Mental Illness Can Have More Impact on Life Expectancy Than Smoking

According to researchers at Oxford University, mental illness has an effect on life expectancy that is equivalent or greater than smoking. A great deal of effort and spending has been invested into smoking cessation programs and smoking awareness campaigns. This new research should prompt the government, health care and social services to shift their focus in an effort to increase life expectancy for those living with mental illness.

Researchers reviewed 20 review papers from clinical studies that reported mortality risk among mental health problems, substance and alcohol abuse, dementia, autistic spectrum disorders, learning disability and childhood behavioral disorders. These studies included over 1.7 million individuals and over 250,000 deaths. They also used studies and reviews that reported life expectancy and risk of dying by suicide. All results were compared to data for heavy smoking.

According to their findings, “one in four people in the UK will experience some kind of mental health problem in the course of a year” while smokers consist of roughly 21% of British men and 19% of women. 

They discovered that all diagnoses studied had an increased mortality risk similar or greater than heavy smoking. Some of the estimated reductions in life expectancy were found to be as follows:

• Bipolar Disorder: 9 - 20 years
  
• Schizophrenia: 10 – 20 years
  
• Drug and Alcohol Abuse: 9 - 24 years
  
• Recurrent Depression: 7 - 11 years
  
• Heavy smoking: 8 - 10 years

Dr. Seena Fazel of the Department of Psychiatry at Oxford University said: "We found that many mental health diagnoses are associated with a drop in life expectancy as great as that associated with smoking 20 or more cigarettes a day."
Despite the fact that this study did not mention the prevalence of smoking among persons with mental illness, the results are still devastating.

There may be many reasons for this phenomenon. For example:

• Psychiatric patients and those with drug and/or alcohol dependence can be more likely to engage in high-risk behaviours.
  
• Physical health problems may not be taken seriously and treated properly due to the stigma attached to their mental illness.
  
• Many mental illnesses can create physical health problems and/or worsen pre-existing ones.
  
• People with serious mental illness may not access healthcare effectively.
  
• The de-medicalization of mental illness may increase the likelihood that physical health problems go untreated or neglected.
  

Life expectancy may increase if only we could make mental health a priority as we have with smoking. In addition to funding and advancing research on mental illness, we should improve health and social services to ensure that persons with mental illness have better access to health care, suitable employment and supports in their community.

Many mental illnesses reduce life expectancy more than heavy smoking

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Brief Opioid Therapy May Eliminate Chronic Pain

According to team leaders, Ruth Drdla-Schutting and Jürgen Sandkühler along with their research team at the MedUni Vienna's Department of Neurophysiology (Centre for Brain Research); opioids can be used for more than temporary pain relief. Apparently, a strong enough dose can actually erase our memory traces of pain in the spinal cord.

At the most basic level, opioids bind to specific sites, called µ-opiate receptors (MOR), which suppresses the stimulation of pain. Characteristically, opioids are only known to alleviate pain while bound to these sites, therefore once treatment is ceased, pain resumes.

Typically, for chronic pain, opioids are administered continuously in moderate doses in order to achieve a permanent binding. This method may result in pain relief, however the treatment is long-term and the cause of pain cannot be eliminated.

To test their theory, that memory traces of pain can be erased with a large enough dose of opioids over a short period, “scientists recreated a surgical procedure in vivo in which pain fibres were stimulated under controlled conditions”.

"Although deep anaesthesia prevents any sensations of pain, we were able to reserve long-term synaptic potentiation in the spinal cord. Despite anaesthesia, there appears to be a memory trace for pain and a pain amplifier has engaged."

“Long-term potentiation (LTP) is a long-lasting enhancement in signal transmission between two neurons that results from stimulating them synchronously.”

Researchers administered high doses of intravenous opioids over a period of an hour and discovered that this completely removed the long-term potentiation. By doing so, this can reverse the cellular changes that cause pain memories. As such, this could actually rid the memory of the sensation that pain is amplified and longer lasting than in actuality and avoid the development chronic pain syndrome.

If proven to be an effective method of treatment, this could mean more than pain management for many people suffering with chronic pain. Current methods temporarily relieve symptoms of pain and typically require long-term opioid use. This type of treatment could greatly reduce the risk of a rapidly growing form of addiction.

Opioids Erase Memory Traces of Pain
Long-term potentiation
mu Opioid receptor

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Sensitivity to Physical Pain Linked To Social Rejection

Psychologists at UCLA have concluded, in the August 14th online edition of Proceedings of the National Academy of Sciences, that there is a genetic link between sensitivity to physical pain and social rejection. A gene that regulates the mu-opioid receptors in the brain that alleviates physical pain also kills the pain of social rejection.

“Their study indicates that variation in the mu-opioid receptor gene (OPRM1), often associated with physical pain, is related to how much social pain a person feels in response to social rejection. People with a rare form of the gene are more sensitive to rejection and experience more brain evidence of distress in response to rejection than those with the more common form.”

Researchers examined the responses of 122 participants from self-report surveys on sensitivity to social rejection, after having collected and assessed their saliva to determine which OPRM1 gene they possessed. At the same time, 31 of the participants were examined through functional magnetic resonance imaging (fMRI) while playing a virtual game of catch. They were told that they were tossing a ball back and forth with 2 other players who were also hooked up on fMRI machines; however the other players were computer generated. Eventually the computer players stopped tossing the ball to the subject.

"What we found is that individuals with the rare form of the OPRM1 gene, who were shown in previous work to be more sensitive to physical pain, also reported higher levels of rejection sensitivity and showed greater activity in social pain–related regions of the brain — the dorsal anterior cingulate cortex and anterior insula — in response to being excluded," said Naomi Eisenberger, co-author and UCLA assistant professor of psychology and director of UCLA's Social and Affective Neuroscience Laboratory.

Baldwin Way, a UCLA postdoctoral scholar and the lead author, states that the findings of this study suggest that feelings of social rejection may occur in the same neural connections that are alleviated by pain killers such as morphine.

Could such findings help to explain the complexities of addiction and lead to the development of more promising treatment options?

Genetic Link Between Physical Pain And Social Rejection Found

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Fighting Addiction With Prescription Heroin

Former MP John Reynolds believes that Canada should start medicating addicts with prescription heroin; in the same manner it would any other health condition that is controlled with medication. Clearly, convincing Canadians of this presumption will not be an easy feat as addiction is hardly comparable to conditions like high blood pressure or diabetes.

“Mr. Reynolds, a member of the InnerChange Foundation in Vancouver, applauded the research arm of Health Canada for financing the Study to Assess Longer-term Opioid Medication Effectiveness (SALOME), which will offer heroin and a legal substitute, Hydromorphone.”

And…“In a secondary phase, some of the 200 addicts who will be recruited to the program will be offered heroin in a pill form - another way of reducing the stigma and health risks associated with injecting drugs.”

"We really hope with SALOME that, if we can show (Hydromorphone) is as effective, there will be so many fewer obstacles to treatment - because it is not called heroin."

Surely society can perceive the benefits for the addict and the community as a whole; however the pill is not the answer. The addict no longer has to commit crimes and suffer various traumas associated with obtaining drugs. The addict can be slowly weaned off drugs in a more controlled manner with the assistance of health professionals in order to ease themselves into proper treatment. The addict would have much needed support during the path to recovery.

No one can deny these benefits; however is the main objective here not to make drug use safer and reduce crime? Many people, including addicts, will view this method as replacing one drug with another, therefore maintaining psychological dependence. In addition, side effects and withdrawal symptoms are not all that unlike those of heroin, morphine or other opiods. Although studies have shown that Hydromorphone can be more successful than methadone, the latter has also not proven to be the much needed solution for many addicts.

I must say that I’m not sold on the idea that addiction is merely a physical condition needing medication, Mr. Reynolds. Recovery requires treatment of both physical and psychological aspects, especially when addiction is so often combined with other mental health conditions.

Prescribe heroin to addicts, former Tory MP says

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Guidelines Finally Exist For Prescription Opioids

The current issue of The Journal of Pain has published a guideline to assist clinicians in prescribing opioid pain medications for patients experiencing chronic non-cancer pain.

“To create this guideline, researchers in the Oregon Evidence-based Practice Center (EPC) at Oregon Health & Science University collaborated with the APS and AAPM for two years, reviewing more than 8,000 published abstracts and nonpublished studies to assess clinical evidence on which the new recommendations are based”.

An extensive literature review revealed that much research is needed in this area; however conclusive evidence suggests that opioids are safe and effective for certain patients, if carefully monitored.

The guideline consists of 25 recommendations, some of which consider the growing concerns for opioid abuse and addiction. Opioids, such as oxycontin and morphine, have gradually become more commonly prescribed and accepted for treating various sorts of pain, including chronic low-back pain, arthritis, fibromyalgia etc., whereas previously opioids were mainly used for treating pain related to post-op, cancer and death.

This new guideline insists that clinicians rule out other possible medications as treatment options before prescribing opioids. However, if it is determined that opioid medication is the ideal choice, clinicians are expected to “conduct a thorough medical history and examination and assess potential risk for substance abuse, misuse or addiction”.

It is shocking to learn that this hasn’t already been considered common practice and that a guideline had to be introduced in order to put this in place! It’s no wonder there has been such an increase in opioid abuse and misuse. Seriously, is this not a typical task for a medical doctor? It seems like a fairly important step in any type of treatment.

Subsequently, with this guideline it will ensure that clinicians “continuously assess patients on chronic opioid therapy by monitoring pain intensity, level of functioning and adherence to prescribed treatments. Periodic drug screens should be ordered for patients at risk for aberrant drug behavior”.

The American Pain Society and the American Academy of Pain Medicine have ensured that patients will be well monitored. To read more about other recommendations in this guideline regarding such topics as methadone use, high dosages, abusers, pregnancy, driving safety, and more, please view the following article: New Guideline For Prescribing Opioid Pain Drugs.

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Nature vs Nurture: Supportive Parenting Can Prevent Substance Abuse

The University of Georgia has published a study in the Journal of Consulting and Clinical Psychology explaining that supportive parenting can actually counteract the effects of a genetic risk factor that increases the likelihood of substance use among youth. This long-term study examined how nature and nurture can influence the behaviour of youth with a genetic predisposition for substance abuse. “We found that involved and supportive parenting can completely override the effects of a genetic risk for substance abuse,” claims Professor Gene Brody.

The research focused on the 5HTT gene that transports serotonin in the brain. According to many studies, most people possess two copies of a long version of this gene, but the select few that possess one or two copies of a short version tend to be more likely to consume alcohol or other substances and partake in impulsive and risky behaviour.

Results were compiled over 4 years from interviews of 253 rural African-American families. Those with the long version of the 5HTT gene comprised of 60% of these youth. Obviously, the remaining 40% were plagued with the short version and a genetic risk factor for substance abuse. Evidently, substance use increased with age. Youth with the short version of the gene that received only minimal supportive parenting used at rate three times more than youth who had high levels of parental support. “In families that were characterized by strong relationships between children and their parents, the effect of the genetic risk was essentially zero” said UGA Institute for Behavioral Research director Steven Beach.

Regardless of the fact that parenting should already be supportive, knowing which version of the 5HTT gene your child possesses could be very helpful in preventing substance abuse. Spending more time with a child, providing emotional support or encouraging better communication seems like very minimal effort to ensure that possible substance abuse is avoided.

Genetic Risk For Substance Use Can Be Neutralized By Good Parenting

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Summit Helps Outpatient Treatment offers Drug and Alcohol Treatment Programs for Adults and Adolescents.

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A Common Sense Approach to Cocaine Addiction Treatment

“For the first time, researchers from the Institut de physiologie et biologie cellulaire (CNRS/Université de Poitiers) have shown that positive and stimulating environmental conditions make it easier to treat cocaine addiction”.

In particular, Marcello Solinas and Mohamed Jaber exposed cocaine addicted mice to an enriched environment during cocaine withdrawal. The environment consisted of small houses, a running wheel, tunnels and many other stimulating items in a large cage.

The researchers observed three measures of typical addictive behaviour:

1. Behavioural Sensitization: the progressive augmentation of behavioural responses to cocaine that develops during repeated administration.

2. Location Preference: the ability of the context to induce drug-seeking behaviour and strengthen the contextual association with drug use.

3. Probability of Relapse: “cocaine's ability to lead to a relapse after a period of withdrawal.”

Results showed that all three of these typical behaviours disappeared after the mice had endured 30 days of the enriched environment. In the brain, this disappearance was seen by a decrease in activity in the specific areas associated with dopamine transmission and relapse.

Does this seem like news to anyone? Of course rehab won’t work for individuals who are thrust right back into the same environmental circumstances. The rehabilitation process should definitely include changes to living conditions. Availability of cocaine will clearly hinder the probability of relapse. The same basic routine will allow an addict to easily slide back into old habits.

Besides pointing out the obvious, this “new” research does provide a bit of insight. Addiction treatment centres may want to consider adding housing support workers to the therapeutic process. The social, physical and mental stimulation seem to be key factors in maintaining sobriety; therefore it might be beneficial to include exercise regimens and educational programs as well. The ideal solution does not seem to be spending 30 days discussing the reason you became an addict only to settle right back into the same old routine after successful completion of a program. Evidently, the emotional aspect is a necessary step in the process, but if anything, this research proves that there is more to treating cocaine addiction. It’s a complete lifestyle overhaul.

Drug Addiction: Environmental Conditions Play Major Role In Effective Treatment And Preventing Relapses, Animal Study Shows

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Tanorexia: The Tanning Junkies

Can one actually become dependent on tanning? Is it really possible to become addicted to using tanning beds? Tanorexia gets its name from similar characteristic pathologies such as those seen in other mental illnesses like substance abuse and body image disorders.

A study performed by Fox Chase Cancer Center examined this phenomena and discovered that "25% of those surveyed reported symptoms of tanning dependence, including symptoms similar to alcohol and drug-addicted individuals". This finding was revealed by using a modified version of a traditional substance abuse and dependence questionnaire that was administered to 400 students and other volunteers at Virginia Commonwealth University. The survey measured such items as tolerance to tanning, withdrawal symptoms, difficulty controlling tanning behaviour in spite of the knowledge of its negative consequences. Some of the questions included:

• Do you think you need to spend more and more time in the sun to maintain your perfect tan?


• Do you continue tanning so your tan will not fade?


• Does this [your belief that tanning can cause skin cancer] keep you from spending time in the sun or going to tanning beds?

The study investigated the participants’ level of intentional and incidental sun exposure, tanning booth use, and chemical sunless tanner usage as well as other health related habits like smoking and exercise.

Research confirmed that 27% of those studied were classified as dependent on tanning, 40% had used tanning booths and the mean age of onset for tanning booth use was only 17 years old. In addition, sun tanners and indoor tanners during the winter were found to be more closely linked to tanorexia than those who are solely indoor tanners. Most intriguing is that those found to be dependent on tanning were more likely to be either thin or smokers, suggesting probable links to risk taking behaviours. This discovery provides a new avenue for further research and development. It also confirms the wideheld belief that tanorexia really is an addiction.

Some Startling facts about skin cancer:

• According to the American Cancer Society, skin cancer is the most common form of cancer.


• Skin cancer accounts for half of all types of cancers.


• Over 1 million new cases are diagnosed yearly in the U.S.


• 90% of all skin cancers are associated with ultraviolet radiation


• Using a tanning bed once a month or more can increase your risk of skin cancer by more than half.

Addicted To Tanning Beds? 'Tanorexia' Common Among University Students
Tanorexics - Ellie Harrison

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A Vaccine Could Prevent Relapse for Cocaine Addicts

Researchers at Linköping University and the German Cancer Research Center DKFZ have discovered the possibility of preventing relapse among cocaine addicts.

Because dopamine-producing nerve cells; part of the brain’s reward system in the midbrain, become more excited with drug use, blocking their glutamate receptors could remove the risk of relapse entirely. They discovered this finding by using a mouse model of cocaine dependence.

"When you take cocaine, the number of glutamate receptors increases, rendering the cell more excitable. When we block this process, we prevent relapses into addiction. This is interesting clinically since that is the phase when we get hold of patients" says the study’s lead author and neurobiologist, David Engblom.

Dopamine becomes more concentrated in the midbrain with the use or abuse of dependence-inducing drugs, such as cocaine, which has a very rapid effect on dopamine levels in the brain. The increased concentration of dopamine produces physical and mental reactions characteristic of a "high".

To terminate this process, patients could be injected with a vaccine that would block glutamate receptors and thus prevent a relapse. It seems like a rather simplistic solution and the research is clearly in its early stages of development, however any research at all that seeks to advance the treatment of addiction is well worth mentioning and investigating further.

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Medication: The Cost Effective Therapy

Finally, there’s more research suggesting the need to reduce the over-medicating of mental illness, specifically depression. The study conducted by Irving Kirsch of the University of Hull discovered that the benefits of anti-depressants, such as fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat / Paxil), are dependent upon the severity of the mental illness.

The study used a meta-analysis of data retrieved from trials supplied by the US Food and Drug Administration. “When the data from all of these trials had been put together, the improvement in depression amongst patients receiving the trial drug, as compared to those receiving placebo (dummy tablets), was not clinically significant in mildly depressed patients or even in most patients who suffer from very severe depression” – Article

It comes as no surprise that only a small group of participants actually benefited from their medications, and these patients tended to be those who suffered from severe depression to begin with. The severely depressed reaped fewer benefits from the placebo and more benefits from the actual medication than those less depressed. This not only suggests that anti-depressants serve their purpose for those who are really suffering, but it clearly demonstrates that not everyone needs to be medicated to function. Over-medicating is a serious problem within our society because it does seem easier to slap on a Band-Aid as opposed to working through months or even years of therapy. Unfortunately, the social and monetary cost of clinical therapy does not seem plausible for everyone in our society, however it hardly seems ethical or even productive to convert the depressed into addicts.

In my opinion, medication should always be the last resort when alternative measures are more proficient in treating mental illness.

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Deal Or Squeal

In recent news, Ottawa’s police Chief, Vern White has made some absurd statements with respect to drug dealing and welfare fraud. His force has decided to report a little over 100 drug dealers to welfare officials for fraud investigations in hopes of having them cut off social assistance. His views are portrayed in a manner that support the greater good of society by saying: “Our focus here, first of all, is to stop people from dealing drugs but secondly to ensure social assistance is provided to people for the right reasons and not for those people who continue to sell drugs and lie about their income”.

On the surface, this act appears to be appealing to the so-called tax payer, however if you glance beneath it seems that there is an ulterior motive. What impact would these sorts of headlines have? Is it really to scare the fraud out of other abusers? Is it to encourage the low-level dealers, who are likely barely surviving at the poverty level with their monthly social assistance cheque to cease taking in that extra cash under the table? Of course, fraud is never legal, but who in their right mind would report income from drug dealing. Some of these dealers may even be dealing to support a drug habit, a poverty stricken family, or even to cover a necessary medication not covered through a drug plan. Whatever the reason may be, threatening to cut their Ontario Works cheque is hardly fighting the war on drugs. Petty dealers are a dime a dozen.

The Chief may have an interesting strategy, but I hardly think he’s aiming at saving tax payer dollars. It seems that the real reason for this announcement is to coerce drug dealers into snitching on their suppliers. The president of the Defence Counsel Association of Ottawa, Mark Ertel, makes an interesting assumption: “You can either become an informant for the Ottawa police or you can be reported for committing welfare fraud”. Article

Granted this might have some impact on the drug epidemic, but the means is through blackmail. Drug dealers may not be the most upstanding citizens; however this type of strategy leaves no room for assistance for these individuals who may be suffering from addiction. Additionally, these addicts who are reported for fraud may stop milking the system, but they may begin committing other crimes to make up for that lost money.

The money these dealers make from committing welfare fraud certainly pale in comparison to the money that flows through the hands of those controlling the drug trade.

Article

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Ottawa: Crack Pipes Back In Circulation

In recent news, the Ontario government has managed to save the popular crack pipe program that the city of Ottawa refused to support. Our Mayor, Larry O’Brien cancelled the program back in July 2007. As of yesterday, news has leaked that the Ministry of Health and Long-Term Care will provide $287,000.00 in funding over the next year to the Somerset West Community Health Centre to manage the controversial program.

Many of those who supported the motion to cancel the program may be furious with the province’s overturn; however from the news articles that I’ve read it appears as though the province has always been the main source of funding, while the city only topped up with a small portion of $7,500.00 a year.

The crack pipe program is said to be an essential part of an integrated drug strategy, along with enforcement, treatment and prevention according Jack McCarthy, director of Ottawa’s Somerset West Community Health Centre.

Although, I’m not fully convinced that this “harm-reduction” approach is entirely necessary, at least to the degree of funding awarded, I am open minded about it and not afraid to admit that I am not fully aware of the statistics. On the surface, to the taxpayer, it appears that this program is an unnecessary waste of money. However, the taxpayer may not realize the savings to be had in health care costs to treat diseases, such as Hepatitis C and AIDS, as well as the enormous relief of strain on health services.

Despite some of the more positive aspects, one cannot deny the fact that this program promotes drug use. It gives the impression that this type of behaviour is accepted as normal within our society. Money might be better spent on programs that serve to prevent and treat addiction. It seems that this city and many other cities lack the funding in these areas.

Besides, I’m not sure how partial I am to the image of a city littered with used crack pipes. I’m certainly more interested in helping addicts on their road to recovery.

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Biological Basis of Addiction

I stumbled upon an article today regarding addiction, an area of study that has been of interest for many years. The research conducted at Indiana University examined the possibility that structural changes in the amygdala may be responsible for the co-morbidity of addiction and mental illness. Those who are familiar with addiction or have worked with addicts know just how often this combination occurs.

The study compared the behaviour of adult rats that had both undergone surgery on their amygdala during infancy. One group had their amydalas damaged while the control group’s amygdalas were left intact. The control group experienced a type of mock surgery.

Interestingly, those that grew up with damaged amygdalas showed more response to novel stimuli, less fear to elevated mazes, continued social activity in the presence of a predator’s scent, were more sensitive to cocaine after only one exposure, and demonstrated consistency of behaviour changes with repeated cocaine injections. All conditions are stated to have remained constant; therefore results are directly related to the amygdala.

This proposes that the structure of the brain can affect vulnerability to drug addiction. Also, with regards to dual diagnosis it suggests that this vulnerability to addiction more effectively explains the high rates of addicts suffering from other mental illnesses as opposed to drug use causing mental illness.

This seems to suggest that a better response to treat mental illness is to reduce pharmacological treatment, a position that I have held from day one of my studies in psychology.

Full Article

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