Who Should Treat Addiction?

By Dr. Stuart Gitlow | March 30, 2012 | 23 Comments | Filed in Addiction &Healthcare

Think about a patient with addiction. He seeks attention for his illness and would like treatment. Should he go to a counselor, a nurse practitioner or a physician? How would his treatment differ in each case? If you’d like to shake things up further, please add psychologists and social workers to the mixture.

If our hypothetical patient is seen by a nurse practitioner in an ambulatory setting yet fails to improve with respect to his addiction, has he failed medical treatment? Would the next step be for the patient to see a physician? Or would it be to enter a more intensive treatment setting?

Our nation is moving quickly toward an environment in which a greater quantity of medical care will be delivered by clinicians who have not attended medical school. Interestingly, we already have that environment in the field of addiction, and have had that scenario for decades. What we do not know, however, is whether this approach is efficacious for the treatment of patients.

Take a simple research study: 200 patients with newly diagnosed addictive disease are divided into two groups matched by age, sex and socioeconomic background, as well as by drug of choice. One group is seen by addiction specialist physicians, the other by addiction specialists who are not physicians, and both are seen with the same frequency and intensity. At 12 months, determine whether there is a difference between the two groups in terms of recovery rate as defined by abstinence and functional improvement.

The study has never been performed.

No one has ever bothered to determine whether social workers are better than physicians at treating addictive illness, or whether physicians are better than psychologists. And though no one has ever bothered to determine if surgical nurses could perform appendectomies successfully, or if counselors can treat life-threatening illnesses like cancer, there has not been a need to answer those questions. So addiction is in an odd place: there is no proof that non-MD/DO care has sufficient quality to be utilized as a replacement for physician-based treatment, yet non-physician treatment already represents the standard in many locations. And of course, there is no proof that non-MD/DO care does not have sufficient quality either.

In the vast majority of patients coming to my practice, prior misdiagnosis or mistreatment reigns high on the problem list on initial intake. Patients treated incorrectly for depressive illness when they have sedative-induced depression, patients treated with combinations of sedatives and stimulants for alleged anxiety accompanying ADHD, patients with known alcoholism prescribed benzodiazepines for mild insomnia or anxiety: the list goes on and on, with physicians in my community being as much to blame as other clinicians.

Addiction is a complex lifelong disease which, if unaddressed, commonly results in death of the patient. Shouldn’t we have some research to determine to whom these patients should be referred?

Stuart Gitlow, MD, MPH, MBA, is Executive Director of the Annenberg Physician Training Program in Addictive Disease and Associate Clinical Professor at the Mount Sinai School of Medicine. He is Acting President of the American Society of Addiction Medicine.

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Survey: Ten Percent of American Adults Report Being in Recovery from Substance Abuse or Addiction

By Josie Feliz | March 6, 2012 | 2 Comments | Filed in News Releases

Data Show More Than 23 Million Adults Living in U.S. Once Had Drug or Alcohol Problems, But No Longer Do

New York, NY, March, 6 2012 – Survey data released today by The Partnership at Drugfree.org and The New York State Office of Alcoholism and Substance Abuse Services (OASAS) show that 10 percent of all American adults, ages 18 and older, consider themselves to be in recovery from drug or alcohol abuse problems. These nationally representative findings indicate that there are 23.5 million American adults who are overcoming an involvement with drugs or alcohol that they once considered to be problematic.

According to the new survey funded by OASAS, 10 percent of adults surveyed said yes to the question, “Did you once have a problem with drugs or alcohol, but no longer do?” – one simple way of describing recovery from drug and alcohol abuse or addiction.

“The OASAS study is an important contribution to the public’s understanding of recovery, as it represents the actual voices of millions of Americans whose lives have improved because they are living free of alcohol and other drug problems,” said Steve Pasierb, President and CEO of The Partnership at Drugfree.org. “This newlearning provides a big reason – more than 23 million reasons – for all those who are struggling with their own, or a loved one’s substance use disorder, to have hope and know that they are not alone. These findings serve as a reminder that addiction is a treatable disease and recovery can be a reality. We are just scratching the surface here and more research is needed in this area, but we are proud to collaborate with New York OASAS in this meaningful process.”

“This research marks a vitally important step for those who are struggling with addiction by offering clear evidence to support what many know experientially – that millions of Americans have found a path to recovery,” said New York State Office of Alcoholism andSubstance Abuse Services (OASAS) Commissioner Arlene González-Sánchez. “It is my hope that this new evidence will strengthen and inspire individuals and those that provide treatment and recovery services to help the broader community understand that treatment does work and recovery is possible.”

Other self-reported findings from the new data conclude that:
More males say they are in recovery than females (12 percent vs. 7 percent).
More adults ages 35-44 report being in recovery, compared to younger adults (18-34) and adults who are 55 years of age or older.
The Midwest has a higher prevalence of adults (14 percent) who say they are in recovery compared to adults in the South (7 percent). In other regions of the country, the percentage of adults[1] who say they are in recovery is 11 percent for the West and 9 percent for the Northeast.

The study also found no significant difference between parents and adults without children who say they are in recovery. This demonstrates that parents are as likely as non-parents to be in recovery.

“This new research also supports findings from a groundbreaking survey done for Faces and Voices of Recovery by Peter Hart Associates that provided the initial evidence that there was a large population in recovery in the United States,” said Tom Hedrick, Senior Program Officer and one of the founding members of The Partnership at Drugfree.org. “Those 2004 findings concluded that ‘38 percent of adults have a family member or close friend (or both) who is in recovery from addiction to alcohol or other drugs.’”

Insights from Experts in the Field of Substance Abuse and Addiction:

“I’ve learned that there is ‘a science of addiction, but not a science of recovery.’ With the survey conducted by The Partnership at Drugfree.org and OASAS, we now have a very strong beginning to developing that science. Through past initiatives, we established some sensible definitions of what ‘being in recovery’ actually means – and this additional work provides fundamental information on how many people are in recovery. These are not only the building blocks for the ‘recovery science’ that have been called for, but they are the foundation for public understanding, acceptance and ultimately, the celebration of recovery.” – A. Thomas McLellan, PhD, Former Deputy Director, White House Office of National Drug Control Policy

“Every American is acutely aware of the negative impact of drug and alcohol addiction; it’s impossible to ignore. Yet we have somehow missed a very positive story about addiction that is right in front of our nose: Tens of millions of our fellow citizens come out the other side to live substance-free, healthy and productive lives. This study is a wake-up call to the reality of recovery in America, as well as a source of hope for the millions of American families who are currently struggling with drug and alcohol problems.” — Keith Humphreys, Professor of Psychiatry at Stanford University School of Medicine

“As these findings demonstrate, recovery is everywhere. All across our country people are living healthy and productive lives in long-term recovery from addiction to alcohol and other drugs, benefiting themselves, their families and communities. Recovery is our best kept secret. It’s time to invest in understanding the solution to alcohol and other drug problems, advocate for the right resources to recover and demonstrate the power and proof of long-term recovery, offering hope to the over 23 million Americans who have yet to find recovery.” — Pat Taylor, Executive Director, Faces and Voices of Recovery

“This research is vitally important – it shows that, until now, even addiction experts have been unaware of how many people across the country are in sustained recovery. We often hear about the latest celebrity’s bad behavior, but it’s rare for the public to see people overcome their addictions, achieve their goals, and go on to become great parents, employees, citizens, etc. The public won’t know these success stories unless we tell them, and that’s what this research does. It breaks new ground and provides tremendous inspiration for those who are currently struggling with drug and/or alcohol problems and their families.” – Deni Carise, PhD, Chief Clinical Officer, Phoenix House Foundation

Resources for Those in Recovery and for Families Facing Addiction

The Partnership at Drugfree.org is reaching families directly through its transformative campaign, You Are Not Alone, which calls on all those affected by addiction – individuals, families, communities and organizations – to take action and help our loved ones in need. You Are Not Alone comes to life in a collection of visual stories, each one a message dedicated to the families of the 11 million teens or young adults who are struggling with substance abuse.

This public storytelling – stories of hope and healing – puts a face to the disease of addiction and brings together the millions directly impacted with those who currently know someone who needs help.

For those families who are currently struggling with addiction or have a loved one who is in recovery, please visit The Partnership at Drugfree.org’s online resource, Recover at drugfree.org.


# # # #

Survey Methodology

The nationally representative survey from The Partnership at Drugfree.org and OASAS was conducted among 2,526 adults, ages 18 and older, living in the United States. Opinion Research Corporation (ORC) conducted the survey in 2011, with a sample consisting of 1,272 male and 1,254 female respondents and with a margin of error +/- 2 percentage points.

ORC CARAVAN® random-digit-dial omnibus survey is conducted among adults 18 years of age and older living in private households in the continental United States. It is a multi-client nationally projectable study and the sample includes both unlisted and listed landline telephone numbers and is fully replicated and stratified by region. All national telephone surveys are weighted to U.S. Census data for age, gender, geographic region, education and race in order to improve the projectability and reliability of the random telephone sample. The survey is enhanced with a sample of cell phone interviews to reflect the growing importance of adults who do not have landlines or rarely use them. This captures the best representation of the adult population, especially among younger adults 18-34.

Survey Question: “Did you used to have a problem with drugs or alcohol, but no longer do?”

About The Partnership at Drugfree.org

Ninety percent of addictions start in the teenage years. The Partnership at Drugfree.org is dedicated to helping families solve the problem of teen substance abuse. Bringing together renowned scientists, parent experts and communications professionals, this public health nonprofit translates research on teen behavior, parenting, addiction and treatment into useful and effective resources at drugfree.org. Its You Are Not Alone campaign is dedicated to supporting families of the 11 million teens and young adults who need addiction treatment, while the organization’scommunity education programs reach families at the grassroots level. The Partnership at Drugfree.org’s mission to help parents prevent, intervene in and find treatment for drug and alcohol use by their children depends on donations from individuals, corporations, foundations and the public sector. We are thankful to SAG/AFTRA and the advertising and media industries for their ongoing generosity.

About OASAS

OASAS oversees one of the nation’s largest addiction services systems dedicated to Prevention, Treatment and Recovery, with more than 1,550 programs serving over 110,000 New Yorkers on any given day. To get help for someone in need, call the toll-free, 24-hour, 7-day a week HOPEline at 1-877-8-HOPENY. For more information, please visit www.oasas.state.ny.us. Follow OASAS:www.twitter.com/nysoasas / facebook profile: NYS OASAS /www.youtube.com/nysoasas / www.flickr.com/photos/nysoasas

Five Public Policies That Will Lead to Pain Relief Without Prescription Overdoses

By Celia Vimont | March 13, 2012 | 8 Comments | Filed in Addiction,Healthcare & Prescription Drugs


Major policy changes are needed to resolve the tension between providing adequate pain relief and tackling the epidemic of prescription opioid overdoses, according to drug policy expert Keith Humphreys, PhD. At the recent American Academy of Pain Medicine meeting, he laid out five policies that can achieve a realistic balance.

“Some of the policies are relatively easy to implement, while others involve changing cultural norms, which is much more difficult,” said Humphreys, Professor of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and a former Senior Policy Advisor at the White House Office of National Drug Control Policy.

According to the National Institute on Drug Abuse, from 1991 to 2009, prescriptions for opioid analgesics increased almost threefold, to more than 200 million. The Drug Abuse Warning Network system, which monitors drug-related emergency department visits and drug-related deaths, found that emergency room visits related to the nonmedical use of pharmaceutical opioids doubled between 2005 and 2009.

The five policies that Dr. Humphreys recommends are:
Implement prescription monitoring programs. “Some of the initial programs were slow and clunky, but we are now seeing systems, such as the one in New York, that are starting to make a difference,” he says.
Use the reimbursement power of insurance programs to lock “doctor shoppers” into a single prescriber. “If an insurer sees someone have five doctors writing them pain pill prescriptions, they can designate one provider as the patient’s pain doctor,” notes Humphreys.
Make prescription recycling a standard practice. “I remember when recycling bottles and cans was considered a strange thing, but now everyone does it,” he says. “Prescription take-back days won’t be fully effective until they become the cultural norm. Dropping off unused pills needs to be something everyone does when they go to the drugstore.”
Make it easier for drug companies to develop abuse-resistant drugs. “Pharmaceutical companies who are trying to do the right thing need to spend hundreds of millions of dollars to develop a pill that becomes inert when crushed, and then they have toapply for a New Drug Application. We need the Food and Drug Administration to create an accelerated review process for these new formulations.”
Change opioid-related medical practice. “We need to educate patients and providers that opioids are not the only treatment for pain,” Dr. Humphreys says. “There are other options, including different types of medications and physical therapy. We also need to educate prescribers in the emergency room and in dental offices that they shouldn’t automatically write a 30-day prescription for opioids. They have to start thinking about how much medication a patient really needs.”

With so many people dying of prescription drug overdoses, a response of doing nothing isn’t an option, he emphasizes. “I tell doctors that change is coming, and they can get involved, or else an uninformed policymaker may do it for them, with some potentially bad results.”

Tobacco Killed 50 Million People in Last Decade Worldwide, Health Groups Say

By Join Together Staff | March 21, 2012 | 3 Comments | Filed in Tobacco


Fifty million people worldwide have died from tobacco-related causes over the past decade, according to a new report by the World Lung Foundation and the American Cancer Society. The groups estimate that if current trends continue, a billion people will die from tobacco use and exposure in this century.

The Tobacco Atlas notes smoking rates in the developed world are on the decline, while rates are climbing in poorer areas of the world. Last year, tobacco use resulted in the deaths of almost 6 million people worldwide, with almost 80 percent occurring in low- and middle-income countries. In China, tobacco is the number one killer, responsible for 1.2 million deaths per year, according to the atlas. That number is expected to grow to 3.5 million by 2030, Reutersreports.

The report said the tobacco industry has launched legal challenges to anti-tobacco policies such as plain cigarette packaging, laws banning smoking in public places, bans on advertising and health warnings on cigarette labels.

According to the report, the world’s six biggest tobacco firms made $35.1 billion in profits in 2010, an amount equal to the combined earnings of Coca-Cola, Microsoft and McDonald’s.

“The tobacco industry thrives on ignorance of the true harms of tobacco use and using misinformation to subvert health policies that could save millions,” Peter Baldini, Chief Executive Officer of the World Lung Foundation, said in a news release.