Note from the Director
Mark Your Behavioral Health Calendars!
Observances (cont.) and Events
March 2–9: Sleep Awareness Week
March 19: Kick Butts Day (Campaign for Tobacco-Free Kids)
March 21–23, 2016
Altarum Institute’s Twitter Chat on Behavioral Health
No Behavioral Health Twitter Chat is scheduled for March, but stay tuned for more chats to come. Follow Altarum on Twitter for the latest notifications.
Note from the Director
March is certainly a busy month for health awareness. The biggest health crisis facing us today is the opioid epidemic. According to the 2014 National Survey on Drug Use and Health, almost 5 million Americans aged 12 years or older used opioids in the past 30 days. The Centers for Disease Control and Prevention reported that in 2014, more than 28,000 people lost their lives due to opioid pain reliever or heroin overdose. With these staggering numbers, it is no wonder that the conversation, from the White House and the presidential candidates down to the community coalitions, finally includes ideas for addressing the disease of addiction, specifically opioid addiction.
In response to this crisis, the White House is proposing $1.1 billion to combat the opioid addiction epidemic. The opioid epidemic is an issue that cuts across racial, economic, and party lines. People on both sides of the aisle understand the seriousness of the issue and are hearing personal stories from people all over the country about its importance.
This infusion of funding could open many doors for the addictions field, and we hope that this includes support for recovery organizations and recovery services. This funding would be the largest amount of money infused into the substance use treatment system since the Substance Abuse Prevention and Treatment Block Grant was established in 1993. Although this money would help generate more options for those people in need of support and would help with the treatment of substance use challenges, we know that other opportunities from Congress can assist in this effort. The Comprehensive Addiction and Recovery Act has passed the judiciary committee after markup and is continuing its journey through congressional hearings. The work that is happening in the recovery communities, recovery high schools, recovery college programs, and the states in tandem with the Office of National Drug Control Policy and the President demonstrates a great momentum toward the hope for recovery for everyone. This money and new legislation would afford opportunities for substance use to be truly treated as the illness that it is rather than handled like a symptom of moral character. This work is so important, and the time is now! We are watching; we hope you are, too!
Sincerely, Diana Williams, Director, Behavioral Health Technical Assistance Center (BHTAC)
Recovery Journeys: Many Paths
Understanding the Unique Challenges of Women in Recovery
Women experience recovery differently from men, and those who are mothers often encounter even greater challenges to sober living. The typical woman seeking recovery presents with no housing, income, or employment; little or no family support; and a history of trauma and/or family violence.
Many women in recovery bear the stigma of being mothers with substance use issues. Men are seldom criticized for not living with their children, but society’s harsh moral judgement fertilizes the seeds of shame for women facing child reunification issues.
Two recovery support organizations, Communities for Recovery in Austin, Texas, and Northern Ohio Recovery Association (NORA) in Cleveland, Ohio, have developed effective, gender-specific recovery programs for women.
Communities for Recovery has been delivering gender-based peer recovery support and services to women since 2010, when it began partnering with the Travis County Parenting in Recovery family drug treatment court. Executive Director Robin Peyson states, “Engaging and maintaining women in recovery requires access to trauma-informed community-based recovery supports and services that ‘wrap’ around them and their families. Self-esteem, self-respect, and self-compassion are key components and integral to recovery for women.”
Providing support in a safe, nonjudgmental, compassionate, and secure environment creates the environment for success. Connecting the women whom it serves with female peer recovery coaches who have managed similar life experiences in their recovery journeys provides an opportunity for deeper connection to the peer coach and positively affects each person’s success.
In addition to gender-based coaching, Communities for Recovery has developed a relationship with an all-women Narcotics Anonymous group, Twisted Sisters, and offers an all-women support group. Frequently, the women who are served have no friendships with other women, so providing opportunities to build strong relationships with other women in recovery in a safe and secure recovery environment is a fundamentally important part of the recovery journey.
NORA, founded in 2004, secured Center for Substance Abuse Treatment funding to open recovery resource centers in northern Ohio to provide recovery support services to 1,250 people annually for its first 4 years. NORA Executive Director Anita Bradley believes that the importance of the three gender-specific programs to the recovery community cannot be overstated.
NORA’s peer-to-peer program, designed to enhance recovery outcomes for women in both early and long-term recovery, connects volunteer peer recovery mentor coaches with newly recovering members. Peer-to-peer services provide access to community support, a phone hotline, and Web-based recovery support.
NORA operates a gender-specific intensive outpatient treatment program for homeless women. Sisters of Sobriety uses evidence-based practices and focuses on the whole person. In addition to substance use treatment service, this comprehensive program offers education, trauma, and family counseling; father/partner support; and child services. A registered nurse provides pharmacological education, and case management staff provides linkages to resources and transportation. Additional adult mental health and behavioral health services, emotional assessment, and counseling for children are available through a partnering organization.
NORA’s Next Step Recovery House serves homeless women who have completed or are engaged in a treatment program and their children. It provides temporary housing in a safe and sober environment, three hot meals a day, financial literacy, employment readiness training, job leads, high school equivalency classes, and trade certifications through a partnership with Cuyahoga Community College. Peer support, child care, domestic violence education, recovery coaching, and access to an onsite nurse are all among the next steps to recovery at NORA’s Next Step Recovery House.
On the Home Front
Altarum Institute’s Council on Aspirin for Health and Prevention
Aspirin is a remarkable drug. Each year, researchers publish hundreds of new scientific studies about aspirin and its benefits. Derived from the bark of the willow tree, it has long been known to fight pain and reduce fevers. Although very inexpensive, aspirin can also prevent heart attacks, strokes, and certain kinds of cancer. Aspirin use carries risks, and not everybody should take it, but it is known to be underused in people who would benefit from it.
To this end, the Council on Aspirin for Health and Prevention exists as an autonomous group of health care professionals dedicated to increasing the appropriate use of aspirin to improve health. Convened by Altarum Institute, the Council considers aspirin-related practice and policy and serves as a forum for scientific review, guidance development, and public awareness. The Council’s efforts are focused on the provider-patient relationship and the interventions, policies, educational strategies, and systems that influence it.
The Aspirin Project is the Council’s brand, its visible outreach effort. For an overview of the Aspirin Project, watch this 1-minute video. For more information about aspirin and the Council, visit the Aspirin Project website.
Here is a quick look at a few Aspirin Project initiatives from 2015:
- Two new research projects were initiated, one on aspirin and the prevention of colon cancer and the other on increasing aspirin use in the African-American population.
- A nationwide consumer survey about aspirin use was published in the American Journal of Prevention Medicine.
- New aspirin-related waiting room ads, like this one, were developed. They are available for free download on the project’s website.
In 2016, the Council has a variety of activities under way:
- Two new fact sheets on aspirin and cancer prevention are now available. One is for health care providers, and the other is for consumers.
- The Aspirin in the News digest is produced every month. It catalogs the aspirin-related consumer news and scientific research studies of the past month.
- A case study on Minnesota’s Ask About Aspirin program is in development. Ask About
Aspirin is a statewide initiative to educate citizens about the appropriate use of aspirin.
Imagine that a simple conversation between a provider and the person seeking care could save a life. When this conversation is about aspirin, it could be true. As we age, low-dose aspirin can keep us in good health. Aspirin prevents strokes in women and heart attacks in men. Evidence is strengthening that it also may prevent some types of cancer. Having people discuss the benefits of aspirin with their doctors can prolong life and reduce health care costs. Because aspirin use has unfortunate side effects, it is critical to carefully determine the right population for aspirin’s preventive use. If we can do better at having the right people take aspirin, at a minimum, we could prevent many heart attacks, strokes, and colon cancer cases.
Spotlights and Highlights
The White House’s Proposed $1 Billion in Funding to Combat Opioid Abuse: What Would That Money Do?
In early February, the White House announced that it would propose $1.1 billion to combat the opioid and heroin addiction epidemic. This money would be included in the upcoming fiscal year 2017 budget request and include targeted funding to do the following:
- Expand medication-assisted treatment and improve access for its use in treating opioid use challenges. The bulk of the proposed funding would go toward this effort, being provided to individual states based on the severity of the epidemic in their region and the soundness of their strategies to respond to the crisis. These funds would expand treatment capacity, subsidize services, and make the services more affordable.
- Expand access to more than 700 substance use treatment providers, including medication-assisted treatment. This expansion is geared to help areas in the country that are most in need of mental health treatment.
- Evaluate the effectiveness of treatment programs using medication-assisted treatment and identify opportunities to improve treatment for patients with opioid use challenges.
This proposal also includes an increased budget for the ongoing effort to expand state prescription overdose prevention strategies, improve the availability of medication-assisted treatment programs, extend access to the life-saving overdose drug naloxone, and support enforcement activities. It includes medical guidance to states based on best practices for addressing the opioid addiction epidemic, including medication-assisted treatment and naloxone use, improved training for doctors on prescribing pain medications, and monitoring of opioid prescriptions. Visit Medpage Today for more information.
Depression Affects Everybody, Even in Utero
Depression has long been known to cause other health risks, including, in expectant mothers, a higher risk of giving birth prematurely. However, a recent article at Science Daily highlights the importance of treating depression in all patients, regardless of age or gender. A recent study determined that having a father with depression increased the risk of premature birth significantly. Exactly how this occurs is unknown and needs to be explored further, but fathers who underwent treatment for depression reduced this additional risk considerably.
Unfortunately, this highlights a key inequity in depression treatment: Men are often less likely to seek help for mental health problems on their own. No one, male or female, young or old, should have to suffer alone, and this study emphasizes the need for outreach and support, especially for men and fathers with depression.
Physician Burnout: A Real Problem Affecting Real People
Physicians and medical students work long hours in highly stressful and competitive environments, and they are not invulnerable to the consequences. Many physicians suffer from emotional and physical exhaustion—the number is up by 10% over the past 3 years—and feel that their work has lost its meaning or that they are ineffective at their jobs. Depressed, stressed, exhausted physicians are unable to deliver quality care and will become unhealthy themselves. However, admitting to having a problem of a mental health nature is highly stigmatized; some state licensing boards ask mental health questions, and exposing mental health issues can end a career.
Facing this outcome, physicians and medical students do not seek help if they suffer from mental pain, including depression. Instead, they hide their problems and try to deal with it on their own. Some use meditation or breathing techniques to try to cope; others self-medicate. Since they often have easier access to controlled drugs and substances, self-medication is a dangerous proposition; statistics regarding physicians’ misuse of opioids, addiction, death, and suicide are high.
Some contention exists over the term “burnout,” as it implies that the physicians are to blame for the state of their mental health—that they failed to balance their work and home lives or chose the wrong path. However, it is not their fault. The pressure, competition, abuse, and stigma in their work environment need to change via implementation of evidence-based practices and breakdown of barriers, allowing physicians to address their mental health properly and without concern. Improving their health will lead to the better health of the people under their care.
Latest in Research
Opioid Treatment Implants: Are They the Best Option?
As awareness of the opioid epidemic and, consequently, medication-assisted treatment grow, it is inevitable that new technology, like the opioid implants called Probuphine, would appear to move the field forward. These devices are matchstick-sized rods that are implanted beneath the skin and steadily secrete buprenorphine. The hope is that these implants will be a safer way to deliver the drug and allow people in recovery from opioids to make fewer trips to a clinic, which may not be easily accessible.
However, the implant lasts only 6 months, a short time for someone in recovery, who may need years of this support. It also fails to address several important questions: Can the dose be safely and easily adjusted to match the recovery needs of individual people? Will it need to be supplemented orally, defeating the purpose of an implant? How will people who are currently taking buprenorphine orally transition to the implant? Will people with the implant check in regularly?
In other words, an opioid treatment implant could be a great boon to medication-assisted treatment and recovery, but it may not be ready for widespread use just yet. Counselors should be wary of recommending implants over other forms of medication-assisted treatment but should also look for future improvements that solve some of the current implant model’s issues.
Obesity and Health Effects
The effects of one’s diet on health are myriad and well-documented. Recent studies at Columbia University Medical Center in New York show that these effects extend to sleep length and quality. By feeding volunteers controlled meals, researchers were able to determine that high fiber intake was associated with greater time spent in slow wave sleep, while saturated fat was associated with less. Sugar was associated with sleep disturbances. Sleep quantity and quality have significant effects on hypertension, diabetes, cardiovascular disease, and general mental health, making the connection to diet important.
Research at Boston University Medical Center on the effects of pre-pregnancy obesity on the newborn child show that infant mortality rates from preterm causes were nearly twice as high for obese women as for women of normal weight. Maternal obesity and gestational diabetes have also been associated with greater likelihoods of developmental disorders in the infants, including autism spectrum disorders.
In the light of this, behavioral health workers should seriously consider using dietary interventions as a powerful tool to improve people’s lives.
Kidney Disease and Mental Health
Kidney disease is often comorbid with substance use challenges and can interfere with addressing those challenges as well as other diseases. The highly stressful and restrictive lifestyle changes and symptoms caused by chronic kidney disease may be difficult for people to manage. These changes are often associated with depression and frustration, making the interactions among kidney disease, physical health, and mental health important information for behavioral health workers to learn.
A recent study determined that measuring a hormone in a standard urine test could accurately diagnose people at risk for chronic kidney disease. Decreased levels of this hormone were shown to be linked to declining kidney health, allowing an accurate diagnosis in the earlier stages of the disease without costly and invasive kidney biopsies.
Once detected, chronic kidney disease can be treated; people are living longer on dialysis and with kidney transplants. When detected early, behavioral health workers can better fit chronic kidney disease treatment into holistic plans, leading to more comprehensive treatment and better quality of life. For more information, visit Mental Health Services for People with Kidney Disease.
No Behavioral Health Twitter Chat is scheduled for March, but stay tuned for new chats soon. Follow Altarum on Twitter for the latest updates on behavioral health and notifications of upcoming discussions. Visit BHTAC for a list of Altarum’s previous Twitter chat guests and Storify to review the conversations.