Prescription opiates (pain killers) and NFL careers

There’s been a lot of talk about athletes using drugs in the last decade. Still, most of the attention has been either to steroids and other performance enhancing drugs or to illegal drug use, the kind that has cost some players their careers (Ricky Williams anyone?). But how many people know that prescription medication abuse is a huge problem among athletes long into their retirement?

A recent study using phone interviews with 644 retired NFL players has revealed that the 7% o them are currently abusing prescription opiates (pain killers like oxycontin). This rate is a full 3 times greater than in the general population!!! When it comes to lifetime abuse, the NFL players were also 3 times more likely to abuse these drugs during their career than the rest of the population is during their lifetime!

With these sorts of collisions, is it ay wonder football players are in severe pain when they retire?Some of this is obvious, NFL players are likely to cause some serious abuse to their bodies (their reporting of moderate to severe pain was also 3 times greater than the general population) and opiate medications are very good at taking away the pain. Indeed, the players who used these drugs during their careers reported more injuries overall as well as more career ending injuries. Still, I was surprised to find that more than half of the players who began using prescription opiates during their NFL career got at least a portion of their pills from illicit sources. I would have imagined that professional athletes would have no problem getting prescription pain killers from doctors but apparently, many of them also used teammates, coaches, and trainers (less shocking) as their sources. Not surprisingly, retired NFL players who drink heavily or who reported misusing prescription drugs during their playing career were 2-3 times more likely to be misusing, or abusing, prescription opiates now. That finding supports past notions about the association between abuse of one drug (like alcohol) and abuse of others and about the good ol’ finding that past behavior is one of the best predictors of future behavior. Still, there were other important factors including  undiagnosed concussions, severe playing pain, and mental impairment, which all contributed further to the likelihood that ex-players would be abusing prescription opiates currently.

Since prescription abuse is one of the leading causes of accidental death in the U.S. and high doses of prescription opiates specifically have been reported to increase the risk of overdose greatly even among people who are taking them regularly (like V.A. patients), it seems there should be at least some focus dedicated to prescription drug use and abuse among athletes, including retired athletes, in order to reduce the risk of death in this population. For all my searching I couldn’t find a good estimate of the current rate of overdose death among athletes so maybe we should start there.

I’m pretty sure that if we look, we’ll find similar patterns among athletes from sports other than football and that there is something more we can do to reduce the abuse of these drugs. I have absolutely no problem with people using opiate pain kills for pain, I just think we need to do whatever we can to cut the overdose risk so that we don’t lose more than 20,000 people to this stuff every year…

Citation:

Linda B. Cottler, Arbi Ben Abdallah, Simone M. Cummings, John Barr, Rayna Banks, Ronnie Forchheimer (2011). Injury, pain, and prescription opioid use among former National Football League (NFL) players. Drug and Alcohol Dependence, 116, 188-194.

inda B. Cottler, Arbi Ben Abdallah, Simone M. Cummings, John Barr, Rayna Banks, Ronnie Forchheimer

New drug testing technology? Cocaine and saliva

A recent development (check it out here) might lead the way to a quicker, more easily administered drug test. Instead of the lab analysis of urine, blood, or other fluids, this recent technology might allow first responders, such as EMTs, to assess a person’s exposure to drugs (prescription and otherwise) by simply dipping this device (think pregnancy test) into their saliva.

As of right now, the researchers have been able to demonstrate the success of the technology with cocaine, but it shouldn’t be too long before they can provide similar devices for many different drugs.

Now, it’s true that I usually focus on abused drugs in this blog, but this technology could help medical professionals identify dangerous drug interactions common to many prescribed, properly taken, medications. Given the huge increases in prescription medication abuse in the United States, that could be extremely useful and might save some of the 12,000 lives annually lost to accidental overdoses.

Maybe when these devices get cheap enough they can be used in addiction treatment centers to provide more immediate testing results.

Who knows, one day, the technology might be widespread enough to make home drug-testing a simple reality. Whether that’s a good or bad thing should probably be left to another post…

Promising new medical treatment options for drug addiction!!!

Researchers are attacking the issue of drug addiction from multiple angles, and the results seem to be more and more ways to help. Some promising new developments in pharmacological (as in medication) therapies include a new cocaine-vaccine, as well as expanded use of Buprenorphine, for the treatment of opiate (heroin, morphine) addiction.

  • These medications are best used along with behavioral treatment in order to increase to probability of treatment success.
  • By reducing cravings, as well as reducing the effects of the drugs themselves, these medications can increase the length of time that patients will stay in treatment, which is the most reliable way of producing better treatment outcomes.

What else is new aside from medications?

There are also some exciting developments in the behavioral treatment, including Contingency Management (CM), a treatment method that tries to reteach addicts positive, drug-free behaviors by reinforcing those over the use of drugs. While some people still have problems with programs that use CM because of the notion of rewarding drug addicts for not using drugs, I say use whatever works!

Lastly, as early as 2003, researchers have noted that proper drug treatment may take longer than the 14-30 day programs that are currently being offered (1). In fact, while the article I’m referring too speaks specifically about methamphetamine addiction, we now know that the long use of many drugs, including cocaine, leads to long lasting brain changes that can take up to a year to show significant recovery.

I personally think that proper drug treatment for long time addicts (anyone with more than a year or so of heavy use) should take on the order of 6 months to a year, and should be supplemented by some outpatient post-care for an extended period of time (I’m far from the only one calling for this, see article 2). It’s the only sensible thing to do given the long term changes that such drug use creates in the brain…

I think it’s about time that insurance companies step up the plate and recognize that the huge cost of drug problems for our society (estimated at more than $100 billion annually) can be vastly reduced by providing sound, scientifically based, medical treatment options for those who need it.

citations:
(1) Margaret Cretzmeyer M.S.W, Mary Vaughan Sarrazin Ph.D., Diane L. Huber Ph.D., R.N., FAAN, CNAAc, Robert I. Block Ph.D. & James A. Hall Ph.D., LISW( 2003) Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment Volume 24.
(2)
A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O’Brien, MD, PhD; Herbert D. Kleber, MD (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of the American Medical Association, Volume 284, pp. 1689-1695.

Question of the day:
Do you know anyone who’s been through residential drug treatment?
How long were they in for?
How many times?
Did it help?

Men and women are not the same: Sex differences in addiction research

You may not have realized it, but men and women are different. Really.

When ot comes to drugs, men and women are differentThough the statement may seem like the most unnecessary, obvious, expression since the dawn of time, it’s surprising how rarely the importance of these differences comes up when we talk about addiction. Still, there’s little doubt that if our hormones, brain development, and even our reaction the to exact same stories aren’t the same, the way we react to drugs, or to addiction treatment, are likely gender specific as well. In fact, while men are almost twice as likely to meet criteria for addiction, women seem to move from casual use to addiction more quickly. Let’s explore some addiction research findings that may tell us why.

Social stress, drug use, and addiction

If you’ve gone through high-school, you know that boys and girls have different sort of social interactions. Women develop tightly knit cliques that aim to protect them from being fully ostracized while keeping out those who may cause trouble within the fold.

Indeed, when researchers compared cocaine using men and women, they found much greater neural activation in the drug-seeking brain regions of women during social stress (things like exclusion, being put down, and such) than were found for men or for women who didn’t use drugs. Similar findings have been reported for a neuroprotective hormone called DHEAS, which was found to be lower in women and in cocaine addicts, signaling their increased vulnerability to stress-induced immune problems. It’s hard to tell which came first, but social stress “triggered” these women’s systems a lot more than it did men. And the differences change behaviors too – Research in monkeys found that while male monkeys used more cocaine if they were “losers” (lower on the social ladder), female monkeys who were “leaders” were found to use more cocaine when given a chance.

Obviously, social standing and events mean different things, and bring about different reactions to drugs, for men and women.

Drug use, the brain, and gender

Not only do men and women act differently when it comes to drugs, but differences have been found in the specific brain changes associated with drug exposure between the sexes!

Research in rats has shown that brain changes following prenatal (before birth) exposure to cocaine are different between males and females and that they interact with exposure to social stimulation. In humans, researchers found differences in brain volume, and its association with early trauma, emotional, and physical, neglect between boys and girls at risk for substance abuse problems. Other work found that the prenatal cocaine exposure was more greatly associated with memory problems in women than men.

Sex (gender) and drugs – the takeaway

So, men and women are not the same. Not a big surprise I know, but the specific ways in which the two sexes react to the intake of drugs and the differences in their responses to stress that may motivate them to use at different times can become important factors to consider both in prevention AND in addiction treatment setting. For instance, it seems that we’d want to look at the possibility that drug prevention efforts should look at social-standing among adolescents when determining might need the most attention. Also, if exposure to drugs affects the brain differently in the different sexes because of differences in the concentration of protective hormones, it’s possible that the specific aspects of treatment that require focus might be different too.

Some food for thought…

Money or cocaine? It all depends on timing

People who are looking for treatment for their cocaine addiction still really like cocaine, but they’ll choose money as an immediate reward if they can only get their drug of choice later.

Cocaine or money? Depends on how long the wait is

Although it might be somewhat surprising, the above finding is the result of a recent study by a team of researchers spanning the U.S. and Australia that was recently published in the journal Psychophramacology.

We’ve talked about the concept of relatively high impulsivity among addicts on A3 before and the concept isn’t a new one — Addicts make drug-focused choices in the short term even if there are larger rewards far off in the horizon. In fact, this sort of delay-discounting (considering future rewards as being worth less) is a general human phenomenon that has simply been found to be exaggerated among addicts.

Think about it – Would you prefer $50 now or $1000 in 6 year? What about $100 now?

By asking a set of similar questions researchers can determine an individuals discounting rate or the amount of discounting people put on the delay in getting the later reward. Up to now, most of this sort of research has been conducted using the same “now” and “later” rewards. People were asked to decide between money now or later, cocaine now or later, cigarettes, meth… you get it.

This recent study made things more interesting by creating a few different conditions:

  1. Money now Versus Money later
  2. Cocaine now Versus Cocaine later
  3. Money now Versus Cocaine later
  4. Cocaine now Versus Money later

The goal was to see if people discount money and drugs equally. Since one of the hallmarks of addiction is that addicts seem to undervalue everything else while overvaluing drugs, figuring out whether bringing delay into the mix was at the least interesting but at best possibly useful in treatment.

The researcher used participants who were actively looking for cocaine treatment and ended up with a relatively small sample of 47 individuals who met criteria for cocaine addiction. As is usually the case with these sorts of studies, most of the participants were men, the average education equaled high-school and the average age was early 40s.

Participants were asked how many grams of cocaine a $1000 was worth and that unique number was used for each participant as the equal point between money and drug. Then they were presented with options such as the above (X number of dollars now or X number of dollars in six months).  As participants made selections, the immediate amount was changed by 50% to counter their choice (it was reduced if they chose immediate and increased if they chose delayed rewards) and the procedure repeated six times for each of seven different delay periods (1 day, 1 week, 1 month, 6 months, 1 year, 5 years, and 25 years).

So, let’s say a participant was first asked if they wanted $500 now or 20 grams of cocaine. If they chose cocaine, their next choice would be $750 now or 20 grams of cocaine later; now if they chose money, the choices became $375 now or 20 grams of cocaine later… and on the experiment went.

Cocaine addicts choose cocaine if they can get it now, but not later

First of all, it’s important to note that the research showed that different participants had pretty stable discounting characteristics. That is, if a participant preferred to get things now rather than later, that was likely true across all conditions regardless of whether the reward was drugs or money. However, the different rewards also had a large influence on this equation.

The main finding from this study was that when faced with the option, cocaine addicts chose immediate money over later cocaine even if the immediate money amount was relatively low. That finding might seem surprising at first given what we think we know about addicts. Aren’t they supposed to always choose drugs regardless of what else we put in front of them?

Apparently, what matters is not only what we put in front of them but also when. Of course, anyone who actually knows an addict (or is one themselves) already understands that trying to simplify addiction to an ability to only choose drugs is silly. Addicts would die of starvation or a host of other issues pretty quickly if that was true. Addiction is much more nuanced than that, and as I mention at the end of this piece, this finding might not be as clear as one might think.

In fact, this finding has already been greatly supported by at least one addiction treatment tactic that we’ve discussed here on A3 – Contingency Management (CM). In CM, individuals in treatment are rewarded for staying clean and doing well in treatment. They’re not given cash but instead are rewarded with vouchers that let them buy food, clothes, etc. for providing drug-free urine tests and going to their assigned group meetings. This addiction treatment method follows the basic tenant of the psychology of learning – people do what they’re rewarded to do. This study offers a fresh perspective on the matter, suggesting that one of the reasons people do well and stay longer in treatment when given CM is that the immediate money reward is thought to be worth more than the possibility of getting drugs later. It might also explain why CM has only really been shown to work well while people are in treatment and not when they leave…

I mentioned earlier that I think these findings may be a little more complicated than they first seem. One of the major issues I have with this study stems from my life as a drug dealer. The users I know quickly equate money with drugs and so it is very possible that in their minds money now also equals cocaine now, although a smaller amount of it and they’ll take whatever drug they can get now instead of having to wait for it. Most regular users I’ve met would easily choose a single gram of meth now instead of 4 or 5 in 6 months. They simply don’t want to wait that long to get high. Money holds its value much better in the long run and this research supports that idea.

Citation:

Bickel, Landes, Christensen, Jackson, Jones, Kurth-Nelson, Redish (2011). Single- and cross-commodity discounting among cocaine addicts: the commodity and its temporal location determine discounting rate, Psychopharmacology

Higher drug abuse among gay youth likely tied to rejection

For a lesbian, gay, or bisexual youth, “coming out” is an extremely stressful, though important event that can result in improved self-esteem, social-support, and psychological adjustment.

However, a recent study found that the reactions to such a disclosure have a lot to do with the risk of those youths abusing alcohol and drugs.

Social rejection and drug abuse among gay youth

The results revealed that the more rejecting reactions a youth receives, the more likely they are to engage in drug abuse including alcohol, cigarette, and marijuana use. This was true even after researchers controlled for a number of other important variables like emotional distress and demographics (race, ethnicity, education, socioeconomic status, etc.).

This makes a lot of sense. After finally deciding to go through with such a monumental disclosure, harsh rejections likely cause some serious damage to a youth’s self-esteem, making escape by drugs an attractive option. Although coming out can eventually lead to increased self-esteem even for this youth, the road there is not an easy one.

The good news was that accepting reactions seemed to protect youths from the harmful effects of being rejected – Social support helps!

The researchers suggested that drug abuse prevention attempts with LGBT youths address the impact of rejecting reactions to sexual-orientation disclosure directly in order to hopefully reduce their negative impact.

Here’s a video about the difficulties of coming out in high-school:

Reference:

Rosario, Schrimshaw, & Hunter (2009). Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions. Psychology of Addictive Behaviors, 23, 175-184.

Parenting advice – What’s important when it comes to teens, alcohol, and drugs

Parents often ask us what they can do to prevent their children or teens from becoming alcoholics, drug addicts, criminals, and the likes. I’ve been all of these and more, and so I’d like to share my insight with you now that I’ve made it over to the other side:

You can’t prevent anything – but you can educate, inform, prepare, and support.

My family breaths success; it also breeds its. My father was a star athlete who turned into a star doctor and a star family man. He also never drank alcohol and couldn’t care less about drugs. My mother was a beauty queen who always helped me get the best grades in school, even if it meant that she ended up doing my art projects for me and keeping me up all night so I’d finish my work. I’m not sure if it was my perception or my parents’ actual wish, but I always felt like unless I saved the world, I would end up a nobody. Drinking enough alcohol to black-out and consuming every drug on earth was never supposed to be on my menu.

A recent article I read in a monthly psychology magazine (see my post on it here) talked about this sense of perfectionism in our culture and its effect on teen depression, anxiety, and alcohol and drug abuse. Did you know that these are highest among more affluent teens?

Advice #1 – Shooting for good performance is important, but focusing on it as a sole measure of success can lead to trouble.

I got gifts for grades, and the best gifts came only with the best grades. Anything short of perfect was pretty much frowned upon and considered “less than my best.” It became impossible for me to actually enjoy anything but the school subjects I excelled in (math, physics, chemistry). It wasn’t until I graduated from college and did some of my own exploration that I learned to appreciate art, English, and history as worthwhile pursuits. It’s a well-know fact in developmental psychology that you don’t reward behaviors that are supposed to be appreciated in their own right. If you do reward them do so with small gifts, nothing large. Big gifts take away the perception that the activity itself brought about enjoyment.

Advice #2 – Parenting requires consistency and openness, but leave the preaching for church.

This constant need for perfectionism also lead to the repression of many issues in my family.

My parents fought often when I was a kid, screaming loud enough for me to take my sister away often and go play. We never talked about the fights so I never managed to learn about conflict, relationships, or resolution. We never talked about my stealing either, whether I was stealing from my family (mainly my father’s porn) or from the neighborhood toy store. The one time I got caught, my father sternly told me to return my new toy and to never be caught stealing again. I began stealing away from my neighborhood; it would be years before he’d hear about me stealing again. It probably would have been better to sit down and talk about what just happened.

Later on, when my mother would find my weed in my room, she would hide it so that my dad won’t find it because he would get mad. We call that enabling. When I was caught stealing at my work, my father didn’t want to tell my mom, so as not to upset her, so he never brought it up again. We call that denial. Neither of these work since they don’t teach a child anything except how to hide things properly and that even responsible adults lie.

But research shows us that preaching is not a good parenting technique so stay open and talk about struggles without being hypocritical and trying to teach lessons that are obviously forced. Kids and teens pick up on that very quickly but they’re ready to learn from their parents.

Advice #3 – Don’t let your sense of pride, or your ego, prevent you from dealing with real issues with your children. Parenting requires you to be the adult in the relationship with your children even when things don’t go your way.

By the time my parents were forced to confront reality, things in my life had spiraled way out of control. They received a call from my LA lawyer telling them that their son had been arrested for some pretty serious drug dealing. My bail was set at $750,000 and I was facing 18 years in prison. That’s pretty difficult to ignore.

Ironically, my arrest, court case, and the year I spent in jail brought my family closer together than we had even been during my teen years or my later drug addiction phase. Having to actually confront many of our issues allowed us to bring some actual intimacy into the family I had run away from so many years before. The important thing was that my parents didn’t pull out the “we told you so” card but rather helped me confront my demons and treat them. It was the best parenting I’d received in my life and it worked.

My parents did the best they could. I know that. Still, I can’t help to wonder if worrying a little less about how things “should be” and a bit more about the reality of parenting their deviant son may have prevented the latter part of this story. Then again, there’s no guarantee of that either. That’s the most important parenting advice I can give when it comes to teens and drugs…