Why People Don’t Get Help for Alcohol Use

Alcohol misuse is common – more than 16 million US adults (about seven percent) have alcohol use disorder. Yet many people don’t get help.  Less than one in 10 people with alcohol use disorder receiving treatment, according to the 2013 National Survey on Drug Use and Health.



Many people with alcohol use disorder don’t think they need treatment, yet even among people who believe they need treatment, only 15-30 percent receive treatment.  Researchers looking into why people don’t get treatment found barriers related to beliefs and attitude the biggest obstacle.



Among people who believe they need treatment, their attitudes are the most commonly reported barriers, according to research reported  in Psychiatric Services in Advance on August 3, 2015  Financial barriers (e.g., couldn’t afford it) and structural barriers (e.g., didn’t have time, didn’t know where to go) were cited much less frequently.



The top barriers to seeking help for alcohol problems were

• I should be strong enough to handle it alone -  42%

• The problem would get better by itself - 33%

• Not serious enough to seek treatment  - 21%

• Too embarrassed to discuss it - 19%



Previous research has identified some characteristics that make if more or less likely that people will seek treatment: unmarried people are more likely to get treatment than married people and men are more likely to get treatment than women.



One ongoing problem, the researchers note, is that many doctors are still uncomfortable asking about alcohol use.



Concerned about your own drinking?  See an online assessment from NIAAA and learn more problem drinking and getting help in Rethinking Drinking. Find help with SAMHSA’s Behavioral Health Treatment Locator or 24-hour toll-free Referral Helpline at 1-800-662-HELP (1-800-662-4357).





By Deborah Cohen, Senior Writer, American Psychiatric Association

Celebrities Take on Roles as Mental Health Advocates

Actor Jared Padalecki, known for his roles in “Supernatural” and “Gilmore Girls,” has become the latest in a long list of celebrities who are speaking out about mental illness. These famous people are talking about their personal experiences and using their popularity to help raise awareness, fight stigma, and encourage people who are struggling to reach out and get help. Padelecki has talked about his struggles with depression and initiated the #AlwaysKeepFighting campaign to raise awareness and support.



Musician Demi Lovato has been outspoken and public about her experience with bipolar disorder and has become an outspoken advocate for mental health.  She recently joined with several organizations, including the Depression and Bipolar Support Alliance, the Jed Foundation, and others, as part of the  Be Vocal: Speak Up for Mental Health initiative. The campaign encourages individuals to speak up for themselves in asking for help and to learn how to speak out for others in the community.



Actress Glenn Close has been outspoken and active in bringing national attention to the issue of mental illness. After seeing her sister cope with a mental illness and the stigma associated with it, Close founded the nonprofit advocacy organization of Bring Change 2 Mind.  



Actor Joey Pantoliano, has also been active in talking about his personal struggles with depression and substance use. He is raising awareness and fighting stigma through his No Kidding, Me Too! foundation.  Among its many activities, NKM2 promotes messages of empowerments and acceptance through an award-winning documentary of the same name and a series of public service announcements.



Brooke Shields has publicly shared her experience with postpartum depression and written her story of despair and recovery in a memoir, “Down Came the Rain: My Journey Through Postpartum Depression.” Carrie Fisher (Princess Leia of “Star Wars” fame) has taken her advocacy to the stage with her autobiographical one-woman play “Wishful Drinking,” where she tells her story of bipolar disorder and substance use with openness and humor.


As Jeffrey Borenstein, M.D., president and CEO of the Brain and Behavior Research Foundation, noted in a recent interview with CNN, "When celebrities speak publicly about their own experiences with depression or other psychiatric conditions, it's very helpful. It opens up a conversation about these issues. If someone you admire is going through the same thing you might be going through, it makes a difference with people, it causes people to seek help."


Borenstein is also host of a PBS series on mental health issues called Healthy Minds.  You can view past episodes on topics such as bipolar disorder, autism, schizophrenia, and more online at WLIW – Healthy Minds.



By Deborah Cohen, senior writer, American Psychiatric Association

Marijuana: Legal Doesn’t Mean Safe

Twenty-three
states and the District of Columbia have laws legalizing some form of marijuana
use, and recreational use of marijuana is legal in four states and D.C.

Does
this growing trend to legalize marijuana mean we don’t need to worry about it?  About
one in 10 people who try marijuana will become addicted to it which means that
they most likely will use it in increasing quantities, develop tolerance (less
effect from it as time goes on), will have withdrawal symptoms if they try to
stop, and will find that the marijuana use is causing them to neglect other
important areas of their life like work, relationships and leisure
activities. 

Even
occasional use of marijuana can have negative effects.  hen someone has marijuana in his/her system,
short term memory is impaired, reflexes are impaired and judgment is
impaired.  These impairments can last 24
hours or longer after the use of the marijuana so it is certainly not safe to
drive after using marijuana. Most people will not be able to perform other
demanding tasks (work-related activities, childcare) at the level they are
accustomed to after using marijuana. 

All the
evidence that we now have indicates that marijuana is possibly permanently damaging
to the developing adolescent brain. All
children should be strongly discouraged from using it at all until they are at
least 21 years of age. If marijuana is
smoked there are also potential physical health risks, such as damage to the
lungs or cardiovascular system.

For more information, see American Psychiatric Association’s  Resource
Document on Marijuana as Medicine.

By Andrew Saxon, MD

Professor and Director, Addiction
Psychiatry Residency Program

University of Washington

Director, Center of
Excellence in Substance Abuse Treatment and Education

VA Puget Sound Health
Care System

Seattle, WA

Reducing the Stigma of Addiction

Nora Volkow, MD, Director, NIDA

Addiction is common – an estimated 1 in 11 people in the United States experiences a substance use disorder in a given year. Despite significant advances in understanding and treatment, stigma still prevents many people from seeking help.

Nora Volkow, M.D., director of the National Institute on Drug Abuse, speaking recently at the APA’s Annual Meeting in Toronto, talked about some of the recent advances in the understanding of addiction and called on psychiatrists to help reduce the stigma of addiction and “help to eliminate the shame and suffering that accompany the addict who experiences relapse after relapse after relapse.”

Volkow opened her speech with a moving and emotional story of how she learned of her grandfather’s alcoholism and suicide. He had died when she was a girl of 6 in Mexico, but Volkow’s mother did not reveal the truth of her grandfather’s addiction and death until many years later, when her mother was dying and after Volkow had already achieved distinction as an addiction expert.

It was a dramatic illustration of the despair experienced by people who have an addiction and continue to engage in a behavior that they may know is destroying them. She described how it was once believed that addiction was a disorder of hyperactive reward centers in the brain—that people with addiction s sought out drugs or alcohol because they were especially sensitive to the pleasure-inducing effects of dopamine.

But Volkow explained that in recent years research has revealed just the opposite: that those with addiction are actually less sensitive to the effects of dopamine. They seek out drugs because of the very potency with which they can increase dopamine in the brain, often at the expense of other pleasurable natural stimulants that do not increase dopamine so dramatically

Moreover, she emphasized that addiction to drugs disrupts multiple systems in the brain that govern the ability to plan, anticipate, and change behavior in response to changing circumstances. Volkow said it is this phenomenon that accounts for the “craving” experienced by addicts and alcoholics in response to environmental triggers—often leading to what she characterized in the account of her grandfather’s death as that “one last moment of self-hatred.”

Adapted from Psychiatric News

Effective Addiction Treatments are Available

By John Renner, MD and Frances Levin, MD

We are all saddened by the death of Philip Seymour Hoffman and the many other
individuals who have died because of overdoses of heroin or pain
medications.  For all of those individuals who struggle with opioid use
problems, it is important to realize that help is available and that effective
treatment can restore them to productive lives.  Some 4.7 million people
in the U.S. have used heroin at least once in their lives.  It is estimated that nearly a quarter of
people that use heroin become dependent on it.



Whether it be through mutual support programs such as NA, long-term residential
treatment, or addiction pharmacotherapy with buprenorphine, methadone or ER
naltrexone, no individual need fear that their condition cannot be
treated.  Friends and family members also need to be educated in the use
of intra-nasal naloxone for the reversal of opioid overdoses.  



APA has long fostered the development of addiction focused training programs
for psychiatrists.  Many psychiatrists have been specifically trained
to provide office-based addiction pharmacotherapy and to manage the
co-occurring psychiatric disorders that often complicate recovery from
substance use disorders.  

More information:

·        
Information on addiction

·         Opioid Overdose Prevention Toolkit (SAMHSA)

·        
Substance
use treatment locator (SAMHSA)

·        
Buprenorphine Physician
and Treatment locator (SAMHSA)

·        
For psychiatrists:  Providers
Clinical Support System for Medication Assisted Treatment

Blog
contributors:

John
Renner, MD

Member, APA Council on Addicition Psychiatry (Past Chair)
Director of Addiction Fellowship Program,

Professor of Psychiatry,  Boston University School of Medicine



Associate Chief of Psychiatry, VA Boston Healthcare System

Frances Levin, MD

Chair, APA Council on Addiction Psychiatry
Kennedy-Leavy Professor of Psychiatry, Columbia University Medical Center

Director, Addiction Psychiatry Fellowship,

New York Presbyterian Hospital

New York State Psychiatric Institute

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