(Science News) – As public health officials tackle opioid addiction and overdoses, another class of prescription drugs has been contributing to a growing number of deaths across the United States.
Benzodiazepines, such as Valium and Xanax, are commonly prescribed for anxiety and insomnia. The drugs are also highly addictive and can be fatal, especially when combined with alcohol or opioids. In the latest sign of the drug’s impact, the number of overdose deaths involving “benzos” rose from 0.54 per 100,000 in 1999 to 5.02 per 100,000 in 2017 among women aged 30 to 64, researchers report January 11 in the Morbidity and Mortality Weekly Report. That’s a spike of 830 percent, surpassed only by increases seen in overdose deaths involving synthetic opioids or heroin.
Overall, there were 10,684 overdose deaths involving benzodiazepines in the United States in 2016, according to the National Institute on Drug Abuse. In 1999, the total was 1,135.
Benzodiazepines have a sedating effect, and are particularly dangerous when used with other drugs that slow breathing, such as opioids and alcohol. In combination, the substances can “cause people to fall asleep and essentially never wake up again,” says Anna Lembke, an addiction psychiatrist at Stanford University School of Medicine. Benzos and opioids are often prescribed together, and opioids contribute to 75 percent of overdose deaths involving benzos.
The rising number of deaths involving benzos hasn’t stopped the flow of prescriptions. The number of U.S. adults who filled a prescription for benzos rose from 8.1 million in 1996 to 13.5 million in 2013, a jump of 67 percent, a study in the American Journal of Public Health in 2016 found. The quantity of benzos acquired more than tripled over the same time.Read More
(The New York Times) – Nearly a century after the film “Reefer Madness” alarmed the nation, some policymakers and doctors are again becoming concerned about the dangers of marijuana, although the reefers are long gone.
Experts now distinguish between the “new cannabis” — legal, highly potent, available in tabs, edibles and vapes — and the old version, a far milder weed passed around in joints. Levels of T.H.C., the chemical that produces marijuana’s high, have been rising for at least three decades, and it’s now possible in some states to buy vape cartridges containing little but the active ingredient.
The concern is focused largely on the link between heavy usage and psychosis in young people. Doctors first suspected a link some 70 years ago, and the evidence has only accumulated since then. In a forthcoming book, “Tell Your Children,” Alex Berenson, a former Times reporter, argues that legalization is putting a generation at higher risk of schizophrenia and other psychotic syndromes. Critics, including leading researchers, have called the argument overblown, and unfaithful to the science.Read More
Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness.
Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixed-effects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models.
Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups.
The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.
(The Washington Post) – All her life, Lorri Devlin had been told that the troubling feelings she frequently experienced had a simple cause: she was “just anxious.”
At age 5, Devlin remembers being jolted awake in the middle of the night by the sound of her teeth chattering. Feeling disoriented and that “something was very wrong,” she entered her parents’ bedroom. But when she spoke, the result was gibberish.
Her pediatrician, she recalled, pronounced her “a nervous child . . . an ulcer candidate.” In high school and college, Devlin often felt an odd sense of detachment. As an adult, she developed a ridge of scar tissue from biting the inside of her cheek while she slept. Sometimes if she was severely stressed, she fainted.
Over the years, Devlin, who was trained as a nurse, had tried therapy, anti-anxiety medication and meditation to cope with her condition, which was diagnosed as panic disorder.
“I was ashamed that I was such a weak person,” she said.
But nearly two years ago, an incident on an airplane flight upended the life of the retired insurance company executive. After more than 50 years, Devlin finally learned the cause of the problem that had colored nearly every aspect of her life.Read More
For those struggling with experiences of psychosis, therapy can be beneficial and even life changing. However, there is no single type of therapy, and a great range and diversity of therapeutic approaches have been developed to help different individuals’ needs, which makes deciding which approach is most helpful for an individual not a straightforward choice. Personal Experiences of Psychological Therapy for Psychosis and Related Experiences uniquelypresents personal accounts of those who have received therapy for psychosis alongside professional clinical commentary on these therapies, giving multiple perspectives on what they involve and how they work.
Presented in a clear and accessible way, each chapter includes accounts of a variety of different therapies, including cognitive behavioural therapy, trauma-focused therapy, open dialogue, and systemic family therapy. The reader is encouraged to explore not only the clinical basis for these therapies but also understand what the treatments mean for the person experiencing them, as well as their challenges and limitations. The book also explores the importance of the individual’s relationship with the therapist. As a whole, the perspectives presented here provide unique insight into a range of widely used psychological therapies for psychosis.
With its special combination of personal experiences and concise introductions to different therapies, this book offers a valuable resource for academics and students of psychiatry, clinical psychology, psychotherapy, mental health care and mental health nursing. It will also be essential reading for those considering treatment, their friends and families, as well as mental health professionals, including psychiatrists, clinical psychologists, psychotherapists and nurses.Read More
(HearingTheVoice.org) – In this article, Arya Aryan reviews It’s All in my Head! by Mick, ‘the story of a normal Dutch guy who hears voices inside his head other people can’t hear’.
Emotional, intimate, humorous, compassionate, sincere and democratic, It’s All in my Head is Mick’s account of the stories that the voices he hears have to tell and share with us. This is a book about both the voices’ stories and Mick’s experience and struggle with them, as well as his journey on the road to agency and recovery. It is a journey from being a passive object to which things happen – ‘things are being destroyed’ (115) – to possessing some degree of agency – ‘I made it’ (151). A similar to the Unnamable’s ‘I invented it all’ (117) – though the voices still have their own ontologically autonomous status. It is a very thought-provoking, insightful memoir into the nature of auditory verbal hallucinations, the process of storytelling and its therapeutic function.Read More
Objective: Small business is a favorably regarded institution in America. Given employment disparities among individuals with psychiatric disabilities compared to other workers, self-employment has potential to promote career development and community integration. However, little is known about what has helped or hindered current small business owners with psychiatric disabilities. This exploratory study identified characteristics of individuals’ work and disability histories, as well as business characteristics, that can inform policy and practice development in support of disability-owned small businesses. Method: A nonprobability sample of 60 U.S. adults with a history of psychiatric disability who were self-employed in 2017 completed a web-based survey that asked about demographics, experiences of disability, motivations for self-employment, and business characteristics. Results: Most survey respondents were operating new, very small, unincorporated home-based service businesses on a part-time basis. Respondents were educated, typically with extensive work histories, but had experienced discrimination and unpleasant attitudes from coworkers and supervisors.
Responses highlighted the importance of freedom and work–life balance. Conclusions and Implications for Practice: Self-employment is not necessarily a fit for everyone, but for individuals with psychiatric disabilities, it may be a pathway back to work. The size of the respondent businesses and the part-time nature of the work suggests that individuals with psychiatric disabilities are operating very small businesses that may serve as a wage employment alternative if they are able to grow in the future, or be sustained as a part-time adjunct to public benefits or other paid or unpaid work.
Impact and Implications
Self-employment is one strategy to improve employment and financial outcomes for individuals with psychiatric disabilities while also promoting community inclusion. This research is an important first step in exploring self-employment among people with psychiatric disabilities so that others can learn about how it works. It shows that some self-employed individuals with psychiatric disabilities are running very small businesses part time, supplementing their income. They have had negative experiences in the workplace and have chosen self-employment seeking freedom, flexibility, and work–life balance.
(CEPUK.org) – For those still interested in the recent antidepressant withdrawal debate, here is a new and important installment.
Before we get to the essential part, let us first recall that our systematic review in Addictive Behaviors (2018) showed, among other things, that around half of people who stop antidepressants experience withdrawal. This conclusion was critiqued in a blog by Joseph Hayes and Sameer Jauhar, to which we responded by pointing out the blog’s many serious errors and misrepresentations (see our response here: http://cepuk.org/2018/11/05/antidepressant-withdrawal-review-authors-respond-mental-elf-critique/
Our response to that blog, however, did not deal with one of Hayes and Jauhar’s core criticisms: that our systematic review had failed to include five randomised control trials (RTCs) [i]. They alleged that these five trials, while primarily focusing on the effectiveness of antidepressants, also contained data on the ‘incidence’ of withdrawal – that is, on how common withdrawal actually is. Had we included this data in our review, Hayes and Jauhar contended, the number of people suffering antidepressant withdrawal would have been lower than we reported, perhaps by around 10% [ii]. It was therefore either remiss or dishonest of us, they implied, not to include data from these studies.
Today, we would like to deal briefly with this particular blog criticism, not merely to show how groundless it is, but more importantly because, by doing so, we gain crucial insight into how shadowy and ethically suspect antidepressant withdrawal research can get when viewed up close.Read More
(The New Yorker Magazine) – A few years ago, the National Academy of Medicine convened a panel of sixteen leading medical experts to analyze the scientific literature on cannabis. The report they prepared, which came out in January of 2017, runs to four hundred and sixty-eight pages. It contains no bombshells or surprises, which perhaps explains why it went largely unnoticed. It simply stated, over and over again, that a drug North Americans have become enthusiastic about remains a mystery.Read More
The Foundation for Excellence in Mental Health Care, with the dedicated support of major donors, began funding pilot projects in 2012 for adapting the Finnish Open Dialogue model to the culture and system of care in the United States. Preliminary outcome data sets are too small to draw conclusions about the U.S. programs’ efficacy, but qualitative data on participant and clinician satisfaction with the practice methods argue for further investigation.
To that end, the Foundation is now reviewing RFP submissions for its competitive grant Expanding the Science and Practice of Open Dialogue: An international collaborative multicenter research project to evaluate the effectiveness of Open Dialogue in various mental health care contexts around the world.
Last week in Psychiatric Services, Kim Mueser asked Is More Rigorous Research on “Open Dialogue” a Priority?, to which we reply, unsurprisingly, “Yes.”
Dr. Mueser’s commentary highlights the need to move the science of Open Dialogue practice beyond the small, insular group of developers, advocates, and early adopters and into the mainstream.
Historically, this would have been done with federal dollars, resources which have typically been required to establish an Evidence Based Practice. Unfortunately, federal dollars aren’t available the way they were when the original EBPs were established.
That is why independent, competitive funding from the Foundation for Excellence in Mental Health Care is so important and timely. Seed funding for innovative thinkers is also often the catalyst for those thinkers acquiring other funding to advance science and practice.
Excellence board member and lead of the first U.S. pilot project, psychiatrist Chris Gordon, writes, “My own experience remains that the mode of care in Open Dialogue is vastly more humane, person-centered, and toxicity-minimizing than standard care. We have experienced great satisfaction and enthusiastic endorsement from most (but not all) individuals and families we have served, but we have seen less impact on psychosis, and more need for the use of medications, than were reported by the originators of Open Dialogue in Finland. This may in part be due to the fact that we rarely see people who are completely new to the mental health system; most people we serve come to us already on antipsychotic medications. Still, at times, psychosis can remit and Open Dialogue makes space and time and opportunity for such natural resolution, and helps people avoid getting stuck in an enervating mental health system. So it’s great for much, much better informed consent and collaborative treatment design, and it’s the process I’d want myself for someone I love – if the team includes a competent psychiatrist who appreciates that medicines sometimes can be very helpful.”