Robin Williams Death Highlights Increasing Suicide Rate among Adults 45-64

U.S. health officials say Robin Williams’ death highlights the increasing rate of suicide among American adults ages 45 to 64, News media reported Williams, 63, died in an apparent suicide in August 2014.

Suicide risk increases in people who are struggling with drug and alcohol use and depression. Williams had dealt with all of these, according to The New York Times. After a period of cocaine use early in his career, Williams quit in the mid-80s. He sought treatment for alcohol abuse in 2006, and had recently been treated for severe depression.

According to the Centers for Disease Control and Prevention (CDC), suicide rates for adults ages 45 to 64 increased 40 percent from 1999 to 2011. Jill Harkavy-Friedman, Vice President of Research at the American Foundation for Suicide Prevention, says the suicide rate for people in middle age to late middle age is higher than any other group. “We don’t hear about middle-age or older people who kill themselves unless they’re a star like Robin Williams,” she said. “Because it’s so shocking when a younger person dies, there’s a tendency of re-reporting and romanticizing.”

Possible reasons for the increased suicide rate in this age group could include economic pressures, health problems and the increased use and abuse of prescription drugs, Julie Phillips, Associate Professor of Sociology at Rutgers University, told the newspaper. She noted social isolation may also play a role.

Efforts to prevent suicide have largely focused on young people and the elderly, according to Alex Crosby of the CDC. “Middle-aged adults got kind of left out in the thinking of where to focus to resources for suicide prevention,” he said. “It’s important for us to examine more closely and put more resources into that population.”

Too Much Alcohol: Making Screening and Counseling Routine

At least 38 million adults in the United States drink too much alcohol, leading to a wide range of negative consequences, including heart disease, breast cancer, sexually transmitted diseases, fetal alcohol spectrum disorders, motor vehicle crashes, and violence. Drinking too much includes binge drinking or high per-occasion use (5 or more drinks on an occasion for men and 4 or more for women), high weekly use, and any alcohol use by pregnant women or those under age 21.
Drinking too much alcohol accounts for about 88,000 deaths in the United States each year and is the fourth leading preventable cause of death. In 2006, it cost the United States about $224 billion. And although this may be a surprise, most people who drink too much are not alcoholics.
More than 30 years of research has shown that alcohol screening and brief counseling is effective at reducing risky drinking. However, this month’s Vital Signs reports that only 1 in 6 adults — and only 1 in 4 binge drinkers — say that a healthcare professional has ever talked about alcohol use with them. We need to work toward making alcohol screening and brief counseling routine.
How many US adults drink too much?
An estimated 30% of adults misuse alcohol, with most engaging in high daily, weekly, or per-occasion use which results in the increased risk for health consequences. However, only about 4% of the US population is alcohol dependent. Drinking too much is dangerous and is associated with many health and social problems, including heart disease, breast cancer, sexually transmitted diseases, unintended pregnancy, fetal alcohol spectrum disorders, sudden infant death syndrome, motor vehicle crashes, and violence.
Is it realistic to expect health professionals to do anything about this problem?
Absolutely. Health professionals are already asking screening questions on an array of risk factors and may even have information about alcohol use on patient history forms. It’s simple to add alcohol screening questions to these forms. The counseling interventions are also brief (6-15 minutes), involve the patient’s active participation, and do not have to be provided by a physician, but can be provided by other health professionals, including nurses, social workers, and psychologists.
Screening and counseling can also be provided electronically to save staff time.
There are many resources for clinicians and public health practitioners with tips on brief counseling with patients who are drinking too much. In addition, the Affordable Care Act requires new health insurance plans to cover alcohol screening and brief counseling without a copayment.

What are the latest guidelines on screening and counseling in healthcare settings? What is the evidence about how well they work?

There are a number of validated screening tools to assess alcohol use, including the AUDIT, AUDIT-C, and a single-question screen for number of days in a year of binge-level alcohol use. Counseling or a brief conversation with those who drink too much can then inform the patient about health problems that could occur as a result of their drinking, and set goals and a plan for reducing drinking if the patient wants to do so. Patients who agree to reduce their drinking are then followed to assess their success.
Counseling interventions are brief (6-15 minutes) screening sessions that can help:

• Reduce average alcohol use by over 3 drinks per week;

• Reduce episodes of binge-level alcohol use by 12%; and

• Improve adherence to recommended drinking limits.

These effects can last for years and can also lead to reduced healthcare utilization, including fewer hospital days and lower costs. A very small percentage of those who are screened will have indications of alcoholism or a severe alcohol use disorder. These patients can be referred for specialized treatment.

What is an ideal screening and counseling intervention in, for example, a primary care outpatient setting, perhaps during an office visit?

Alcohol screening can be done using a set of validated questions, such as the AUDIT, AUDIT-C, or even a single question about days of binge-level alcohol use in the past year. These questions can be worked into an existing patient questionnaire or asked of patients during other clinical activities. Scoring the screening questions typically takes no more than a few seconds. Only patients who screen positive will require counseling.
Alcohol screening and counseling is similar to smoking cessation interventions, with the use of motivational interviewing and the 5 A’s of behavioral change intervention (ask, advise, assess, assist, and arrange). The clinician works with the patient to come up with a plan for reducing their drinking that takes into consideration their specific health issues as well as problems with functioning at home or work, and legal problems. Follow-up occurs in future visits to determine whether the patient’s drinking and associated problems are improving.

In what settings and in what age groups should health professionals consider screening? Which health professionals might carry out the screening and counseling most effectively — physicians, NPs or PAs, RNs, or others.
Alcohol screening and brief counseling can occur in primary care settings, trauma care settings, emergency departments, and many other health and social service settings. It can be delivered by social workers, nurses, psychologists, and others. Delivering alcohol screening and counseling by phone, computer, or mobile devices can also reduce the demand on staff time for delivering this service.

Are there some successful or innovative programs that have used these guidelines in practice?

One example of successful integration of alcohol screening and brief counseling into routine clinical care is Kaiser Permanente of Northern California. It has recently integrated this service into its primary care practices, covering 3.4 million members. During a 4-month period (July-November 2013) there were 230,000 brief interventions or referrals. Staff supported this implementation, in part because the screening process was built into their electronic health record (EHR) system.

What are the ways that alcohol screening and brief counseling can be integrated into EHRs?

There are a variety of e-tools, including prompts and other reminder systems, that can be used to help clinicians integrate alcohol screening and brief counseling into their practices. The Community Preventive Services Task Force has also recommended the use of electronic methods (eg, use of computers, telephones, or mobile devices) to deliver components of alcohol screening and brief intervention. In addition, alcohol screening and brief counseling are being considered for inclusion as a meaningful use measure in EHRs, which could also help support the use of this service in clinical settings.

What should clinicians do differently tomorrow to start to improve this situation?
Doctors, nurses, and other health professionals can take 3 key actions:

• Screen all adult patients for alcohol use as part of their regular services by using clinical intervention guidelines and overall implementation guidelines;

• Counsel those who drink too much to drink less, using specific techniques such as motivational interviewing to establish a plan, and then reassess their success in future visits; and

• Advise pregnant women and underage youth not to drink at all.

They can also train staff to support the routine delivery of this intervention and make changes in the healthcare delivery system to ensure the success of alcohol screening and counseling activities.

It snuck up on us

FEDS PLEDGING FULL ATTENTION TO HEROIN EPIDEMIC

U.S. Attorney General Eric Holder recently acknowledged the epidemic “snuck up on us” at a national law enforcement summit on heroin in April. But, he also used the summit to pledge renewed attention to what he called “an urgent public health crisis.”
Holder cited a rise in investigations and heroin seizures by the DEA over the past three years and the Justice Department’s commitment to specialty drug courts that let addicts get treatment “and return to their communities before incarceration.”
Last year, the DEA seized more than 2,100 kilos, or about 2.3 tons, of heroin at the Mexican border. That’s more than triple the amount seized in 2008. But DEA officials say they weren’t specifically targeting heroin. There’s just more heroin crossing the border.
At the summit, Holder acknowledged more needs to be done. “Addressing this … will require a combination of rigorous enforcement and robust treatment.”
At the same time, the explosion of heroin users, addicts and overdose deaths has some critics asking why it took so long and whether a faster response by public officials — at all levels — could have slowed or prevented heroin’s resurgence. Much of the criticism is aimed at the Food and Drug Administration’s handling of the approval the original opioid pain pills for wide use.
“This did not sneak up on us,” said Kolodny, who is also chief medical officer for Phoenix House, a New York-based drug treatment non-profit organization. “The opioid epidemic began in the late 1990s, and very early on we saw people who were addicted to opioids move over to heroin. Had the FDA been doing its job, I don’t think we would have an epidemic today.”
I never understood the concept of letting an addict crash and burn before you intervene. This is a public health crisis. Addiction is a chronic disease.

CHARLOTTE WETHINGTON, MOTHER OF A HEROIN VICTIM AND ADVOCATE FOR TREATMENT

Wethington, the anti-drug activist, said the fervor with which government officials are acting is encouraging, but much delayed.
“I was trying to sound the warning bell and nobody was listening,” said Wethington, who now works as an addiction and recovery counselor.
Unable to find local help from doctors, law enforcement or treatment centers during and after her son’s overdose, Wethington pushed for changes to Kentucky law to allow families to petition courts to intervene and order addiction and rehab services for drug addicts — even if they had no criminal record.
“I never understood the concept of letting an addict crash and burn before you intervene,” she said. “This is a public health crisis. Addiction is a chronic disease.”
Kentucky adopted the Matthew Casey Wethington Act for Substance Abuse Intervention in 2004 — modeled after an existing Florida law. Ohio adopted a variation of Casey’s law in 2012. Advocates in at least 11 other states, including Indiana, Arizona, New York and Florida, are working to do the same.
“I get calls from people all over the country who ask me how can I get Casey’s law in my state. It’s bittersweet because we couldn’t save our own son.”

A Snapshot of Annual High-Risk College Drinking Consequences

The consequences of excessive and underage drinking affect virtually all college campuses, college communities, and college students, whether they choose to drink or not.

Death: 1,825 college students between the ages of 18 and 24 die from alcohol-related unintentional injuries, including motor vehicle crashes (Hingson et al., 2009).

Injury: 599,000 students between the ages of 18 and 24 are unintentionally injured under the influence of alcohol (Hingson et al., 2009).

Assault: 696,000 students between the ages of 18 and 24 are assaulted by another student who has been drinking (Hingson et al., 2009).

Sexual Abuse: 97,000 students between the ages of 18 and 24 are victims of alcohol-related sexual assault or date rape (Hingson et al., 2009).

Unsafe Sex: 400,000 students between the ages of 18 and 24 had unprotected sex and more than 100,000 students between the ages of 18 and 24 report having been too intoxicated to know if they consented to having sex (Hingson et al., 2002).

Academic Problems: About 25 percent of college students report academic consequences of their drinking including missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall (Engs et al., 1996; Presley et al., 1996a, 1996b; Wechsler et al., 2002).

Health Problems/Suicide Attempts: More than 150,000 students develop an alcohol-related health problem (Hingson et al., 2002), and between 1.2 and 1.5 percent of students indicate that they tried to commit suicide within the past year due to drinking or drug use (Presley et al., 1998).

Drunk Driving: 3,360,000 students between the ages of 18 and 24 drive under the influence of alcohol (Hingson et al., 2009).

Vandalism: About 11 percent of college student drinkers report that they have damaged property while under the influence of alcohol (Wechsler et al., 2002).

Property Damage: More than 25 percent of administrators from schools with relatively low drinking levels and over 50 percent from schools with high drinking levels say their campuses have a “moderate” or “major” problem with alcohol-related property damage (Wechsler et al., 1995).

Police Involvement: About 5 percent of 4-year college students are involved with the police or campus security as a result of their drinking (Wechsler et al., 2002), and 110,000 students between the ages of 18 and 24 are arrested for an alcohol-related violation such as public drunkenness or driving under the influence (Hingson et al., 2002).

Alcohol Abuse and Dependence: 31 percent of college students met criteria for a diagnosis of alcohol abuse and 6 percent for a diagnosis of alcohol dependence in the past 12 months, according to questionnaire-based self-reports about their drinking (Knight et al., 2002).

Facts About Alcohol Poisoning

Excessive drinking can be hazardous to everyone’s health! It can be particularly stressful if you are the sober one taking care of your drunk roommate, who is vomiting while you are trying to study for an exam.

Some people laugh at the behavior of others who are drunk. Some think it’s even funnier when they pass out. But there is nothing funny about the aspiration of vomit leading to asphyxiation or the poisoning of the respiratory center in the brain, both of which can result in death.

Do you know about the dangers of alcohol poisoning? When should you seek professional help for a friend? Sadly enough, too many college students say they wish they would have sought medical treatment for a friend. Many end up feeling responsible for alcohol-related tragedies that could have easily been prevented.

Common myths about sobering up include drinking black coffee, taking a cold bath or shower, sleeping it off, or walking it off. But these are just myths, and they don’t work. The only thing that reverses the effects of alcohol is time-something you may not have if you are suffering from alcohol poisoning. And many different factors affect the level of intoxication of an individual, so it’s difficult to gauge exactly how much is too much (BAC calculators).

What Happens to Your Body When You Get Alcohol Poisoning?

Critical Signs and Symptoms of Alcohol Poisoning

What Should I Do If I Suspect Someone Has Alcohol Poisoning?

What Can Happen to Someone With Alcohol Poisoning That Goes Untreated?

Alcohol depresses nerves that control involuntary actions such as breathing and the gag reflex (which prevents choking). A fatal dose of alcohol will eventually stop these functions.

It is common for someone who drank excessive alcohol to vomit since alcohol is an irritant to the stomach. There is then the danger of choking on vomit, which could cause death by asphyxiation in a person who is not conscious because of intoxication.

You should also know that a person’s blood alcohol concentration (BAC) can continue to rise even while he or she is passed out. Even after a person stops drinking, alcohol in the stomach and intestine continues to enter the bloodstream and circulate throughout the body. It is dangerous to assume the person will be fine by sleeping it off.

Critical Signs and Symptoms of Alcohol Poisoning

Mental confusion, stupor, coma, or person cannot be roused.
Vomiting.
Seizures.
Slow breathing (fewer than eight breaths per minute).
Irregular breathing (10 seconds or more between breaths).
Hypothermia (low body temperature), bluish skin color, paleness.
What Should I Do If I Suspect Someone Has Alcohol Poisoning?

Know the danger signals.
Do not wait for all symptoms to be present.
Be aware that a person who has passed out may die.
If there is any suspicion of an alcohol overdose, call 911 for help. Don’t try to guess the level of drunkenness.

What Can Happen to Someone With Alcohol Poisoning That Goes Untreated?
Victim chokes on his or her own vomit.
Breathing slows, becomes irregular, or stops.
Heart beats irregularly or stops.
Hypothermia (low body temperature).
Hypoglycemia (too little blood sugar) leads to seizures.
Untreated severe dehydration from vomiting can cause seizures, permanent brain damage, or death.
Even if the victim lives, an alcohol overdose can lead to irreversible brain damage. Rapid binge drinking (which often happens on a bet or a dare) is especially dangerous because the victim can ingest a fatal dose before becoming unconscious.

Don’t be afraid to seek medical help for a friend who has had too much to drink. Don’t worry that your friend may become angry or embarrassed-remember, you cared enough to help. Always be safe, not sorry.

Opioids drive continued increase in drug overdose deaths

Drug overdose deaths increase for 11th consecutive year

Drug overdose deaths increased for the 11th consecutive year in 2010, according to an analysis from the Centers for Disease Control and Prevention. The findings are published today in a research letter, “Pharmaceutical Overdose Deaths, United States, 2010,” in the Journal of the American Medical Association (JAMA).
CDC’s analysis shows that 38,329 people died from a drug overdose in the United States in 2010, up from 37,004 deaths in 2009. This continues the steady rise in overdose deaths seen over the past 11 years, starting with 16,849 deaths in 1999. Overdose deaths involving opioid analgesics have shown a similar increase. Starting with 4,030 deaths in 1999, the number of deaths increased to 15,597 in 2009 and 16,651 in 2010.
In 2010, nearly 60 percent of the drug overdose deaths (22,134) involved pharmaceutical drugs. Opioid analgesics, such as oxycodone, hydrocodone, and methadone, were involved in about 3 of every 4 pharmaceutical overdose deaths (16,651), confirming the predominant role opioid analgesics play in drug overdose deaths.
CDC researchers analyzed data from CDC’s National Center for Health Statistics 2010 multiple cause-of-death file, which is based on death certificates.
The researchers also found that drugs often prescribed for mental health conditions were involved in a significant number of pharmaceutical overdose deaths. Benzodiazepines (anti-anxiety drugs) were involved in nearly 30 percent (6,497) of these deaths; antidepressants in 18 percent (3,889), and antipsychotic drugs in 6 percent (1,351). Deaths involving more than one drug or drug class are counted multiple times and therefore are not mutually exclusive.
“Patients with mental health or substance use disorders are at increased risk for nonmedical use and overdose from prescription painkillers as well as being prescribed high doses of these drugs,” said CDC Director Tom Frieden, M.D., M.P.H. “Appropriate screening, identification, and clinical management by health care providers are essential parts of both behavioral health and chronic pain management.”
Additional steps are being taken at the national, state and local levels, as well as by non-governmental organizations, to help prevent overdoses from prescription drugs.
In particular, the federal government is:
• Tracking prescription drug overdose trends to better understand the epidemic.
• Encouraging the development of abuse-deterrent opioid formulations and products that treat abuse and overdose.
• Educating health care providers and the public about prescription drug abuse and overdose.
• Requiring that manufacturers of extended-release and long-acting opioids make educational programs available to prescribers about the risks and benefits of opioid therapy, choosing patients appropriately, managing and monitoring patients, and counseling patients on the safe use of these drugs.
• Using opioid labeling as a tool to inform prescribers and patients about the approved uses of these medications.
• Developing, evaluating and promoting programs and policies shown to prevent prescription drug abuse and overdose, while making sure patients have access to safe, effective pain treatment.
Promising steps that many states are taking include:
• Starting or improving prescription drug monitoring programs, which are electronic databases that track all prescriptions for opioids in the state.
• Using prescription drug monitoring programs, public insurance programs, and workers’ compensation data to identify improper prescribing of opioids.
• Setting up programs for public insurance programs, workers’ compensation programs, and state-run health plans that identify and address improper patient use of opioids.
• Passing, enforcing and evaluating pill mill, doctor shopping and other state laws to reduce prescription opioid abuse.
• Encouraging state licensing boards to take action against inappropriate prescribing.
• Increasing access to substance abuse treatment.