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Tuesday, February 19, 2013
Monday, February 18, 2013
Commentary: Why the Term “Enabling” Does More Harm Than Good
The term “enabling” is commonplace in the field of
addiction. It is used within support group settings, in treatment
programs and throughout the professional literature about addiction and
the family. I consider it one of the most frequently misunderstood terms
in our field. In fact, as my research about family caregivers of people
with substance use disorders has evolved, I have come to loathe the
term “enabling.” Here is why.
There is a great deal of misinterpretation about what qualifies as behavior that is “enabling.”
Webster’s definition of the term includes: “a) to provide with the
means or opportunity; and b) to make possible, practical or easy.”
Wikipedia notes that enabling also is used “to signify dysfunctional
approaches that are intended to help but in fact may perpetuate a
problem….” Examples include taking responsibility, blaming others or
making accommodations for a person’s harmful conduct, so that the person
is shielded from the harm it may do and the pressure to change.
Using these definitions, doing your son’s laundry might be considered
enabling, as it makes it easier for him and takes responsibility for
the chore away from him. In actuality, it may or may not be enabling
–depending on the context. If you do this chore to make things easier
for your son because he attended a self-help meeting – you probably are
supporting recovery – not enabling self-destructive behaviors. On the
other hand, if you are doing your son’s laundry because he was drunk all
weekend and will be embarrassed to go to school or work in unlaundered
clothes, then you are enabling him to continue engaging in
self-destructive behavior. You are helping him avoid the negative
consequences of drinking.
I find family members often are confused over the issue of what
constitutes enabling. Some have ardently been told that any support
offered to a recovering child or spouse can be considered enabling. The
philosophy seems to be that the person needs to learn to “fend for
themselves” or “live life on life’s terms.” This is difficult to argue.
We all need to learn the necessary skills to survive and thrive in our
environments. Especially as parents, it is our responsibility to foster
this in our children. But it does not mean that we cannot help our loved
ones in productive ways.
Recovery, especially early recovery, is hard work. Offering to
support the intense effort of this work can be helpful. For example – if
a loved one does not have access to a car, it is supportive to offer to
drive her to AA meetings, or soccer practice or any other
recovery-supporting activity.
Some say that the addicted person must take responsibility for
coordinating his or her own travel – and indeed – this can be a good
goal. But offering to help at first or occasionally does not enable the
person to escape the negative consequences of addiction – and it can
help to support recovery.
It is loaded with negative and judgmental connotations that are misplaced.
Worse yet, enabling is sometimes described as “dysfunctional,” which
can lead family members to the conclusion they are dysfunctional and
have let their loved one down. The important distinction that is
sometimes missed is that it is the behavior that is dysfunctional, not
the person. The vast majority of parents that I have met have only done
what most parents do; that is try their best to help their child. They
engage in the same behaviors as other parents. It is just that they find
themselves in a strange and difficult situation where behaviors that
normally are helpful do not function that way.
I believe that the term enabling causes more harm than good. I would like to get rid of the term altogether.
Rather than labeling a family member’s behavior as “enabling,” focus
on the consequences of the addicted person’s behavior. Ask yourself – by
doing this, do I allow him or her to avoid a negative consequence of
the drinking or drug use? If the answer is yes, resist the urge to
intervene. It is important that the person experience the negative
consequences that substance abuse renders. Also ask yourself – by doing
this, am I encouraging efforts he or she has made at recovery? If the
answer is yes, go for it! It is helpful to recognize and show signs of
support and appreciation for the hard work that an addict undertakes to
sustain recovery.
We must remember that addiction is a disease and recovery requires
ongoing maintenance. This is a lot of work – and supporting the WORK of
recovery can be a loving thing to do.
Kimberly Kirby, PhD
Director of the Parent’s Translational Research Center; Senior Scientist
Friday, February 15, 2013
Generic Drug Distributor Sues Suboxone Maker for Monopolizing Treatment Market
The generic drug distributor Rochester Drug Co-Operative
Inc. has sued the maker of the opioid addiction treatment Suboxone for
allegedly monopolizing the opioid treatment market, Bloomberg reports.
The maker of Suboxone (buprenorphine and naloxone), Reckitt Benckiser
Group, developed a film version of Suboxone that is placed under the
tongue, to replace the tablet form of the drug. According to the
lawsuit, filed in U.S. District Court in Wilmington, Delaware, this
prevented competition, because pharmacists cannot substitute the cheaper
generic version.
“Reckitt concocted a multifaceted anticompetitive scheme, executed
over the course of several years, to maintain and extend its monopoly
power,” Rochester Drug stated in its complaint. The article notes
Suboxone is used to help control opioid withdrawal symptoms.
In September, 2012, Reckitt notified the Food and Drug Administration it was voluntarily discontinuing the supply
of Suboxone tablets in the United States, due to increasing concerns
with children’s exposure and risk for accidental poisonings. The U.S.
Poison Control Centers found consistently and significantly higher rates
of accidental unsupervised pediatric exposure with Suboxone tablets,
compared with the film.
ADHD Drugs Not Effective in Many Young Children, Study Concludes
Treatment for attention deficit hyperactivity disorder
(ADHD) does not appear to help many young children, a new study
concludes.
The study followed 186 children, ages 3 to 5, who had moderate to
severe ADHD. Six years after their diagnosis, about 90 percent still
showed symptoms such as over-activity, impulse control or
inattentiveness, according to Bloomberg.
Two-thirds of the children were on medication. These children did not
show significant differences in ADHD severity, compared with those who
were not taking drugs. Almost two-thirds of treated children had
significant hyperactivity and impulsivity, compared with 58 percent of
those not taking medication.
“ADHD in preschoolers is a chronic and rather persistent condition,
one that requires better long-term behavioral and pharmacological
treatments than we currently have,” study author Mark Riddle of the
Johns Hopkins Children’s Center in Baltimore, said in a news release.
The study appears in the Journal of the American Academy of Child & Adult Psychiatry.
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AAPNY Conference: Meeting the Challenge through Education of the Addiction Professional
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Thursday, February 14, 2013
Florida Task Force on Prescription Drug Abuse and Newborns Releases Report
A task force of doctors, public health experts and social
workers in Florida has released a report designed to combat the growing
problem of babies born to mothers who are addicted to prescription
drugs.
The report
found more than 1,560 babies born in Florida in 2011 were diagnosed
with symptoms of neonatal abstinence syndrome (NAS). These babies often
spend three weeks in neonatal intensive care, with a cost as high as
$53,400 per baby. In contrast, the typical hospital cost for a healthy
newborn is $9,500, according to the Tampa Bay Times.
NAS babies suffer from withdrawal symptoms such as tremors, abdominal
pain, incessant crying, rapid breathing, and sometimes seizures, the
report notes.
The task force made recommendations in the areas of prevention,
intervention and best practices, and treatment. It recommended that
hospitals be required to report babies born with symptoms of NAS, as
they do with babies born with infectious diseases such as measles and
tuberculosis. The group wants to help treatment facilities reach more
women, and recommended considering new laws to offer pregnant women
immunity for seeking substance abuse treatment.
Task force member Dr. Ken Solomon, a neonatologist, told the
newspaper more research is needed to identify the best way to treat
newborns in withdrawal. He noted that some hospitals administer
methadone, while others use morphine.
Neonatologist Dr. Mary Newport said she is concerned about the
long-term effects of NAS. At her hospital, 30 percent of neonatal
intensive care unit admissions last year involved drug exposure. “We’ve
had this rash of all of these children who had this very intense drug
exposure, and then withdrawal and treatment for that. They are about to
hit the school system,” Dr. Newport said.
Veterans with PTSD Often Prescribed Drugs Not Supported by Guidelines
Veterans with post-traumatic stress syndrome (PTSD) are
often prescribed medications not supported by existing government
guidelines, according to a new study. Most of these prescriptions are
written by mental health care providers, according to UPI.
Researchers analyzed electronic pharmacy data from the Veterans
Health Administration (VHA) for 356,958 veterans with PTSD, who received
medications from VHA prescribers. The researchers from the Iowa City
Veterans Affairs Health Care System found among veterans with PTSD who
had continuous VHA medication use, 65.7 percent were prescribed elective
serotonin-norepinephrine reuptake inhibitors (SSRI/SNRIs).
Second-generation anti-psychotics were prescribed for 25.6 percent of
the veterans, while benzodiazepines were prescribed for 37 percent.
The findings appear in the journal Psychiatric Services.
Four Loko Maker to Put “Alcohol Facts Panel” on Can
The maker of the sweet alcoholic drink Four Loko will put
an “alcohol facts panel” on the back of cans containing more than two
servings of alcohol, to settle the Federal Trade Commission’s (FTC)
charges of deceptive marketing.
The panel will be similar to the nutritional facts label found on foods, the Associated Press reports. It will disclose the alcohol by volume, and the number of servings in the can.
According to a FTC news release,
the drink’s maker, Phusion Projects, must redesign cans with more than
two-and-a-half servings of alcohol so they can be resealed. This new
design will encourage drinkers not to consume the entire can in one
sitting.
The agency noted it does not have the jurisdiction to ban Four Loko,
or to force the company to limit its size or alcohol content.
The FTC had said Four Loko ads implied the 23.5-ounce can was equal to one or two regular 12-ounce beers, but is really more like four or five beers, the article notes. The cans contain up to 12 percent alcohol.
The FTC had said Four Loko ads implied the 23.5-ounce can was equal to one or two regular 12-ounce beers, but is really more like four or five beers, the article notes. The cans contain up to 12 percent alcohol.
The commission had wanted to require Phusion to put new labels on
drinks with more than two-and-a-half servings of alcohol, but changed
the requirement to cans with more than two servings of alcohol, based on
public comments about the dangers of supersized drinks.
The FTC also wanted to require a label on the front of the can that
compared the amount of alcohol in Four Loko to a regular beer. It
dropped that recommendation after some critics said it could lead to
binge drinking, by suggesting the drink was a fast, inexpensive way to
get drunk.
Four Loko originally contained caffeine and alcohol. Following warnings by the Food and Drug Administration, Phusion Projects removed caffeine from the drink.
Wednesday, February 13, 2013
Accidental Poisonings from Prescription Drugs on the Rise in Pets
A growing number of pets are being accidentally poisoned, and prescription medicines are largely to blame, The Wall Street Journal reports.
The American Society for the Prevention of Cruelty to Animals (ASPCA)
reports it received more than 180,000 calls about poisonous substances
last year, up 7 percent from 2011. Since many pet owners rush poisoned
pets to their veterinarian instead of calling a hotline, the number of
accidental poisonings may be higher, the article notes.
Prescription medications for humans have accounted for the majority
of calls about accidental poisonings for the past five years, increasing
2 percent last year to more than 25,200 calls. Pet owners made almost
18,500 calls about over-the-counter medications and supplements, up 2.8
percent from the previous year.
While insecticides and rodenticides are the most deadly household
items for pets, common human medicines can also be fatal, depending on
the pet’s weight, how much the pet consumes, and the strength of the
medicine. “One acetaminophen will kill a cat,” Kevin T. Fitzgerald, a
veterinarian with VCA Alameda East Veterinary Hospital in Denver, told
the newspaper.
Last year, calls about prescription painkillers increased 63 percent,
while calls about antidepressants rose 47.5 percent. “More and more
people are on these drugs, and dogs find them on the nightstand,” Dr.
Fitzgerald said.
The fatality rate among pets from accidental poisoning appears to be
low, at 0.2 percent of cases, according to Tina Wismer, Director of the
ASPCA’s Animal Poison Control Center. She notes the center does not know
the outcome of each call, so the rate might be higher. Dogs are more
likely than cats to be accidentally poisoned. Labrador Retrievers
accounted for almost 14,000 calls to the center.
To limit pets’ access to dangerous substances, keep medications in a
secure location such as a medicine cabinet, and take the medication when
the pet isn’t nearby.
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