found that those who report quite a lot or
a great deal of boredom are more likely to be younger,
to be women, to rate their health worse, to be in low
employment grades and to report lower physical
activity levels (Table 1). We also found that those
with a great deal of boredom were more likely to
die during follow-up than those not bored at all
(Table 2). In particular, they were more likely to die
from a CVD fatal event [hazard ratio (HR) 2.53; confidence
interval (CI) 1.23–5.21]. Furthermore, we
found some suggestive evidence of cumulative effects
in the mortality after Phase 2, as those still reporting
boredom at Phase 2 had slightly higher risks than
those reporting it once or never. 

 

Have you ever felt bored (Fig 1)? Ever found yourself with nothing engaging to do? Experienced a lack of interest in everything and everyone around you? Although not a pleasant state in which to find oneself, is boredom bad for health? In a rare moment of idleness one day, we pondered whether the expression ‘bored to death’ has any basis. Are people who are bored more likely to die earlier than those who are not?

Boredom levels were reported in the later versions of the baseline questionnaire (1985–88) of the Whitehall II cohort study. Participants were civil servants, based in London, aged 35–55 years. They were asked in a self-completed questionnaire about boredom during the past 4 weeks (response options were ‘not at all’, ‘a little’, ‘quite a lot’, ‘all the time’). At the risk of participants becoming bored of answering this question, it was repeated at Phase 2 some 3 years later, but not since. Information on mortality was ascertained through the NHS Central Registry, by using their unique NHS identification number. Follow-up for total mortality was available up to the end of April 2009. Excluding those with prevalent cardiovascular disease (CVD) at baseline, gave a sample size of 7524 men and women.

We found that those who report quite a lot or a great deal of boredom are more likely to be younger, to be women, to rate their health worse, to be in low employment grades and to report lower physical activity levels (Table 1). We also found that those with a great deal of boredom were more likely to die during follow-up than those not bored at all (Table 2). In particular, they were more likely to die from a CVD fatal event [hazard ratio (HR) 2.53; confidence interval (CI) 1.23–5.21]. Furthermore, we found some suggestive evidence of cumulative effects in the mortality after Phase 2, as those still reporting boredom at Phase 2 had slightly higher risks than those reporting it once or never. With further adjustments for employment grade, physical activity levels and poor self-rated health, the hazard ratios for CVD for those with a great deal of boredom were reduced and did not reach statistical significance (1.96; CI 0.94–4.05).

Ennui in the office

We conclude that those who report being bored are more likely to die younger than those who are not bored. However, the state of boredom is almost certainly a proxy for other risk factors. Whilst some aspects of life may not be so easily modified (e.g. disease status or position in society), proneness to boredom, particularly in younger populations, could be indicative of harmful behaviours such as excessive drinking, smoking, taking drugs and low psychological profiles.1 Finding renewed interest in social and physical activities may alleviate boredom and improve health, thus reducing the risk of being ‘bored to death’.

Reference

Boredom Proneness Its Relationship to physical health symptoms

The results also indicate a significant relationship between boredom proneness and a negative social orientation, as described by the HSCL interpersonal sensitivity
subscale (e.g., “feeling that people are unfriendly or dislike you,” “Your feelings being easily hurt”). This adds tangential support to the findings of Leong and Schneller (1993), Maroldo (1986), and Tolor (1989), who reported boredom proneness to be significantly
associated with alienation, low sociability, and shyness, respectively.
The significant relationship between BPS scores and the HSCL obsessive–compulsive (OC) subscale appears somewhat surprising at first glance. However, many of the OC subscale items consist of statements regarding difficulty with attentional deficits (e.g,
“trouble concentrating,” “Your mind going blank,” “trouble remembering things”). When discussing the construct of boredom (or the boredom-prone individual), several authors
have stated that boredom is connected with distractibility, low attentional control, and concentration difficulties (Damrad-Frye & Laird, 1989; Farmer & Sundberg, 1986; Hamilton,
1981; Hamilton, Haier, & Buchsbaum, 1984). For instance, Fisher (1993) stated, when bored, an individual “. . . feels a pervasive lack of interest in and difficulty concentrating
on the current activity” (p. 396).
Finally, our finding that high boredom-proneness scores are related to greater somatization
complaints adds empirical support to previous work that reported negative associations
between boredom and eating behaviors (e.g., Martin, 1989; Pascale & Sylvester,
1988) and physical-health symptoms (e.g., Ferguson, 1973; Smith et al., 1981). It should be noted, however, that this prior work did not assess boredom levels using psychometrically sound instrumentation. Perhaps one reason for the relationship between boredom proneness and greater symptom reporting is that individuals with high BPS scores may be overly focused on themselves (or their internal states) and therefore be more likely to perceive that problems may exist. For instance, many authors (e.g., Eisnitz, 1974; Weinberger & Muller, 1975) have discussed the connection between boredom and the tendency to dwell on oneself (e.g., narcissism). Recently, Wink and Donahue (1997) found greater BPS scores to be related to high narcissism scores. In a related vein, Spacks (1995) argued that the focus on oneself is a primary reason for the increased incidence in reports of boredom in society. As she has stated, “The inner life comes to be seen as consequential, therefore itsinadequacies invite attention” (1995, p. 23). Finally, Seib and Vodanovich (1998) found
that individuals with high BPS total scores had greater scores indicative of “maladaptive” self-awareness, as indicated by greater scores on the Self-Reflectivity subscale of the
Self-Consciousness Scale (Fenigstein, Scheier, & Buss, 1975).

 

 

The Un- Engaged Mind

The Unengaged Mind

“I’m bored!”
Boredom is a common problem. In a survey of North
American youth, 91% of respondents reported that they experience
boredom (The National Center on Addiction and Substance
Abuse, 2003). It is often perceived as a fairly trivial and
temporary discomfort that can be alleviated by a simple change
in circumstances, such as finally being called into the doctor’s
examining room. However, boredom can also be a chronic
and pervasive stressor with significant psychosocial consequences.
Indeed, boredom is even associated with mortality,
lending grim weight to the popular phrase “bored to death”
(Bloomfield & Kennedy, 2006; Britton & Shipley, 2010;
Maltsberger, 2000).

For example, boredom
is correlated with mental health symptoms, such as
depression and anxiety (Goldberg, Eastwood, LaGuardia, &
Danckert, 2011; LePera, 2011; Sommers & Vodanovich, 2000),
alexithymia (Eastwood, Cavaliere, Fahlman, & Eastwood,
2007), and somatization complaints (Sommers & Vodanovich,
2000). Furthermore, boredom has been identified as a complicating
factor in the psychiatric rehabilitation of mental disorders,
such as schizophrenia (Newell, Harries, & Ayers, 2011;
Todman, 2003), and in recovery from traumatic brain injury
(Kreutzer, Seel, & Gourley, 2001; Oddy, Humphrey,
& Uttley, 1978; Seel & Kreutzer, 2003). Boredom is also negatively
correlated with a sense of purpose in life. boredom is linked with impulse control deficits such as overeating and binge eating (Stickney & Miltenberger, 1999),
drug and alcohol abuse (Lee, Neighbors, & Woods, 2007;
LePera, 2011; Wiesbeck et al., 1996), and problem gambling
(Mercer & Eastwood, 2010). Boredom at work (Fisher, in
press) can cause serious accidents if safety depends on continuous
vigilance, as in medical monitoring or long-haul truck driving.

 

 

Boredom – a very real road to addiction

Source:

As the saying goes… “An idle mind is the devil’s playground.” Anyone with too much time on their hands may find themselves in hot, troubled waters. People who tend to be bored may also be weary or restless because of lack of any personal interests. They are bored with themselves, their jobs and life.

Boredom usually stems from one’s own lack of motivation, endeavor or creativity. Everyone gets bored now and then, but it is the difference between changing that mood to healthy alternatives versus sitting around with friends “passing the pipe” for a few high flying hits. This kind of boredom can ultimately lead to an anti-social, destructive path toward addiction.

It’s hard to imagine anyone being bored today; even if they are not interested in stretching their muscles, feelings or their minds. Computers, IPods, IPhones and game boxes can provide hours of (in my opinion) useless activity, so it seems that one has to look hard and actually seek out boredom. Boredom takes some perseverance to shake off. It is a state of mind and requires a committed determination to do something about it or change up the routine.

One can form a habit out of being bored because it can present a degree of comfort and safety. Eventually, since no one expects anything from you and in turn, you don’t expect anything from yourself, drugs and/or alcohol can seem like an acceptable choice of behavior and the easiest and quickest fix requiring little or no effort is to “get high” or drink.

Drugs or alcohol can appear to take away the pain of emotional, mental or physical challenges. Boredom is often simply a state of awareness that shows up just prior to the surfacing of difficult, painful things we have stuffed away from our conscious awareness.

As difficult a challenge as boredom can present to overcome for anyone of any age, the answer lies in confronting and moving through and beyond the CAUSES of boredom. Anyone experiencing significant levels of boredom needs to ask themselves what challenging (and likely unpleasant) experience they are attempting to avoid. .

When children or adolescents are spending too much time in front of the television (or screens of any kind!) or listlessly whiling away hours it is time to step in. Curtail the screen-time hours and help your child look for and plan stimulating activates or hobbies. If they are not interested in pursuing them independently then get involved yourself or recruit other members of the family.

Strong, positive energy coupled with the right attitude is important to infuse into your child to shake his or her lazy, boring life and get with a new productive program. If executed early and properly, then boredom will have no opportunity to lead to dangerous experimentation with potentially addictive behaviors.

If you are an adult and active yet bored with work or mundane, tedious activities, push yourself to discover new adventures and even make new friends. If your job represents a form of security, but is painstakingly boring, explore new possibilities for employment even if you never fill out an application or get a job interview.

Talk to other family members and tell them of your boredom so that they can support and work with you in determining other paths to avoid your boredom. This might help to deter you from turning to alcohol or substance abuse in order for you to alleviate your own boredom in a self destructive, detrimental way. It also makes you accountable to others and them to you, if you have put out your hand for help.

Being bored is no fun. It’s a waste of precious time and has zero productivitychips.

Be creative and shake things up in your life. You never know what might happen, especially if you keep an open mind. The alternative is either a stale, lackluster lifestyle or one where the only entertainment is destructive, out of control addictive behavior. Take responsibility and choose (hopefully) the more creative and productive path.

If I can be of service, please visit my website www.familyrecoverysolutions.com and I invite you to explore my book Reclaim Your Life – You and the Alcoholic/Addict. It can be purchased through PayPal or at Amazon. In addition, my book is available as an audio through PayPal only.

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