Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Substance Abuse. Show all posts
Showing posts with label Substance Abuse. Show all posts

Friday, March 8, 2024

What Does Being Sober Mean Today? For Many, Not Full Abstinence

Ernesto Londono
The New York Times
Originally posted 4 Feb 24

Here are two excerpts:

Notions of what constitutes sobriety and problematic substance use have grown more flexible in recent years as younger Americans have shunned alcohol in increasing numbers while embracing cannabis and psychedelics - a phenomenon that alarms some addiction experts.

Not long ago, sobriety was broadly understood to mean abstaining from all intoxicating substances, and the term was often associated with people who had overcome severe forms of addiction. These days, it is used more expansively, including by people who have quit drinking alcohol but consume what they deem moderate amounts of other substances, including marijuana and mushrooms.

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As some drugs come to be viewed as wellness boosters by those who use them, adherence to the full abstinence model favored by organizations like Alcoholics Anonymous is shifting. Some people call themselves "California sober," a term popularized in a 2021 song by the pop star Demi Lovato, who later disavowed the idea, saying on social media that "sober sober is the only way to be."

Approaches that might have once seemed ludicrous-like treating opioid addiction with psychedelics - have gained broader enthusiasm among doctors as drug overdoses kill tens of thousands of Americans each year.

"The abstinence-only model is very restrictive," said Dr. Peter Grinspoon, a primary care physician at Massachusetts General Hospital who specializes in medical cannabis and is a recovering opioid addict. "We really have to meet people where they are and have a broader recovery tent."

It is impossible to know how many Americans consider themselves part of an increasingly malleable concept of sobriety, but there are indications of shifting views of acceptable substance use. Since 2000, alcohol use among younger Americans has declined significantly, according to a Gallup poll.

At the same time, the use of cannabis and psychedelics has risen as state laws and attitudes grow more permissive, even as both remain illegal under federal law.

A survey found that 44 percent of adults aged 19 to 30 said in 2022 that they had used cannabis in the past year, a record high. That year, 8 percent of adults in the same age range said they had used psychedelics, an increase from the 3 percent a decade earlier.

Saturday, June 4, 2022

About one-fifth of lawyers and staffers considered suicide at some point in their careers, new survey says.

Debra Cassens Weiss
American Bar Association Journal
Originally posted 10 MAY 22

A new survey of lawyers and staff members hailing mostly from BigLaw has found that anxiety, depression and isolation remain at concerning levels, despite a slight decrease in the percentages since the survey last year.

The Mental Health Survey by Law.com and ALM Intelligence found that 67% of the respondents reported anxiety, 35% reported depression and 44% reported isolation, according to an article by Law.com.

The survey, conducted in March and April, asked respondents from around the world about their mental health and law firm environments in 2021.

The percentage of respondents who contemplated suicide at some point in their professional careers was 19%, the article reports.

In addition, 2.4% of the respondents said they had a drug problem, and 9.4% said they had an issue with alcoholic drinking.

About 74% of the respondents thought that their work environment contributed to their mental health issues. When asked about the factors that had a negative impact on mental health, top concerns were always being on call (72%), billable hour pressure (59%), client demands (57%), lack of sleep (55%) and lean staffing (49.5%).

The survey asked about the impact of remote work for the first time. About 59% said remote work increased their quality of life; about 62% said it increased the quality of home-based relationships; about 54% said it led to an increase in their billable hours; and 50% said it improved personal finances. But 76% said remote work hurt the quality of interpersonal relationships with colleagues.


Tuesday, April 26, 2022

Ethical considerations for psychotherapists participating in Alcoholics Anonymous

Kohen, Casey B.,Conlin, William E.
Practice Innovations, Vol 7(1), Mar 2022, 40-52.

Abstract

Because the demands of professional psychology can be taxing, psychotherapists are not immune to the development of mental health and substance use disorders. One estimate indicates that roughly 30% to 40% of psychologists know of a colleague with a current substance abuse problem (Good et al., 1995). Twelve-step mutual self-help groups, particularly Alcoholics Anonymous (AA), are the most widely used form of treatment for addiction in the United States. AA has empirically demonstrated effectiveness at fostering long-term treatment success and is widely accessible throughout the world. However, psychotherapist participation in AA raises a number of ethical concerns, particularly regarding the potential for extratherapy contact with clients and the development of multiple relationships. This article attempts to review the precarious ethical and practical situations that psychotherapists, either in long-term recovery or newly sober, may find themselves in during AA involvement. Moreover, this article provides suggestions for psychotherapists in AA regarding how to best adhere to both the principles of AA (i.e., the 12 steps and 12 traditions) and the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct

Here is an excerpt:

Recent literature regarding the use of AA or other mutual self-help groups by psychotherapists is scant, but earlier studies suggest its effectiveness. A 1986 survey of 108 members of Psychologists Helping Psychologists (a seemingly defunct support group exclusively for substance dependent doctoral-level psychologists and students) shows that of the 94% of respondents maintaining abstinence, 86% attended AA (Thoreson et al., 1986). A separate study of 70 psychologists in recovery who were members of AA revealed the majority attained sobriety outside of formal treatment or intervention programs (Skorina et al., 1990). 

Because AA appears to be a vital resource for psychotherapists struggling with substance misuse, it is important to consider how to address ethical dilemmas that one might encounter while participating in AA.

Conclusion

Psychotherapists participating in AA may, at times, find that their professional responsibility of adhering to the APA Code of Ethics hinders some aspects of their categorical involvement in AA as defined by AA’s 12 steps and 12 traditions. The psychotherapist in AA may need to adjust their personal AA “program” in comparison with the typical AA member in a manner that attempts to meet the requirements of the profession yet still provides them with enough support to maintain their professional competence. This article discusses reasonable compromises, specifically tailored to the length of the psychotherapist’s sobriety, that minimize the potential for client harm. Ultimately, if the psychotherapist is unable to find an appropriate middle-ground, where the personal needs of recovery can be met without damaging client welfare and respecting the client’s rights, the psychotherapist should refer the client elsewhere. With these recommendations, psychotherapists should feel more comfortable participating in AA (or other mutual self-help groups) while also adhering to the ethical principles of our profession.

Thursday, November 4, 2021

The AMA needs to declare a national mental health emergency

Susan Hata and Thalia Krakower
STAT News
Originally published 6 OCT 21

As the pandemic continues to disrupt life across the U.S., a staggering number of Americans are reaching out to their primary care doctors for help with sometimes overwhelming mental health struggles. Yet primary care doctors like us have nowhere to turn when it comes to finding mental health providers for them, and our patients often suffer without the specialty care they need.

It’s time for the American Medical Association to take decisive action and declare a national mental health emergency.

More than 40% of Americans report symptoms of anxiety or depression, and emergency rooms are flooded with patients in psychiatric crises. Untreated, these issues can have devastating consequences. In 2020, an estimated 44,800 Americans lost their lives to suicide; among children ages 10 to 14, suicide is the second leading cause of death.

Finding mental health providers for patients is an uphill climb, in part because there is no centralized process for it. Timely mental health services are astonishingly difficult to obtain even in Massachusetts, where we live and work, which has the most psychologists per capita. Waitlists for therapists can be longer than six months for adults, and even longer for children.

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By declaring a mental health emergency, the AMA could galvanize health administrators and drive the innovation needed to improve the existing mental health system. When Covid-19 was named a pandemic, the U.S. health care infrastructure adapted quickly to manage the deluge of infections. Leaders nimbly and creatively mobilized resources. They redeployed staff, built field hospitals and overflow ICUs, and deferred surgeries and routine care to preserve resources and minimize hospital-based transmission of Covid-19. With proper framing and a sense of urgency, similar things can happen for the mental health care system.

To be clear, all of this is the AMA’s lane: In addition to the devastating toll of suicides and overdoses, untreated mental illness worsens cardiac outcomes, increases mortality from Covid-19, and shortens life spans. Adult mental illness also directly affects the health of children, leading to poor health outcomes across generations.

Sunday, June 27, 2021

On Top of Everything Else, the Pandemic Messed With Our Morals

Jonathan Moens
The Atlantic
Originally posted 8 June 21

Here is an excerpt:

The core features of moral injury are feelings of betrayal by colleagues, leaders, and institutions who forced people into moral quandaries, says Suzanne Shale, a medical ethicist. As a way to minimize exposure for the entire team, Kathleen Turner and other ICU nurses have had to take on multiple roles: cleaning rooms, conducting blood tests, running neurological exams, and standing in for families who can’t keep patients company. Juggling all those tasks has left Turner feeling abandoned and expendable. “It definitely exposes and highlights the power dynamics within health care of who gets to say ‘No, I'm too high risk; I can't go in that patient's room,’” she said. Kate Dupuis, a clinical neuropsychiatrist and researcher at Canada’s Sheridan College, also felt her moral foundations shaken after Ontario’s decision to shut down schools for in-person learning at the start of the pandemic. The closures have left her worrying about the potential mental-health consequences this will have on her children.

For some people dealing with moral injury right now, the future might hold what is known as “post-traumatic growth,” whereby people’s sense of purpose is reinforced during adverse events, says Victoria Williamson, a researcher who studies moral injury at Oxford University and King’s College London. Last spring, Ahmed Ali, an imam in Brooklyn, New York, felt his moral code violated when dead bodies that were sent to him to perform religious rituals were improperly handled and had blood spilling from detached IV tubes. The experience has invigorated his dedication to helping others in the name of God. “That was a spiritual feeling,” he said.

But moral injury may leave other people feeling befuddled and searching for some way to make sense of a very bad year. If moral injury is left unaddressed, Greenberg said, there’s a real risk that people will develop depression, alcohol misuse, and suicidality. People suffering from moral injury risk retreating into isolation, engaging in self-destructive behaviors, and disconnecting from their friends and family. In the U.K., moral injury among military veterans has been linked to a loss of faith in organized religion. The psychological cost of a traumatic event is largely determined by what happens afterward, meaning that a lack of support from family, friends, and experts who can help people process these events—now that some of us are clawing our way out of the pandemic—could have serious mental-health repercussions. “This phase that we’re in now is actually the phase that’s the most important,” Greenberg said.

Monday, May 11, 2020

US 'Deaths of Despair' From COVID-19 Could Top 75,000, Experts Warn

Megan Brooks
MedScape.com
Originally posted 8 May 20

An additional 75,000 Americans could die by suicide, drugs, or alcohol abuse because of the COVID-19 pandemic, projections from a new national report released today suggest.

The number of "deaths of despair" could be even higher if the country fails to take bold action to address the mental health toll of unemployment, isolation, and uncertainty, according to the report from the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care.

"If nothing happens and nothing improves ― ie, the worst-case scenario ― we could be looking at an additional 150,000 people who died who didn't have to," Benjamin Miller, PsyD, WBT chief strategy officer, told Medscape Medical News.

"We can prevent these deaths. We know how and have a bevy of evidence-based solutions. We lack the resources to really stand this up in a way that can most positively impact communities," Miller added.

Slow Recovery, Quick Recovery Scenarios

For the analysis, Miller and colleagues combined information on the number of deaths from suicide, alcohol, and drugs from 2018 as a baseline (n = 181,686). They projected levels of unemployment from 2020 to 2029 and then used economic modeling to estimate the additional annual number of deaths.

Across nine different scenarios, the number of additional deaths of despair range from 27,644 (quick recovery, smallest impact of unemployment on suicide, alcohol-, and drug-related deaths) to 154,037 (slow recovery, greatest impact of unemployment on these deaths), with 75,000 being the most likely.

The info is here.

Friday, April 12, 2019

Not “burnout,” not moral injury—human rights violations

Pamela Wible
www.idealcare.org
Originally posted March 18, 2019

Here is an excerpt:

Moral injury now extends beyond combat veterans to include physicians in 2018 when Dean and Talbot announced their opposition and alternative to the label physician “burnout.” They believe (as I do) that physician cynicism, exhaustion, and decreased productivity are symptoms of a broken system. Economic forces, technological demands, and widespread intergenerational physician mental health wounds have culminated in a highly dysfunctional and toxic health care system in which we find ourselves in daily forced betrayal of our deepest values.

Manifestations of moral injury in victims include self-harm, poor self-care, substance abuse, recklessness, self-defeating behaviors, hopelessness, self-loathing, and decreased empathy. I’ve witnessed all far too frequently among physicians.

Yet moral injury is not an official diagnosis. No specific solutions are offered at medical institutions to combat physician moral injury though moral injury treatment among military may include listening circles (where veterans share battlefield stories), forgiveness rituals, and individual therapy. The fact is most victims of moral injury struggle on their own.

With no evidence-based treatments for physician moral injury and zero progress after forty years of burnout prevention, what next? Enter the real diagnosis—human rights violations—with clear evidence-based solutions.

The info is here.

Saturday, March 2, 2019

Serious Ethical Violations in Medicine: A Statistical and Ethical Analysis of 280 Cases in the United States From 2008–2016

James M. DuBois, Emily E. Anderson, John T. Chibnall, Jessica Mozersky & Heidi A. Walsh (2019) The American Journal of Bioethics, 19:1, 16-34.
DOI: 10.1080/15265161.2018.1544305

Abstract

Serious ethical violations in medicine, such as sexual abuse, criminal prescribing of opioids, and unnecessary surgeries, directly harm patients and undermine trust in the profession of medicine. We review the literature on violations in medicine and present an analysis of 280 cases. Nearly all cases involved repeated instances (97%) of intentional wrongdoing (99%), by males (95%) in nonacademic medical settings (95%), with oversight problems (89%) and a selfish motive such as financial gain or sex (90%). More than half of cases involved a wrongdoer with a suspected personality disorder or substance use disorder (51%). Despite clear patterns, no factors provide readily observable red flags, making prevention difficult. Early identification and intervention in cases requires significant policy shifts that prioritize the safety of patients over physician interests in privacy, fair processes, and proportionate disciplinary actions. We explore a series of 10 questions regarding policy, oversight, discipline, and education options. Satisfactory answers to these questions will require input from diverse stakeholders to help society negotiate effective and ethically balanced solutions.

Sunday, November 18, 2018

Dartmouth Allowed 3 Professors to Sexually Harass and Assault Students, Lawsuit Charges

Nell Gluckman
The Chronicle of Higher Education
Originally published November 15, 2018

Seven current and former students sued Dartmouth College on Thursday, saying it had failed to protect them from three psychology and brain-science professors who sexually harassed and assaulted them. In the lawsuit, filed in a federal court in New Hampshire, they say that when they and others reported horrific treatment, the college did nothing, allowing the professors’ behavior to continue until last spring, when one retired and the other two resigned.

The 72-page complaint, which seeks class-action status, describes an academic department where heavy drinking, misogyny, and sexual harassment were normalized. It says that the three professors — Todd F. Heatherton, William M. Kelley, and Paul J. Whalen — “leered at, groped, sexted,” and “intoxicated” students. One former student alleges she was raped by Kelley, and a current student alleges she was raped by Whalen. Dartmouth ended a Title IX investigation after the professors left, and, as far as the complainants could tell, did not attempt to examine how the abuse occurred or how it could be prevented it from happening again, according to the complaint.

In a written statement, a Dartmouth spokesman said that college officials “respectfully but strongly disagree with the characterizations of Dartmouth’s actions in the complaint and will respond through our own court filings.”

The info is here.

Wednesday, July 18, 2018

Why are Americans so sad?

Monica H. Swahn
quartz.com
Originally published June 16, 2018

Suicide rates in the US have increased nearly 30% in less than 20 years, the Centers for Disease Control and Prevention reported June 7. These mind-numbing statistics were released the same week two very famous, successful and beloved people committed suicide—Kate Spade, a tremendous entrepreneur, trendsetter and fashion icon, and Anthony Bourdain, a distinguished chef and world traveler who took us on gastronomic journeys to all corners of the world through his TV shows.

Their tragic deaths, and others like them, have brought new awareness to the rapidly growing public health problem of suicide in the US. These deaths have renewed the country’s conversation about the scope of the problem. The sad truth is that suicide is the 10th leading cause of death among all Americans, and among youth and young adults, suicide is the third leading cause of death.

I believe it’s time for us to pause and to ask the question why? Why are the suicide rates increasing so fast? And, are the increasing suicide rates linked to the seeming increase in demand for drugs such as marijuana, opioids and psychiatric medicine? As a public health researcher and epidemiologist who has studied these issues for a long time, I think there may be deeper issues to explore.

Suicide: more than a mental health issue

Suicide prevention is usually focused on the individual and within the context of mental health illness, which is a very limited approach. Typically, suicide is described as an outcome of depression, anxiety, and other mental health concerns including substance use. And, these should not be trivialized; these conditions can be debilitating and life-threatening and should receive treatment. (If you or someone you know need help, call the National Suicide Prevention Lifeline at 1-800-273-8255).

The info is here.

Wednesday, January 24, 2018

Top 10 lies doctors tell themselves

Pamela Wible
www.idealmedicalcare.org
Originally published December 27, 2017

Here is an excerpt:

Sydney Ashland: “I must overwork and overextend myself.” I hear this all the time. Workaholism, alcoholism, self-medicating. These are the top coping strategies that we, as medical professionals, use to deal with unrealistic work demands. We tell ourselves, “In order to get everything done that I have to get done. In order to meet expectations, meet the deadlines, then I have to overwork.” And this is not true. If you believe in it, you are participating in the lie, you’re enabling it. Start to claim yourself. Start to claim your time. Don’t participate. Don’t believe that there is a magic workaround or gimmick that’s going to enable you to stay in a toxic work environment and reshuffle the deck. What happens is in that shuffling process you continue to overcompensate, overdo, overextend yourself—and you’ve moved from overwork on the face of things to complicating your life. This is common. Liberate yourself. You can be free. It’s not about overwork.

Pamela Wible: And here’s the thing that really is almost humorous. What physicians do when they’re overworked, their solution for overwork—is to overwork. Right? They’re like, “Okay. I’m exhausted. I’m tired. My office isn’t working. I’ll get another phone line. I’ll get two more receptionists. I’ll add three more patients per day.” Your solution to overwork, if it’s overwork, is probably not going to work.

The interview is here.

Thursday, November 3, 2016

Why It's So Hard to Get Mental Healthcare in Rural America

By Syrena Clark
Vice News
October 7, 2016

Here is an excerpt:

Conditions in rural areas can also exacerbate mental-health problems. One in five adults suffers from mental illness, but in rural areas, rates of depression and suicide attempts are significantly higher than in urban areas, according to a report by the Center for Rural Affairs. Mostly because of isolation and poverty. For people who can't afford or access mental healthcare, some turn to self-medication, treating symptoms with drugs, alcohol, and self-harm, worsening their own illnesses. Where I live, it's easier to buy Klonopin from a dealer than it is from a psychiatrist.

After years of inadequate treatment, I swallowed an entire bottle of Gabapentin, a type of seizure medication. My goal was to die. When I was later strapped into an ambulance, the drive to the hospital was over an hour. I got better there, but after six days, I was discharged. It was far too soon, but there simply weren't enough beds to stay.

Mackie said his organization and others are investing in programs that will bring more attention to mental healthcare in rural areas, including programs that "[educate] people in rural areas to be able to provide assistance and care at a basic level," so as to start a pipeline of people who can later become licensed mental-health professionals.

The article is here.

Wednesday, September 28, 2016

The Ethics of Behavioral Health Information Technology

Michelle Joy, Timothy Clement, and Dominic Sisti
JAMA. Published online September 08, 2016.
doi:10.1001/jama.2016.12534

Here is an excerpt:

Individuals with mental illness and addiction experience negative stereotyping, prejudice, discrimination, distancing, and marginalization—social dynamics commonly called stigma. These dynamics are also often internalized and accepted by individuals with mental health conditions, amplifying their negative effect. Somewhat counterintuitively, stigmatizing beliefs about these patients are common among health care workers and often more common among mental health care professionals. Given these facts, the reinforcement of any stigmatizing concept within the medical record system or health information infrastructure is ethically problematic.

Stigmatizing iconography presents the potential for problematic clinical consequences. Patients with dual psychiatric and medical conditions often receive low-quality medical care and experience worse outcomes. One factor in this disparity is the phenomenon of diagnostic overshadowing. For example, diagnostic overshadowing can occur in patients with co-occurring mental illness and conditions such as cardiovascular disease or diabetes. These patients are less likely to receive appropriate medical care than patients without a mental health condition—their psychiatric conditions overshadow their other conditions, potentially biasing the clinician’s judgment about diagnosis and treatment such that the clinician may misattribute physical symptoms to mental health problems.

The article is here.

Thursday, November 19, 2015

With Sobering Science, Doctor Debunks 12-Step Recovery

Interview with Lance Dodes
NPR
Originally posted March 23, 2014

Here is an excerpt:

There is a large body of evidence now looking at AA success rate, and the success rate of AA is between 5 and 10 percent. Most people don't seem to know that because it's not widely publicized. ... There are some studies that have claimed to show scientifically that AA is useful. These studies are riddled with scientific errors and they say no more than what we knew to begin with, which is that AA has probably the worst success rate in all of medicine.

It's not only that AA has a 5 to 10 percent success rate; if it was successful and was neutral the rest of the time, we'd say OK. But it's harmful to the 90 percent who don't do well. And it's harmful for several important reasons. One of them is that everyone believes that AA is the right treatment. AA is never wrong, according to AA. If you fail in AA, it's you that's failed.

Thursday, June 18, 2015

The cheapest way to end homelessness is ridiculously simple

By Drake Baer
Business Insider
Originally published May 28, 2015

Here is an excerpt:

What's counterintuitive about housing first is that people get to keep their homes even if they keep using drugs or alcohol. As we reported last February, this method is better at keeping people from lapsing back into homelessness than traditional housing methods, where homeless people have to lock down jobs and stay sober to keep their temporary housing.

So you could say that the Housing First method isn't just more compassionate to the people who suffer from homelessness, it's also more effective at keeping them off the streets and preventing the drain on community funds.

"If you move people into permanent supportive housing first, and then give them help, it seems to work better,” Nan Roman, the president and CEO of the National Alliance for Homelessness, told The New Yorker in September. “It's intuitive, in a way. People do better when they have stability."

The entire article is here.

Monday, October 27, 2014

Drug Addiction Seen as 'Moral Failing,' Survey Finds

By Robert Preidt
HealthDay Reporter
Originally posted on October 3, 2014

People with drug addiction are much more likely to face stigma than those with mental illness because they're seen as having a "moral failing," according to a new survey.

The poll of more than 700 people across the United States also found that the public is less likely to approve of insurance, housing and employment policies meant to help people with drug addiction.

The study results suggest that many people consider drug addiction a personal vice rather than a treatable medical condition, according to the Johns Hopkins Bloomberg School of Public Health researchers.

The entire article is here.

Sunday, March 9, 2014

How A Big Drug Company Inadvertently Got Americans Hooked On Heroin

By Jillian Berman
The Huffington Post
Originally posted February 24, 2014

Here is an excerpt:

In recent years, more prescription drug abusers have started turning to heroin for a cheaper high as the price of pills skyrockets on the black market, Bunt said. Two factors have contributed to the cost increase: opioid addiction boosting demand and doctors becoming more cautious about prescribing opioids, decreasing supply, Bunt said.

Another reason for the price increase: The Drug War, according to a January 2012 report from Radley Balko. Government crackdowns have made it difficult for even reputable doctors to prescribe pain pills. To fill the void, doctors and others looking to make a buck off the prescription pills created so-called "pill mills" -- offices that prescribe pain medication in high volume and often serve people addicted to the drugs.

The entire article is here.