There is a common phrase thrown around by those in recovery from drug and alcohol abuse that describes a sentiment while they were using: incomprehensible demoralization. While this phrase is applied to thousands of diverse stories and situations, the feeling is the same. Most in recovery can attest to their moments of incomprehensible demoralization.
Recently this sentiment was in the public eye with news stories about people getting drunk, doing very regretful things and woefully apologizing afterwards. Some of the things they did while intoxicated disrupted their careers and reputations with a swift and lasting effect that only serves to reinforce the sentiment of incomprehensible demoralization.
The first popular story occurred about a month ago when Reese Witherspoon’s husband got pulled over for drunk driving in Atlanta. Reese was caught on camera on the side of the road talking back to the police. In an aggressive and boastful tone she asked and asserted, “you don't need to know my name?!….Well, you are about to find out who I am!” She acted as if being famous exempted her from being treated normally - or in her case - handcuffed and arrested.
Overnight her reputation went from being the sweet girl next door to being egotistically irresponsible and rude. Days later she publically apologized and soberly knew that the police were “just doing their job.” The harsh reality is that what she did while drunk had no bearing on who she really is as a person. It is because of regretful drunk actions like this that people experience demoralization. Often what people do while drunk is far different what their normal selves would dictate - which consequently is also a telltale sign of a problem with alcohol.
In another incident last week, an Eco-Tourism Field Guide named Brian Masters, who had dedicated his education and life to garner that line of work, lost his job. This happened after a video went viral of him charging at an elephant while drunk as his friends recorded him. Now “the guide involved in the confrontation is no longer employed by Singita and further disciplinary procedures are in progress with regard to others involved," according to a post on the group's Facebook page. Singita describes the video as “disturbing," and say the elephant was "extremely agitated by the confrontation and retreated into the bush.”
In response to the event, Masters said “I admit full responsibility for the actions and am deeply, deeply remorseful…There has been a lot of baying for blood and a campaign to name and shame so here I am. I am so sorry this happened and I wish I could undo the stupidity of the act but I can’t; all I can do is apologize and hope people can see the sincerity I am trying to convey.” As aforementioned, although others may not relate to the story specifically, the sentiment is exactly the same. In short, Witherspoon and Masters likely feel the same exact way about themselves although their stories bear no resemblance.
These incidents depicted in the videos below show the destruction that even one night of alcohol abuse can cause. They show how character-changing alcohol can be and how it can cause deep regret. Luckily the demoralization eventually fades, especially after a sound apology as they have made and self forgiveness kicks in.
Wednesday, May 22, 2013
Sunday, May 12, 2013
Is the DSM V Diagnosing Addiction Right?
What has long been considered the go-to resource for diagnosing mental and addictive disorders, has been recently critiqued by Dr. Thomas R. Insel, the Director of the National Institute of Mental Health.
Dr. Insel is considered an expert in the field of mental health disorders and says that the Diagnostic Statistical Manual of Mental Disorders (DSM) doesn’t account for important diagnostic tools such as the role of biology, neuroscience and genetics. Currently, the DSM looks at symptoms as the driving criteria to diagnose patients for mental and addictive disorders. For example, the critera for substance dependence is:
1.Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
2.Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3.The substance is often taken in larger amounts or over a longer period than intended.
4.There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5.A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6.Important social, occupational, or recreational activities are given up or reduced because of substance use.
7.The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
If someone has experienced 3 of these critera within the same 12 month period, they are diagnosed with substance dependence. According to Dr. Steven E Hyman, former Director of the National Institute of Mental Health, the DSM “chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’” Hyman explains that this caused a scientific dilemma because those who qualify for one diagnosis qualify for five by default but don’t actually have five diseases. Both Dr. Insel and Hyman explain that patients have an underlying condition that causes the symptoms. Therefore, the lens through which we look at patients and research should be through the overall condition rather than just the symptoms.
Dr. Insel asserts that the DSM created in the 1960s and 10970s is outdated and “As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” because people think everything has to match the criteria. He explains that biology doesn’t follow the rigid criteria of the DSM and we should look at the causes and condition. For example, over the past 40 years neuroscience has shown that genetic abnormalities can put people at risk for addiction, schizophrenia or bipolar disorder. The drugs created for disorders like bipolar disorder show nothing about the causes of the disorder and therefore drug makers have no goal for drug development that targets the problem before it manifests. Dr. Hyman, Insel and other experts would like the current direction of cancer research, such as characterizing it by genetic and molecular signatures, to serve as a model for the direction of mental health research.
With the newest DSM since 1994 set to come out in a few weeks, practitioners say it shouldn’t be disregarded entirely. It is still the primary tool available to diagnose disorders, but those like Dr. Insel and Hyman say that while using it, keep in mind that it doesn’t reflect the entire picture of the disorder - namely the causes of the condition - and it should not guide research.
Dr. Insel is considered an expert in the field of mental health disorders and says that the Diagnostic Statistical Manual of Mental Disorders (DSM) doesn’t account for important diagnostic tools such as the role of biology, neuroscience and genetics. Currently, the DSM looks at symptoms as the driving criteria to diagnose patients for mental and addictive disorders. For example, the critera for substance dependence is:
1.Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance.
2.Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms.
3.The substance is often taken in larger amounts or over a longer period than intended.
4.There is a persistent desire or unsuccessful efforts to cut down or control substance use.
5.A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
6.Important social, occupational, or recreational activities are given up or reduced because of substance use.
7.The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example, current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption).
If someone has experienced 3 of these critera within the same 12 month period, they are diagnosed with substance dependence. According to Dr. Steven E Hyman, former Director of the National Institute of Mental Health, the DSM “chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’” Hyman explains that this caused a scientific dilemma because those who qualify for one diagnosis qualify for five by default but don’t actually have five diseases. Both Dr. Insel and Hyman explain that patients have an underlying condition that causes the symptoms. Therefore, the lens through which we look at patients and research should be through the overall condition rather than just the symptoms.
Dr. Insel asserts that the DSM created in the 1960s and 10970s is outdated and “As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” because people think everything has to match the criteria. He explains that biology doesn’t follow the rigid criteria of the DSM and we should look at the causes and condition. For example, over the past 40 years neuroscience has shown that genetic abnormalities can put people at risk for addiction, schizophrenia or bipolar disorder. The drugs created for disorders like bipolar disorder show nothing about the causes of the disorder and therefore drug makers have no goal for drug development that targets the problem before it manifests. Dr. Hyman, Insel and other experts would like the current direction of cancer research, such as characterizing it by genetic and molecular signatures, to serve as a model for the direction of mental health research.
With the newest DSM since 1994 set to come out in a few weeks, practitioners say it shouldn’t be disregarded entirely. It is still the primary tool available to diagnose disorders, but those like Dr. Insel and Hyman say that while using it, keep in mind that it doesn’t reflect the entire picture of the disorder - namely the causes of the condition - and it should not guide research.
Wednesday, May 1, 2013
Swedes Created Breathalyzer that Detects Drugs
A recent advancement in the technology used for Breathalyzers may benefit the state of Colorado in preventing substance abuse related accidents. Colorado has seen its fair share of drunk driving and the recent passing of Amendment 64 has made people question the safety and legality of drivers under the influence of marijuana.
Apparently Switzerland has a high rate of substance related accidents as well, which promoted them to create a new device that can detect 12 different substances including the most commonly abused drugs such as marijuana, morphine, crystal meth, cocaine and heroin. Currently the process and enforcement mechanisms behind testing drivers for drugs other than alcohol have been limited at best. Testing for substances require blood and urine samples - which police can't conduct roadside.
The Swedish designed Breathalyzer was tested on 47 patients in an addiction clinic and was able to detect drugs with an accuracy rate of 87% - which is in line with the accuracy rate of most urine and blood tests. One drawback of the device is that it was able to pick up on the use of substances 24 hours after they were reportedly used. Therefore the level of substances and determination if one is “under the influence” at the time they are suspected cannot be accurately detected. According to the lead of the study published in the Journal of Breath Research, Professor Olof Beck, future studies can be refined to correlate the breath with actual concentrations of the drugs.
In this way, law enforcement could use the Breathalyzer preliminarily at the scene and then later confirm it by urine and blood tests. While this seems viable, a lot of regulations would be required - such as determining the levels of drugs that would be deemed “over the limit” according to the height, weight, history of use, developed tolerance and gender of the suspect. Prosecution and enforcement would be difficult as DWI and DUI defense attorneys would have a field day with the amount of indeterminate factors of what is "over the limit" for each substance. But considering and fine tuning this option in the future seems increasingly important as the Center for Disease Control reports that the aforementioned drugs are involved in roughly 18% of fatal car crashes.
Apparently Switzerland has a high rate of substance related accidents as well, which promoted them to create a new device that can detect 12 different substances including the most commonly abused drugs such as marijuana, morphine, crystal meth, cocaine and heroin. Currently the process and enforcement mechanisms behind testing drivers for drugs other than alcohol have been limited at best. Testing for substances require blood and urine samples - which police can't conduct roadside.
The Swedish designed Breathalyzer was tested on 47 patients in an addiction clinic and was able to detect drugs with an accuracy rate of 87% - which is in line with the accuracy rate of most urine and blood tests. One drawback of the device is that it was able to pick up on the use of substances 24 hours after they were reportedly used. Therefore the level of substances and determination if one is “under the influence” at the time they are suspected cannot be accurately detected. According to the lead of the study published in the Journal of Breath Research, Professor Olof Beck, future studies can be refined to correlate the breath with actual concentrations of the drugs.
In this way, law enforcement could use the Breathalyzer preliminarily at the scene and then later confirm it by urine and blood tests. While this seems viable, a lot of regulations would be required - such as determining the levels of drugs that would be deemed “over the limit” according to the height, weight, history of use, developed tolerance and gender of the suspect. Prosecution and enforcement would be difficult as DWI and DUI defense attorneys would have a field day with the amount of indeterminate factors of what is "over the limit" for each substance. But considering and fine tuning this option in the future seems increasingly important as the Center for Disease Control reports that the aforementioned drugs are involved in roughly 18% of fatal car crashes.
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