Interventions Are Key To Ongoing Scientific Research

Curiosity and determination inspire scientific research studies…

It’s true! Scientific research and studies that involve human physiology and behavior are most often provoked by a certain determination and enough curiosity to seek answers to problems that are impacting our society. Over the past two years our blog posts have often discussed the results of a new study; we share this information with our readers to spark their own curiosity and prompt them to seek more information on the intervention process should their family circumstances demand it.

The KNICK television drama weaves a story with history, medical research and addiction

The KNICK takes place in New York City’s Knickerbocker Hospital in the early 1900s. One could ask “what’s so captivating about this time and place?” This is a series that offers the viewer an inside view of what not only life in New York City was about in 1900, but also a candid view of how medical research and new inventions were developed “hands on.”  And yes, drug addiction is part of The KNICK’s storyline, as well as the concept of doing an intervention and getting someone to treatment.

Here you can watch a snippet of the season finale, Episode #10…

If you are having trouble viewing the video, you can see it here.

Two new research projects are worth noting…

If you have ever worked in a hospital emergency department (ED or ER), then chances are you’ve noted that a good percentage of the patients presenting (non-trauma) have either a primary or secondary issue tied to substance abuse. These patients arrive at the ER due to an accidental overdose, accidental injuries due to substance abuse (auto accidents, slips, falls, fights), chronic diseases due to substance abuse (pancreatitis, hepatitis, liver failure) or physical detox / withdrawal symptoms like delirium tremens. This being the case it would stand to reason that when a patient comes to an ED and admits to or exhibits signs of substance abuse this could be the perfect time for the medical professionals to intervene beyond treating the acute symptoms. But what intervention protocol works best in these situations?

Michael Bogenschutz. MD, chief of the Division of Addiction Psychiatry at the University of New Mexico’s (UNM) Department of Psychiatry and Behavioral Science is indeed looking for answers to how best manage the opportunity to intervene when patients present with substance abuse symptoms.

According to UNM Health Science Center News Beat, Dr. Bogenschutz is focusing on how well screenings, interventions and referrals work by conducting two studies:

  • Bogenshutz is leading a five-year study of opioid-addicted patients who visit the ER. Past research, including his own, has shown that brief ER interventions had little or no effect on heavy drug users, so the current study takes a more active approach. Case managers follow up with patients to steer them toward addiction treatment and to assist with other needs, like housing or legal representation. 
  • In a second study, Bogenschutz focuses on older adult alcoholics. Researchers in Denmark, Germany and New Mexico will compare patients who receive four motivational counseling sessions with those receiving the four sessions, plus an additional eight weeks of more active therapy focused on finding rewarding alternatives to drinking.

 

Looking to the future…

We understand that substance use disorder is a chronic disease; however, with intervention, treatment and aftercare, remission is possible and long term sobriety is achievable. Ongoing research about addiction serves to validate these processes that promote health and wellness.

Is An Intervention Ever Too Early?

Let’s talk about interventions

The word intervention is often used when speaking of political, financial, commerce, legal and medical situations. Basically it means to come between disputing people or groups to intercede or mediate in an effort to change the course of events.

When it comes to health, particularly mental and behavioral health we define an intervention as:

An orchestrated attempt by one or many people – usually family and friends – to get someone to seek professional help with an addiction or some kind of traumatic event or crisis, or other serious problem. The term intervention is most often used when the traumatic event involves addiction to drugs or other items.

The process of this type of intervention was introduced in the 1960s by Dr.Vernon Johnson who was a recovering alcoholic and an Episcopal priest. He promoted what he referred to as “early intervention” to interrupt the disease of alcoholism before the process of the disease destroyed one’s life.

Johnson’s concept is key to what many family members ask themselves everyday…”should we have noticed earlier what was coming, could we have prevented the escalation of the disease of addiction…should we have intervened earlier?”

Research results examines the outcome of early intervention in children

It was 1991 when the Fast-Track Project study began. This was a collaborative study including researchers from Duke University, Pennsylvania State, Vanderbilt and the University of Washington. They screened nearly 10,000 five year-old children who lived in Durham, Nashville, Seattle and rural sections of Pennsylvania. Of these 10,000 the researchers identified 891 who were at high risk. Half of these were selected as a control group and the other half were assigned to participate in the Fast Track intervention. Here is an overview of the Fast Track Project as provided on the website:

Fast Track is a comprehensive intervention project designed to look at how children develop across their lives by providing academic tutoring and lessons in developing social skills and regulating their behaviors. Selection began when the participants entered kindergarten and children were placed either in the intervention group or the control group. The intervention was guided by a developmental theory stating the interaction of multiple influences on the development of behavior. There can be multiple stressors and influences on children and families that increase their risk levels. In such contexts, some families that experience marital conflict and instability can cause inconsistent and ineffective parenting. These children can sometimes enter school poorly prepared for the social, emotional, and cognitive demands of this setting. Often the child will then attend a school with a high number of other children who are similarly unprepared and are negatively influenced by disruptive classroom situations and punitive teacher practices. Over time, children in these circumstances tend to demonstrate particular behaviors, are rejected by families and peers, and tend to receive less support from teachers, further increasing aggressive exchanges and academic difficulties.

As youth get older, their risk for these behaviors increase due to peer influences, academic difficulties, and their personal identity development. The Fast Track project is thus based on the hypothesis that improving child competencies, parenting effectiveness, school context and school-home communications will, over time, contribute to preventing certain behaviors across the period from early childhood through adolescence.

The study was sponsored by the National Institute of Mental Health (NIMH)

The study’s findings…

The study was to cover 10 years and over those years the researchers published numerous progress reports. Most recently Kenneth A. Dodge, Ph.D. at Duke University (who headed the original project and secured the original sponsorship of the NIMH) worked with researchers from Pennsylvania State University, the University of Alabama, Tufts University and Simon Fraser University. The goal was to reach out to the original subjects and determine how they were doing some eight years after the program had ended. The full results are published on-line in the American Journal of Psychiatry: Impact of Early Intervention on Psychopathology, Crime, and Well-Being at Age 25.

This study showed modest improvements in psychological markers that predict long-term antisocial behavior and criminality and according to a Los Angeles Times article.  

Program graduates had fewer legal problems, substance abuse issues and risky sexual behaviors. The data suggest that intervention can work, and effects can persist over many years. Overall, the likelihood of psychological, criminal, sexual and behavioral problems dropped by about 9 percentage points from those of nonparticipants, the study found.

Dr. Dodge is quick to point out: “It’s not miracles; it’s not huge impacts. We weren’t successful with every child, but on average we have been able to prevent some of those [negative] outcomes.”

Some closing thoughts…

Being a member of a family is a journey that we all take. We travel through good times and difficult times that include financial hardships, illness, and emotional trials that if not recognized early can impact many members of the core family group and beyond. Often parents will notice signs, but are reluctant to ask questions and seek answers. Even spouses will look the other way and hope for a positive outcome. It is always best not to look away, but to reach out for help when you realize that your loved one is experiencing mental health issues and/or addiction.

Correctly guiding ourselves through life is challenging enough and trying to help a loved one who is suffering from alcoholism and drug addiction can seem impossible.

Often, the person in active addiction has difficulty managing their own lives and as time goes by it seems to get worse. The impact of their addiction on their lives are evident through loss of things like jobs, relationships and self-care. Perhaps several attempts and conversations have been initiated to help them without success. This is because the person trying to help is often too close and doesn’t have the professional background to be both emotionally neutral and aware of resources that match the needs of the addict. Such addiction professionals can help via home interventions or through recommending applicable treatment for the addict who is suffering.

Bottom line: It is never too early to consider an intervention!

Interventions: A Reachable Moment

An intervention offers a lifeline…

We know what a teachable moment is…

Hardly a news cycle goes by that we don’t hear the expression “This is a teachable moment!” It is one of those phrases that catches our attention and makes us consider what we have learned from a particular life event. Educators really like the term. Politicians like the term. Medical professionals like the term.

Just today if you search the news for the term teachable moment, here are a couple of headlines that stand out:

 

Have you heard of a reachable moment?

The word reachable is adjective that we often use to better define a goal, like a reachable milestone. We might think of the word attainable or possible.  Or we might think of the verb “reach” and consider how we often find ourselves wondering if all of our love and concern actually “reaches” our loved one.

In late June we happened upon a news story that talked about “reachable moment,” it took us by surprise.

 

Mass General will screen all patients for substance abuse…

On June 30, 2014, The Boston Globe published this article: MGH to screen all patients for substance abuse…Querying part of effort to treat addiction.

When you first peruse the headline you might find yourself thinking “doesn’t every hospital in the United States screen patients for substance abuse?” For the most part, it is true that if you present yourself to an emergency department, then during the quick history and physical you most likely will be asked questions about alcohol use or drug use, particularly if you appear to be impaired and suffering from trauma.

However, according to CBS Boston: “Massachusetts General Hospital (MGH) plans to begin questioning all patients about their use of alcohol and illegal drugs starting this fall, even if they are at MGH for a totally unrelated issue.”

 

A bedside intervention…

Dr. Sarah Wakeman is the medical director for substance use disorders at MGH’s Center for Community Health Improvement. She shared with The Boston Globe that nearly 25% of all patients hospitalized for routine medical problems also have active substance abuse disorders. So by asking critical questions of each patient during the hospital stay becomes “a reachable moment” or a bedside intervention. 

The particular questions might include:

  • How often have you had six or more drinks on one occasion?
  • How often have you used illegal drugs in the past year?
  • Do you use prescription medication for nonmedical reasons?

“Mass. General recently studied 2,583 patients with identified substance abuse disorders who were in the hospital for various medical problems — some related to addiction — and found they had longer stays and higher readmission rates than other patients. The cost of their care averaged nearly $10,000 per admission, 40 to 50 percent higher than the cost of treating patients with other chronic conditions such as congestive heart failure and pneumonia.” 

So how will this all work?

Well, in the first place, this new program will cost a considerable amount of money.  Mass General is planning to spend $1.4 million per year on this new addiction screening and treatment program. If the patient answers the screening questions in such a way that indicates overuse, then one of the hospital addiction team will visit the patient and encourage a more in depth conversation about their life and habits.

Mass General plans to hire five “recovery coaches.” They will work at the main hospital and the three community health centers. The coaches are former substance abusers and are certified by the state. Coaches will take people to Alcoholics Anonymous and work with them to follow a treatment plan both inpatient and outpatient.

Interventions require a plan…

In life even the best laid plans can go by the wayside, but to start a new treatment modality requires arduous planning and fine tuning. We are anxious to see how the Mass General plan works out. Interventions require planning.

The interventionist will then derive a treatment action plan that can be executed immediately. The immediacy of getting a loved one the help they need is well understood and the interventionist will act with the same immediacy to fulfill the treatment action plan, which will consist of the following:

  • A determination of the need for an intervention – sometimes when the loved one has already agreed on receiving treatment, a recommendation will be made that don’t involve an intervention.
  • Arrangements to execute the intervention (travel, timing, special needs and considerations for the time, place and type of intervention).
  • Pre-intervention counseling and advisement – thorough determination of what families need to prepare such as verbal or written statements to the loved one and what to expect emotionally during an intervention.
  • The intervention.
  • Transport to treatment, either with the addicted, family or interventionist or via scheduled travel arrangements to the recommended treatment center.

This process highlights that in challenging and emotionally vulnerable situations, we can’t do things alone. Just as people need support groups and spiritual practice to lessen their burdens, loved ones of addicts need professionals to guide them through the process of getting addiction help – it cuts the stress and turmoil tenfold and can end of being the best investment to make in the life of a loved one.

If you would like to consider a treatment action plan for a loved one, please click here to learn more about the exact next steps to take and click here to learn about the success rates of the Southern California interventionist.

FOMO ~ Binge Drinking ~ Interventions

What we can glean from watching television…

It is early November and many new college students are fast approaching that first visit home for the holidays. And it could be that many parents might be in for a surprise. Parents may find themselves facing the startling news that their young college student has developed some bad habits while being away at college.

We got to thinking about this today because last evening we watched an episode of NBC’s PARENTHOOD and early this morning a couple of news stories caught our attention.

PARENTHOOD’s depiction of dorm life at UC Berkeley…

If you are not a regular viewer of PARENTHOOD, here is a very tight synopsis, provided by the PARENTHOOD’s website, of what happened last evening between to two UC Berkeley freshmen, Drew and Natalie.

While studying in his dorm room, Drew is interrupted by a knock from Natalie, completely wasted and obviously horny. Drew remains clueless until she throws herself at him. He’s not going to complain! However, in the morning, everything’s back to normal. Does she even remember last night?

 

ABC News covers binge drinking at UC Berkeley

This morning we watched with interest as ABC News KGO-San Francisco covered a news story of how binge drinking at UC Berkeley is putting a strain on the City of Berkeley’s EMS System.

If you are having trouble viewing the video, you can see it here.

FOMO (Fear of missing out)

In the world we live in we all find ourselves always “checking” social media. Some older adults will set limits for themselves, vowing only to check Facebook or their email once per day. But you know the feeling; you can sit in a restaurant and watch a family of four consume an entire meal without ever looking at each other. Why? Because each person has their hand-held device and they are all may be suffering from FOMO!

Young teens and young adults almost always want to fit in. They yearn to be part of the in-crowd. Aiden Cochrane of the University of Virginia wrote in The Cavalier Daily:

“To me, FOMO is the anxiety created when we must choose a single course of action at the expense of missing out on a number of appealing others. More drastic cases of FOMO can make the patients take part in an activity — that their better judgment would normally preclude — for the sole reason of being too afraid to miss out on any sort of experience, with enjoyment not even guaranteed.”

 

Parents and family members should be aware as the holidays approach…

As the holidays approach and hopefully you have a few extra hours to sit down with your teenager or young adult child to really talk about their life and how things are going. It is important to remember when our children are unsafe, we don’t feel safe and engaging in addictive behavior (like binge drinking) is very unsafe.

Often, parents inflict excess suffering upon themselves by thinking that they are at fault for their child’s addiction or that somehow they could have done something different to prevent it. This is not the case. Teens and young adults face an inordinate amount of pressure from peers and are increasingly exposed to drugs in social situations. When the rebelliousness seems to no longer be a phase and your child has become increasingly withdrawn, depressed and isolated, it is time to seek help.

Teens are at greater risk of overdose because of the high rates of those who engage in prescription drug abuse and drug cocktails. Every year thousands of parents in the US get help for their children through interventions and proper placement in drug treatment programs. Even if your child is in high school or college, treatment for their addiction must be a priority. With the prominence of addiction in teens and young adults, educational institutions work with parents and communities understand. Most parents feel as though they have already lost their child, and they have to an extent – as the addiction has taken over their child’s sense of logic, responsibility and life aspirations. These do come back however after learning how to live life without drugs and alcohol regardless of outside pressure from friends and peers. To learn more about how this is possible and what steps can be taken, contact us.

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Intervention Should Be A First Priority, Not The Last Resort

A brief history of Interventions

Sometimes family members mistakenly believe that conducting or orchestrating an intervention with a loved one who is suffering from addiction and whose life is out of control is the last resort. They may liken it to throwing someone a life preserver to aid in the steps to recovery. They also believe that interventions are a relatively new concept to utilize when seeking help for their loved ones. It may surprise you to learn that interventions originated in the 1960s!

It was in the 1960s when Dr. Vernon Johnson, an Episcopal priest and recovering alcoholic, concluded, according to a Wikipedia article:

…that an alcoholic did not need to “hit rock bottom” before recovery. ‘He introduced the concept of intervention by family, friends, and employers. He supported “early intervention”, because it interrupted the progression of the disease of alcoholism before the disease completely destroyed the alcoholic’s life.’

 

Learning about interventions via television

In 2005 A&E launched the television series INTERVENTION. For many people learning about this series and watching this series was their first exposure to the concept of an intervention. If you are a regular viewer, then you know that these episodes are dramatic sometimes ending with very good results and sometimes leaving the viewing public with a sense of a cliffhanger.  Almost always, the intervention is taking place with someone who is at or very near “rock bottom,” as opposed to early in their disease.

New research examines early intervention

In January 2013 there have been a number of articles published dealing with the efficacy of offering early intervention, particularly dealing with teenagers and college aged students. For example, in JAMA Psychiatry the research results were published first online from a study conducted in the United Kingdom:
Effectiveness of a Selective, Personality-Targeted Prevention Program for Adolescent Alcohol Use and Misuse.

An overview of the study…

This study was referred to as an “Adventure Trial” and the parameters were:

  • 21 schools in London were involved in the study
  • 2,548 students with an average age of 13.8 years were selected and classified as high or low risk of developing future alcohol dependency
  • High risk students’ profiles included personality traits like anxiety, impulsivity, sensation-seeking and hopelessness
  • Four members of staff in each intervention school were trained to deliver group workshops targeting the personality profiles

Study findings, according to PsychCentral:

  •  “After two years, high-risk students in intervention schools were at a 29 percent reduced risk of drinking, 43 percent reduced risk of binge drinking and 29 percent reduced risk of problem drinking compared to high-risk students in control schools.”
  •  “Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29 percent reduced risk of taking up drinking and 35 percent reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population.”

 

Intervention should be a first priority

Obviously, the study discussed above has to do with promoting efforts early on in a person’s life, while in middle school or high school, to help prevent or reduce the risk of one developing an addiction. And these efforts are to be applauded, but many times no matter how involved different social communities become in one’s life addiction can and will take hold. So what should family members do to help their loved one?

First and foremost, be aware. When you see signs of an addictive disorder, pay attention. Do not be afraid of asking non-judgmental questions. Secondly, talk to your family physician. Third, if you have other extended family members who have dealt with addiction, seek their counsel. Fourth, if your employer offers an Employee Assistance Program, then take advantage of its services.  And, finally but early on, contact an interventionist, discuss your options.

Consider an intervention for your loved one early on; don’t wait until you or your loved one is dealing with the physical, mental, financial and spiritual toll of addiction.

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Teens: Is It Depression Or Behavior Problems That More Likely Affect Grades?

Parenting is not about letting go…

Raising teenagers

 

“Even as kids reach adolescence, they need more than ever for us to watch over them. Adolescence is not about letting go. It’s about hanging on during a very bumpy ride.” Ron Taffel, Ph.D.

For sure, being the parent of a teenager is hard work. We worry everyday when they leave for school, we worry about their grades, their involvement in sports, their friends, we worry about their ability to go on to college and we also try to keep a close eye on their behaviors. These behaviors include experimenting with drugs and alcohol and more frequently we try to be aware of any signs of depression.  It can be, as Dr. Taffel says, a very bumpy ride.

New study looks at depression, behavior problems and lower grades

Many parents are taken aback when their children reach high school and they witness a sudden or subtle slip in their teenager’s grade point average (GPA). Parents begin to wonder if the grade school teachers were too easy in their grading requirements or if their child really just isn’t as smart as they had thought or hoped. Parents search for answers. Parents observe their teenagers looking for signs of depression which could lead to the report card being less than stellar. But often parents will ignore behaviors that more likely can cause the slip in school performance. These behaviors could include attention deficit, substance abuse and/or delinquency – all behaviors that no parent wants to consider.

The December 2012 issue of The Journal of Health and Social Behavior published a study led by Jane D. McLeod, Indiana University, Department of Sociology. The full report Adolescent Mental Health, Behavior Problems, and Academic Achievement  states that “prior research on the association of mental health and behavior problems with academic achievement is limited because it does not consider multiple problems simultaneously, take co-occurring problem into account, and control for academic aptitude.”

An overview of the study…

The researchers examined data provided by the National Longitudinal Study of Adolescent Health. This data was gathered by following youth from middle and high school years through the transition to early adulthood.

  • Researchers used a stratified sample of 80 high schools and 52 middle schools.
  • 7th through 12th grade youth who attended these schools were invited to participate in an in-school survey. The number of participants was 90,118.

According to HealthDay News the study found:

  • Unlike students with depression, those with behavior problems such as attention issues, delinquency or substance use had lower GPAs than others.
  • Delinquency and substance use were associated with receiving lesser educational degrees, while depression was not.
  • Students with two of these problems typically earned lower GPAs and lesser degrees than those with one problem, and some combinations of problems had more harmful effects than others.
  • Substance use worsened the educational risks associated with depression, attention issues and delinquency.
  • Having depression did not, however, increase the educational risks associated with attention issues, delinquency or substance use.

Quoting Jane McLeod:

“There’s a fairly sizable literature that links depression in high school to diminished academic achievement. The argument we make in our study is what’s really happening is that youths who are depressed also have other problems, and it’s those other problems that are adversely affecting their achievement.”

Parenting teens and considering an intervention

The holiday season is here. Thanksgiving has come and gone. Now families across the United States are making plans for the December holidays of Christmas, Hanukkah, Kwanzaa and New Years. It is a time of year that school semesters are drawing to a close and our teenagers and college students will be receiving their term grades. And while we all look forward to happy holidays spent with our children, this may be the time to question the grade point averages that just don’t make sense. If the report card is sending the parent a message, take the time to ask questions and to be observant of your child’s behavior patterns. If you suspect that substance abuse may be a problem and you need help with an intervention, then by all means reach out for that help.

An intervention at this point in your child’s life may be the best holiday present you can provide…a gift that can last long into adulthood.

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