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Relapse is NOT a Failure

It is heartbreaking when someone you know has a relapse after some period of successful recovery. The hope generated by the period of sobriety is smashed and the pain comes flooding back. it is disheartening and frustrating. We tend to second guess our future and become angry and resentful. We start to proceed through the stages of grief once again and wonder why this happened.
Here are five things you need to know about relapse courtesy of The Partnership for Drug Free Kids

1. Relapse is common. Although relapses are not inevitable, they are common. Many
people have one or more relapses before achieving long-lasting sobriety or abstinence.
This does not mean the end of efforts toward abstinence and recovery. The person
needs to get back into treatment and the family needs to continue attending a support
group, professional counseling, or both.
2. Work together to prevent relapse. People in recovery may have frequent urges to drink
or use drugs, and feel guilty about it, even though these urges are a normal part of
recovery. It’s important to work together to anticipate high-risk situations (such as a party
where alcohol will be served) and plan ways to prevent them.
3. Relapse can happen during good times, too. Sometimes relapse occurs when the
person is doing well with their recovery. He or she feels healthy, confident, and/or “cured”
and believes that he or she is ready to go back to casual, regular or “controlled” use of
drugs or alcohol. The person may remember the honeymoon period of their use (even
though it may have been long ago) — where his or her use didn’t cause problems and
may want to return to that place. But this is often impossible since addiction changes the
physical makeup of the brain and the person is recovery is no longer able to use drugs or
alcohol in a controlled fashion.
4. If relapse occurs. Medical professionals, particularly those who specialize in substance
use disorders, are an extremely important asset during a time of relapse. They can help
the person learn techniques for containing feelings, focusing on the present, and making
use of support from others. Relying on group support from Twelve Step programs,
engaging in prayer or meditation, and finding other ways to stay on an even keel can also
be extremely helpful.
5. Learn from relapse. Experts have found that a relapse can serve as an important
opportunity for the recovering person and other family members to identify what triggered
the relapse in the first place — and find ways to avoid it in the future.

9 Facts About Addiction People Usually Get Wrong

There are a lot of misconceptions out there about addiction and alcoholism. Most of us were raised with certain perceptions based on the ideas of the culture that we were raised in. Our parents and other care takers tasked with our upbringing had their own notions, mostly based on nothing more than granpas’ opinion, and proceeded to pass them on to us. Here are some facts that hopefully, will help you on your personal journey learning to out grow your own upbringing and deal with the addictions in your life.
Nine Facts about Addiction most people get wrong.

Drinking Alcohol and Hypertension: Think You Are Not At Risk?

Pretend you are me. Forty-three, and always had chronically low blood pressure – almost to the point of hypotension. I used to get it measured at anywhere between 80-50 mmHg to 100-70 mmHg. Not so much anymore…

I’m not overweight. I eat right. I don’t really smoke cigarettes. And I exercise frequently, getting cardio at least 3-4 times per week.

But now, my blood pressure runs on the high side of normal to the low side of above average. But why? I realize that this is not hypertension, per say, but it does reveal how alcohol was gradually affecting my health – despite my engagement in other health habits.

Well, I am a recovering alcoholic. There’s no guarantee that’s the reason, but it’s a darn good suspect.

You see, alcohol and hypertension are intricately related. Drinking heavily can raise blood pressure beyond normal levels. Consumption of more than just 3 drinks during one occasion can temporarily increase your blood pressure. Repeated sessions of heavy drinking can lead to long-term effects.

The good news is that cutting back or stopping altogether can help bring blood pressure down. Systolic pressure (the top number) can fall by 2-4 millimeters of mercury (mmHg), and result in a reduction of 1-2 mmHg in diastolic blood pressure.

Also, alcohol is very calorie-rich, and often contributes to weight gain – another risk factor for hypertension. This was not my problem, but it affects many, many adults in the U.S. If you are overweight, cutting calories and losing weight can help, as well.

Cutting Back
However, heavy drinkers who are concerned about blood pressure should slowly reduce how much they are drinking rather than quit abruptly. This is because they are at risk for a sudden hike in blood pressure during withdrawal.

However, detoxing in a medical facility is highly preferred. This is because a patient can quit cold turkey safely under 24-hour medical supervision.

Other Risks
And of course, in addition to hypertension, heavy alcohol consumption can lead to heart failure, stroke, and heart arrythmia (irregular heart beat.) It can also trigger high triglycerides, and contribute to variety of cancers, as well as liver disease.

Also, if you have a family history of high blood pressure, your personal risk of drinking alcohol and hypertension-related symptoms also increase.

“Alarming” Death Rate in Primary care for Opiate Abusers

Patients with opioid use disorder (OUD) who are seen in the general healthcare setting are more than 10 times more likely to die than their counterparts without OUD, new research shows.
An analysis of electronic health records (EHRs) for more than 2500 patients with OUD who were treated at a major university hospital system showed a crude mortality rate of 48.6 deaths per 1000 person-years — a rate that was more than 10 times higher than the expected death rate in the general population for individuals of the same age and sex. The data covered an 8-year period.
“My original thinking was that the mortality rate could not be very high in the general healthcare setting because general healthcare centers are supposed to have more comprehensive health services, and most people are insured. But when I saw such a high mortality rate, I was shocked,” lead investigator Yih-Ing Hser, PhD, professor of psychiatry and behavioral sciences, David Geffen School of Medicine at the University of California, Los Angeles, told Medscape Medical News.
The study was published online April 20 in the Journal of Addiction Medicine.

Too Little, Too Late

Treatment of OUD has traditionally been delivered in specialty addiction centers, such as methadone treatment programs, “isolated from the primary care system or general medical systems,” the authors note.
Recent healthcare reforms through the Federal Mental Health Parity and Addiction Equity Act and the Affordable Care Act have led to an expansion of services for substance use disorders (SUDs) in primary care. Although most clinicians in the general healthcare system are aware of the risk for elevated mortality among OUD patients in publicly funded SUD treatment settings, they “do not fully appreciate the mortality risks to their patients,” the authors note.
To investigate the mortality rates of OUD in the general healthcare environment, the researchers studied the EHRs from a large university health system from 2006 to 2014. They identified 2576 patients, who ranged in age from 18 to 64 years at their first OUD diagnosis.
They also obtained mortality data from the National Death Index of the US Centers for Disease Control and Prevention. The duration of follow-up was from either the time of first OUD diagnosis to death or to December 31, 2014, for those still alive.
During the follow-up period (a mean of 3.7 person-years), there were 465 (18.5%) confirmed deaths, yielding an all-cause crude mortality rate of 48.6 per 1000 person-years.
Individuals who died were older at the time of first OUD diagnosis (48.4 vs 39.8 years) and were more likely to be male (41.7% vs 31.6%), black (11.2% vs 6.8%), and uninsured (87.1% vs 51.3%). The mean age of patients at death was 51.0 years (SD = 11.0).
Deceased patients were more likely to have been diagnosed with other co-occurring SUDs (particularly SUDs involving tobacco, alcohol, cannabis, and cocaine). Drug-related problems represented the most common cause of death (19.8%). These included accidental poisoning or drug overdose, intentional poisoning, and alcohol use disorder or drug use disorder.
Physical health problems associated with death included heart disease, respiratory disorders, hepatitis C virus (HCV) infection, liver disease, cancer, and diabetes.
Cardiovascular disease and cancer were the most common physical causes of death (17.4% and 16.8%, respectively), followed by infectious diseases (13.5%, with 12.0% HCV and 0.8% HIV), diseases of the digestive system (12.2%, with 4.9% alcohol-related liver disease), and external causes (6.7%).
HCV (hazard ratio [HR], 1.99; 95% confidence interval [CI], 1.62 – 2.46) and alcohol use disorder (HR, 1.27; 95% CI, 1.05 – 1.55) were the two statistically significant and clinically important indicators of overall mortality risk.

Lack of Screening

The overall indirect standardized mortality rate of 10.3 (95% CI, 9.4 – 11.3) represented a mortality risk that was more than 10-fold higher than that of the general population, after adjustment for sex and age.
The researchers call these findings “alarming,” suggesting that they “may reflect several past and current issues with current healthcare delivery systems in identifying and addressing OUD problems.”
“The general healthcare system has not been well studied with regard to substance abuse,” Dr Hser noted.
“Patients in this setting are much older at diagnosis than in publicly funded settings, and they have much higher morbidity and morbid conditions,” she said. “But general healthcare providers are not sufficiently screening for addictions, so it comes very late in the process for the person to receive appropriate interventions.
“Even when patients with OUD are identified, these clinicians may not have the resources to treat them, because general systems usually do not have addiction specialists on board,” she added.
The responsibility does not lie solely with individual practitioners.
“The timing is perfect, because the 21st Century Cures Act that former President Obama signed is now dispersed throughout the states to improve access to medication-assisted treatment. Policy makers and healthcare systems in each state need to start talking with each other and come up with a better plan to improve the infrastructure, train the physicians, and provide support when they need it,” she said.

More Training Needed

Commenting on the study for Medscape Medical News, Daniel G. Tobin MD, assistant professor of medicine, Yale University School of Medicine, and medical director of adult primary care, the Saint Rafael Campus, Yale–New Haven Hospital, described the study as “meaningful” but recommended caution when interpreting the findings.
“The study analyzed data from electronic medical records and identified people with opioid use disorder based on coding, which is a study limitation, because the coding had to be done correctly,” said Dr Tobin, who was not involved with the study.
“If clinicians did not include the diagnosis in the chart or did not code correctly, the number of opioid users might be underrepresented in the data,” he said, “leading to an overestimation of mortality rates in OUD in the general healthcare setting,” he explained.
Nevertheless, he said, “the study does show that having this diagnosis is associated with a high risk of mortality, and that the mortality is not necessarily due to overdose, which is the general conception of mortality from OUD.
“Since the patients in the study were identified roughly 5 years later than in addiction centers, these 5 additional years can lead to many health problems. I agree with the authors’ conclusion that the later the diagnosis is made, the more damage is done, so one interesting take-away is that we have to diagnose and treat OUD as soon as possible,” he said.
He agreed that more money, training, and infrastructure are necessary. “Not only do individual doctors need to take ownership, but there also has to be some infrastructure support so it becomes a routine part of primary care.”
Dr Hser added that clinicians in primary care settings can be an important force in shaping the nation’s effort to effectively address the opioid epidemic, but they need a lot of help. “They should get adequate training and get connected with an appropriate network that can help overcome many barriers that we are facing in treating addiction.”

Cheap and Available: The Growing Threat of Synthetic Cannabinoids

Synthetic Cannabinoids
Synthetic cannabinoids (sometimes referred to as “synthetic marijuana,” “spice,” or “K2”) are a family of man-made, psychoactive chemicals that are sprayed onto plant material, which is often smoked or ingested to achieve a “high.” Use of these products carries the potential for acute adverse health effects.

Historically, synthetic cannabinoid compounds were developed to study cannabinoid receptors, but in recent years these compounds have emerged as drugs of abuse. In 2005, synthetic cannabinoid products emerged in European countries before appearing in the United States in 2009.

Today, synthetic cannabinoid products are distributed worldwide under countless trade names and packaged in colorful wrappers designed to appeal to teens, young adults, and first-time drug users. These products are sold under a variety of names and are sometimes sold in convenience stores and other retail outlets as incense or natural herbal products. The lack of oversight over the manufacture and labeling of synthetic cannabinoid products means that users do not actually know the kind of synthetic cannabinoids in the product and the amount to which they are being exposed.[1]

Although these products are often labeled as “not for human consumption” and marketed as “incense,” health professionals and legal authorities are keenly aware that people use these products for their psychoactive effects. Despite federal and state regulations to prohibit synthetic cannabinoid sale and distribution, reports of harmful effects are increasing. All states now have at least one law on the books, but these laws vary widely. This is not only a problem in the United States but around the world.

Signs and Symptoms of Synthetic Cannabinoid Exposure
In April 2015, the CDC’s Health Studies Branch worked with the Mississippi Department of Health during an outbreak of 724 cases of illness and death associated with synthetic cannabinoid use in the state.[2] We used clinician-suspected or patient-reported synthetic cannabinoid use, plus the presence of symptoms, as our case criteria, so it is possible that 724 cases are an underrepresentation. Synthetic cannabinoids are metabolized quickly, so not detecting them (even if testing is available) does not rule out exposure. Of course, this method may also have included people whom providers suspected of having used synthetic cannabinoids but who did not actually use the drug.

As part of that investigation, CDC analyzed the medical records of 119 patients who presented to the University of Mississippi Medical Center (UMMC) for illness related to synthetic cannabinoid use. Like other instances of synthetic cannabinoid intoxication, these patients had nonspecific symptoms, but the most frequently reported signs and symptoms were:

Hypertension;

Tachycardia;

Aggressive or violent behavior;

Confusion;

Alternating agitation and aggression; and

Depressed mental status (such as somnolence or unresponsiveness).

As seen in previous outbreaks of adverse events linked to synthetic cannabinoid use, most users were young men, with a median age of 29 years. Statewide, from April 2 to May 3, 2015, nine deaths associated with synthetic cannabinoid use were reported to the state’s poison center, although the number of people who died could be higher due to underreporting. At the UMMC, patients who were older and had a history of psychiatric illness or substance abuse were more likely to die or be admitted to the intensive care unit. The median age of those who died was 32 years.

Synthetic cannabinoids are not detected on routine urine or serum drug screens, and most hospital laboratories do not have the capability to test for synthetic cannabinoids. Testing at referral laboratories is available; however, clinicians should be aware that test panels are limited in scope and will not detect all of the synthetic cannabinoids currently being used. In the Mississippi investigation, patient samples were sent to a research laboratory that specializes in detecting novel synthetic cannabinoids. The lab detected MAB-CHMINACA, a chemical compound that had recently entered the market.

An Emerging Public Health Threat
The use of synthetic cannabinoids may indicate an emerging public health threat due to:

Apparent rapid increase in use;

Variable and unpredictable toxicity of new compounds on the market; and

Difficulty in enforcing legal bans due to fast-changing types and mixtures of drug contents.

Here are some key points to keep in mind about synthetic cannabinoid use:

Synthetic cannabinoids are not marijuana and are not safe.

They are dangerous and can cause severe illness and even death.

Easy access and a misperception that these products are legal and relatively safe are contributing to their popularity.

Although the legality of these products may vary by state, many specific synthetic cannabinoids have been banned at the federal level. Consider synthetic cannabinoid use in patients with symptoms of drug intoxication with negative drug screens. Symptoms are generally short-lived, and most patients recover rapidly.

If you suspect that a severely ill patient may have used synthetic cannabinoids, check for rhabdomyolysis and kidney injury, and monitor for seizures and cardiac arrhythmias. Care is symptomatic and supportive. Low-dose benzodiazepines have been used successfully to treat agitation.

And finally, if you see severe illness or clusters of illness following patients’ use of these products, notify your local poison center or health department.