Across the U.S., governors are terming alcohol sales an essential business and loosening restrictions to permit home delivery and carryout cocktails,

Are alcohol sales actually essential? According to the federal government, just over half of Americans age 18 and above (55.3%) drank alcohol in the past 30 days; just over a quarter binged – more than four drinks on an occasion for women, or five for men – and 1 in 17 (5.8%) had an alcohol use disorder, ranging from mild to severe.

For those in this latter group who are actually dependent on it, alcohol may indeed be essential.

But evidence thus far in the epidemic is that people in general are buying more alcohol, and in larger quantities. As someone who has spent 30 years studying the link between alcohol policy and public health, I know that this is likely to result in a spike in alcohol use disorders for years to come.

This increase in drinking will have both a short- and a long-term impact on health and safety. In the short term, alcohol abuse suppresses multiple aspects of the body’s immune system response, with particular effects on the lungs’ ability to fight off infections like COVID-19.

The rise in off-premise sales of alcohol and home consumption will also likely affect interpersonal violence. Adding alcohol to a possibly violent situation is like pouring gasoline on a lit fire.

Prior to the coronavirus outbreak, CityHealth, a project of the de Beaumont Foundation and Kaiser Permanente rated the nation’s 40 largest cities on whether they have claimed jurisdiction over alcohol sales within their borders.

Eight can regulate alcohol outlets, including limiting hours and days of sale, establishing maximum purchase amounts, and banning price discounting, which is known to increase alcohol consumption. If necessary, they can also shut down premises.

Another eight have elements of local control over alcohol sales, but lack jurisdiction over some portion of new or existing outlets.

The remaining 24 cities lack control, because they are preempted from it by state laws that prohibit local action, or because they have not expressly taken such authority in their city codes. Yet even in these cities, civic and public health leaders could use emergency powers to limit or shut down alcohol sales in their jurisdictions.

A large body of research has found that the number of stores selling alcohol in an area, and how they serve and sell it matters for public health. The Task Force on Community Preventive Services concluded that limiting both the density of outlets and the hours and days they may sell are effective measures for reducing alcohol problems.

Read full article here 

How do you feel now you’re a non-smoker?  My answer came spontaneously  – LONELY – he (my therapist) looked surprised and I felt embarrassed, why did I say lonely??  It’s like I’m saying cigarettes were my friends – I know they were not my friends, but it’s true, I feel lonely without them!!

Now I can see how deeply honest that answer was – in each of the addictive habits I’ve dabbled in, there’s always been an attempt to solve the terrible aloneness of life, so when I read this article recently, I really resonated with this patient of Dr Dean Ornish who told him, “I’ve got 20 friends in this package of cigarettes; they’re always there for me, and no one else is. You want me to give up my 20 friends? What are you going to give me instead?”

Initially I did a lot of physical yoga practice – Hatha Yoga (Asana) and Pranayama.  Those are still part of my daily practice.

Today, more than ever, I am so grateful to have networks of connection and community during this time of social isolation due to the Covid 19 virus.  Thanks to all those who are making their yoga classes available online, and to members of 12 step fellowship who have organized online meetings – it’s great to see people empowered in their response to this crisis.

19 years ago I went to an ashram as a ‘smoking rehab’ and kept going back every few weeks.  There I learned about Ayurveda, the sister science of Yoga.  What I was given instead of my pack of 20 friends was the biggest gift of my life – the integration of Yoga and Ayurveda that allowed me to blossom more fully into health and wellbeing from my foundational recovery tool of the 12 step programs.  This led to Yoga of Recovery which I’ve been offering for over 15 years.  I’m so grateful for all those who’ve joined me on YoR retreats.  The biggest boost to my life, health and happiness has come through sharing the healing I found using the paths of Yoga and the life science of Ayurveda.   This has brought me to a beautiful group of people and I’m grateful every day for the many benefits – physical and emotional health based in deeper self-understanding and simple daily routines.

I live in the grace of social networks that feel safe and supporting — my extended family of choice, and a sustainable lifestyle.  What has been most healing for me is service, purpose, beauty of self-expression and meaning.  Thank you to my true friends xxx

with Love and deepest gratitude, Durga Leela

 

 

 

Psychiatrist M. Scott Peck, a self-confessed nicotine addict and author of The Road Less Traveled, offered his perspective in a 1991 lecture, “Addiction: The Sacred Disease.” Dr. Peck’s thesis:

At birth, humans become separated from God. Everyone is aware of this separation, but some people are more attuned to it than others. They report feeling an emptiness, a longing, what many refer to as “a hole in their soul.” They sense that something is missing, but don’t know what it is.

Five things you may not know about alcohol, the most commonly used drug in the world

1) Alcohol is a Group 1 carcinogen according to the International Agency for Research on Cancer (IARC; i.e., it is known to cause cancer) and the US Department of Health and Human Services. For example, when examined as a group, studies investigating the relationship between drinking and cancer show that consuming as little as 1.5 standard drinks per day (i.e., 20 grams of pure alcohol) increases breast cancer risk in women by 25% and esophageal cancer risk by 86% (see here).  

2) Harmful drinking and alcohol use disorder account for 12.1% of all disability-adjusted life-years lost (i.e., healthy years lost due to premature death or disease/disability) for men, and 4.5% for women in the United States (see here).  

3) Worldwide, 6% of all deaths are attributable to alcohol consumption, greater than HIV/AIDS, violence, or tuberculosis (see here), while harmful alcohol use is the leading risk factor for death in males aged 15-59, and leading risk factor for all disability-adjusted life years lost in 15-24 olds (see here). 

4) The potential negative harms of alcohol use can be challenged at a public health level with several straightforward policy changes (see here, for example). These policies include, for example, reducing excess availability of alcohol (e.g., by controlling the density of establishments that can sell alcohol), increasing the price of alcohol (e.g., via alcohol-specific taxes and minimum pricing), and regulating the reach of alcohol advertising, especially ads that target young people.  

5) Excessive drinking – including but not limited to alcohol use disorder – costs the United States approximately $250 billion annually, in lost productivity as well as health care, criminal justice, and various forms of property damage including motor vehicle crashes (see here).

I’ve been thinking of Dr Frank Plummer who I posted about on 21 January 2020 as I remembered he was recognized for leadership roles in the Sars, H1N1 flu and Ebola epidemics.  I was hoping that his brain surgery for alcohol addiction had worked and that he was back at work – offering his service and genius toward a new vaccination for the Covid-19 virus currently playing havoc across the globe.  I am sad to report that Dr Plummer, one of Canada’s top scientists and researchers died, reportedly of a heart attack.

Just over a year ago, Dr Plummer had chosen to participate in a surgical trial for experimental brain surgery to treat his alcoholism and had spoken about the positive results.  The procedure, called deep brain stimulation (DBS), was being conducted in North America for the first time for otherwise untreatable alcohol addiction at Toronto’s Sunnybrook Hospital.

He was the guinea pig in a clinical trial investigating whether brain implants can help treat alcohol use disorder.

Although he loved his work he found it stressful, with 12-hour days that began with coffee and would end with several glasses of scotch, which escalated to about 20 ounces a night.  It didn’t seem to affect his work – until 2012, when his “liver packed it in”.  The diagnosis of chronic liver failure was followed by a liver transplant, but he found his alcohol had become a powerful thirst – he tried treatment – rehab programmes, support groups, counselling, medications – but he would inevitably slip back into drinking.

“It was pretty hopeless cycle…,I was in the hospital a lot, I almost died several times.”

He went looking for “a more robust clinical solution, perhaps one not yet discovered” – and was referred for an experimental procedure using deep brain stimulation (DBS) to help patients with treatment-resistant alcohol use disorder. DBS is frequently described as a type of “pacemaker” for the brain.

Patients are awake for the surgery.

Dr Plummer says the worst part of the procedure were the noise and vibrations when surgeons drilled into his skull in order to implant the electrodes.  “It was a large drill that drills about a 25 cent piece out of your skull on both sides

Dr Plummer was the trial’s first patient and underwent the experimental surgery just over a year ago.  The surgeon says Dr Plummer has seen an improvement in both his cravings and his mood.

Dr Plummer said the surgery had given him a new lease on life after a series of health problems had forced him to confront his battle with alcohol addiction.  He had returned to HIV research with the hopes of developing a vaccine for the disease and had begun writing a book about his experience in Kenya working on the frontlines of the Aids crisis.

He received numerous accolades for his work, including receiving the Order of Canada, one of the country’s highest honours, and the Canada Gairdner Wightman Award, which recognises scientists whose work has had a significant impact on health outcomes in the developing world.  He will be sorely missed.

I’ve been thinking of this story and it showed up in a newsletter this weekend so I thought I’d share it here:

Once, millions of people were gathering at a religious place of pilgrimage. There was a very saintly old person who couldn’t really walk that far distance to join everyone. He had a small hut somewhere on the way, but it was hundreds of miles away. The pilgrims were passing through, and he had the opportunity to see all who were going to the pilgrimage. At one point he saw a kind of peculiar figure, not a human figure, going toward the place of pilgrimage.

The saint stopped him and asked, “Hey, who are you? You look a little funny. Where are you going?”

“Oh, I’m going for the pilgrimage.”

“Ah, what is your purpose?”

“Well, I have an assignment.”

“Tell me, what is the assignment? What is your name?”

“I’m named Mister Cholera.”

“What? You’re Mister Cholera? Why are you going there?”

“I have been assigned to remove five hundred people from the face of the earth, and am taking that pilgrimage as an excuse. I’m going to fulfill my mission.”

“Oh, I see. Well, if that is God’s purpose, you should do it, because people go there and forget about their sanitary conditions. They create the environment for that, so probably you will have lots of disciples.”

When the pilgrimage was over, everybody returned to their homes. At that time the news flashed, saying that almost fifteen hundred people had died of cholera. This saintly person was a little annoyed. “Why should one who calls himself God’s messenger tell a lie? He could just as well have told me that he was going to claim fifteen hundred lives. He said only five hundred, but took a thousand more. I must watch for him and ask him this question.” So he carefully looked for him, and, of course, after a couple of days Mister Cholera passed by.

The saintly man approached him, “Sir, will you please stop?”

“Yes, I know your thought. I know why you have stopped me. But don’t make me responsible for that. I did only my job; I took only five hundred.”

“How dare you say that? There were fifteen hundred people who died.”

“Well sir, that’s due to my follower, my friend.”

“Who is that friend?”

“Mister Fear. I took only five hundred. But because people heard there was cholera, the very fear of cholera killed another thousand. What can I do sir?”

It’s a fact. Fear of the disease kills more people than the disease itself. So make the mind strong. After all, what is it that we are afraid of? One day we are going to die. If death comes, say, “Oh, you have come. You are going to take away this garb and get me a new one? Okay, take this and get me a new model.” If you only have right understanding, there’s no room for fear.

To overcome fear, build up thoughts of hope, courage, and faith. Don’t dwell on your troubles. Use your mantra or prayer; read scriptures. If you have faith in God you need not be frightened of anything. If God doesn’t have the power to take care of things, why should you go in search of God? With that faith in the Supreme Power nothing can affect you. Once a South Indian saint saw the angel of death face to face, and told him, “Don’t you know God is protecting me? You better run away quickly. If God finds you coming near me God will surely destroy you. Please run, save yourself.” How could he say such a thing to death itself? Because he had tremendous faith in God. That is the strength of a devotee. So build up the body, build up the nerves, and build up the mind until your faith is so strong there is no fear at all and you are the master.

from Swami Satchidananda

In September 2004, Forbes magazine published a Satel article under the headline, “OxyContin doesn’t cause addiction. Its abusers are already addicts.”

In an article for The Wall Street Journal headlined “Oxy Morons,” Satel defended the company. “The real public-health damage here comes from the pitched campaign conducted by zealous prosecutors and public-interest advocates to demonize the drug itself,” she wrote.

After Purdue and Dezenhall launched their “anti-story,” media reports of OxyContin addiction and abuse declined for several years. In 2001, there were 1,204 stories that included the words “OxyContin,” “abuse” and “Purdue” published in media outlets archived on the Nexis database. The number plummeted to 361 in 2002 and to 150 in 2006.

Purdue’s counterattack against an ambitious investigative series about OxyContin abuse may have contributed to that drop. An October 2003 series in the Orlando Sentinel, “OxyContin Under Fire,” found that Purdue’s aggressive marketing combined with weak regulation had contributed to “a wave of death and destruction.”

The series, however, was marred by several errors that were detailed in a front-page correction nearly four months later. The reporter resigned, and two editors on the series were reassigned. While acknowledging the mistakes, the newspaper did not retract the series, and its review upheld the conclusion that oxycodone was involved in a large number of the overdoses in Florida.

Dezenhall Resources, in an email, took credit for forcing the newspaper to issue the corrections. “Dezenhall’s efforts resulted in a complete front-page retraction of the erroneous 5-day, 19-part, front-page Orlando Sentinel series,” Hershow wrote in a 2006 email summarizing Dezenhall’s work for Purdue under the subject line “Success in Fighting Negative Coverage.”

Purdue officials and the company’s public relations agencies came up with a 13-point plan to generate media coverage of the errors. It included getting a doctor to talk about how the series “frightened and mislead (sic) the people of Florida” and having a pain patient write a newspaper opinion column on the subject. The Sentinel series, one Purdue official wrote to other company executives and Dezenhall’s Hershow, was an opportunity to let the country know about “all of the sensational reporting on OxyContin abuse over the past 4 years. The conclusion: this is the most overblown health story in the last decade!”

In the six years after Purdue challenged the Sentinel’s findings, the death rate from prescription drugs increased 84.2% in Florida. The biggest rise, 264.6%, came from deaths involving oxycodone. The state became a hotbed for inappropriate opioid prescribing as unscrupulous pain clinics attracted out of state drug seekers. The route traveled by many from small towns in Appalachia to the Florida clinics was nicknamed the “Oxycontin Express.”

Read the full article on ProPublica, a nonprofit newsroom that investigates abuses of power. This story is a collaboration between ProPublica and STAT.

 

 

Opioid use disorder seems to be driven by physical or psychological pain as often as it is driven by a vulnerability to recreational opioid use. Those who began using primarily for the treatment of pain, however, view themselves as fundamentally different from recreational users which creates important barriers to care.

Given the growing prevalence of opioid use disorders over the past decade, and their continued rise despite efforts to prevent prescription misuse, it is important to accurately understand which pathways different individuals take that can result in problematic opioid use.  There are scant prospective data documenting how individuals develop opioid use disorders, so we are limited to retrospective analyses.  Understanding the pathways taken to opioid use disorders may shed light on possible routes rarely considered, so that efforts to prevent harmful opioid use might be enhanced and treatments might be tailored to greater effect.

Five pathways to opioid use disorder emerged from spontaneous open-ended interviews: 

The different pain pathways, taken together, account for as large a percentage (50%) of new opioid use disorder as recreational use and prior substance use vulnerabilities combined.

Opioids used as antidepressants? Relief of emotional distress by opioids is anecdotally perceived by some to have an antidepressant or energizing effect (different from the dissociated high typically associated with opioid misuse) that also reinforces use and requires escalating doses to maintain this effect.

Fear of uncontrolled pain inhibits efforts to seek addiction treatment or reduce opioid use

Identifying as a pain patient may interfere with identifying as having a substance use disorder: The participants who were first treated for pain and then developed an opioid use disorder view themselves anecdotally in a different category as others with a similar opioid use disorder, acting as a further barrier to participating in substance use disorder treatment.  When participating in treatment, they often focus on the differences between themselves and the others in treatment, thus potentially decreasing the effectiveness of treatment.

WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?

Pain, both physical and psychological, is a driver of opioid misuse and is simultaneously a barrier to treatment given concerns that the pain will not be adequately addressed once the opioids are stopped.

Pain patients do not identify with broader opioid use disorder patients and may benefit from specialized substance use treatment focused on those primarily using opioids for pain.

Furthermore, relief of emotional distress may reinforce misuse (there is increasing research on the antidepressant effect of some of the opiate receptor pathways) and may explain in part the increased risk of opioid misuse among those with mental health diagnoses.  Thus screening for prior substance use vulnerabilities and prior mental health struggles is strongly recommended prior to the initiation of opioid prescriptions.

Read more here