18. September 2011 by stationmanager.

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.

1. “At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”

The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.

Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.

A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.

“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”

n so, Hajela pointed out, choice does play a role in getting help.

“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.

This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.

“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.

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12. September 2011 by stationmanager.

Over the past year, SAMHSA – as part of its Recovery Support Strategic Initiative – has worked with the behavioral health field to develop a working definition of recovery that captures the essential, common experiences of those recovering from mental and substance use disorders, along with 10 guiding principles that support recovery.

One of the key events that led to the current working definition of recovery was a 2010 meeting of behavioral health leaders, including mental health consumers and people in addiction recovery, who developed a draft definition and principles of recovery to reflect common elements of the recovery experience for those with mental/substance use disorders. Other significant efforts include national consensus meetings that SAMHSA held in 2004 and 2005 to develop separate definitions of recovery from mental health problems and addictions. SAMHSA is developing a working definition of recovery to help policy makers, providers, funders, peers/consumers and others to design, deliver, and measure integrated and holistic services and supports to more effectively meet the needs of individuals served by behavioral health systems.

In recent months, SAMHSA has reviewed drafts of the working recovery definition and principles with stakeholders at meetings, conferences and other venues. Additionally, in May 2011, SAMHSA posted the working definition and principles on the SAMHSA blog and invited comments from the public. Many of the comments received have been incorporated into the current working definition and principles.

In order to encourage greater public engagement on this important definition, SAMHSA is inviting the public to provide further feedback.

The current working definition and principles are as follows:

Recovery from Mental and Substance Use Disorders: A process of change through which individuals work to improve their own health and wellbeing, live a self-directed life, and strive to achieve their full potential.

Through the Recovery Support Strategic Initiative, SAMHSA has delineated four major dimensions that are essential to a life in recovery:

• Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way;
• Home: a stable and safe place to live;
• Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and
• Community: relationships and social networks that provide support, friendship, love, and hope.

Guiding Principles of Recovery

Recovery is person-driven: Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals. Individuals optimize their autonomy and independence to the greatest extent possible by leading, controlling, and exercising choice over the services and supports that assist their recovery and resilience. In so doing, they are empowered and provided the resources to make informed decisions, initiate recovery, build on their strengths, and gain or regain control over their lives. For children and youth, especially those who are younger, families and caregivers play a key and sometimes primary role in shaping their path to recovery.

Recovery occurs via many pathways: Individuals are unique with distinct needs, strengths, preferences, goals, culture, and backgrounds  including trauma experiences  that affect and determine their pathway(s) to recovery. Recovery is built on the multiple capacities, strengths, talents, coping abilities, resources, and inherent value of each individual. Recovery pathways are highly personalized and non-linear in that they are characterized by continual growth and improved functioning that may involve setbacks. Because setbacks are a natural, though not inevitable, part of the recovery process, it is essential to foster resilience for all individuals and families. Abstinence is an important choice for individuals with addictions. In some cases, these pathways can be enabled by creating a supportive environment, this is especially true for children, who may not have the legal or developmental capacity to set their own course.

Recovery is holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, education, addictions and mental illness treatment, services and supports, primary healthcare, dental care, complementary and alternative services, spirituality, creativity, social networks, recreation, and community participation. The array of services and supports available should be integrated and coordinated.

Recovery is supported by peers and allies: Mutual support and mutual aid groups, including the sharing of experiential knowledge and skills, as well as social learning, play an invaluable role in recovery. Peers encourage and engage other peers and provide each other with a vital sense of belonging, supportive relationships, valued roles, and community. Through helping others and giving back to the community, one helps one’s self. Peer-operated supports and services provide important resources to assist people along their journeys of recovery and wellness. Professionals can also play an important role in the recovery process by providing clinical treatment and other services that support individuals in their chosen recovery paths. While peers and allies play an important role for many in recovery, their role for children and youth may be slightly different. Peer supports for families are very important for children with behavioral health problems and can also play a supportive role for youth in recovery.

Recovery is supported through relationships and social networks: An important factor in the recovery process is the presence and involvement of people who believe in the person’s ability to recover; who offer hope, support, and encouragement; and who also suggest strategies and resources for change. Peers, family members, providers, faith groups, community members, and other allies form vital support networks. Through these relationships, people leave unhealthy and/or unfulfilling life roles behind and engage in new roles (e.g., partner, caregiver, friend, student, employee) that lead to a greater sense of belonging, personhood, empowerment, autonomy, social inclusion, and community participation.

Recovery is culturally-based and influenced: Culture and cultural background in all of its diverse representations – including values, traditions, and beliefs – are keys in determining a person’s journey and unique pathway to recovery. Services should be culturally grounded, attuned, sensitive, congruent, and competent, as well as personalized to meet each individual’s unique needs.

Recovery is supported by addressing trauma: The experience of trauma (such as physical or sexual abuse, domestic violence, war, disaster, and others) is often a precursor to or associated with alcohol and drug use, mental health problems, and related issues. Services and supports should be trauma-informed to foster safety (physical and emotional) and trust, as well as promote choice, empowerment, and collaboration.

Recovery involves individual, family, and community strengths and responsibility: Individuals, families, and communities have strengths and resources that serve as a foundation for recovery. In addition, individuals have a personal responsibility for their own self-care and journeys of recovery. Individuals should be supported in speaking for themselves. Families and significant others have responsibilities to support their loved ones, especially for children and youth in recovery. Communities have responsibilities to provide opportunities and resources to address discrimination and to foster social inclusion and recovery. Individuals in recovery also have a social responsibility and should have the ability to join with peers to speak collectively about their strengths, needs, wants, desires, and aspirations.

Recovery is based on respect: Community, systems, and societal acceptance and appreciation for people affected by mental health and substance use problems – including protecting their rights and eliminating discrimination – are crucial in achieving recovery. There is a need to acknowledge that taking steps towards recovery may require great courage. Self-acceptance, developing a positive and meaningful sense of identity, and regaining belief in one’s self are particularly important.

Recovery emerges from hope: The belief that recovery is real provides the essential and motivating message of a better future – that people can and do overcome the internal and external challenges, barriers, and obstacles that confront them. Hope is internalized and can be fostered by peers, families, providers, allies, and others. Hope is the catalyst of the recovery process.

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9. September 2011 by stationmanager.

A profile of National Institute on Drug Abuse (NIDA) Director, Dr. Nora Volkow, in The New York Times, says her mission is to ensure that the nation’s drug policy, which is increasingly focused on prescription drugs, is grounded in science.

Dr. Volkow oversees a $1.09 billion budget for an agency that is dealing with skyrocketing rates of prescription drug abuse. Hospitalizations from prescription drugs have jumped fivefold in the last decade, while overdose deaths have risen fourfold, the article notes. Dr. Volkow says that prescription drugs are especially challenging because they are needed for patients in pain, yet are the cause of so many cases of substance abuse.

Dr. Volkow says she is in favor of a planned merger between NIDA and the National Institute on Alcohol Abuse and Alcoholism, according to the newspaper. She said that addictions share many triggers and much biology, and tend to move together.

An expert in the brain chemical dopamine, Dr. Volkow has conducted research that has helped explain how addiction causes changes in brain function. Don C. Des Jarlais, who directs the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center in New York, told the newspaper that Dr. Volkow “is as responsible as anyone for showing that addiction really does cause changes in brain function. Her work is a primary basis for considering it a disease, rather than poor choices or immoral behavior.”

Dr. Volkow recently wrote, “On a personal level, as a physician I have never met an addicted person who chose to be addicted or who expected that this compulsive, uncontrollable behavior would emerge when they started taking drugs. Like any other medical disorder that impairs the function of vital organs, repair and recovery of the addicted brain depends on targeted and effective treatments that must address the complexity of the disease. Research is the cornerstone in proving how this can be done.”

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