WASHINGTON, Sept. 10, 2012 -- Today on World Suicide Prevention Day, the National Action Alliance for Suicide Prevention (Action Alliance) released an ambitious national strategy to reduce the number of deaths by suicide. The strategy was called for by Health and Human Services (HHS) Secretary Kathleen Sebelius and former Department of Defense Secretary Robert Gates when they launched the Action Alliance on Sept. 10, 2010. The 2012 National Strategy for Suicide Prevention, a report from the U.S. Surgeon General and the Action Alliance, details 13 goals and 60 objectives for reducing suicides over the next 10 years.

The Action Alliance, co-chaired by Gordon Smith, chief executive of the National Association of Broadcasters, and Army Secretary John McHugh, highlights four immediate priorities to reduce the number of suicides: integrating suicide prevention into health care policies; encouraging the transformation of health care systems to prevent suicide; changing the way the public talks about suicide and suicide prevention; and improving the quality of data on suicidal behaviors to develop increasingly effective prevention efforts.

The Obama Administration also announced a series of activities that will help prevent suicide:

• Secretary Sebelius announced $55.6 million in new grants for national, state, tribal, campus and community suicide prevention programs made possible under the Garrett Lee Smith Memorial Act and partially funded by the Prevention and Public Health Fund under the Affordable Care Act, the health care law enacted in 2010.
• The Department of Veterans Affairs (VA) launched, Stand by Them: Help a Veteran, a joint VA-Department of Defense (DoD) outreach campaign that includes a new public service announcement, Side by Side, designed to help prevent suicide among veterans and servicemembers and focuses on the important role family and community play in supporting Veterans in crisis. Throughout September and beyond, VA and DoD are urging community-based organizations, Veterans Service Organizations, health care providers, private companies and other government agencies to connect Veterans and Service members in need of assistance to the Veterans Crisis Line (1-800-273-8255, press 1). Additionally, as directed by President Obama's Mental Health Executive Order issued August 31st, VA is also doubling the workforce of the Crisis Line and hiring 1,600 new mental health professionals.

"Our message today is one of hope," Secretary Sebelius said. "The national strategy will bring together the nation's resources, both public and private, in an organized effort to provide life saving services and improve the ability of individuals, friends and family members to recognize the warning signs of despair and take action to save lives."

"By implementing this plan, we will engage diverse sectors of our communities, from health care systems and policy-makers to the media and public," said Gordon Smith, a former U.S. senator from Oregon. "It will take all of our efforts to win this fight against suicide that touches so many American lives."

VA Deputy Secretary W. Scott Gould said, "All of us working together - friends, family, neighbors, the public and the private sector - can make a difference for Service members and Veterans transitioning back into their communities. Recognizing the warning signs of suicide and knowing where to turn for help will save lives."

Army Secretary McHugh commented on the impact of suicide on the military community in particular. "Suicide is one of the most challenging issues we face," he said. "In the Army, suicide prevention requires soldiers to look out for fellow soldiers. We must foster an environment that encourages people in need to seek help and be supported."

Suicide is a public health issue that results in an average of 100 American deaths each day, more than double the average number of homicides. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), more that 8 million adults in the United States had serious thoughts of suicide within the past 12 months.

The first National Strategy for Suicide Prevention was launched in 2001 by then-Surgeon General David Satcher. The progress achieved over the years, the significant advances in knowledge, research and practice of preventing suicide, and public comment informed the development of the new Strategy by the Action Alliance. Since the development of the first strategy, more than 100 best practices in suicide prevention are now documented and form the foundation of the new strategy.

"The latest research shows that suicide is preventable, suicidal behaviors are treatable, and the support of families, friends, and colleagues are critical protective factors. Suicide prevention needs to be addressed in the comprehensive, coordinated way outlined in the national strategy," said Surgeon General Regina M. Benjamin. Dr. Benjamin also released a new public service announcement promoting the national suicide prevention line – 1-800-273-TALK (8255).

The Action Alliance is composed of approximately 200 public- and private- sector organizations united by a common vision of a nation free from the tragic experience of suicide. One of the private sector partners, Facebook is supporting the strategy by harnessing the power of social networking and crisis support to help prevent suicides across the nation.

"All too often, people in crisis do not know how—or who—to ask for help," said Facebook's Global VP for Public Policy, Marne Levine. "At Facebook, we have a unique opportunity to provide the right resources to our users in distress, when and where they need them most. By enabling connection to trained and caring professionals around the world, we can do our part to let users know help is available. Through a concerted and coordinated effort on the part of private industry, government, and concerned family and friends, we can make a real difference in preventing suicide and saving lives."

A new service offered by Facebook enables users to report a suicidal comment they see posted by a friend to Facebook using either the Report Suicidal Content link or the report links found throughout the site. The person who posted the suicidal comment will then immediately receive an email from Facebook encouraging him or her to call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or to click on a link to begin a confidential chat session with a crisis worker.

Additionally,

• If you are concerned about yourself or someone you care about, call the National Suicide Prevention Lifeline 24/7 for free, confidential help (1-800-273-8255).
• To view or order printed copies of the National Strategy for Suicide Prevention and other materials, visit www.samhsa.gov/NSSP.
• To learn more about suicide prevention, visit www.sprc.org.
• To view the U.S. Surgeon General's new "Everyone Plays A Role" PSA, visit http://www.surgeongeneral.gov/
• To view the Department of Veterans Affairs new "Side by Side" PSA, visit http://www.veteranscrisisline.net/materials/spmsupport/files/side-by-side-SD-eng-60-cc.wmv

SOURCE National Strategy for Suicide Prevention


Read more here: http://www.heraldonline.com/2012/09/10/4250401/new-national-strategy-paves-way.html#storylink=cpy

By David Sack, M.D.

http://blogs.psychcentral.com/addiction-recovery/2012/08/athletes-prescription-drug-addiction/

During Olympic season, the public watches in awe as talented athletes from around the world compete, secretly waiting to see which ones are going to test positive for steroids. But steroids aren’t the only drug problem plaguing elite athletes. There is growing concern in a number of sports that players are sacrificing their health and their careers to prescription drug addictions.

A Budding Epidemic in SportsTwo of the most commonly abused medications in sports are narcotic painkillers, such as Vicodin and OxyContin, and prescription stimulants, such as Ritalin or Adderall. Prescription painkillers are frequently prescribed (at least initially) for legitimate pain complaints following injuries sustained on the field. Their widespread misuse isn’t surprising given the aggressive nature of sports and the intense pressure on athletes to play injured.

Retired NFL players misuse opioid pain medications at a rate more than four times that of the general population, according to a study from Washington University. More than half (52 percent) of NFL retired players said they used prescription pain medication, 71 percent of whom admitted abusing the drugs during their sports career.

Athletes are drawn to prescription stimulants because they believe the drugs give them a boost of focus and energy. Seeking a competitive edge, some players feign symptoms of attention deficit hyperactivity disorder (ADHD) to get “legal” amphetamines. According to records from Major League Baseball, the number of players getting “therapeutic use exemptions” from baseball’s amphetamines ban quadrupled in recent years. While some players undoubtedly have a legitimate medical need for ADHD medications, it appears that others are merely looking for ways to evade the amphetamine ban.

A Set-Up for Addiction?Being a professional athlete may seem like a dream job, but intensive training and pressures to perform can have unexpected side effects, including an increased risk of addiction and other mental health issues. Why the association between sports and drug addiction?

Theories abound, but a growing body of research shows that exercise can stimulate the dopamine reward system in the brain much like drugs of abuse. While most of us could use more exercise in our lives, elite athletes may develop a compulsive preoccupation with training that resembles addiction. A study published in the Journal of Sports Sciences, which tracked competitive runners in the U.S. and triathletes in Hong Kong, found more than half had compulsive-exercise tendencies. As Texas Rangers outfielder Josh Hamilton described it when he was sidelined with a back injury, “alcohol and drugs were the closest thing I could find to getting that feeling when I was playing the game.”

The heavy physical training elite athletes endure may prime the brain for addiction. According to a study from Tufts University, an extreme preoccupation with training can mimic the biological effects of drug abuse, leading to withdrawal-like symptoms such as anxiety and depression when the exercise stops. Exercise releases the body’s natural opioids, endorphins, and has long been touted for relief of stress, anxiety and depression. These findings could help explain why athletes often struggle with substance abuse, especially once they leave their sport.

In addition to the biological components, athletes face extreme pressure to impress coaches and please adoring fans, which may contribute to drug and alcohol abuse, eating disorders and other mental health issues. Exhaustion from training and competing has also led to symptoms of depression and anxiety in some athletes.

Self-Medicating Pain and LossWhen athletes get injured or retire, they may feel torn about losing their place in the spotlight. The let-down many athletes experience can bring on unexpected mental health issues. Several beloved athletes have come forward with their struggles, including:

• Seven-time Olympic medalist and former world record holder Amanda Beard, whose swimming career was marked by depression, bulimia and substance abuse.

• Eight-time world record holder Geoff Huegill battled drug abuse, dramatic weight gain and depression following his retirement from swimming after the 2004 Olympics.

• After spending a season on injured reserve, Tennessee Titans wide receiver O.J. Murdock died of what appeared to be a self-inflicted gunshot wound.

For athletes, the perks of the job may actually contribute to the problem. Many have the means to fund hefty drug habits, yet exhaust all of their resources by the time they realize they need treatment. Since their family, friends, coaches, the public and even law enforcement want to see them continue playing, many are shielded from the negative consequences of their addiction.

Inside reports suggest that the professional sports culture may encourage and even facilitate drug dependency among players, making addictive medications easily accessible and taking whatever measures necessary to keep the players on the field. As awareness has grown about the epidemic of prescription drug addiction, sports organizations are tightening the reigns but problems remain:

• Former New York Jets backup quarterback Erik Ainge missed the entire 2010 season because of an addiction to painkillers following a football injury.

• Randy Grimes, former lineman for the Tampa Bay Buccaneers, came forward in 2009 to talk about his addiction to prescription painkillers.

• Former NBA player Chris Herren gave up his career to a 14-year drug addiction.

• Last year, hockey player Derek Boogaard died at age 28 of a drug overdose while recovering from a concussion.

• In 2009, former Philadelphia Eagles defensive tackle Sam Rayburn was arrested for attempting to obtain a controlled substance by forgery or fraud to fuel a prescription painkiller addiction that at its peak involved consuming more than 100 Percocets a day.

The tragic stories, too numerous to mention, highlight the harsh realities behind the glamorous image of sports stardom. At the same time the medical community at large is trying to distinguish legitimate from illegitimate needs for prescription medication, sports doctors and team managers must strike this same balance or risk having their best players sidelined by addiction.

http://www.laboratoryequipment.com/news/2012/08/drug-combination-can-fight-cocaine-addiction

A fine-tuned combination of two existing pharmaceutical drugs has shown promise as a potential new therapy for people addicted to cocaine — a therapy that would reduce their craving for the drug and blunt their symptoms of withdrawal.

In laboratory experiments at The Scripps Research Institute, the potential therapy, which combines low doses of the drug naltrexone with the drug buprenorphine, made laboratory rats less likely to take cocaine compulsively — a standard preclinical test that generally comes before human trials.

While the two-drug combination would have to prove safe and effective for people in clinical trials before approval by the U.S. Food and Drug Administration (FDA), the work represents a significant advance in the field because there are currently no FDA-approved medications for treating cocaine addiction.

Many individual drugs have been tried in clinical trials in the past as potential treatments, but they have all failed to show significant efficacy in treating people addicted to cocaine, says Scripps Research’s Prof. George Koob, chair of the Scripps Research Committee on the Neurobiology of Addictive Disorders and team leader for the research, which appears this week in the journal Science Translational Medicine.

“Combining drugs with multiple actions may be a useful approach that has not been utilized extensively,” Koob says.

“These findings potentially represent a huge bridge from basic research to the establishment of a new and effective medication for cocaine addiction,” adds Senior Research Associate Leandro Vendruscolo, a co-author on the study with Scripps Research colleagues Assistant Prof. Sunmee Wee (first author), former Research Associate Kaushik Misra, and Research Associate Joel Schlosburg.

Cocaine and the Brain’s Reward System

Cocaine abuse is a major problem in the United States, and an Office of National Drug Control Policy study that came out in the mid-1990s estimated that Americans spend more on cocaine than on all other illegal drugs combined. The National Institute on Drug Abuse estimated that in 2008 1.9 million Americans had used cocaine within the last month. About a quarter of all drug-related emergency room visits are linked to cocaine use — 482,188 in 2008 alone.

How doctors think about treating people addicted to cocaine and other drugs has evolved in the last generation as they have come to better understand how these substances affect the brain’s physiology. Where once treatment for addiction focused solely on therapy, counseling and other forms of social support, treatment today for many types of addiction combines those traditional approaches with anti-stress medications and other pharmaceuticals that directly address the long-term physiological effects of a drug on the body.

Koob and his colleagues have been at the forefront of this revolution in our understanding of the prolonged effect of drug abuse on the brain.

When cocaine, a chemical salt extracted from the leaf of the coca plant, is snorted, injected or smoked, the chemical enters the bloodstream and readily crosses the blood–brain barrier, accumulating rapidly in areas linked to the so-called motivational/pleasure circuits of the brain.

There, the cocaine molecules interfere with the normal regulation of dopamine by binding to dopamine transporters and blocking them from recycling the neurotransmitter. This leads to the build-up of dopamine in the brain's motivational systems, which produces a euphoric feeling in the user — a quick rush that hits seconds after the user takes the drug and lasts several minutes. This physiological action triggers opposing actions in the brain, one of which is increases in a neuropeptide dynorphin that produces stress/aversive like effects (effectively an opponent process).

What Koob and his colleagues have demonstrated over the last several years is that excessive and prolonged cocaine use changes the point at which this euphoria is achieved, at least in part by activating these stress/aversive systems in the brain. Over time, it takes more of the drug to achieve the same effect and — after cocaine use is stopped — stress and aversion remains elevated.

In a paper in Psychopharmacology in 2009, the team showed two different systems (kappa opioid system and mu receptor) had different effects on the cocaine intake of rats with short versus extended access to the drug. “This finding gave us a firm idea that, during extended access to cocaine, the positive brain reward function becomes attenuated while the negative brain stress/aversive systems get involved,” says Wee.

Consequences of this resetting include the withdrawal and cravings people addicted to cocaine feel when they stop the drug. These negative emotional/aversive effects drive relapse — an unfortunate reality for many addicts who try to quit — because drug use can temporarily alleviate their negative symptoms.

A Combination Approach

The idea behind treating drug addiction with pharmaceuticals is to restore the brain’s reward and stress/aversive systems to normal, and the new study explored how combining two existing pharmaceuticals might achieve that purpose: one that doesn’t work on its own and one that works but is not prescribed because it is itself addictive.

Naltrexone is already approved by the FDA for treating alcohol and tobacco addiction.

Buprenorphine is an opiate — a painkiller similar to morphine or heroin — and it is known to be effective at helping people who are addicted to both heroin and cocaine kick their combined drug habits because it has mu opioid partial agonist effects (moderately produces the pleasurable effects of opioids) and kappa opioid antagonist effects (reverses the stress/aversive-like effects of opioid withdrawal by blocking the actions of dynorphin).

However, buprenorphine itself produces dependence and it is generally not prescribed unless someone is already addicted to a similar opiate, like heroin. The danger is that treating cocaine addiction with buprenorphine would merely substitute one dependence for another, causing people to suffer from buprenorphine withdrawal instead of cocaine withdrawal.

The Scripps Research team found a way around this problem by combining buprenorphine with a low dose of naltrexone, showing that giving rats this combination effectively blocked compulsive cocaine self-administration without causing the physical opioid withdrawal syndrome seen in rats treated with buprenorphine alone.

By Patricia Anstett

http://www.freep.com/article/20120708/FEATURES08/207080589/Revolutionary-new-drug-Vivitrol-offers-new-life-to-addicts

Friday is Amanda Gordon's one-year anniversary of being clean from heroin and prescription drugs, a remarkable recovery she never expected to achieve because she had failed so many times before.

But a monthly injection of Vivitrol has accomplished what nothing else did, including nine stints in hospital detox programs.

Her mother, Katherine Gordon, an automotive warranty specialist grateful for her daughter's release from addictions that devastated her only child and her family, goes as far as to call Vivitrol "the closest thing to a miracle I've seen."

• Live chat Tuesday at 3 p.m.: Advice on overcoming drug and alcohol addiction

The drug, approved in 2010 by the U.S. Food and Drug Administration for treating narcotics addictions in adults 18 and older, is an important advance, changing the world of addiction treatment, many doctors in the field say. Vivitrol, compared with other treatments, they say, is more effective, has no potential for abuse and sale on the street, and can be prescribed by any doctor. The drug is prescribed for addiction to heroin and prescription painkillers such as Vicodin and OxyContin, a rising problem nationally, as well as for alcoholism.

Studies in Russia of 250 heroin patients -- data submitted to gain approval from the FDA -- showed 70% of patients who used Vivitrol for at least six months were clean. But the drug's high cost -- about $1,000 per injection -- remains controversial, as does the notion of using an injection to treat drug abuse instead of focusing more on long-term behavioral changes, as prescribed by 12-step prorgrams.

There also aren't any studies to compare Vivitrol with other drugs and "that's a concern," said Dr. Carl Christensen, medical director for addiction services at the Detroit Medical Center. He said the drug can't be used during pregnancy.

The National Institute of Drug Abuse is continuing research on Vivitrol, as is the company that makes it.

After a slow start reaching doctors, family doctors such as Dr. Raghad Lepley, Amanda Gordon's physician in Highland Township, north of Milford, have started prescribing the injections.

"This is a very new era in addiction treatment," Lepley said.

Finding reliefGordon, who turns 24 Tuesday, began using heroin and prescription painkillers at 16 when she was an honor roll student at Waterford-Mott High School.

Heroin was her preference, but she crushed up painkillers and snorted them when that's all that was around. "Your whole purpose was to wake up, get some money and go get it," she said.

Once she started on Vivitrol, the urge to use drugs "wasn't there anymore," Gordon said. "I wasn't obsessing over it. I think if any addict could have that obsession lifted for 28 days, they'd see just what a difference it makes."

In contrast to any physician being able to prescribe Vivitrol, doctors need either special training or certification to prescribe other treatment drugs such as methadone or Suboxone. Both are synthetic versions of opioid drugs such as heroin and OxyContin, leading patients to sabotage their recoveries by sometimes abusing them.

Lepley said Gordon "jumped" at the chance to use Vivitrol because "we don't have a lot of options" to treat heroin and painkiller addictions.

Still, Vivitrol brings controversy because of its cost and concerns that no shot can provide the personal commitment to change that alcoholics and drug addicts must address.

Vivitrol costs $1,100 for each injection. Alkermes Inc., the Waltham-Mass.-based manufacturer of the drug, provides financial help for 13 months that reduces the price by half for people with private insurance and cuts co-pays for patients with Medicaid or Medicare to as low as $5 an injection, according to Richard Pops, CEO for Alkermes.

Doctors who use Vivitrol may try to wean people off the drug after a year, though some may need to take the shots for years, the same as other addiction drugs.

Gordon's Blue Cross Blue Shield insurance pays for nearly all the cost of the drug, but not all insurance plans do, one reason top doctors at two major metro Detroit drug rehab programs say they don't routinely prescribe it.

"I don't recommend it" because "it's just cost-prohibitive at this point," said Dr. Philip Gilly, chief of inpatient services at the Henry Ford Health System's Maplegrove Center in West Bloomfield.

Dr. Jeffrey Berger, medical director for the Brighton Center for Recovery, part of the St. John Providence Health System, said he worries also that a shot is "seductive to patients."

"It's the medicalizing of recovery that concerns me," he said. "What I see happening overall is the tendency to think that treatments come in a pill ... and people are not wanting to do the work for a substantial recovery."

Still, he predicted, Vivitrol "changes the whole ballgame."

Costly national problemMore than 1.8 million Americans are addicted to prescription painkillers such as Vicodin and OxyContin, and another 800,000 are addicted to heroin, according to 2010 data -- the latest available -- from the federal Substance Abuse and Mental Health Services Administration. Another 18.2 million have been diagnosed as problem drinkers.

Addiction is a costly national problem because so many addicts fail in recovery and overuse more expensive care in emergency rooms when they overdose or develop drug-related problems.

Drug abuse involving prescription medicines accounted for 1.3 million emergency room visits in 2010. That compares with 1.2 million visits for illegal drugs, 600,000 for alcohol and drugs combined, and 200,000 for underage drinking, according to statistics released this month by the federal Drug Abuse Warning Network, which tracks drug abuse in the U.S.

Rehab stints can cost $15,000 or more for a week's stay, and centers increasingly report seeing patients like Gordon who return more than a half-dozen times.

Dr. R. Corey Waller is an addiction specialist working with a large drug population that floods the Grand Rapids-based Spectrum Health System emergency department. Vivitrol is "exceptionally good" at treating alcoholism and "doubles positive outcomes" for problem drinkers and heroin and painkiller drug abusers, Waller said.

"The difference is night and day," Waller said of Vivitrol, comparing it with other recovery methods, including counseling alone.

The 12-step programs, the cornerstone of Alcoholics Anonymous and others like it, work no more than one quarter of the time, Waller said, referring to figures quoted widely. "Those numbers don't lie," Waller said.

The national resource group 12Step.org referred questions about success rates to an e-mail list of meetings of its sponsors. Those contacted did not respond. Confidentiality is an important component of the programs and many decline news media interviews.

Drugs in the suburbsGordon was introduced to the world of hard drugs through a former boyfriend, a drug dealer.

She was hooked in less than three months, she said.

Her parents, now divorced, didn't catch on for several years. "She was white-bread America," said her mother, who has remarried and lives in Commerce Township. "She had a 4.0," her mother said. "She had everything going for her."

She said her daughter played tuba in her school's marching band, symphony orchestra and jazz ensembles for awhile. Gordon's mother now understands how widespread drug use is, affecting the suburbs, as well as core city neighborhoods. "To see this kind of epidemic in Oakland County just floors me. I had no idea," Kathy Gordon said.

Amanda Gordon found that snorting heroin or crushed up painkillers didn't get her high enough. Deathly afraid of needles as a child, her friends talked her into injecting drugs because they said she'd get higher, and need less.

But they had to hold her down, as she sobbed, to inject her the first time, she said.

As her addiction grew, Gordon needed more to get high. When she became skinny and withdrawn, her mother started to suspect a problem, but she thought it was an eating disorder because Gordon still was doing well at school.

Kathy Gordon learned of her daughter's drug use after Amanda Gordon fought with a friend, who in turn told her mom that Gordon was a drug addict.

Kathy Gordon insisted her daughter enter rehab. While in rehab, she took the drug Suboxone, but it didn't work for her.

"It's a choice," Amanda Gordon explained. "I'd say, 'I'm going to get high today,' so I wouldn't take it."

At least three of her friends died of drug overdoses.

More ultimatums came from her parents: Get clean or get out. More rehab stints followed, as did enrollment in a methadone program. There, she met other drug users who sold her heroin, Suboxone or clean urine so she could pass the drug tests required to stay in the program.

"People would sell their pee at the methadone clinics," she said. "They don't watch you. You just go in the bathroom."

Two separate police raids within a year on the Gordon family home, where Amanda Gordon was living with her boyfriend after Kathy Gordon remarried and moved out, led to Amanda Gordon's final awakening.

She said she was disgusted with herself and a habit that grew and grew.

On July 13, 2011, Gordon begged her mother to take her to Lepley, whom she had heard about through a friend at a drug treatment program.

She wanted to try Vivitrol.

Finding a way outGordon, savvy from years in drug programs, sabotaged her first Vivitrol shot. She was supposed to be drug-free for seven to 10 days before taking it -- but she wasn't and she lied to Lepley. The combination of Vivitrol and heroin in her system left her curled up in a ball, crying for three days as she weathered painful withdrawal symptoms.

Her mother, who stayed in touch with Lepley and Gordon's friends, did her best to help her daughter soothe the symptoms.

"We got pineapples, strawberries, chocolate dips and Ensure," a liquid nutrition drink, Kathy Gordon recalled.

Somehow Amanda Gordon got through 28 days to her next shot.

Each month, she felt better. She returned to school and got an associate's degree in general studies from Oakland Community College. She dumped the longtime boyfriend and has found happiness in another relationship. She attends weekly Alcoholics Anonymous meetings, which are open to people with all addictions.

She wants to work. She just needs a job.

For now, she busies herself with a new puppy, her boyfriend, working out at a local gym, her job search and occasional talks she gives publicly to people about drug addiction. One in June was to a national organization of court administrators who oversee drug cases.

"I'm happy for the first time in years," she said.

As she planned for her daughter's birthday celebration Tuesday, Kathy Gordon wondered what gift she'd buy her daughter. She might buy her a ring because Amanda Gordon has little jewelry after years of pawning her stuff for drugs, she said in an e-mail.

"The biggest celebration is just going to be having the family together," Kathy Gordon said. "There were so many years that her behavior made it nearly impossible to have family gatherings. She would be late or not show up at all or show up and promptly fall asleep....It was easier just not to plan.

"Today, we have Amanda back, and the monster that impersonated her for so long is gone."

‘Everything is practice.’ ~Pele

Post written by Leo Babauta.

When we learn a martial art, or ballet, or gymnastics, or soccer … we consciously practice movements in a deliberate way, repeatedly. By conscious, repeated practice, we become good at those movements.

Our entire lives are like this, but we’re often less conscious of the practice.

Each day, we repeat movements, thought patterns, ways of interacting with others … and in this repeated practice, we are becoming (or have already become) good at these things. If you constantly check Facebook or Twitter, that is practice, and you are forming that habit, though it’s usually not with too much awareness.

When you smoke, or eat junk food, or speak rudely to others, or put yourself down internally, this is something you are practicing to be good at. You may already be good at these things.

What if, instead, we practiced consciously, deliberately, and became good at the things we really want to be good at?

What if you first, above all skills, learned to be more aware of what you are practicing? What if constant conscious action is the skill you became good at?

If you could learn to take conscious action, you could learn to practice other things you want to be good at, rather than the ones you don’t.

What Are You Practicing?Ask yourself these things throughout the day, to practice conscious action:

• Do I want to practice rushing through my morning, or can I wake a little earlier and simplify my morning routine so that I practice a slow, enjoyable morning ritual?
• Do I want to practice checking my inboxes when I first get to my computer, or can I do something better?
• Do I want to practice leaving dirty dishes out, or can I practice washing my bowl when I’m done with it?
• Do I want to practice leaving clothes strewn about, or papers lying on the counter, or can I take a few seconds to put them where they belong?
• Do I want to speak angrily to my kids or spouse, or can I speak to them with kindness and compassion?
• Do I want to practice complaining and self-pity, or can I practice gratitude?
• Do I want to practice rushing and being busy, or can I practice simplifying and going slowly?
• Do I want to practice eating fried foods, sugary foods, salty junk food snacks, fast foods … or can I practice eating whole foods, vegetables and fruits, nuts and beans and seeds?
• Do I want to practice surfing time-wasting sites, or can I practice clearing away distractions and creating?
• Do I want to practice watching mindless entertainment, or can I practice moving my body and exerting myself in activity?
• Do I want to practice smoking, or can I learn a healthier way to deal with stress?
• Do I want to practice shopping, or can I practice giving?

These are only examples … your life will show you what you’ve been practicing, and you can decide what you might rather practice instead. Or you might be completely happy with what you’ve been practicing.

How to Practice
The first step is always awareness. When you are conscious of what you are doing, you can decide whether this is an action or thought pattern you want to practice, or if there’s an alternative you’d rather be good at.

As you go through your day, practice this awareness. It’s the first skill, and it’s the most important one. Be aware, without feeling guilty or angry at yourself, of what you’re doing and thinking. You will forget to to this, but remind yourself. You might wear a rubber band around your wrist, or carry a talisman, or make tally marks on a slip of paper each time you remember.

As you get good at conscious action, start to practice those actions and thought patterns you want to be good at. Start to notice the ones you’d really rather not be good at, and see if you can deliberately practice other actions and thought patterns.

As you consciously, deliberately repeat these things, you’ll get better at them. It takes a lot of repetition to get good at a skill, but you’ve got time.

Important Conclusions
You won’t be able to change all your habits at once, and I’m not implying that you should try. The habit you’re really changing is consciousness, and practice. Other habits will be difficult to change, especially if you’re trying to change all of them, but it’s OK if you mess up. Give yourself permission to make mistakes without guilt, and instead just deliberately practice again, and again.

If something is too hard, and you can’t get it right no matter how many times you practice, you can try it in smaller steps. If you can’t quit smoking, try not smoking once, and instead relieving stress through walking or doing some pushups or meditation or self-massage. If you can’t quit junk food, just replace one snack with a fruit, or add a tasty veggie to your dinner.

I’d like to emphasize that this isn’t about perfection. There is no perfect way of life, and you don’t need to strive to be perfect every moment of the day. I believe you’re already perfect. This is just about conscious action, which is a useful skill to have.

Remember that we become good at what we repeatedly do, and what we do repeatedly can be done consciously. It’s when we’re conscious that we are truly alive.

‘If you want others to be happy, practice compassion. If you want to be happy, practice compassion.’ ~Dalai Lama

By Lisa Riordan Seville and Hannah Rappleye
NBC News LANCASTER, Ohio --

http://openchannel.msnbc.msn.com/_news/2012/06/07/12091096-crackdown-on-painkiller-abuse-fuels-new-wave-of-heroin-addiction?lite

Holly Yates started using painkillers in the ninth grade, at parties and hanging out with friends. The pills were everywhere, easy to get and cheap. By the time she was 18, she was abusing oxycodone, Percocet and other pill severy day.

Then they stopped being enough. 

“My cousin, she was into heroin and I started hanging out with her,” said Yates, a hazel-eyed 20-year-old. “She told me about it, and I was like, ‘I want to try it.’ The first time that I shot it up, it was like, ‘Where has this been all my life?’”

Experts say Yates and others in this town of about 38,000 southeast of Columbus are on the leading edge of a frightening new drug abuse trend – one that is ironically being fueled by a national crackdown on prescription painkillers. While new regulations and law enforcement efforts have significantly reduced the supply of these drugs, they say, those efforts have inadvertently driven many users to another type of opiate that is cheap, powerful and perhaps even more destructive – heroin.

“It’s an epidemic,” said Dr. Joe Gay, director of the regional addiction and mental health clinic Health Recovery Services, who has studied patterns of drug use in the state.

A flood of cheap heroin from Mexico, which is now one of the leading sources of the drug to the United States, is one reason for the return of the scourge. According to the Justice Department, the drug is showing up in new areas, including upscale suburban towns where heroin was once rare. 

In Illinois, for example, researchers at Roosevelt University have found a spike in young suburban heroin abusers. Long Island, New York, has in recent years seen a rash of addiction among the young. A spike in heroin use and related crime has Dane County, Wis., reeling. Even states like Washington, where heroin has a longtime presence, have seen a sharp increase among young users. In King County, home to Seattle, nearly a third of those entering treatment for heroin abuse in 2009 were between ages 18 and 29 -- a sharp increase from a decade before.

  With increased availability has come a spike in the number of visits to emergency room visits for issues related to heroin use, including a 13 percent increase from 2005 through 2009, according to the national Drug Abuse Warning Network. The highest rates of admission were for young adults, 21 to 24 years old.

“Twenty years ago, half of the heroin addicts in treatment lived in two states — New York and California,” said Gay. "(Now, in Ohio) we’re seeing it spread out of the cities, into the suburbs and into the rural areas.”

The demographics of heroin addiction are also shifting, he said. 

'It's not going away'
Until a few years ago, addicts were overwhelmingly men who lived in urban areas, many of them from racial minorities. An alarming number of those entering treatment programs in Ohio -- a good measure of addiction -- are young, he said. Most are white. They are from poor rural counties and wealthy suburbs. Many are girls and women.

In Ohio, the new face of heroin addiction could be the girl or boy next door.

“Everybody does it,” Yates said. “It’s just here, and it’s not going away.”

Sarah Mayer, 27, was an early traveler on the path from dabbling in prescription pills to putting a needle in her arm.

Born and raised in Hilliard, a tree-lined suburb of Columbus, she grew up in what is, by all accounts, a loving home. Her father works at the local bank. Her mother is a nurse.

Derailed plans
In high school, Mayer went to parties and drank occasionally, but she kept her grades up. During her last year in high school, in 2002, she took college classes. After graduation, she started a fully-paid-for nursing program. But her plans were derailed by addiction to oxycodone, an opiate-based painkiller found in many medicine cabinets across the country.

“I really didn’t know what I was getting myself into,” Mayer said. By 2005, she and her boyfriend were taking the pills regularly to get high. But over time, the effects diminished.

One day in early 2006, Sarah and her boyfriend found themselves nearly broke and without the pills they needed. Desperate and sick with withdrawals from the opiates, her boyfriend left the house to try to find pills.

He came back with a bag of powder heroin.

“He knew how I felt about heroin,” Mayer said. “That was the one thing I said I would never do.”

Young recovering heroin addicts Tej Yaich, 20, Holly Yates, 20 and Tara McCormac, 22, and Dr. Joseph Gay share their stories and discuss the growing heroin crisis in Ohio.

Despite her conviction, within 24 hours, she had snorted it. She would spend another three years chasing that first high. “It was almost like all of the wind was knocked out of my chest, I could barely hold my head anymore,” said Mayer. “It was like my whole body just exhaled.” 

Soon, she began injecting it. It would take her years, and at least six trips to recovery programs, before she successfully got clean in October 2009. She’s now working toward a degree in nursing, and recently made the dean’s list. 

The addiction was something the Mayer family never saw coming. 

“There was never a thought that ever entered my mind that I would ever lose a child through addiction,” said Randy Mayer, Sarah’s father. “Watching this thing grab her and not let go, I mean, it was a horrible time.” 

  But in Hilliard, where he also grew up, Randy Mayer said he is seeing this happen to others. 

“I’ve met some other families, locally here -- they’re dealing with the same kind of situation,” he said. “The fact of the matter is, these towns like this are fertile for this to spread.” 

Paul Coleman, director at the Maryhaven clinic near Columbus, where Mayer sought treatment, said about a quarter of the nearly 130 adolescents currently getting treatment there have used opiates --  something he’s never seen in his 22 years at the center.

“A few years ago if you would have asked me how many young patients I would have using opiates I wouldn't have said 25 percent,” Coleman said. “I would have said none.”

The White House has called prescription drug abuse the nation’s fastest-growing drug problem. The Centers for Disease Control and Prevention has officially dubbed it an epidemic.

'Crisis'
In Ohio and elsewhere, however, the beast has two heads. Opiate abuse, which includes both prescription painkillers and heroin, has become a “crisis of unparalleled proportions,” according to Ohio’s Department of Alcohol and Drug Addiction Services. In 2001, just eight of Ohio’s 88 counties reported a significant number of patients were entering substance abuse treatment for opiate addiction. By the same measure, 85 of Ohio’s 88 counties reported an opiate problem in 2010.

The state has taken action. In 2006, it implemented a system to track prescriptions to help prevent so called “doctor shopping,” where addicts move from one physician to the next looking for prescriptions. Last year, it also passed a law to help fight “pill mills,” unscrupulous storefront clinics known for readily dispensing prescriptions.

Similar measures have been taken across the nation. Combined with new pill formulations that make the medication harder to crush up to snort or shoot, the efforts have curbed supply and abuse. Experts agree this is a positive step. But in Ohio, the crackdown has had unexpected consequences.

The pills have become expensive, and often hard to obtain. Prescription opiates now sell for anywhere from $30 to $80 dollars a pill. A $10 bag of heroin offers a similar or better high.  Unable to find pills, or afford them, addicts go looking for something else to feed the craving. Heroin is cheap, plentiful and potent.

It is also deadly. In fact, the state saw a record number of heroin-related deaths in 2010, which now account for one in every five overdose deaths in the state. Cuyahoga County, home to Cleveland, recorded 106 heroin-related deaths in 2011 -- an increase of nearly 180 percent since 2003, according to the Cuyahoga County Medical Examiner's Office. In early May, Loraine County, Ohio, saw five fatal overdoses in 10 days due to a batch of highly potent, or badly cut, heroin. Experts worry other counties may soon follow suit,and that those dying might be among what the Ohio Department of Alcohol & Drug Addiction Services reports show is the fastest growing demographic of heroin users -- young people between ages 20 and 35.

It’s an addiction that surprises even those who find themselves in its grip.

“If you were to tell me that I was going to use heroin ... the same week in which I used it, I probably would have laughed in your face,” said Tej Yaich, a 20-year-old from Pickerington, Ohio. “That’s something that I would never have done.”

For Yaich, who has been sober for more than a year, addiction started at home. His parents had prescriptions sitting unused in the medicine cabinet. Yaich said he was 15 when he first tried them, crushing them up at night so his parents wouldn’t hear the noise. The experiment became a habit. Then the supply started to dry up.

“One day I went to call my guy that was selling to me and he said he didn’t have pills at that time, but he had something equally as good,” said Yaich. “He said, ‘You’ll like it.’”

What the dealer had was heroin, and he was right. Yaich started by snorting it, then quickly moved on to shooting up. From one bag, he worked himself up to two, then five. At the height of his addiction, he said, he injected up to 25 bags a day.

Yaich’s story is typical of those that Dr. Steven Matson hears from young people coming into his clinic at Nationwide Children’s Hospital in Columbus. Matson, who helped Yaich recover, runs a program there that uses a fairly new medication called buprenorphine, a semi-synthetic opioid that when used correctly helps to curb cravings to assist in recovery.

When Matson started this work three years ago, the young people coming into his clinic were “fringe,” he said. Now they are as often from upscale suburbs of Columbus as from poorer, more rural areas.

“Because of the availability of these drugs now, it is not an usual story that we hear, ‘I went to a party, some friends there were doing heroin, so I shot up,’” he said. “It seems like madness that you would go to a party and never have used anything and then use heroin. But that’s what’s happening with some children.”

Matson’s program also helped Holly Yates recover. She’s been sober since Thanksgiving Day 2010. For more than a year, she’s held a job as a stylist at a local hair salon. She saved up to buy herself a silver Honda Accord. In the back seat are two car seats for her young nephews, who her older brothers now trust her to babysit.

But things can be lonely in Lancaster, where she says nearly everyone her age uses drugs, and many are hooked on heroin.

“It’s just hard being young and staying clean,” Yates said. “I mean this town, it’s just, like, that’s all that’s here.”

“I just want kids my age to know that you don’t have to keep using,” she added. “You can be clean, and you can have a better life.”

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.