By Michelle Andrews
May 29, 2012
What's in a name? That's a question that experts are wrestling with as they prepare to revise the diagnostic manual that spells out the criteria for addiction and other substance-use problems.

The catalyst for this discussion is a set of proposed changes to the Diagnostic and Statistical Manual of Mental Disorders, the reference guide upon which clinicians, researchers, insurers and others rely to identify and classify psychiatric disorders. The revised guide, called DSM-5, will incorporate changes to more than a dozen categories of disorders, including those related to mood, eating and personality, as well as substance use and addiction.

Developed under the auspices of the American Psychiatric Association, the revised manual is scheduled for release in May 2013.

The new guidelines would do away with the diagnostic categories of "substance abuse," which generally is defined by such short-term problems as driving drunk, and "substance dependence," which is chronic and marked by tolerance or withdrawal, in favor of a combined "substance use and addictive disorders" category.

They would also, for the most part, merge the criteria used to diagnose disorders related to the use of alcohol, cigarettes, illicit or prescription drugs and other substances into a single 11-item list of problems typically associated with these disorders. The list covers issues such as being unable to cut down or control the use of that substance and failing to meet obligations at work, school or home.

People would be given a diagnosis based on how many criteria on that list they met: no disorder (0-1), mild disorder (2-3), moderate (4-5) or severe (6 or more).

Supporters say the proposed changes, by creating a category for mild disorders, may make it easier to identify and address drug or alcohol problems before they become serious.

According to the National Institute on Alcohol Abuse and Alcoholism, people are at risk for developing a substance use disorder if their drinking exceeds four drinks on any single day and more than 14 drinks per week for men, and three drinks on any single day and more than seven drinks per week for women.

People who routinely drink heavily at sporting events or regularly get high with friends may be at risk for a substance use disorder, but they generally don't need lengthy treatment to change their ways, experts say. The new DSM guidelines might make it easier for primary-care doctors to be reimbursed by insurers for screening for alcohol and drug problems and conducting short counseling sessions that have been shown to be effective.

The goal is to educate patients about the higher risks they face of, for example, having a car accident or liver problems if they drink, and to motivate them to change, says Keith Humphreys, a psychiatry professor at Stanford University and a former senior drug policy adviser to the Obama administration.

"A lot of times, people aren't aware that their consumption is way higher than average," he says. "If you tell people they drink more than others, they can change and avoid the consequences."

The U.S. Preventive Services Task Force also recommends screening and behavioral counseling to reduce alcohol misuse in adults. Under the federal health law adopted in 2010, it's covered as a free preventive benefit for people in health plans that are new or have changed enough to lose their grandfathered status.

But some addiction experts worry that using the 11-point list of criteria to place substance use disorders on a continuum from mild to severe suggests that there's a natural escalation from non-use to occasional use to risky use to addiction.

"I think that's not consistent with clinical research," says Eric Goplerud, who directs the substance abuse, mental health and criminal justice studies department at NORC, a research organization at the University of Chicago.

It's analogous to depression, he says. "People are sad when bad things happen to them, but not all are on an escalator that will lead them to psychotic depression."

Because the new guidelines use a single spectrum for substance use and addictive disorders, some addiction experts worry that, for example, adolescents who meet the criteria for mild substance use because they've engaged in binge drinking and missed classes because of it within the past 12 months - thereby earning a score of 2 -- might be labeled as having a mild addictive disorder, which in many cases would not be accurate.

Some may resist treatment if they are labeled addicts, says Yifrah Kaminer, a professor of psychiatry and pediatrics at the University of Connecticut Health Center. "Adolescents vehemently don't like stigmatization," he says. "They'll say, 'This treatment is only for addicts, and I don't want to go.' "

Even though the Mental Health Parity and Addiction Equity Act of 2008 requires insurers to cover mental and physical health services equally, "people still have to fight for addiction treatment," says Marvin Seppala, chief medical officer at Hazelden, a Minnesota nonprofit that runs drug and alcohol treatment centers around the country. The parity law doesn't cover group plans at companies with 50 or fewer employees, nor individual health insurance plans.

http://www.kaiserhealthnews.org/Features/Insuring-Your-Health/2012/Psychiatric-Manual-Addiction-Diagnosis-Michelle-Andrews-052912.aspx

by Carl Sherman, Ph.D.
http://www.additudemag.com/adhd/article/1475.html

“Mindful awareness” sounds spiritual. Is it?
Mindful awareness, or mindfulness, is part of many religious traditions. For example, Buddhism features a form of mindfulness meditation known as vipassana.

But mindfulness is not necessarily religious or spiritual. It involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment.

It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain, anxiety, and depression.

How can mindfulness help people with AD/HD?
It improves your ability to control your attention. In other words, it teaches you to pay attention to paying attention. Mindful awareness can also make people more aware of their emotional state, so they won’t react impulsively. That's often a real problem for people with ADHD.

Researchers have talked about using mindfulness for ADHD for some time, but the question was always whether people with ADHD could really do it, especially if they're hyperactive.

How does your center teach the practice of mindful awareness?
We've tried to make the technique user-friendly. Our eight-week program consists of weekly two-and-a-half-hour training sessions, plus at-home practice. We start with five-minute, seated meditations at home each day, and gradually work up to 15 or 20 minutes. We also give the option to practice longer or to substitute mindful walking for the seated meditation.

We use visual aids, like a picture of a cloudy sky, to explain the basic concepts, because people with AD/HD tend to be visual learners. The blue sky represents the space of awareness, and the clouds represent all the thoughts, feelings, and sensations that pass by.

That's it? You do something for just a few minutes a day, and it makes your AD/HD better?
Not quite. The meditation sessions are important practice, but the key is to use mindfulness throughout your daily life, always being aware of where your attention is focused while you are engaged in routine activities. For example, you might notice while you drive that your attention wanders to an errand you must run later that day. Lots of people practice mindfulness while eating. Once you get used to checking in with yourself and your body, you can apply the technique anytime you start to feel overwhelmed.

Can I learn to practice mindfulness on my own?
Yes, the basic practice is very simple. Just sit down in a comfortable place where you won't be disturbed and spend five minutes focusing on the sensation of breathing in and breathing out—pay attention to how it feels when your stomach rises and falls. Soon, you may notice that you're thinking of something else—your job or some noise you just heard or your plans for later in the day. Label these thoughts as "thinking," and refocus your attention on your breath.

Do this daily. Every couple of weeks, increase the length of time you spend on the exercise—10 minutes, 15, up to 20 or more if you feel you can. Try the same thing throughout each day, focusing on your breath for a few minutes as you walk from place to place, or when you're stopped at a red light or sitting at the computer.

What if you just can't keep your mind focused? Will the exercise still do any good?
It’s the nature of the mind to be distracted. Mindful awareness isn’t about staying with the breath, but about returning to the breath. That’s what enhances your ability to focus.

And this emphasis on re-shifting your attention, of outwitting the mind's natural tendency to wander, is what makes us think this technique could be especially helpful to someone who has AD/HD.

By Ann Douglas
Living columnist
Here’s some good news about that much talked about teenage brain. Teenagers who practice mindfulness — a technique that involves focusing on what is happening in the moment and being aware of and accepting of emotions — benefit from increased self-control, healthier relationships, and improved overall well-being.

Psychologists at Australia’s University of Wollongong and George Mason University in Washington, DC, studied mindfulness in 776 Grade 10 students over a one-year period. The results of their research were published in the August 2011 issue of the Journal of Adolescence.

Mindfulness is a useful strategy for teenagers because it allows them to think through their emotions as opposed to reacting impulsively — something their brains are primed to do during the teen years.

“The teen brain is still undergoing a period of active construction,” explains Dr. Jean Clinton, an associate clinical professor in the Department of Psychiatry and Behavioural Neuroscience at McMaster University, division of Child Psychiatry. “And, during this time, teenagers are more reactive. Mindfulness allows them to pay attention to their feelings rather than being their feelings.”

Mindfulness also involves accepting what you are feeling and understanding that an emotion is just an emotion: it doesn’t control you, explains Shelley Hermer, a social worker based in Peterborough, Ontario. “Feelings come and feelings go. And there’s no such thing as a bad feeling. Being angry is just as valid as being excited.”

So how can you apply this new research about mindfulness to your life as a parent the next time your teenager storms through the front door, livid about something that happened at school?

“Focus on responding with empathy,” says Clinton. “Say, ‘Tell me what happened.’” It’s important to resist the temptation to try to fix the problem or to allow your own emotions to take over. “It’s not about you. It’s about your teenager.”

Then, once your teenager has had a chance to tell his story, encourage him to reflect on his feelings, says Clinton. “Ask questions like, ‘What about it really upsets you? Why are you so angry?’ In asking these types of questions, you are being your teen’s mindful brain. You are helping him to figure out that it is helpful to take a step back and ask these types of questions when he is feeling really angry or upset.”

Then, once your teenager has had a chance to acknowledge what he is feeling and to reflect on those feelings, suggest some self-soothing strategies that he can use to bring his emotions under control, says Clinton. Talking a shower, going for a walk or a run, or talking to a friend are strategies that many teens find helpful.

The mindfulness research about teenagers makes a lot of sense to Mississauga mother and early childhood consultant Cathy Kerr. Kerr has been taking a mindful approach to raising her two daughters, Sarah, 16, and Larissa, 12. She feels that it is important that her daughters grow up understanding that there needs to be a balance between caring for yourself and caring for other people. “Having empathy is a really big part of problem-solving in general — knowing how you affect other people,” she explains.

She also wants her daughters to grow up knowing how to take good care of themselves. That’s why Kerr and her daughters make weekly treks to a Yoga studio together. “Yoga really teaches you how to relax, tune in and let go. I like knowing that they’re learning the same things that I am about relaxing.”

Clearly, Kerr’s 16-year-old daughter, Sarah Weredynski, has taken these lessons to heart. She practices yoga on an almost daily basis at home. “Yoga exercises your mind, body, and spirit,” Weredynski explains. “After yoga, I feel fresh. I try to fit it in first thing in the morning on weekends. That way, I can go into my day knowing I’ve done something good for myself.”

Yoga seems to be working for Weredynski. She doesn’t get stressed easily or often. A sticky note on her dresser helps her to keep track of upcoming deadlines for assignments. And when friends start to obsess about the little things, she reminds them to “calm the heck down” and to keep things in perspective. “Not everything is the end of the world,” she explains.

http://www.thestar.com/living/article/1181009--teen-brain-benefits-from-mindfulness-training

ANNA SOSTEK - Pittsburgh Post-Gazette
Can someone be just mildly alcoholic? — That -- in its simplest terms -- is at the heart of a change in a psychiatric manual that could have a major effect on diagnosis and treatment of alcoholism and other addictions.

The changes come as part of revisions to the definition of addiction in the Diagnostic and Statistical Manual of Mental Disorders, produced by the American Psychiatric Association and commonly referred to as the "Bible of mental illness."

Alcoholism isn't a medical term. Rather, the proposed guidelines would classify mild, moderate and severe forms of "alcohol use disorder" instead of the "alcohol abuse" and "alcohol dependency" used in the current edition.

"It's a drastic change," said Antoine Douaihy, associate professor of psychiatry and medical director of addiction medicine services at Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center. "I'm wondering what kind of impact this is going to have on how we approach, how we categorize and how we treat these patients."

Broadening the definition to include mild and moderate forms of the disorder -- along with other major changes involving addiction disorders -- could result in millions of people falling into the diagnostic categories who didn't previously qualify. Such an increase could have major financial ramifications in terms of insurance eligibility.

People now need two or more of 11 problematic behaviors over a 12-month period to be diagnosed with some degree of alcohol use disorder. These include "alcohol taken in larger amounts or over a longer period than was intended," "a persistent desire or unsuccessful effort to cut down or control alcohol use," and "craving or strong desire or urge to use alcohol." Other behaviors include classic physiological symptoms such as increased tolerance or withdrawal.

Many who treat patients who struggle with addiction believe that an expansion of those categories is much needed. "As a whole across the country, alcohol and drug problems are grossly under-diagnosed and under-recognized," said Neil Capretto, medical director at Gateway Rehabilitation Center in Pittsburgh.

"It's a drastic change," said Antoine Douaihy, associate professor of psychiatry and medical director of addiction medicine services at Western Psychiatric Institute and Clinic of the University of Pittsburgh Medical Center. "I'm wondering what kind of impact this is going to have on how we approach, how we categorize and how we treat these patients."

As a practitioner "in the trenches," Capretto doesn't think that the new designation will have much impact on day-to-day treatment. By the time his patients get to rehab, they are generally addicted under any measure.

But to the extent that expanding the guidelines could get people into treatment sooner, he is in full support.

"Where in the past somebody might have been reluctant to make a diagnosis, they could now say, 'Well, it's mild,' " he said. "If you intervene earlier on, there's more potential to make an impact."

Brent Robbins, an associate professor of psychology at Point Park University, sees the issue differently. While it's true that more people could probably benefit from treatment, he's critical of the broadening of the definition of psychiatric ailments.

"With every DSM that's come along, there's a tendency toward a sort of bracket creep," he said, likening the changes on addiction to broadening of diagnostic criteria for autism, depression and attention deficit hyperactivity disorder. "There's a trend to define disorders in a way that would include more people than the previous edition."

To him, "mild addiction" is a confusing concept because addiction is a discrete concept that involves changes in the brain's biochemistry. There are real differences in how someone who abuses alcohol on occasion should be treated versus someone who is truly dependent on it, he said.

"Everyone who goes to frat parties at age 19 and drinks too much doesn't have an addiction," he said. "They are abusing the substance, clearly, but that's very different from someone who has an addiction. The difference between substance dependent and substance abuse is being lost, and that's not a good thing."

Reach Anna Sostek at [email protected].

GREENVILLE, SC -- Armed robbers are targeting your local pharmacies, and they are still on the loose.

Deputies say at least three men are responsible for 5 armed robberies targeting CVS stores and a Walgreens in Greenville County.

Deputies say the pharmacies are often targets for people to get their drug fix or to make a quick buck on the streets.

7 On Your Side spoke with an addiction specialist who says prescription drug addiction is on the rise.

Tears fill Rosa Robinson's eyes as she talks about her battle with drug addiction.

Robinson says one night she and her daughter went on a drug and alcohol binge.

her daughter never woke up.

"She died of a massive heart attack taking Lortab and drinking, and I woke up and I feel guilty," Robinson said.

Robinson says she's been an addict for more than 30 years.

"You don't care about nothing but yourself and your means of how to use and that's it," Robinson said.

Phoenix Center of Greenville, Executive Director Adam Brickner says it’s that mentality that puts others in danger.

Brickner says it’s not unusual for addicts to turn violent to get their fix.

"There are a lot of collateral damages associated with addiction to opiates," Brickner said.

The problem, Brickner says there has been a major increase in prescription drug abuse, but there aren't enough places to go for help.

"We are seeing a lot of Detox facilities close down, recently one Anderson, Oconee County closed down, one in Spartanburg closed down, so unfortunately we are seeing fewer and fewer programs," Brickner said.

The Phoenix Center has a 2 to 3 week waiting list for its Detox program.

Brickner says there is no easy solution tight state and county budgets have hurt drug rehab programs.

"That's a huge policy issue as people demand that these services exist they will continue to be funded," Brickner said.

Robinson says she's an example of why these programs need to be funded.

"I know I'm at rock bottom I have to do something," Robinson said.

Brickner says if you keep prescription drugs in your home you aren't using bring them to a local drop off center, especially if you have teenagers.

http://www2.wspa.com/news/2012/may/16/prescription-drug-abuse-rise-upstate-ar-3806135/

By Brian Alexander
Jill, Ann, and Kimberly go off to college with warnings from their parents about sex and the “Freshman 15” ringing in their ears. Months later, Jill has gained 15 pounds and Ann has become a sexual adventurer. Kimberly, on the other hand, has not only maintained her weight, she's been too busy studying in the library stacks to hook up.

What accounts for the differences?

Click here to read the rest of the article
http://vitals.msnbc.msn.com/_news/2012/04/23/11292844-brain-scans-show-why-some-cant-resist-temptation?lite

An epidemic similar to that of "crack babies" in the early 90s may be resurfacing, with the number of infants being born addicted to prescription painkillers increasing fivefold since 2000.

According to a new study released Monday, babies born with neonatal abstinence syndrome—exposure to addictive drugs while in the mother's womb—are increasingly addicted to Oxycodone, Vicodin, Heroin or opiates and can suffer from seizures, breathing problems, difficulty feeding and inconsolability, according to Stephen Patrick, a neonatal-perinatal medicine fellow at the University of Michigan and lead author of the report.

"Opiate painkillers are the new epidemic," he says. "It's becoming a problem. We need to increase attention from a public health perspective and talk about how we deal with opiates and the way they're prescribed."

Click Here for Continued Article:
http://www.usnews.com/news/articles/2012/04/30/number-of-babies-born-addicted-to-prescription-painkillers-skyrockets