For heavy drinkers in treatment for abusing their partners, therapy targeting alcohol abuse could help improve violent behavior, according to a new study. Alcohol can impair judgement and lower inhibitions which in turn can lead to aggressive behavior, says study lead Gregory Stuart of the University of Tennessee in Knoxville. "One theory is that alcohol can narrow focus to negative aspects of the environment, and is linked to impulsivity," he says. But even though alcohol is a factor in many domestic disputes, arrested perpetrators are often referred by the court to "batterer" programs—which rarely address drinking. For the study, researchers recruited 252 men who had been arrested in Rhode Island for domestic violence and also reported binge drinking (five or more drinks per session at least once a month). They found that the participants who received the extra session of alcohol counseling in addition to domestic violence therapy showed greater short-term improvement in both their drinking and their violent behavior. However, after a year, the two groups demonstrated similar amounts of improvement in aggressive behavior. Stuart says the alcohol abuse therapy helped give men a "jump start" on reducing their violent behavior sooner into treatment. He hopes the study results will lead to improvements in batterer programs, by incorporating treatment for substance abuse. He says: "The goal is to gently lead them to the conclusion that potentially stopping the use of alcohol and drugs is a good idea.”
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Addiction to prescribed opioids has become an epidemic in the US, as The Fix has frequently reported. Who’s to blame? It’s the addicts who “doctor shop” and misuse their prescriptions, right? Not quite—after all, if you're a doctor shopper, you're probably addicted already. The doctors who prescribe drugs like Oxycontin to chronic pain patients, and the pharma companies that falsely billed such drugs as “non-addictive” for chronic use, have had large parts to play.
In an effort to spread awareness of the problem and the possible solutions, The Fix sponsored a lunch presentation for physicians at the Yale Club in New York last Saturday, co-hosted by the National Center on Substance Abuse at Columbia University (CASAColumbia) and Physicians for Responsible Opioid Prescribing (PROP). “There is no objective national effort...[to address the epidemic]...this leads us to conclude it’s up to the medical professionals,” said Susan Foster, CASAColumbia’s director of policy and research analysis, during her opening talk on the prevalence of the problem.
Leading psychiatrist Dr. Andrew Kolodny, chief of psychiatry at Maimonides Medical Center in New York and president of PROP, then gave a riveting presentation on the root causes of America's opioid epidemic, and the vital need for change in prescribing practices. Every US state has seen an alarming rise since the late '90s in fatal opioid overdoses, Kolodny showed us, and most who die were introduced to the drugs by a prescription. With doctors having to rely on self-reported information about patients' pain levels, we've actually arrived, said Kolodny, at the point of "de facto legalization of heroin." But most doctors haven't been prescribing opioids for chronic pain maliciously, he stressed; the drugs' manufacturers successfully presented them as "non-addictive" for such use, and doctors began prescribing them out of compassion. Now we know better.
In the final talk, Fix contributor Dr. Andrew Tatarsky, director of the Center for Integrative Psychotherapy for Substance Misuse, founder of the Center for Optimal Living and a founding member of the Division on Addiction of New York State Psychological Association, stressed the importance of the doctor-patient relationship in dealing with the problem, and the value of a holistic approach. And he urged the audience of primary care physicians to address the stigma associated with addiction. Various stereotypes about addicts can contribute to over-prescribing, he said, but "Everyone is vulnerable to substance misuse." Tatarsky also noted various possible alternative treatments for chronic pain, including relaxation techniques, yoga, exercise and diet.
The event—in which Dr. Richard Juman, the former president of the New York State Psychological Association and the coordinator of The Fix's Professional Voices strand, played a major role—was designed to “engage primary care physicians to address addiction,” as Susan Foster summarized. It appeared to be working: The doctors stayed on long after the end to ask follow-up questions on how they should apply what they'd learned about opioid addiction to their practice. Attending GPs like Dr. Vincent Esposity and Dr. Jeff Trilling, for example, told us that the chance to meet "like-minded people" within their community was valuable to them, "because the resources just aren’t there.” ￼
Celebrity chef and TV personality Anthony Bourdain got honest about his history with hard drugs, during an Ask Me Anything ("AMA") on Reddit yesterday. The site's users did ask him anything—including grilling him on his history with addiction, and how he manages to avoid drug relapse. "I was a complete asshole. Selfish, larcenous, druggy, loud, stupid, insensitive and someone you would not want to have known," he says about his early 20's. "I would have robbed your medicine cabinet had I been invited to your house." Bourdain, 57, has spoken before about being addicted to heroin when he was younger, but he drinks openly on his show, Anthony Bourdain: No Reservations. "I am a VERY unusual case," he says. "Most people who kick heroin and cocaine have to give up on everything. Maybe cause my experiences were so awful in the end, I've never been tempted to relapse." One of his worst experiences apparently included "combing the shag carpet for paint chips in the hope that they were fallen crack bits," he recalls, and "smoking them anyway." Alcohol may not be the only substance in which Bourdain continues to indulge. When asked if he "hated" Amsterdam, he responds that the city "may not be the first place I think of as a food destination but I liked it fine! #420."
Australian butchers have reported a trend of disappearing cuts of meat, which they believe are being traded in for drugs. “People are getting desperate and it’s a sign of the times because it’s a high-value product,” says Terry O'Hagan, the general manager of Goalt Coast's Super Butchers stores. “We’ve been told meat is now currency for drugs.” Super Butchers' six Gold Coast locations have been hit at least once a fortnight, with one thief reportedly nabbing an armful of top-shelf rib fillets worth $500 ($515 USD). “Why would you need all that meat? It is a couple of months’ worth,” says O'Hagan. “I feel it was stolen to sell.” Last year, the city of Dubbo, Australia, reported a similar streak of steak thefts, which were allegedly being swapped for prescription drugs. “Some people prescribed the drug for pain relief are prepared to swap it for meat,” said Dubbo Magistrate Andrew Eckhold at the time. “This is something happening in Dubbo that I have never seen in other areas.” Authorities haven't confirmed that the recent thefts are drug-motivated. But all kinds of specialty items have been used as drug currency across the world—in the US, addicts were recently blamed for Tide detergent disappearing from pharmacy shelves.
Of the approximate 30 million people in the US with eating disorders, about 10 million of them are men, according to the National Eating Disorders Association. Buton the American Psychiatric Association’s website, the first symptom listed for anorexia is “menstrual periods cease.” Eating disorders are widely regarded as a problem that primarily impacts women and girls, and this misperception can make it difficult for many men and boys to be diagnosed and treated properly, ABC reports. "I can't get my period,” says Victor Avon, a recovered anorexic and spokesman for the National Eating Disorders Association. “Never had it before, and it'll be a miracle if I do get it. Right here in this book, this says I have a girls' disease and that I'm broken." Doctors often misdiagnose eating disorders in men, and many treatment facilities only accept women. Also, loved ones may not notice dramatic weight loss because mens’ bodies are less likely to become visibly emaciated—and even if they do, men are less likely to wear tight or revealing clothes, making it easier to hide weight loss.
Experts agree that the medical community needs to work on recognizing eating disorders as a problem that affects men as well as women. "This is not something that is rare," says psychiatrist Cynthia Bulik, who directs the University of North Carolina Center of Excellence for Eating Disorders. "I think we need to get past the misperception that this is something that's rare, because it does a huge disservice to boys and men." The American Psychiatric Association is expected to remove the menstruation symptom from its new DSM, to be published this spring. But gender norms may continue to influence how society views men who suffer from the illness. "I think for males it's that males don't talk about feeling dizzy," says Dr. Vicki Berkus, who directs Eating Disorder Programs for CRC Health Group. "That old 'pull yourself up by the bootstraps, real men don't have issues,' which is totally false." Therapist Jacquelyn Ekern, founder of the Eating Disorder Hope organization, says men are "less likely to come forward with it because some of them feel emasculated by it. However, they shouldn't. It is an equal opportunity disease, and there are so many factors that can contribute."