Read all about it here.
Don’t Forget — National Prescription Drug — Take Back Day is TOMORROW!
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How long should therapy last?
I like this opinion article from the NY Times written by Jonathan Alpert, a psychotherapist practicing in New York.
I don’t disagree with long — term psychotherapy when it’s the desire of the patient and within the skillset of the practitioner. It’s exactly what some patients want as they unravel complicated lives and complicated reactions to it.
But…
as therapists, we must face that some people want and need quick strategies that focus directly on problem solving.
This often means defining the problem (which is different than the chief complaint) and pursuing treatment that increases the possibility of solving the problem. This is much different than comforting the patient. This is the money quote from the article:
… there’s a difference between feeling good and changing your life. Feeling accepted and validated by your therapist doesn’t push you to reach your goals. To the contrary, it might even encourage you to stay mired in dysfunction. Therapy sessions can work like spa appointments: they can be relaxing but don’t necessarily help solve problems. More than an oasis of kindness or a cozy hour of validation and acceptance, most patients need smart strategies to help them achieve realistic goals.
A good therapist can accomplish this without antagonizing the patient. Good therapists balance on the razor’s edge with keeping enough tension in the air that reinforces the need for change, all the while helping the patient’s self — confidence that change is possible and necessary.
I do think the author should have mentioned that certain disorders may have both a treatment phase (an acute burst of therapy, with a goal on designing strategies that increase the possibility for change) and a maintenance phase. In a maintenance phase, especially for chronic relapsing disorders like addictions, it can help to continue regular meetings with the goal of preserving recovery rather than acute treatment. This is often called “relapse prevention” therapy. Relapse prevention helps the client maintain recovery by focusing on positive gains in treatment while monitoring for warning signs of increasing addiction risk.
Club Drugs, Hallucinogens, and PCP
I have a new seminar online which you can find by going here.
This is the topic at the University of Colorado Addiction Psychiatry lecture tomorrow.
It’s been updated to include information about methedrone, mephedrone, methylone aka Bath Salts, Plant Food, Pond Water Cleaner, Ivory Wave…
As always, feel free to contact me if you’re interested in a presentation to your local group. Free in Denver!
Save lots of money (and get better anyway)
I just stumbled across this article by Dr. Aaron Carroll who writes at The Incidental Economist and is also the author of books like
Don’t Swallow Your Gum!: Myths, Half-Truths, and Outright Lies About Your Body and Health
Read the entire post here if you are interested.
Basically, there are new drugs which innovate, new drugs which replicate… and new drugs which obfuscate. That’s it for the rhymes today.
A good example, in my specialty, is “new” Lexapro sits along “old” Celexa. Lexapro is $$$. Celexa costs $. Drugs like Lexapro extend patent protection not by creating a novel molecule but by modifying Celexa just enough so that from the FDA’s standpoint it’s a new drug. There is not one shred of evidence that Lexapro is better than Celexa, and don’t expect any — in the brain, Celexa and Lexapro are identical.
Another examples is Pristiq (which is modified Effexor).
If anybody’s interested there’s a LOT to say about this but I’ll wait to see if there’s much interest in the topic.
The OxyContin Generation
Unlike most “generations” which segregate based on a slice of the demographic, I’d say the OxyContin Generation started in the late 1990s, includes everybody from near — teens to senior citizens, includes all races, all parts of the country, and continues today. You might give it a different name today — especially since OxyContin was reformulated and made more difficult to abuse — but whether we rebrand it as the Vicodin generation, the oxycodone generation… it’s all the same.
Prior to the 1990s, pharmaceutical opioid abuse was a known problem, for sure, but the major opioid abuse epidemic in the United States involved heroin. For lots of reasons, both local to the United States (push for chronic pain enhancements, relaxation of state boards of medicine in their view of “overprescribing”) as well as geopolitical (believe it or not, the Taliban had a sharp role in reducing the world’s supply of opium/heroin), the drug of abuse pattern in the United States shifted quite dramatically from illegal opioids like heroin to sundry legal opioids like OxyContin. OxyContin took parts of the eastern United States by storm in the late 1990s, even earning the name Hillbilly Heroin because of its surge of popularity in Appalachia.
So, what are we left with now? An epidemic of pharmaceutical abuse that finds
- 2500 pre-teens/teens misusing an opioid for the first time every day
- more Americans dying from drug overdosages than car accidents
- booming morbidity in emergency departments from pharmaceuticals
Here’s an article from the NY Times that looks at how the battle is being played out one patient at a time. I like this article, because it focusses on the group caught in the crossfire between an out — of — control drug epidemic and the vulnerable patient population it’s created.
Youth Suicide Prevention
Did you know that…
- About 15% of highschoolers seriously consider suicide
and
- Suicide is the third leading cause of death in the 10 — 24 age group
This brief from the CDC highlights the above facts and also points you towards very helpful resources that help to assess, understand, and monitor the at — risk population.
Almost One Million Fewer Users of Cocaine in US 2005 — 2010
From the SAMHSA blog, here’s a summary about the gradual reduction in cocaine use in the United States.
The article doesn’t go into the many reasons that cocaine is less popular. Some of these are:
- reduced Colombian production
- ongoing large volume interdiction at the Mexican border
- more shipments to Europe
- all of the above make cocaine more expensive, while the US in an economic downturn
- drugs have fads, just like fashion and pop culture products
For more information, check out my free presentation on Stimulants. This is the same presentation given at the University of Colorado on April 4.
National Prescription Drug Take — Back Day is Saturday, April 28
Saturday, April 28, is National Prescription Drug Take — Back Day. It’s sponsored by the DEA and in partnership with local law enforcement as well as the University of Colorado and other agencies.
The Take — Back Day in November 2011 collected 188.5 tons (!!!) of unused and expired medications.
Since there is a glut of dangerous medications sitting in the medicine cabinets all across the country, taking your unused and expired medications for safe disposal is good for the environment, helps you avoid an accidental exposure, and reduces the chance that your child, neighbors, or visitors rummage through your home for drugs.
Metro — Denver locations for the National Prescription Drug Take — Back Day can be found here.
New Stimulant seminar online
I’m teaching at the University of Colorado Department of Psychiatry on Wednesday. Here’s a copy of the presentation. The topic is Stimulants.
If your organization would like training on drug abuse, please let me know!
2 “medical” mariuana physicians arrested in Larimer County
From the Denver Post, here’s a brief news blurb about two docs arrested for allegedly handing out phony marijuana recommendations.
The doctors are Dr. Dallas Wilson and Dr. Joseph Montante.
As I’ve offered before, this is not a rare occurrence. Only a small percentage of the “medical” marijuana recipients are the infirm with chronic medical disabilities like glaucoma, cancer, or chemotherapy induced nausea.