Wednesday, January 28, 2009

Anger and Drug Addiction

Substance abuse and dependence has grown beyond even the bleakest predictions of the past. In the United States alone, there are an estimated 23 million people who are struggling (on a daily basis) with some form of substance abuse or dependence. The toll it is having on our society is dramatically increased when we factor in the number of families who suffer the consequences of living with a person with an addiction, such as:

Job loss
Loss of child Custody
Domestic Violence/Aggression
Marital problems/divorce
Financial problems
Fetal Birth/damage
Depression/anxiety/chronic anger
What is it worth to you and your family to avoid these consequences?

Unfortunately, most substance abusers may not even be aware that they have an underlying anger problem and do not "connect" their anger problem to their alcoholism, drug addiction and substance abuse. Therefore, they do not seek (or get) help for their anger problem. But more often than not, their anger is the underlying source (and psychological origin) of their disorder.

Anger "emotionally" precedes the use of cocaine and alcohol for many alcohol and cocaine dependent individuals. Anger is an emotional and mental form of "suffering" that occurs whenever our desires and expectations of life, others or self are thwarted or unfulfilled. Addictive behavior and substance abuse is an addict's way of relieving themselves of the agony of their anger by "numbing" themselves with drugs, alcohol and so on. This is not "managing their anger", but suppression.

When we do not know how to manage our anger appropriately, we try to stuff the anger down inside ourselves and "keep it there". Over time, it fosters and often gives rise to even more painful emotions, such as depression and anxiety. Thus, the individual has now created an additional problem for themselves besides their substance abuse, and must be "dual diagnosed" to receive proper treatment. Several clinical studies have demonstrated that anger management intervention for individuals with substance abuse problems is very effective in reducing or altogether eliminating a relapse.


Wednesday, January 21, 2009


Parents share secrets and strategies with each other about how to deal with fussy eaters, colicky infants, and tantrum throwers. But bedwetters?
The problem of bedwetting is still shrouded in embarrassment despite the fact that it's very common. As a matter of fact, one in five 5-year-olds is a bedwetter, according to the American Academy of Pediatrics.

To understand why kids wet the bed, we talked to WebMD's pediatric expert, Steven Parker, MD. He shares the six most common questions parents ask him about bedwetters -- and what he tells them.

Q: Why is my child bedwetting?
Before I answer, I need to know a few details. Has your child consistently wet -- that is, never had dry nights -- or has your child been dry, and the bedwetting is a recent problem?

Those are two very different situations. Most of the time, the child was never dry, a problem known as primary bedwetting (or by the medical term, primary enuresis).

A much smaller number of children has what we call “secondary” bedwetting or enuresis. In this case, the child was dry for a long time, maybe a year, and then becomes a bedwetter. That is more unusual, and there is more likely to be a medical cause or a trigger, such as psychological stress or trauma. But that's true in less than 10% of cases.

Most of the time, a child has primary bedwetting, and after a thorough physical examination and examination of the urine, no medical reason is found. In that case we rarely figure out the cause. But I say to the parents: one in five kids at age 5 has this. How abnormal can that be?

Q: What causes a child to be a bedwetter?
Bedwetting of the primary type does seem to run in families. So whatever the cause is, it is likely that children who are bedwetters have some sort of genetic reason. It's also possible one or both of their parents wet the bed.

The most popular theory is that bedwetters have a slight delay in maturation of their nervous system. When the bladder is full, the sleeping brain has to send a message down to the bladder not to pee. If your child's nervous system is a bit underdeveloped, the message might not get through.

Another theory is that children who are bedwetters are very deep sleepers. They are sleeping so soundly their brains don't tell their bladder to hold it. I think delayed maturation is probably the better explanation. And that perhaps if you are slow in maturation, you may also have a different sleep pattern.
Some experts also think that bedwetters may simply make more urine at night than other kids, and their bladder can't hold it all. Others hypothesize that their bladders have a smaller capacity to hold in the urine compared with kids who stay dry.

Q: What should be done about bedwetting?
The first step is to talk about it with your pediatrician, which many parents don't do because they are embarrassed, or their child is. But it's crucial to do so because the first step in assessing a bedwetter is to rule out any medical causes.
A urine test could reveal a urinary tract infection or excess sugar in the urine as a cause. A physical examination might demonstrate constipation, for instance, which could push on the bladder and cause the bladder to release urine at inappropriate times. A sleep history may reveal that a child has a sleep disorder called sleep apnea, in which breathing stops for a brief time. Urine can escape during those episodes.

Sometimes, secondary bedwetting can occur if a child is psychologically stressed or if he has lived through a disaster recently, such as a hurricane or fire. Those children may need some counseling or other help.
Most of the time, however, your child will naturally outgrow bedwetting as he gets older. To help your child outgrow bedwetting, you can try a number of behavioral strategies outlined below.

Q: At what age should we do something about bedwetting?
If you are all OK with it -- and I mean the entire family -- you don't have to do anything. Except wash the sheets, of course, and perhaps have your child wear disposable underwear. About 15% of bedwetters get better, or outgrow it, every year without any treatment. By age 18, only 1% to 2% still wet the bed.

But if you, or more importantly, your child, is so upset by this that it is disrupting your family, then we can talk about treatments.

The best time to do this is when your child says he wants to deal with it. When the child gets sick of it, says he feels like a baby, or is embarrassed because he can't go to friends' houses for sleepovers, this is a good time to talk to your doctor about remedies.

Q: What bedwetting product or treatment works best?
There aren't a lot of great studies comparing treatments. But it's pretty clear that what works best are the urinary alarms, far and away. In a recent published review, researchers compared bed alarms with behavioral interventions and medications. They concluded that bed alarms are the most effective.

Many models of alarms are available, but all include a moisture sensor that you put in your child’s underpants that sounds an alarm when it detects urine. Once the alarms train the sleeping brain to inhibit the bladder contractions -- and prevent the urine from being released -- most kids stay dry. Better still, they remain dry even after the alarm is discontinued.

The downside of alarms? They take a while to work -- usually months. They require participation by the parents, who may have to get up with their child and take him [or her] to the bathroom when the alarm goes off. It requires a lot of commitment.

Q: What bedwetting product or treatment works best?
Another strategy is to wake your child up two or three hours after he has gone to bed, and perhaps right before you go to bed, and have him pee. It has some effectiveness. You might also have your child wear disposable underwear until he or she outgrows bedwetting.

Somewhat less effective, I think, is limiting fluids after dinner. And if your kid is really thirsty, it's not worth it.

Some parents work with the child during the day to help him hold in the urine longer. They may set an egg timer when the child says he has to go and ask him to hold it for another few minutes, starting with 5 and working up to 45 or so. The theory is it will increase bladder capacity.

Medications are another option. Two options are desmopressin (DDAVP), which reduces the amount of urine produced at night, and an antidepressant called imipramine (Tofranil), which may work the same way or may change the sleep pattern. However, medications only work when they are taken. Once the medication is stopped, the bedwetting comes back.

Although medications have side effects, often they can be used on a short-term basis, such as when your child wants to go on a sleepover.

Q: What else can I do for my bedwetting child?
You can reassure your child that he will eventually grow out of it. No matter how frustrated you are, don't punish your child for bedwetting. I try to normalize the experience for the child. I sit down and talk to them. I say, "You think you are the only one. But you are not. I know a lot of kids at your school who also wet." That seems to make them feel better, or at least less humiliated.

By Kathleen Doheny

Sunday, January 18, 2009

Glossary to understand anxiety

The following are health and medical definitions of terms that appear in the Anxiety article.

Abnormal: Not normal. Deviating from the usual structure, position, condition, or behavior. In referring to a growth, abnormal may mean that it is cancerous or premalignant (likely to become cancer ).
See the entire definition of Abnormal

Alcohol: An organic chemical in which one or more hydroxyl (OH) groups are attached to carbon (C) atoms in place of hydrogen (H) atoms. Common alcohols include ethyl alcohol or ethanol (found in alcoholic beverages), methyl alcohol or methanol (can cause blindness) and propyl alcohol or propanol (used as a solvent and antiseptic ). Rubbing alcohol is a mixture of acetone , methyl isobutyl ketone, and ethyl alcohol. In everyday talk, alcohol usually refers to ethanol as, for example, in wine, beer, and liquor. It can cause changes in behavior and be addictive.

Anxiety: A feeling of apprehension and fear characterized by physical symptoms such as palpitations , sweating, and feelings of stress . Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. These disorders fill people's lives with overwhelming anxiety and fear. Unlike the relatively mild, brief anxiety caused by a stressful event such as a business presentation or a first date, anxiety disorders are chronic, relentless, and can grow progressively worse if not treated.

Anxiety disorder: A chronic condition characterized by an excessive and persistent sense of apprehension with physical symptoms such as sweating, palpitations , and feelings of stress . Anxiety disorders have biological and environmental causes.

Balance: A biological system that enables us to know where our bodies are in the environment and to maintain a desired position. Normal balance depends on information from the inner ear, other senses (such as sight and touch) and muscle movement.

Benzodiazepines: A class of drugs that act as tranquilizers and are commonly used in the treatment of anxiety. Benzodiazepines can cause drowsiness.

Biofeedback: A method of treatment that uses monitors to feed back to patients physiological information of which they are normally unaware. By watching the monitor, patients can learn by trial and error to adjust their thinking and other mental processes in order to control "involuntary" bodily processes such as blood pressure, temperature, gastrointestinal functioning, and brain wave activity.

Brain: That part of the central nervous system that is located within the cranium ( skull ). The brain functions as the primary receiver, organizer and distributor of information for the body. It has two (right and left) halves called "hemispheres."

Breathing: The process of respiration, during which air is inhaled into the lungs through the mouth or nose due to muscle contraction, and then exhaled due to muscle relaxation.

Caffeine: A stimulant found naturally in coffee beans, tea leaves, cocoa beans (chocolate) and kola nuts (cola) and added to soft drinks, foods, and medicines. A cup of coffee has 100-250 milligrams of caffeine. Black tea brewed for 4 minutes has 40-100 milligrams. Green tea has one-third as much caffeine as black tea.

Cell: The basic structural and functional unit in people and all living things. Each cell is a small container of chemicals and water wrapped in a membrane .

Childhood: (1) The time for a boy or girl from birth until he or she is an adult. (2) The more circumscribed period of time from infancy to the onset of puberty .

Chocolate: A food or flavoring made from the seeds of the cacao or chocolate tree. Chocolate is rich in flavinoids, compounds that act as antioxidants. Flavinoids may also lower blood pressure and improve blood flow, by regulating the synthesis of nitric oxide, which dilates blood vessels. Flavinoids, like aspirin, help keep platelets from aggregating on vessel walls. Thus, chocolate may have health benefits, provided it is consumed in moderation.

Chronic: This important term in medicine comes from the Greek chronos, time and means lasting a long time.

Complication: In medicine, an additional problem that arises following a procedure, treatment or illness and is secondary to it. A complication complicates the situation.

Depression : An illness that involves the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. A depressive disorder is not the same as a passing blue mood. It is not a sign of personal weakness or a condition that can be wished away. People with a depressive disease cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people with depression.

Diagnosis: 1 The nature of a disease ; the identification of an illness. 2 A conclusion or decision reached by diagnosis. The diagnosis is rabies . 3 The identification of any problem. The diagnosis was a plugged IV.

Family history: The family structure and relationships within the family, including information about diseases in family members.

Generalized anxiety disorder: Abbreviated GAD. A condition characterized by 6 months or more of chronic, exaggerated worry and tension that is unfounded or much more severe than the normal anxiety most people experience. People with GAD usually expect the worst. They worry excessively about money, health, family, or work, even when there are no signs of trouble. They are unable to relax and often suffer from insomnia. Sometimes the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety. Many people with GAD also have physical symptoms, such as fatigue, trembling, muscle tension, headaches, irritability or hot flashes. People with GAD may feel lightheaded or out of breath. They also may feel nauseated or have to go to the bathroom frequently. Nearly 3% of the adult US population age 18 to 54 has GAD during the course of a given year. GAD most often strikes in childhood or adolescence, but can also begin in adulthood. It affects women more often than men, may run in families, and may also grow worse with stress. GAD often coexists with depression, substance abuse, and other anxiety disorders. Irritable bowel syndrome, often accompanies GAD. Treatment for GAD includes medications and cognitive-behavioral therapy.

Genetics: The scientific study of heredity . Genetics pertains to humans and all other organisms. So, for example, there is human genetics, mouse genetics, fruitfly genetics, etc.

Health: As officially defined by the World Health Organization, a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

strong>Medical history: 1. In clinical medicine, the patient's past and present which may contain clues bearing on their health past, present, and future. The medical history, being an account of all medical events and problems a person has experienced, including psychiatric illness, is especially helpful when a differential diagnosis is needed.

Nausea: Nausea is the urge to vomit. It can be brought by many causes including, systemic illnesses, such as influenza, medications, pain, and inner ear disease.

Nicotine: An alkaloid (a nitrogen-containing chemical) made by the tobacco plant or produced synthetically. In the plant kingdom, nicotine is not restricted to tobacco but is widespread. The tobacco plant, Nicotiana tabacum, belongs to the nightshade family, which also includes potatoes, tomatoes, eggplant and red peppers. All contain nicotine. However, the concentration of nicotine in those vegetables is far lower than the level in tobacco. Nicotine has powerful pharmacologic effects (including increased heart rate, heart stroke volume, and oxygen consumption by the heart muscle) as well as powerful psychodynamic effects (such as euphoria, increased alertness, and a sense of relaxation). As is now well known, nicotine is also powerfully addictive. When someone becomes habituated to nicotine and then stops using it, they experience the symptoms of withdrawal, including anxiety, irritability, restlessness, shortened attention span and an intense, sometimes irresistible, craving for nicotine.

Obsessive-compulsive disorder: A psychiatric disorder characterized by obsessive thoughts and compulsive actions, such as cleaning, checking, counting, or hoarding. Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home.

Panic: A sudden strong feeling of fear that prevents reasonable thought or action.

Panic disorder : A disorder characterized by sudden attacks of fear and panic. The episodes may resemble a heart attack . They may strike at any time and occur without a known reason but more frequently are triggered by specific events or thoughts, such as taking an elevator or driving. The attacks may be so terrifying that some people associate their attacks with the place they occurred and will refuse to go there again.

Psychology: The study of the mind and mental processes, especially in relation to behavior. There are a number of fields of psychology. Clinical psychology is concerned with diagnosing and treating disorders of the brain, emotional disturbances, and behavior problems. Child psychology is the study of the mental and emotional development of children and is part of developmental psychology, the study of changes in behavior that occur through the life span. Cognitive psychology deals with how the human mind receives and interprets impressions and ideas. Social psychology looks at how the actions of others influence the behavior of an individual.

Serotonin: A hormone , also called 5-hydroxytryptamine , in the pineal gland , blood platelets, the digestive tract, and the brain. Serotonin acts both as a chemical messenger that transmits nerve signals between nerve cells and that causes blood vessels to narrow.

Side effects: Problems that occur when treatment goes beyond the desired effect. Or problems that occur in addition to the desired therapeutic effect.

Stress: Forces from the outside world impinging on the individual. Stress is a normal part of life that can help us learn and grow. Conversely, stress can cause us significant problems.

Tension: 1) The pressure within a vessel, such as blood pressure: the pressure within the blood vessels. For example, elevated blood pressure is referred to as hypertension. 2) Stress, especially stress that is translated into clenched scalp muscles and bottled-up emotions or anxiety. This is the type of tension blamed for tension headaches.

Therapy: The treatment of disease .

Trauma: Any injury , whether physically or emotionally inflicted. "Trauma" has both a medical and a psychiatric definition. Medically, "trauma" refers to a serious or critical bodily injury, wound, or shock . This definition is often associated with trauma medicine practiced in emergency rooms and represents a popular view of the term. In psychiatry , "trauma" has assumed a different meaning and refers to an experience that is emotionally painful, distressful, or shocking, which often results in lasting mental and physical effects.


What are Anxiety Disorders?
Anxiety is a normal reaction to stress. It helps one deal with a tense situation in the office, study harder for an exam, keep focused on an important speech. In general, it helps one cope. But when anxiety becomes an excessive, irrational dread of everyday situations, it has become a disabling disorder. More about Anxiety Disorders »

Five major types of anxiety disorders are:
Generalized Anxiety Disorder
Obsessive-Compulsive Disorder (OCD)
Panic Disorder
Post-Traumatic Stress Disorder (PTSD)
Social Phobia (or Social Anxiety Disorder)

Introduction to anxiety

Generalized anxiety disorder or GAD is characterized by excessive, exaggerated anxiety and worry about everyday life events. People with symptoms of generalized anxiety disorder tend to always expect disaster and can't stop worrying about health, money, family, work or school. In people with GAD, the worry often is unrealistic or out of proportion for the situation. Daily life becomes a constant state of worry, fear and dread. Eventually, the anxiety so dominates the person's thinking that it interferes with daily functioning, including work, school, social activities and relationships.

What Are the Symptoms of GAD?

GAD affects the way a person thinks, but the anxiety can lead to physical symptoms, as well. Symptoms of GAD include:

Excessive, ongoing worry and tension
An unrealistic view of problems
Restlessness or a feeling of being "edgy"
Muscle tension
Difficulty concentrating
The need to go to the bathroom frequently
Trouble falling or staying asleep
Being easily startled
In addition, people with GAD often have other anxiety disorders (such as panic disorder, obsessive-compulsive disorder and phobias), suffer from depression, and/or abuse drugs or alcohol.

What Causes Generalized Anxiety Disorder?

The exact cause of GAD is not fully known, but a number of factors -- including genetics, brain chemistry and environmental stresses -- appear to contribute to its development.

Genetics: Some research suggests that family history plays a part in increasing the likelihood that a person will develop GAD. This means that the tendency to develop GAD may be passed on in families.

Brain chemistry: GAD has been associated with abnormal levels of certain neurotransmitters in the brain. Neurotransmitters are special chemical messengers that help move information from nerve cell to nerve cell. If the neurotransmitters are out of balance, messages cannot get through the brain properly. This can alter the way the brain reacts in certain situations, leading to anxiety.

Environmental factors: Trauma and stressful events, such as abuse, the death of a loved one, divorce, changing jobs or schools, may lead to GAD. GAD also may become worse during periods of stress. The use of and withdrawal from addictive substances, including alcohol, caffeine and nicotine, can also worsen anxiety.

How Common Is Generalized Anxiety Disorder?

About 4 million adult Americans suffer from GAD during the course of a year. It most often begins in childhood or adolescence, but can begin in adulthood. It is more common in women than in men.

How Is Generalized Anxiety Disorder Treated?

If no physical illness is found, you may be referred to a psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses. Treatment for GAD most often includes a combination of medication and cognitive-behavioral therapy.

Medication: Medicines are available to treat GAD and may be especially helpful for people whose anxiety is interfering with daily functioning. The medications most often used to treat GAD are from a class of drugs called benzodiazepines. These medications are sometimes referred to as "tranquilizers," because they leave you feeling calm and relaxed. They work by decreasing the physical symptoms of GAD, such as muscle tension and restlessness. Common benzodiazepines include Xanax, Librium, Valium and Ativan. Another medicine, BuSpar, also may be used to treat chronic anxiety. BuSpar works by affecting the activity of certain neurotransmitters, including serotonin. Unlike the benzodiazepines, BuSpar does not cause sedation (sleepiness) or lead to dependency. Antidepressants, such as Paxil and Effexor, are also being used to treat GAD.

Cognitive-behavioral therapy: People suffering from anxiety disorders often participate in this type of therapy, in which you learn to recognize and change thought patterns and behaviors that lead to troublesome feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.
In addition, relaxation techniques, such as deep breathing and biofeedback, may help to control the muscle tension that often accompanies GAD.

Can Generalized Anxiety Disorder Be Prevented?

Anxiety disorders cannot be prevented. However, there are some things that you can do to control or lessen symptoms, including:

Stop or reduce your consumption of products that contain caffeine, such as coffee, tea, cola and chocolate.
Ask your doctor or pharmacist before taking any over-the-counter medicines or herbal remedies. Many contain chemicals that can increase anxiety symptoms.
Exercise daily and eat a healthy, balanced diet.
Seek counseling and support after a traumatic or disturbing experience.


Friday, January 16, 2009

Stress and heart disease

For years it has been “common knowledge” that people who are under a lot of stress have an increased risk of heart disease. But is this common knowledge correct? And if so, what kind of stress increases the risk of heart disease, how does it increase risk, and what can be done about it?

Sorting out the effect of stress on the heart is made complicated by three factors: 1) people mean different things by “stress;” 2) the kind of stress people think causes heart disease may not be the worst kind; 3) until recently, there has been little scientific evidence that stress causes heart disease.

What kind of stress are we talking about?
When people refer to “stress,” they may be talking about two different things: physical stress, or emotional stress. Most of the medical literature on stress and heart disease refers to physical stress. But most people are referring to the emotional variety when they talk about stress.

Physical stress: Physical stress – exercise or other forms of physical exertion – places measurable and reproducible demands on the heart. This physical stress is generally acknowledged to be good. In fact, the lack of physical stress (i.e., a sedentary lifestyle) constitutes a major risk factor for coronary artery disease. So this kind of “stress” is usually considered to be good for the heart – as long as the heart is normal.

If there is underlying heart disease, however, too much physical stress can be dangerous. In a person who has coronary artery disease, for instance, exercise can place demands on the heart muscle that the diseased coronary arteries cannot meet, and the heart becomes ischemic (i.e., starved for oxygen.) The ischemic heart muscle can cause either angina (chest pain), or a heart attack (actual death of cardiac muscle).

In summary, physical stress is generally good for you, and is to be encouraged, as long as you have a normal heart. On the other hand, with certain kinds of heart disease, too much or the wrong kind of physical exertion may be harmful.
But either way, physical stress does not cause heart disease.

Emotional stress: Emotional stress is generally the kind of stress people are talking about when they refer to stress causing heart disease. “It’s no wonder she died,” you’ll hear people say, “with all the mess he put her through.” But is it true? Did Ed really kill Elsie with all his gambling and drinking and staying out all hours of the night?

Everyone – even doctors – have the notion that emotional stress, if it is severe enough or chronic enough, is bad for you. Most even believe that this kind of stress can cause heart disease. But scientific evidence that it actually does so has been hard to come by.

Emotional stress and heart disease
There is a fair amount of circumstantial evidence that chronic emotional stress can be associated with heart disease and early death.

Several studies have documented that people without spouses die earlier than married people. (While some might claim this constitutes evidence that emotional stress is actually good for you, most authorities agree that having a spouse actually provides a significant degree of emotional support and stability.) Other studies have shown fairly conclusively that people who have had recent major life changes (loss of a spouse or other close relative, loss of a job, moving to a new location) have a higher incidence of death. People who are quick to anger or who display frequent hostility have an increased risk of heart disease.

So emotional stress is bad, right? It didn’t start out bad. Evolutionarily speaking, emotional stress is a protective mechanism. When our ancestors walked over a rise and suddenly saw a saber-tooth tiger 40 yards away, a surge of adrenaline prepared them for either fight or flight as they considered their options.

But in modern times, now that saber-tooth tigers are few and far between, most often neither fight nor flight is the appropriate reaction to a stressful situation. (Neither fleeing from nor punching your annoying boss, for instance, is generally considered proper.) So today, the adrenaline surge that accompanies a stressful situation is not channeled to its rightful conclusion. Instead of being released in a burst of physical exertion, it is internalized into a clenched-teeth smile and a “Sure, Mr. Smithers, I’ll be happy to fly to Toledo tomorrow and see about the Henderson account.”

It appears that the unrequited fight-or-flight reaction, if it occurs often enough and chronically enough, may be harmful.

How does emotional stress cause heart problems?
From a scientific standpoint, we really don't know for sure that it does. But we do know that people who live in a chronically stressed-out condition are more likely to take up smoking and overeating, and are far less likely to exercise.

We also know that the surge in adrenaline caused by severe emotional stress causes the blood to clot more readily, increasing the risk of heart attacks. British investigators have shown that chronic work stress can produce chronic increases in adrenaline levels, and have related those changes to an increased risk of heart disease. A study at Duke University showed that the stress of performing difficult arithmetic problems can constrict the coronary arteries in such a way that blood flow to the heart muscle is reduced.

So science is beginning to support the theory that chronic emotional stress can promote coronary artery disease. Certainly such stress is associated with behaviors that increase coronary artery disease, and there's at least suggestive evidence that it may even have a direct effect in producing coronary disease.

Is all emotional stress bad?
No. It has been observed for years, for instance, that many executives with high-pressure jobs seem to remain quite healthy until old age – they seem to flourish in their pressure-cooker jobs. Recent studies have shed light on this phenomenon.
It turns out that the type of emotional stress one experiences is important. In comparing the outcomes of individuals with different types of job-related stress, it was found that people with relatively little control over their own workplace destiny (clerks and secretaries for instance) fared far worse than their bosses. (Bosses, of course, tend to have more control over their own lives – and the lives of others. As someone once said, it’s good to be king.) A sense of loss of control, therefore, appears to be a particularly important form of emotional stress. Furthermore, this evidence seems to confirm that if some sense of control over one’s destiny is maintained, job related stress can be exhilarating rather than debilitating.

What can be done about emotional stress?
Actually, quite a bit of evidence suggests that it may be the individual, and not the stress itself that is the problem. People with Type A personalities (time-sensitive, impatient, chronic sense of urgency, tendency toward hostility, competitive) are at higher risk for coronary artery disease than people with Type B personalities (patient, low-key, non-competitive). In other words, given the same stressful situation, some will respond with frustration and anger, the rush of adrenaline and the fight-or-flight mode, and some will react serenely.

This is why the common advice to “avoid stress” is so useless. Nobody can avoid all stress without completely dropping out of society and becoming a monk. Besides, people of the Type A persuasion will create their own stressful situations. A simple trip to the grocery store will be filled with episodes of bad drivers, poorly-timed traffic lights, crowded aisles, indifferent checkout clerks, and thin plastic grocery bags that rip too easily. “The world is filled with half-brained incompetents whose only purpose is to get in my way,” they will conclude. “It’s a wonder any of them survived to adulthood.”

With this sort of mind-set, retiring, changing jobs, or moving to Tucson are not likely to significantly reduce stress levels – the stress will be there whether it is imposed externally, or whether you have to manufacture it. Reducing stress levels in these cases, then, requires not an elimination of stressful situations (which is impossible), but a change in the way stress is handled. Type A’s have to learn to become more B-like.

Essentially, new responses need to be learned, so that the fight-or-flight adrenaline surge is not automatically engaged at the first sign of trouble. Stress management programs have begun to demonstrate some success in accomplishing this end.

Stress management programs often consist of breathing exercises, stretching exercises, Yoga, meditation, and/or massage. There are probably several useful approaches, but they all aim toward the same goal – to blunt the adrenaline response to minor stress.

A recent study from Duke University reported a significant reduction in heart attacks among patients with coronary artery disease who underwent a formal stress management program, which was used in conjunction with a smoking cessation program, a weight-loss program, and control of lipids.

Stress management techniques may be quite helpful in reducing the risk of coronary events, and have the added benefit of being risk-free. Thus, there seems to be little reason not to recommend some form of stress management in people with heart disease, or with risk factors for heart disease. And finally, it should be pointed out that exercise is a great way of reducing chronic stress, and in addition has the advantage of directly lessening the risk of coronary artery disease, and helping to control obesity.

By Richard N. Fogoros, M.D.,

Monday, January 5, 2009

Drug Abuse (4): Stress Leads to the Use and Abuse of Drugs

Some of the Basic Facts
Stressful events can have a direct affect on the use of alcohol or other drugs. Stress is a major contributor to the initiation and continuation of addiction to alcohol or other drugs, as well as to relapse or a return to drug use after periods of abstinence.

Stress is one of the major factors known to cause relapse to smoking, even after prolonged periods of abstinence.

Children exposed to severe stress may be more vulnerable to drug use. A number of clinical and epidemiological studies show a strong association between psychosocial stressors early in life (e.g., parental loss, child abuse) and an increased risk for depression, anxiety, impulsive behavior, and substance abuse in adulthood.
When We Refer to "Stress," Just What Are We Talking About?
Stress is a term we all know and use often, but what does it really mean? It is hard to define because it means different things to different people. Stress is a normal reaction to life for people of all ages. It is caused by our body's instinct to protect itself from emotional or physical pressure or, in extreme situations, from danger.

Stressors differ for each of us. What is stressful for one person may or may not be stressful for another; each of us responds to stress in an entirely different way.

How a person copes with stress--by reaching for a beer or cigarette or by heading to the gym--also plays an important role in the impact that stress will have on our bodies.

By using their own support systems, some people are able to cope effectively with the emotional and physical demands brought on by stressful and traumatic experiences. However, individuals who experience prolonged reactions to stress that disrupt their daily functioning may benefit from consulting with a trained and experienced mental health professional.

How Does the Body Respond to Stress?
The stress response is mediated by a highly complex, integrated network that involves the central nervous system, the adrenal system, the immune system, and the cardiovascular system.

Stress activates adaptive responses. It releases the neurotransmitter norephinephrine, which is involved with memory. This may be why people remember stressful events more clearly than they do nonstressful situations.

Stress also increases the production of a hormone in the body known as corticotropin releasing factor (CRF). CRF is found throughout the brain and initiates our biological response to stressors. During all negative experiences, certain regions of the brain show increased levels of CRF. Interestingly, almost all drugs of abuse have also been found to increase CRF levels, which suggests a neurobiological connection between stress and drug abuse.

Mild stress may cause changes that are useful. For example, stress can actually improve our attention and increase our capacity to store and integrate important and life-protecting information. But if stress is prolonged or chronic, those changes can become harmful.

Stress, Drugs, and Vulnerable Populations
Stressful experiences increase the vulnerability of an individual to relapse to drugs even after prolonged abstinence.

Individuals who have achieved abstinence from drugs must continue to sustain their abstinence - avoiding environmental triggers, recognizing their psychosocial and emotional triggers, and developing healthy behaviors to handle life's stresses.

A number of relapse prevention approaches have been developed to help clinicians address relapse. Treatment techniques that foster coping skills, problem-solving skills, and social support play a role in successful treatment.

Physicians and therapists should be aware of what medications their patients are taking but should not discourage the use of medical prescriptions to help alleviate stress. Some people may need medications for stress-related symptoms or for treatment of depression and anxiety.

What is Drug Addiction Treatment?

There are many addictive drugs, and treatments for specific drugs can differ. Treatment also varies depending on the characteristics of the patient.
Problems associated with an individual's drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.

A variety of scientifically based approaches to drug addiction treatment exists. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person's drug-related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients. The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse.

Drug addiction treatment can include behavioral therapy, medications, or their combination.

Treatment medications, such as methadone, LAAM, and naltrexone, are available for individuals addicted to opiates. Nicotine preparations (patches, gum, nasal spray) and bupropion are available for individuals addicted to nicotine.

Components of Comprehensive Drug Abuse Treatment
The best treatment programs provide a combination of therapies and other services to meet the needs of the individual patient.

Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical for treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorder, bipolar disorder, or psychosis.
Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment often is not sufficient. For many, treatment is a long-term process that involves multiple interventions and attempts at abstinence.

Rehab Programs
Alcohol and drug rehab programs offer hope to men and women and their families suffering from the devastating consequences of chemical dependency. Deciding to seek recovery for yourself or someone you care about may be one of the most courageous and life-altering steps you’ll ever take.

Alcohol and drug rehab centers should offer a variety of treatment programs that can meet individual needs and offer sustained help. Programs may include inpatient, residential, outpatient, and/or short-stay options. While alcohol and drug addiction progress through predictable stages, each individual’s experience has quite personal and unique characteristics. It takes a trained professional, either a physician or therapist specializing in addictions, to make an accurate diagnosis and prescribe the most appropriate treatment program.

Not all alcohol and drug rehab centers are the same—they can differ significantly in philosophies, program options, credentials, staff skills and qualifications, and cost. The process of selecting the right drug rehab center can be confusing. Most of us don’t know exactly what to look for or the questions to ask that will help determine the drug rehab center that’s best designed to meet our needs.

Saturday, January 3, 2009

Drug Abuse ( prescription drugs) - 3

Prescription drugs are rapidly becoming primary drugs of abuse in the United States and throughout the world. There are many commonly held misconceptions of the abuse potential for powerful substances such as Oxycontin ®, because such substances can be obtained legally, and have legitimate use in the medical profession.

Although many prescription drugs can be abused or misused, there are three classes of prescription drugs that are most commonly abused.

o Opioids, which are most often prescribed to treat pain

o CNS depressants, which are used to treat anxiety and sleep disorders

o Stimulants, which are prescribed to treat the narcolepsy, attention-deficit hyperactivity disorder (ADHD), and obesity

Preventing and detecting prescription drug abuse
Although most patients use medications as directed, abuse of and addiction to prescription drugs are public health problems for many Americans. However, addiction rarely occurs among those who use pain relievers, CNS depressants, or stimulants as prescribed; the risk for addiction exists when these medications are used in ways other than as prescribed. Health care providers such as primary care physicians, nurse practitioners, and pharmacists as well as patients can all play a role in preventing and detecting prescription drug abuse.

Health Care Providers
About 70 percent of Americans - approximately 191 million people - visit a health care provider, such as a primary care physician, at least once every 2 years. Thus, health care providers are in a unique position not only to prescribe needed medications appropriately, but also to identify prescription drug abuse when it exists and help the patient recognize the problem, set goals for recovery, and seek appropriate treatment when necessary. Screening for any type of substance abuse can be incorporated into routine history taking with questions about what prescriptions and over-the-counter medicines the patient is taking and why. Screening also can be performed if a patient presents with specific symptoms associated with problem use of a substance.

Over time, providers should note any rapid increases in the amount of a medication needed - which may indicate the development of tolerance - or frequent requests for refills before the quantity prescribed should have been used. They should also be alert to the fact that those addicted to prescription medications may engage in "doctor shopping," moving from provider to provider in an effort to get multiple prescriptions for the drug they abuse.

Preventing or stopping prescription drug abuse is an important part of patient care. However, health care providers should not avoid prescribing or administering strong CNS depressants and painkillers, if they are needed.

Pharmacists can play a key role in preventing prescription drug misuse and abuse by providing clear information and advice about how to take a medication appropriately, about the effects the medication may have, and about any possible drug interactions. Pharmacists can help prevent prescription fraud or diversion by looking for false or altered prescription forms. Many pharmacies have developed "hotlines" to alert other pharmacies in the region when a fraud is detected.

There are several ways that patients can prevent prescription drug abuse. When visiting the doctor, provide a complete medical history and a description of the reason for the visit to ensure that the doctor understands the complaint and can prescribe appropriate medication. If a doctor prescribes a pain medication, stimulant, or CNS depressant, follow the directions for use carefully and learn about the effects that the drug could have, especially during the first few days during which the body is adapting to the medication. Also be aware of potential interactions with other drugs by reading all information provided by the pharmacist. Do not increase or decrease doses or abruptly stop taking a prescription without consulting a health care provider first. For example, if you are taking a pain reliever for chronic pain and the medication no longer seems to be effectively controlling the pain, speak with your physician; do not increase the dose on your own. Finally, never use another person's prescription.

Treating prescription drug addiction
Years of research have shown us that addiction to any drug, illicit or prescribed, is a brain disease that can, like other chronic diseases, be effectively treated. But no single type of treatment is appropriate for all individuals addicted to prescription drugs. Treatment must take into account the type of drug used and the needs of the individual. To be successful, treatment may need to incorporate several components, such as counseling in conjunction with a prescribed medication, and multiple courses of treatment may be needed for the patient to make a full recovery.

The two main categories of drug addiction treatment are behavioral and pharmacological. Behavioral treatments teach people how to function without drugs, how to handle cravings, how to avoid drugs and situations that could lead to drug use, how to prevent relapse, and how to handle relapse should it occur. When delivered effectively, behavioral treatments - such as individual counseling, group or family counseling, contingency management, and cognitive-behavioral therapies - also can help patients improve their personal relationships and ability to function at work and in the community.

Some addictions, such as opioid addiction, can also be treated with medications. These pharmacological treatments counter the effects of the drug on the brain and behavior. Medications also can be used to relieve the symptoms of withdrawal, to treat an overdose, or to help overcome drug cravings. Although a behavioral or pharmacological approach alone may be effective for treating drug addiction , research shows that a combination of both, when available, is most effective.

More on treatment of:
• Opioids
• CNS Depressants
• Stimulants

Thursday, January 1, 2009

Drug Abuse (Cocaine)-2

What is Cocaine?
Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine has been labeled the drug of the 1980s and '90s, because of its extensive popularity and use during this period. However, cocaine is not a new drug. In fact, it is one of the oldest known drugs. The pure chemical, cocaine hydrochloride, has been an abused substance for more than 100 years, and coca leaves, the source of cocaine, have been ingested for thousands of years.
Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia, in the mid-19th century. In the early 1900s, it became the main stimulant drug used in most of the tonics/elixirs that were developed to treat a wide variety of illnesses. Today, cocaine is a Schedule II drug, meaning that it has high potential for abuse, but can be administered by a doctor for legitimate medical uses, such as a local anesthetic for some eye, ear, and throat surgeries.
There are basically two chemical forms of cocaine: the hydrochloride salt and the "freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intra nasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable.
Cocaine is generally sold on the street as a fine, white, crystalline powder, known as "coke," "C," "snow," "flake," or "blow." Street dealers generally dilute it with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.
What is Crack?
Crack is the street name given to the freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. The term "crack" refers to the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride.
Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy.
How is Cocaine Used?
The principal routes of cocaine administration are oral, intranasal, intravenous, and inhalation. The slang terms for these routes are, respectively, "chewing," "snorting," "mainlining," "injecting," and "smoking" (including freebase and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves the inhalation of cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection. The drug can also be rubbed onto mucous tissues. Some users combine cocaine powder or crack with heroin in a "speedball."
Cocaine use ranges from occasional use to repeated or compulsive use, with a variety of patterns between these extremes. There is no safe way to use cocaine. Any route of administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death. Repeated cocaine use by any route of administration can produce addiction and other adverse health consequences.
What are the short-term effects of Cocaine Use?
• Increased energy
• Decreased appetite
• Mental alertness
• Increased heart rate and blood pressure
• Constricted blood vessels
• Increased temperature
• Dilated pupils
What are the long-term effects of Cocaine Use?
• Addiction
• Irritability and mood disturbances
• Restlessness
• Paranoia
• Auditory hallucinations
What Are the Medical Consequences of Cocaine Abuse?
Cardiovascular Effects
• Disturbances in Heart Rhythm
• Heart Attacks
Respiratory Effects
• Chest Pain
• Respiratory Failure
Neurological Effects
• Strokes
• Seizures and headaches
Gastrointestinal Complications
• Abdominal Pain
• Nausea

What Treatments are Effective for Cocaine Abusers?
There has been an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be poly-drug users, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of problems. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient's drug abuse.

Next: Prescription drugs