ABA

H E A LT H S E R V I C E S

FRONT COVER

FALL 2016 ISSUE

‘ L I G H T T O U C H ’ Psychiatric Rehab ’ s

THERAPEUTIC TOOLBOX TECHNIQUES FOR RECOVERY

Diagnosing DUALITY

TREATING COOCCURING DISORDERS

COMMUNITY

Roots ABA’S PUBLIC

HEALTH MISSION

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ABA H e a l t h S e r v i c e s

CONTENTS To send a comment or

FALL 2016 ISSUE

question, write to: ABA Health Services 3939 Reistertown Rd, Baltimore, MD 21215 (973) 868-5401

FEATURES 08 COMMUNITY ROOTS

ABA Magazine is published by theinfluence.org

Bringing mental health care to the people 12 GETTINGHIS MIND RIGHT The power of ‘coming back’ 16 AN EXTRA PUSH INTORECOVERY Good things come in small groups 46 DIAGNOSIS DUALITY Treating co-occurring addiction and mental illness 50 THE LIGHTTOUCH Psych rehab helps clients succeed 54 THETHERAPEUTICTOOLBOX Mental health and addiction care share common techniques 60 THE GO-BETWEEN ABA coordinator manages care plans

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Copyright 2016 by AVA Consultants. No part of this publication may be reproduced in any form or by any means without the prior written permission of the publisher, excepting brief quotations in connection with reviews written specifically for inclusions in magazines or newspapers, or limited excerpts strictly for personal use. Printed in the United States of America. All rights reserved.

IN THE NEWS 24 BEND BUT DON’T BREAK Yoga is being used to help people maintain recovery and avoid relapse 26 COPINGWITH DISCRIMINATION Discrimination remains largely ignored as a cause of substance abuse 28 FIGHTING FIREWITH FIRE Researchers look to combat addiction through repurposed pharmaceuticals 30 HIDDENDANGERS Alcohol poses whole host of health concerns 32 MORETHAN SKINDEEP Implant represents revolutionary approach to treating opioid addiction

34 UNDERSERVED AND UNDETERRED Overcoming the unique challenges LGBTQ individuals face with addiction 36 RELAPSETRACKERS Fitness trackers can help prevent relapses 38 PROLONGINGTHE PAIN Study suggests painkillers may be having the opposite effect in the long run 40 GROWING CONCERNOVER HEROIN USE New poll shows Americans are increasingly concerned with the dangers that heroin use poses to the country 44 BOOM, BUST, ANDDRUGS Study says economic downturn leads to increase in substance use disorders

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AB A H e a l t h S e r v i c e s

MISSION

THE MISSION OF ABA IS TO PROVIDE QUALITY HEALTH CARE SERVICES THAT ENABLE INDIVIDUALS TO RESTORE AND MAINTAIN THEIR

HEALTH STATUS AND ATTAIN OPTIMUM HUMAN DIGNITY.

PHILOSOPHY THE PHILOSOPHY OF ABA IS THAT MENTAL HEALTH PROBLEMS ARE PUBLIC HEALTH PROBLEMS AND BY PROVIDING CERTAIN PUBLIC HEALTH SUPPORT TO A PREDISPOSED INDIVIDUAL AND FAMILY IN THEIR COMMUNITY, THAT THE INDIVIDUAL COULD IMPROVE AND BECOME AN EFFECTIVE AND CONTRIBUTING MEMBER OF THE COMMUNITY. TOWARDS THE MANAGEMENT OF THEIR HEALTH, PEOPLE HAVE THE RIGHT AND DUTY TO PARTICIPATE INDIVIDUALLY AND COLLECTIVELY IN THE PLANNING AND IMPLEMENTATION OF THEIR HEALTH CARE.

HISTORY ABA WAS ESTABLISHED IN 2002 TO PROVIDE COMMUNITY OUTPATIENT MENTAL HEALTH SERVICES – OMHC AND PRP IN BALTIMORE CITY AND SURROUNDING AREAS. ABA PROVIDES DIAGNOSIS, TREATMENT, REHABILITATION AND SUPPORT TO INDIVIDUALS TO DEVELOP AND ENHANCE COMMUNITY AND INDEPENDENT LIVING SKILLS.

Minding Your Health

Over the past few decades in the United States, the public mental health system has shifted from a reliance on large institutions to smaller, community-based settings where services can be better provided to help people in need live meaningful lives. Society's growing understanding of mental illness has stimulated interest in a public health approach to mental health, although that does not necessarily mean that public health agencies must lead these efforts. Community-based agencies, like Baltimore-based ABA Health Services, play an essential role. At ABA Health Services, care is based on the belief that, by providing certain public health support to consumers in their communities, they can live, and thrive, as effective and contributing members of the community. Towards the management of their health, ABA also believes people have the right and duty to participate individually and collectively in the planning and implementation of their own health care.

ABA provides diagnosis, treatment, rehabilitation and support to children, adolescents and adults, to develop and enhance community and independent living skills. Outpatient mental health services at ABA include therapeutic behavioral services (TBS), psychological testing, a psychiatric rehabilitation program, therapy, and psychiatric services. Services are provided by a doctor of public health, psychiatrists and other physicians, psychologists, registered nurses, social workers and counselors. MEETING AN ACUTE NEED Albert Njoku, who founded ABA in 2002, rst became aware of an acute need for more mental health services when he was doing public health

”MANY PEOPLE WERE HAVING PROBLEMS ACCESSING THE PUBLIC MENTAL HEALTH SYSTEM, AND THERE

WAS A LACK OF TRUST.” – Albert Njoku, founder, ABA Health Services

BRINGING MENTAL HEALTH CARE TO THE PEOPLE 8

consulting for the Maryland Department of Health. “Many people were having problems accessing the public health system,” Njoku says. Njoku came to the U.S. from his native Nigeria in 1980, after earning a bachelor's degree in health and physical education. After emigrating, he earned a master's in hospital management from the University of Pittsburgh's School of Public Health, and a DrPH degree In health services administration. Njoku has worked in the mental health eld for the past 20 years, rst as an associate professor of health services management and director of research at Southeastern University in Washington, D.C., and then as a consultant for the U.S. Department of Health and Human Services and as a health planner for the state of Maryland. When Njoku was getting ABA off the ground, he spent much of his time visiting area hospitals, clinics and health care and social service agencies to make them aware of the range of services ABA could provide to those in need. Over time, ABA developed a solid referral base, and built a positive reputation as a care provider – which also resulted in many “word-of-mouth” and walk-in referrals. “Providing mental health services is a public health challenge, and we don't do it in isolation,” Njoku says. Unlike some community-based agencies, ABA provides a wide range of services on-site and off-site, with staff psychiatrists, therapists and counselors and a recently-added substance abuse program. Another thing that distinguishes ABA is its location in an area of West Baltimore that has one of the city’s highest concentrations of public health challenges – including poverty, relatively high rates of mental illness and substance abuse, prostitution, drug dealing and other crimes. Joel Coonin, a clinical social worker who has been working in the mental health eld since 1952, has worked at ABA for several years. “This is a good agency; I'm quite fond of what they do here,” says Coonin, who formerly worked for the Veterans Administration, and also served as an assistant clinical professor of social work at the University of Maryland. “What I like most about ABA is that they are very thorough; they aren't 'hit and miss.' We've had patients who received care at top notch hospitals who hadn't been successful; they have come here and done well.” 9

”PROVIDING MENTAL HEALTH SERVICES IS A PUBLIC HEALTH CHALLENGE, AND WE DON'T DO IT IN ISOLATION.” – Albert Njoku

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”IT'S A GOOD GROUP OF PEOPLE HERE AND WE HELP EACH OTHER OUT.” - Edward, ABA Health Services consumer

In his Baltimore neighborhood , 56-year-old Edward lives about a block away from ABA Health Services. Still, he wasn't aware of ABA until his physician suggested he see a psychotherapist there to get help with his mental health challenges. Making that one-block walk in 2011 started Edward on a journey of recovery after years of dependence on alcohol and cocaine. Last February, he became one of the rst consumers admitted to ABA's new, intensive outpatient treatment program for addiction, at the suggestion of his therapist and ABA founder and Executive Director Albert Njoku. It might be an understatement to say Edward has led an interesting life. His criminal record lists 113 arrests, and 56 convictions over the years, many for shoplifting offenses committed to support his habit. But that was Edward's life before ABA. What's more important now is that, since he started getting help in February of 2011, he hasn't been arrested or jailed. “After a while, I just got tired of the same thing over and over again,” says Edward, who Growing up in Baltimore's Park Heights-Pimlico neighborhood, Edward started using at age 15, partly due to “peer pressure,” he says. After a while, getting high everyday became as normal as brushing his teeth. “It takes a while before you realize that you have a problem.” Edward says ABA came into his life at the right time. “I knew I wanted to stop using drugs and ABA has helped me a lot.” “The people that run the program at ABA make you want to keep coming back; they are professional and now supports himself as a self-employed landscaper.

friendly. And they are not judgmental; you can't run a

THE POWER OF

'COMING

BACK’ substance abuse group and be judgmental.” Regardless of social class, gender, income, race or other supercial differences between people, no one is immune from addiction, Edward notes. “Addiction is color-blind and it doesn't matter if you are rich or poor; if you're addicted, you're addicted.” KEEPS COMING BACK Like many other recovering people, Edward has found that the simple act of “coming back” for intensive outpatient sessions three times a week is what enables him to stick with the process of recovery. Without the help he has found at ABA, Edward might well be in prison, rather than getting better, he says. “It's a good group of people here and we help each other out. We discuss ways of staying clean and dealing with cravings.” “One thing you denitely have to do is change people, places and things. If you don't do that, pretty soon you'll be right back out there. You have to learn to respect addiction.” “If I ever have any thoughts of getting high, the nine hours I spend there on Monday, Wednesday and Friday give me a chance to get my mind right.” Along with his adult daughter and 9-year-old grandson, the most important thing in Edward's life now is his recovery, and his three-times a week intensive outpatient sessions at ABA. “I'm not doing this because I was ordered by the court; I'm doing it because I enjoy it. ABA is a really good place.”

”THE THREE HOURS I SPEND THERE GIVE ME A CHANCE TO GET MY MIND RIGHT .” – Edward

ABA H e a l t h S e r v i c e s

MENTAL HEALTH THERAPY AND COUNSELING

WE ARE COMMITTED TO YOUR PSYCHOLOGICAL CONCERNS AND OUR SERVICES ARE PROVIDED BY LICENSED/CERTIFIED MENTAL HEALTH PROFESSIONALS. DURING SESSIONS, OUR CLINICIAN PROVIDES AN INTERACTIVE DISCUSSION OF YOUR CONCERNS AND OPTIONS FOR INTERVENTION OR TREATMENTS. THE SERVICES INCLUDE HISTORY, PSYCHIATRIC DIAGNOSTIC AND EVALUATION, PSYCHOTHERAPY (INDIVIDUAL, FAMILY, GROUP), TREATMENT PLAN.

Minding Your Health

3939 REISTERTOWN RD, BALTIMORE, MD 21215 410-367-7821

Angela Hall , an enrollment specialist at ABA Health Services, appreciates having the opportunity to make a difference in clients' lives. People who are battling addictions have some things in common, but tend to vary in their commitment to getting and staying clean and sober, says Hall, whose initial interest in the addiction treatment eld was inuenced by seeing family members and friends struggle with addiction. “Addiction seems to be everywhere.” “Here at ABA, we see some people who really want to recover; others may be here because someone suggested they needed to be here. I always hope that with them continuing to come here, they may want to change that, and really decide to change.” “That's why we're here – to give them an extra push and tell them, ‘You can do it.’” Hall, who has a bachelor's degree in social work, is working on earning her master's degree in addiction counseling. She's gaining a valuable on-the-job education in watching ABA counselors work with treatment consumers in group settings.

GOOD THINGS

COME IN SMALL GROUPS

”THAT'S WHY WE'RE HERE:

TO GIVE THEM AN EXTRA PUSH AND TELL THEM, ' You can do it .'“ –– Angela Hall, enrollment specialist, ABA Health Services

Consumers help each other The time-tested, small-group therapy setting is an effective way to get people started on the path to recovery, Hall says. “I think it makes a big difference because the members tend to form bonds in group and even socialize with each other outside of group. They show up diligently for group, and are excited to talk about things that are going on in the world. They are able to nd a way to express their opinions and even help each other in crisis. That's the important part of it; they are all there for the same reason, to support each other.” “We know that the program here is serving its purpose and making a difference for a number of individuals who come here to get help.” Over time, even consumers who may initially be reluctant to be in addiction treatment tend to develop an appreciation for the potentially life-saving services offered by ABA, Hall says.

Treatment providers can use a variety of approaches and methods to help steer addicted people into recovery. But, in the end, “it's up to the individual and if they are really ready to make a change, that's the main thing. If someone is not willing to make a change, we are not going to see much progress.” In treatment, honesty and straight-talk take the place of the denial and dishonesty that are part of the disease of addiction. “I like consumers to just be honest with me, so we both know where we stand. I will never turn someone away and say, 'I can't help you.' The best thing to tell consumers who are reluctant is that, when they are ready, we'll be there to help them move forward.”

”THE PROGRAM HERE IS SERVING ITS PURPOSE AND MAKING A DIFFERENCE FOR A NUMBER OF INDIVIDUALS WHO COME HERE TO GET HELP.” – Angela Hall

THERAPEUTIC BEHAVIORAL SERVICES (TBS) ABA Health Services also offers therapeutic behavioral services for children, teens and young adults. TBS could complement the other services that we provide to minors who need more in-home services. TBS helps to mend the relationship between the patient and the care provider, to avoid the patient being placed in a higher level of care or institutionalized in a residential treatment facility, and TBS allows them to live at home with their family.

Minding Your Health

ABA H e a l t h S e r v i c e s 410-367-7821 19

SUBSTANCE ABUSE TREATMENT

Doyou knowsomeonewhocould use some help in their recovery? Aba Health Services has a program for substance abuse treatment that includes detoxification, behavioral counseling, medication evaluation and individualized treatment for addiction. Weworkwith individualswho have serious addictions to drugs and alcohol and help them in deviating from destructive habits or behaviors. So If you knowsomeonewho has become A substance abuser PLEASE... refer them toour counselors at Aba Health Services. 20

ABA H e a l t h S e r v i c e s

3939 Reistertown Rd, Baltimore, MD 21215 410-367-7821

Minding Your Health

SERVICES PSYCHIATRIC VISITS || MENTAL HEALTH THERAPY AND COUNSELING SUBSTANCE ABUSE TREATMENT || PSYCHOLOGICAL TESTING THERAPEUTIC BEHAVIORAL SERVICES (TBS)

Minding Your Health

A BA H e a l t h S e r v i c e s

3939 Reistertown Rd. || Baltimore, MD 21215 || 410.367.7821

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HELP IS ONE CLICK AWAY

Bend But Don’t Break Yoga is being used to help people maintain recovery and avoid relapse

Yoga is no longer exercise your annoying, health-conscious friend won’t stop talking about.The ancient practice is now being used to help people recover from addiction. While scholars estimate yoga was developed sometime around 300 to 400 B.C., the practice hasn’t stopped changing over the last 2,000 years. A new wave of yogis are now helping people in recovery connect their spiritual and physical sides through yoga by combining the practice with more traditional 12-step elements. “It’s just a way of coming back to a sense of wholeness,” says Nikki Myers, a yoga therapist who helped develop the 12-step yoga system. “We use yoga as a process in order to bring that reintegration.”

Myers says she developed the system primarily as a means of relapse prevention. She says a typical 12-step yoga session would begin the same way most 12- step meetings do, with a focus on sharing and discussion of important recovery topics. Once the “meeting” portion of the session is over, the group will then move into a series of yoga poses designed to help participants focus on their physical recovery. “A focus needs to be on the body- based piece as well as the cognitive piece in order for wholeness to really be manifested,”Myers says. “Once you include those things, the whole idea is that these will begin to offer us a set of tools that we can use both on the mat in the yoga practice and off the mat when the triggers of life show up.”

“It’s just a way of coming back to a sense of wholeness.” - Nikki Myers, yoga therapist

The right tools Myers says the idea that yoga can provide a set of tools is critical as the practice of yoga is much more than the poses themselves. She says there’s also a focus on breathing techniques, a meditation of sorts, and a connection to one’s physical reactions that can prove vital when faced with difficult circumstances. Myers recalls how one woman who participated in 12-step yoga later found herself in a very stressful situation at home with her kids misbehaving and everything going wrong. She said she could feel the negativity boiling up inside her. It was the kind of stress that had triggered her to drink in the past, but the woman said in that moment she was able to relax and calm herself by focusing on her breathing and remembering the feeling of tranquility she had experienced in class. “It had a way of creating a space, giving her tools to create a space between her reactions and instead take a different neural pathway,”Myers says. “These are the kind of tools that we’re looking to have people use.” “A focus needs to be on the body-based piece as well as the cognitive piece in order for wholeness to really be manifested.” - Nikki Myers

Not a replacement Myers is quick to point out that yoga is not a substitute for traditional 12-step support, but rather an additional measure that some people may find helpful. She says some people have pushed back against the practice, but others have been enthusiastic about its power, with classes spreading across the country and even internationally. Myers says she hopes that one day 12-step yoga will be as common as other treatment programs. But she says as long as people are maintaining sobriety and finding wholeness within themselves, she’ll be proud of the difference her system has made. “We’ll tell people, ‘Notice this in your body, what it really feels like,’” Myers says. “Healing only happens in safe space.”

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Discrimination, whether based on race, gender, or sexual orientation, has long been thought to be a contributor to substance abuse. Now a new study has confirmed the relationship between discrimination and addiction, but it’s also brought up many more questions that still need to be answered in order to improve treatment outcomes. Researchers at the University of Iowa recently completed a peer review study in which they looked at 97 previous studies on discrimination and alcohol use. Their goal was to summarize the collective knowledge researchers have uncovered throughout the years, and what they found confirmed in more detail what many had previously suspected.

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“Generally there is good scientific support, but the evidence is mixed for different groups

and for types of discrimination.” - Dr.Paul Gilbert, University of Iowa

overtly racist or sexist to another person. But less research has been done on what are known as micro-aggressions, small everyday occurrences that can rub a person the wrong way. That research is improving, but there are other factors that need to be more fully explored. While studies have looked at historical trauma in the African-American population, the concept has not been fully investigated with regards to Hispanic and Asian populations. “This notion of historic trauma could be really relevant to other groups, but it hasn't received much attention at all,” Dr. Gilbert says. “This is something we should pay attention to.” All of this adds up to the fact that treatment providers may be missing a key piece of the substance abuse puzzle.

The team found that discrimination did indeed lead to an increase in drinking frequency, quantity of alcohol consumed, and in the risk for alcohol use disorders. Researchers say drinking can represent a coping mechanism in response to the stress caused by discrimination, and several studies showed clients acknowledging this direct link themselves. But when looking at specific populations and types of discrimination, the picture becomes less clear. “The story is that generally there is good scientific support, but the evidence is mixed for different groups and for types of discrimination,” says Dr. Paul Gilbert, the study’s lead author. “We don’t really know comparing one type or one level to another.” For example, much research has been done on interpersonal discrimination where someone is

But just because the intricacies of how discrimination affects drinking aren’t yet fully understood, that doesn’t mean our current knowledge base can’t be helpful. Dr. Gilbert says simply knowing that experiences with discrimination can drive drinking could inform the way treatment providers interact with clients, opening new areas of their lives to explore during treatment. “It can serve as sort of an early warning or indicator,” Dr. Gilbert says. “For treatment providers, it’s worth looking at: is there something that may be keeping folks from accessing services or affecting outcomes?”

Dr. Gilbert says treatment providers should continue to address discrimination as part of a holistic approach to recovery. He says it will be up to researchers to fill

in the gaps to find the precise ways that discrimination affects drinking behavior. “We’ve got good evidence on this level of interpersonal discrimination,” Dr. Gilbert says. “We’ve gotten the low-hanging fruit, now it’s time to start working on the stuff that’s a little further up the tree.”

“It can serve as sort of an early warning or indicator.”

FIGHTING FIRE WITH FIRE FIGHTING FIRE

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ADJUSTING ALCOHOL CONSUMPTION Another team of researchers at the University of Queensland in Australia believe the FDA-approved drug pindolol could be used to stop alcohol abuse. Pindolol is an anti-hypertensive medication used to treat high blood pressure. But because of the way it interacts with neurotransmitters in the brain, they believe it could also be eective in treating alcohol use disorders (AUDs). To study the drug’s eect, the team used mice and exposed them to an alcohol consumption regimen similar to a binge drinking cycle common in humans. For mice also given pindolol, the team found they were able to reduce drinking in the long term (after at least 12 weeks).e team did not see as positive of results in the short term (only four weeks), but they say they’re still excited about its potential uses. “Although further mechanistic investigations are required, this study demonstrates the potential of pindolol as a new treatment option for AUDs that can be fast-tracked into human clinical studies,” the authors wrote.

espite years of stigma, medication-assisted treatment (MAT) is steadily gaining in popularity among treatment providers. Government groups like the U.S. Department of Health and Human Services are actively campaigning to get more providers to oer MAT as a potentially vital resource for patients. While such groups often promote well-known medications such as methadone and buprenorphine, drug researchers are looking for new medications that could be a lifeline to patients in need. But new medications can cost millions to research and take years to get on the market.at’s why some researchers are taking a closer look, and nding success, with drugs already approved by the FDA. CURBING COCAINE USE Researchers at the University of Pennsylvania say a drug already on the market for diabetes may be able to curb cocaine use.e FDA-approved drug Byetta, used to regulate blood sugar in diabetic patients, is derived from a natural hormone known as GLP-1.e research team looked at how the hormone functioned in rats and found that the same hormone that regulates food intake could be used to suppress cocaine consumption. “ese results are very provocative and suggest these compounds could be repurposed for drug addiction,” says Dr. Heath Schmidt, one of the lead researchers. “We have seen a reduction in cocaine consumption…but it doesn’t completely abolish it.” Currently, there is no FDA-approved drug for the treatment of cocaine abuse. But because Byetta and a similar drug have already gained federal approval, researchers say that leaves fewer hurdles before they could be used in treatment settings. Although still far from human trials, researchers say they’re optimistic, especially because their research suggests the hormone is not specic to cocaine and could be used in treatment of other substance abuse disorders. “I think this opens up a large world view with regards to this system in the brain,” Dr. Schmidt says. “ere’s really a lot to be explored here and I think it’s really an exciting time to be in the eld and exploring the GLP-1 system.”

Most people are aware that excessive alcohol consumption is bad for your liver. But newresearch shows it can also be harmful toother parts of your body and put you at risk for a number of diseases previously thought to be unrelated toalcohol use.

Trouble breathing A research team from Loyola

Cancer nightmare

Cardiovascular concerns Heart disease is the number one killer of people worldwide, and medical experts everywhere have been trying to gure out how to reduce the risks associated with cardiovascular conditions. New research suggests they should take a closer look at alcohol. While some studies have suggested that low levels of alcohol consumption can improve heart health, a team of researchers from the University of California - San Francisco found that to be a bit of a mixed bag. In studying health dierences between people living in “dry” (alcohol sales prohibited) and “wet” (alcohol sold more freely) counties in Texas, they found varying results. “Greater access to alcohol was associated with more atrial brillation and less myocardial infarction and congestive heart failure,” the authors wrote. “Although an increased risk of congestive heart failure was seen shortly after alcohol sales were liberalized.” So while they did see a dip in some cardiovascular conditions, the results also show a clear link between alcohol access and various health problems. Researchers said policy makers should use this information when establishing laws to protect public health. “We believe that our results have broadly applicable health implications relevant to people with and at risk for various types of cardiovascular disease,” the authors wrote.

When people think about substances that can cause cancer, they often think of cigarettes or other tobacco products. But a new study shows alcohol may also be a major contributing factor to no fewer than seven types of cancer. A researcher from the University of Otago in New Zealand, Dr. Jennie Connor, looked at a number of studies dealing with cancer and alcohol and found strong evidence that excessive drinking can cause cancer in seven parts of the body. Connor identi ed those areas as the “oropharynx, larynx, oesophagus, liver, colon, rectum and breast.” She wrote that while there are always limitations to determining exactly what caused a speci c disease, the evidence is overwhelming. “Current estimates suggest that alcohol-attributable cancers at these sites make up 5.8 percent of all cancer deaths worldwide,” Connor wrote. “Con rmation of speci c biological mechanisms by which alcohol increases the incidence of each type of cancer is not required to infer that alcohol is a cause.”

University in Chicago recently found that excessive drinking could also cause problems in the respiratory system.e team looked at levels of nitric oxide in the exhaled breath of over 12,000 people. Nitric oxide protects against a number of respiratory diseases and can even be used in medical settings as a treatment for sick infants. e researchers found that excessive drinkers had less nitric oxide in their breath, meaning they were more susceptible to respiratory infection and disease. Although more research is still needed to determine the full extent of the relationship between alcohol and nitric oxide, the authors of the study said the results are troubling. “Alcohol use impacts several lung diseases, and heavy consumption has been associated with poor clinical outcomes,” the authors wrote. “e fractional excretion of exhaled nitric oxide (Feno) has clinical implications in multiple airways diseases.”

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Sign of the times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treatment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the eld who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government ocials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to prescribe medications like buprenorphine, but they say too few patients receive the medication they need. National Institute on Drug Abuse, in a statement. “is product will expand the treatment alternatives available to people suering from an opioid use disorder.” ] [ "Opioid abuse and addiction have taken a devastating toll on American families.” - Dr. Robert M. Cali, FDA Commissioner “Scientic evidence suggests that maintenance treatment with these medications in the context of behavioral treatment and recovery support are more eective in the treatment of opioid use disorder than short-term detoxication programs aimed at abstinence,” said Dr. Nora Volkow, director of the

edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could oer renewed hope to thousands of people struggling with an addiction to opioids. is summer, the U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid dependence. Buprenorphine had previously been available only as a pill or a dissolvable lm placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Cali said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” e implant comes in the form of four one-inch rods that are placed under the skin on the upper arm.e implant must be administered surgically and comes with the possibility of certain side eects, but experts say it could be more convenient and more eective for patients.ey say by eliminating the need to take pills, ll prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.

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Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or lm tablet. In a study of the implant’s eectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And ocials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.

Underserved And UndeRterred Overcoming the unique challenges LGBTQ individuals face with addiction A s more and more addiction treatment centers are looking for ways to tailor programs to address the individual needs of clients, one section of the population is being largely overlooked. Advocates say treatment providers need to be more aware of the unique issues and barriers facing the LGBTQ community. Numbers don’t lie

LGBTQ individuals at much higher rates than they do the heterosexual population. Some estimates show an addiction rate between 30 and 40 percent, compared to around 10 percent of the population in general. While statistics also show that LGBTQ individuals enter into treatment more readily than the rest of the country, they also face program. Advocates say 46 percent of homosexual men and women have had a homophobic therapist, and 34 percent felt their sexuality was seen as irrelevant. While putting sexuality aside to address addiction glance, advocates say recognizing those recovery. Need for understanding Understanding a person’s sexuality and gender identity can be as important as understanding their race or ethnic background in that it can uncover potentially hidden sources of stress or trauma that may contribute to substance use. Just as counselors should consider the social experiences of African-Americans, so too should they consider the unique circumstances faced by members of the LGBTQ community. “In order to not continue to create trauma towards the LGBTQ community, the more culturally competent a person or work/recovery environment is, the better,” says Molly Gilbert, director of business development for the PRIDE Institute in Minnesota.

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e PRIDE Institute specializes in addiction treatment for the LGBTQ community, and Gilbert says a lack of understanding or awareness by treatment providers can create barriers for people seeking treatment. Even for organizations that seek to become “inclusive” communities, they may not set up a program that accurately addresses LGBTQ concerns, or providers may not realize how they are doing harm to LGBTQ individuals, transgressions known as micro-aggressions. “Micro-aggressions occur daily towards the community and educating heterosexual colleagues, supporters and the rest of society is key in helping to diminish these daily slights and harm,” Gilbert says. Education first To improve treatment outcomes and the experiences of LGBTQ people in general, advocates say it’s vital that treatment providers, physicians, and social service

employees educate themselves on some of these unique challenges and barriers. But they also say LGBTQ people need to educate themselves as well. “Educating the LGBTQ

community on the dangers of abuse of alcohol and drugs, and the fact that the

community is actually being targeted by

institutions such as big tobacco, alcohol companies and drug manufacturers is key,” Gilbert says. With very few LGBTQ-specic treatment centers across the country, advocates know many

LGBTQ individuals will end up in heteronormative treatment facilities. And while that can present problems, Gilbert says with the right education and the right system in place, recovery is attainable. “With the right therapy coexisting with a mainstream treatment center, we believe it is doable.”

“There’s a lot of information that can be gained from when somebody relapses.”

- Dr. Stephanie Carreiro, University of Massachusetts

Fitness trackers could help prevent relapses

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Dr. Carreiro says wearable biosensors can detect a relapse event for some substances (like heroin and cocaine) by sensing a change in heart rate or other physical conditions. The treatment provider can then use the tness tracker’s other information, like the time and location of the relapse event, to develop a prole about the conditions that prompt a patient to use. “It gives us very specic contextual information and serves as that reminder to the patient that someone could potentially know right away when they relapse,” Dr. Carreiro says.

Fitness trackers, or wearable biosensors, like Fitbit and Jawbone are the latest tness trend to gain widespread popularity. But some believe they could be used to treat addiction as well. New research suggests the devices can be used to reliably detect relapses, which could then give treatment providers the information they need to prevent relapses in the future. “There’s a lot of information that can be gained from when somebody relapses,” says Dr. Stephanie Carreiro, a researcher from the University of Massachusetts.

ACCOUNTABILITY MATTERS That accountability to someone who could see the relapse is an important step in moving past simple self-reporting and drug testing. People can lie during self-reports and drug testing will only show that drugs were used, but not information like how much was used, when it was used, and where. Because the sensors can be easily removed, the system will only work for patients who are truly motivated to stay sober. Dr. Carreiro says rather than a big brother scenario with treatment providers tracking a patient’s movements, the devices simply connect a patient to their support network.

“We could potentially trigger an interaction with a patient just seeing if they’re okay and need some help,” Dr. Carreiro says.

“It definitely served as a reminder that there was something motivating them to stay sober.”

- Dr. Stephanie Carreiro

SIMPLE REMINDER In a study of 15 patients, nearly everyone kept wearing the devices even when relapsing. Dr. Carreiro says that’s because many people are already used to wearing tness trackers, and the treatment plan simply ts into the daily routines they’ve already established. Researchers also say just having a physical object on a patient’s wrist to remind them about their dedication to sobriety can be enough to prevent a relapse. “Multiple people looked at it and thought of going back to jail or being there for their children,” Dr. Carreiro says. “It denitely served as a reminder that there was something motivating them to stay sober.”

WHAT ABOUT PREVENTION? The ultimate goal is to prevent relapses and keep patients on the path to sobriety. While the technology is advancing quickly, researchers say the collective knowledge base simply isn’t there yet to predict a relapse event. But as they conduct more studies and develop better algorithms with the information gained, they should be able to tailor interventions to a specic patient and hopefully keep them from relapsing. “We need to continue to dene different proles so that we can get a more complete understanding of what’s happening,” Dr. Carreiro says. “That’s when it will be the most powerful.”

“We were surprised that morphine was able to induce these really long-lasting changes,” says Dr. Peter Grace, the study’s lead author. Dr. Grace says the cause of the chronic pain increase has to do with cells that form part of the immune system. He says if those areas could be isolated or their eects reduced, the resulting pain may not be as great. “If it does turn out to be a relevant issue to patients, then what our study suggests is that targeting the immune system may be the key to avoiding these kinds of eects,” Dr. Grace says. “Opioids could essentially work better if we could shut down the immune system in the spinal cord.” e team’s research only looked at spinal cord injuries and morphine, and did not study other opioids that are commonly prescribed to patients experiencing pain. But he said it’s likely drugs like Vicodin or OxyContin could aect other parts of the body in a similar way. “While we haven't actually tested other opioids in this particular paradigm, we predict that we would see similar eects,” Dr. Grace says.

ain relievers are supposed to relieve pain. It sounds simple enough, but new research suggests a common pain medication may actually be prolonging chronic pain. Morphine is an opioid painkiller commonly prescribed in hospitals and clinics, and while it is eective in the short term, doctors don’t always consider the potential consequences for pain down the road.at’s why a team of researchers based out of the University of Colorado - Boulder set out to study how morphine treatment aects chronic pain, and found some troubling results. e team, which used mice with spinal cord injuries, found that in mice not given morphine, their pain thresholds went back to normal about four to ve weeks after the injury. But mice who were given morphine didn’t see their pain levels return to normal until around 10 to 11 weeks, meaning the use of morphine eectively doubled the length of their chronic pain. P

Chronic problem Chronic pain can be debilitating for many people facing serious health problems, and it can also be a key factor in substance abuse. Many people report developing a dependence on opioids after having them prescribed for an injury. But new research suggests the number of people who develop dependency issues because of chronic pain may be far higher than people realize. A study from researchers at Boston University looked at a group of nearly 600 people who had either used illicit substances or misused prescription drugs.

ey found that 87 percent reported suering from chronic

pain, with 50 percent of those people rating their pain as severe.ey also found that 51 percent of people who had used illicit drugs like marijuana, cocaine and heroin had done so to treat their pain. While many prevention eorts focus on recreational users, the numbers suggest that chronic pain plays just as prominent a role in substance abuse. “Many patients using illicit drugs, misusing prescription drugs and using alcohol reported doing so in order to self-medicate their pain,” the authors of the study wrote. “Pain needs to be addressed when patients are counseled about their substance use.”

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CONCERN OVER HEROIN USE GROWING

New Poll Shows Americans Are Increasingly ConcernedWith

45 percent of Americans think heroin use is a bigger problem in their communities than shows they’re not wrong. According to the Centers for Disease Control, heroin-related overdose deaths nearly quadrupled from 2002 to 2013. Experts fear the numbers will continue to rise, with recent data showing roughly 156,000 Americans began using heroin in 2012 alone. Political Discourse a time when lawmakers and treatment providers are struggling to combat the rise in heroin overdoses. Several states have passed legislation making it legal to purchase Naloxone, a drug that works as an antidote for opiates, and Congress is considering several bills that would change the way federal authorities handle drug issues.

ore and more Americans are feeling the dangers of heroin, with nearly half of adults describing heroin abuse as a very serious problem,

according to a recent poll.

1,000 U.S. adults about heroin abuse, with 49 percent saying they thought it was a very serious problem, and another 38 percent saying they thought it was somewhat serious. heroin epidemic is hitting, with one-third of respondents saying they personally know someone who has become addicted to heroin or another opiate. Numbers Don’t Lie Public perception of heroin use has changed quickly over the last few years. A Rasmussen Reports survey in November of 2015 found

groups to increase understanding of addiction as a disease, 28 percent said those who use heroin are most to blame. Still, the poll showed public opinion remains somewhat balanced, with 48 percent of people saying all groups are equally to blame. A Universal Issue races. Although black and Hispanic Americans were more likely than white respondents to cite heroin as a very serious problem, all three groups had similar views on nearly every other question. across almost every demographic over the past decade, and poll numbers show perception and reality are more in line than most would like to admit.

commander-in-chief have also paid closer attention to the heroin epidemic, with the issue playing a more prominent role in this year’s presidential campaign than it has in

past election cycles. Who’s To Blame?

voters are paying close attention to the problem may come as no surprise considering how much blame the public puts on them. Of those surveyed, 5 percent said the U.S. government and those who decide how heroin users are treated are most to blame for the current heroin problems. In comparison, drug dealers themselves were singled out by only 11 percent of “49 percent of U.S. adults think heroin abuse is a very serious problem, and 38 percent say it’s somewhat serious.” -

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ABA H e a l t h S e r v i c e s 43

Minding Your Health

Boom, Bust, and Drugs Study says economic downturn leads to increase in substance use disorders When the economy tanks, drug abuse goes up.That’s the finding of a new study which shows the state of the economy is closely linked with substance abuse disorder rates for a variety of substances. The study, conducted by researchers from Vanderbilt University, the University of Colorado and the Substance Abuse and Mental Health Services Administration (SAMHSA), found the use of substances like ecstasy becomes more prevalent during economic downturns. Researchers also found that other drugs like LSD and PCP see increased use only when the economy is strong. But for overall substance use disorders, the findings were clear.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens,” says Christopher Carpenter, one of the lead researchers. “Our results are more limited in telling us why this happens.” Researchers say it’s possible that people turn to substance use as a means of coping with a job loss or other major life changes caused by economic pressures, but their particular study did not pinpoint an exact cause and effect. Not all drugs are equal The study showed that a downward shift in the economy has the biggest impact on painkillers and hallucinogens. Rates of substance abuse disorders were significantly higher for those two categories than any other class of drug.

Researchers also found the change in disorder rates was highest for white adult males, a group which was one of the hardest hit during the Great Recession.They say more research is needed to determine exactly how the economy and drug use are related, but they say the study highlighted some key groups for prevention and treatment workers to target during future economic downturns.

“Problematic use (i.e., substance use disorder) goes up significantly when the economy weakens.” - Christopher Carpenter, Vanderbilt University

Slippery slope Despite some lingering questions, researchers were able to show the significance of the economy’s role in problematic substance use.The study showed that even a small change in the unemployment rate can have a tremendous impact on the risks for substance abuse disorders. “For each percentage point increase in the state unemployment rate, these estimates represent about a 6 percent increase in the likelihood of having a disorder involving analgesics and an 11 percent increase in the likelihood of having a disorder involving hallucinogens,” the authors write. Previous studies have focused on the economy’s link to marijuana and alcohol, with many looking at young people in particular.This study is one of the first to highlight illicit drugs, which given the current opioid epidemic, holds important lessons for those working to curb problematic drug use.

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When it’s needed most The study bears significant weight for treatment facilities and public policy makers in particular. During economic downturns, government agencies typically look to cut spending on treatment programs as a way to save money, something researchers say may be more costly in the end. “Our results suggest that this is unwise,” Carpenter says. “Such spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise, at least for disorders involving prescription painkillers and hallucinogens.”

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“Spending would likely be particularly effective during downturns since rates of substance use disorders are increasing when unemployment rates rise.” - Christopher Carpenter, Vanderbilt University

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