Breakingthecycles.com – Changing the Conversations

by Lisa Frederiksen

We read and hear about the cost savings of prevention programs, but sometimes it’s important to assess for a specific program and/or collaborative effort.

Quoting the Executive Summary, Section 1, of SAMHSA (Substance Abuse and Mental Health Services Administration) report, “Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis:”

Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for decision making for substance abuse prevention. This report reveals the importance of supporting effective prevention programs as part of a comprehensive substance abuse prevention strategy. The following patterns of use, their attendant costs, and the potential cost savings are analyzed:
-  Extent of substance abuse among youth;
- Costs of substance abuse to the Nation and to States;
- Cost savings that could be gained if effective prevention policies, programs, and services were implemented nationwide;
- Programs and policies that are most cost beneficial.

1.1. Costs of Substance Abuse
Studies have shown the annual cost of substance abuse to the Nation to be $510.8 billion in 1999 (Harwood, 2000). More specifically,
- Alcohol abuse cost the Nation $191.6 billion;
- Tobacco use cost the Nation $167.8 billion;
- Drug abuse cost the Nation $151.4 billion.
Substance abuse clearly is among the most costly health problems in the United States. Among national estimates of the costs of illness for 33 diseases and conditions, alcohol ranked second, tobacco ranked sixth, and drug disorders ranked seventh (National Institutes of Health [NIH], 2000). This report shows that programs designed to prevent substance abuse can reduce these costs.

1.2. Savings From Effective School-Based Substance Abuse Prevention
If effective prevention programs were implemented nationwide, substance abuse initiation would decline for 1.5 million youth and be delayed for 2 years on average. It has been well established that a delay in onset reduces subsequent problems later in life (Grant & Dawson, 1997; Lynskey et al., 2003). In 2003, an estimated:
- 5.6 percent fewer youth ages 13–15 would have engaged in drinking;
- 10.2 percent fewer youth would have used marijuana;
- 30.2 percent fewer youth would have used cocaine;
- 8.0 percent fewer youth would have smoked regularly.
The average effective school-based program in 2002 costs $220 per pupil including materials and teacher training, and these programs could save an estimated $18 per $1 invested if implemented nationwide. Nationwide, full implementation of school-based effective programming in 2002 would have had the following fiscal impact:

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis
- Saved State and local governments $1.3 billion, including $1.05 billion in educational costs within 2 years;
- Reduced social costs of substance-abuse-related medical care, other resources, and lost productivity over a lifetime by an estimated $33.7 billion;
- Preserved the quality of life over a lifetime valued at $65 billion.
Although 80 percent of American youth reported participation in school-based prevention in 2005 (SAMHSA, 2004), only 20 percent were exposed to effective prevention programs (Flewelling et al., 2005). Given this level of participation, it is possible that some expected benefits already exist for these students, and the estimates in this paper are adjusted for these probable benefits. These cost-benefit estimates show that effective school-based programs could save $18 for every $1 spent on these programs.

1.3. Conclusion
The cost of substance abuse could be offset by a nationwide implementation of effective prevention policies and programs. SAMHSA’s Strategic Prevention Framework should include a planning step that considers cost-benefit ratios. Communities should consider a comprehensive prevention strategy based on their unique needs and characteristics and use cost-benefit ratios to help guide their decisions. Model programs should include data on costs and estimated cost-benefit ratios to help guide prevention planning.

To download a free copy of this report, click here.

by Lisa Frederiksen

Four times the number of people who are alcoholics, abuse alcohol. Four times! And often they are not aware they are drinking more than their brains and bodies can process, nor the consequences of doing so, nor that they can take steps to cut down and bring their drinking within the health and safety limits.

To help all of us do what we can to raise awareness about these kinds of issues, the U.S. Department of Health and Human Services SAMHSA (Substance Abuse and Mental Health Services Administration) coordinates the national observance of April as National Alcohol Awareness Month. This year, the Office of Disease Prevention and Health Promotion (ODPHP) has launched Alcohol Awareness Month toolkit. The toolkit provides readers with easy, actionable ways to educate and engage people in Alcohol Awareness Month—and it’s free. The toolkit can be viewed online or downloaded in PDF format. Elements include:

• A sample newsletter or listserv article
• Sample tweets (for those on Twitter)
• “5 Ways to Get Involved”
• Background information and related healthfinder.gov content
• A list of tools and resources
• E-cards, Web badges and more

Additionally, the following offers a sampling of what you’ll find on the website that you, too, can share with those in your sphere of influence…

Did you know that “one drink” equals: 5oz. of wine, a 12oz. bottle of beer, OR a 1.5oz. shot? http://bit.ly/4VS9. #nho [Tweet this! ]

Not sure about your drinking? 4 questions to ask yourself: http://bit.ly/RfSYM. #nho [Tweet this! ]

Every cent matters. How much are you spending on alcohol? This fun Alcohol-Spending Calculator can tell you: http://bit.ly/ZZc3k. #nho [Tweet this! ]

Health Tip: When trying to control your alcohol intake, take a day off. Choose one day a week to abstain from alcohol. #nho [Tweet this! ]

So please help spread the word and pass this information along…

by Lisa Frederiksen

Definition of Moderate Drinking Limits:
For Women:  No more than 7 standard drinks in a week, nor 3 of the 7 in a day
For Men:  No more than 14 standard drinks in a week, nor 4 of the 14 in a day
A standard drink is defined as 5 ounces of table wine, 12 ounces of beer or 1.5 ounces of liquor (e.g., vodka). Often “drinks” served at  parties or in bars or restaurants  contain more than one standard drink.

What Knowing Moderate Drinking Limits Can Do For You
1. Helps you to keep your own drinking under control.

2. Helps you avoid the unnecessary, unproductive and down right destructive exchanges that can occur when you try to make sense out of the actions and behaviors of someone who has exceeded moderate drinking limits — especially the “per day” limit.

The 2nd reason can be especially important. When a person exceeds the “per day” limit (which is almost always consumed on a per occasion basis), they run the risk of drinking more than their brains and body can process. This, in turn, causes them to engage in drinking behaviors (e.g., getting into fights, arguments about the drinking, driving while impaired, having unprotected or unwanted sex). Check out these related posts, “I’m Sorry, but I was wasted,” “Why BAC Can Keep Rising After a Person Stops Drinking.”

Knowing that it is a person’s exceeding moderate drinking limits – especially the per day limits – that is causing the drinking behaviors is what can help you avoid a whole lot of endless, pointless talk or angst about nothing you have any control over — namely, the drinking behaviors. When a person drinks more than their brain and body can processes, they affect the very areas of their brain needed to think straight and act responsibly.

By keeping this in mind, you will know that as a person exceeds his/her limits, there is…
- no point in having a ’serious’ discussion,
- no point getting into a fight about their drinking behaviors, and
- definitely every reason not to get in the car with them (yes, a woman consuming 3 or a man consuming 4 drinks in a two hour period will likely register a .08 BAC).

by Lisa Frederiksen

U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Agency (SAMHSA) is committed to promoting evidence-based and promising practices in serving persons with mental illnesses and/or substance use disorders. They’ve produced a new series, The Evidence-Based Practice (EBP) Knowledge Informing Transformation (KIT) series, with  materials that provide innovative, engaging, and effective learning tools that help shape mental health services toward recovery.

One I’d like to especially draw your attention to is titled, “Co-Occurring Disorders: Integrated Dual Disorders Treatment.” With over half of persons who have an alcohol misuse problem also having a mental illness, known as a dual diagnosis (aka, a co-occurring disorder), it is important to learn more about this new evidence-based treatment practice. This treatment approach helps people recover because it offers both mental health and substance abuse services at the same time and in one setting.

Click here for details, downloads and ordering.

by Lisa Frederiksen

This article, Depressed Parent’s Negative Effects on Kids are Combatable,” appeared in the Sunday, March 14, Los Angeles Times. It points to the impacts of a parent’s undiagnosed, untreated (and not discussed in an effective, straightforward manner) depression on their children. Impacts include the consequences of the parents’ inconsistent expectations and discipline, role reversals (children comforting parent or trying to be strong for parent) and parental withdrawal. The impacts, themselves, included depression and anxiety disorders, poor coping skills, learned helplessness and poor social relations. BUT, the good news is that the effects of parental depression can be reversed in two key ways: 1) the parent getting the help they need, and 2) the family openly and honestly talking about what is going on and what is being done to fix it.

I bring this article to your attention because it parallels what happens to children as a result of a parent’s undiagnosed, untreated (and not discussed in an effective, straightforward manner) alcohol misuse. Those negative impacts are very similar to the ones described above, and they, too, can be reversed if: a) the parent seeks help, and b) the family starts opening and honestly talking about it.

The “talk” does not have to be complicated nor deep nor all-encompassing; nor do you have to have all of the answers at once. In fact, talking in spurts and often is better with children. Equally important will be to let your children talk to you — to let them tell you their feelings without having those feelings corrected, fixed or explained. The Lucile Packard Foundation for Children’s Health website has some terrific resources that can help.

by Lisa Frederiksen

One of the things that can keep family members and alcohol misusers stuck is the debate about how much is too much and what makes a person an alcoholic and does not being an alcoholic make excessive drinking okay. In a recent post, “Controlled Drinking Can’t Work for an Alcoholic,” I discussed what makes a person an alcoholic, and why a person who is not an alcoholic can perhaps learn to drink in moderation.

Recently I found this website, Moderation Management. They offer suggestions for how to drink in moderation, as well as face-to-face and online support meetings. They provide the following answers on their website to these two questions:  “Why is a moderation program needed?” and “What is Moderation Management?”

Why is a Moderation Program needed?
According to the NIAAA and many other independent researchers, there are four times as many problem drinkers as alcoholics in this country. Yet there are very few programs that specifically address the needs of beginning stage problem drinkers, while there are literally thousands of programs for the smaller population who are seriously alcohol dependent.

By the time people reach serious stages of alcohol dependency, changing drinking becomes more difficult, and treatment is usually costly. MM believes that this situation needs to be remedied in the interest of public health and human kindness with early intervention and harm reduction programs. Moderation programs are less costly, shorter in duration, less intensive, and have higher success rates than traditional abstinence-only approaches.

Nine out of ten problem drinkers today actively and purposefully avoid traditional treatment approaches. This is because they know that most traditional programs will label them as “alcoholic”,  probably force attendance at 12 step and abstinence based meetings, and prescribe lifetime abstinence as the only acceptable change in drinking.

They may also have real concerns about how their participation in these programs will affect their jobs and ability to attain future medical and life insurance. MM is seen as a less threatening first step, and one that problem drinkers are more likely to attempt before their problems become nearly intractable.

Not surprisingly,  approximately 30% of MM members go on to abstinence-based programs.  This is consistent with research findings from professional moderation training programs. Traditional approaches that are based on the disease model of alcohol  dependence and its reliance on the concept of powerlessness can be particularly counterproductive for women and minorities, who often already feel like victims and powerless.

Outcome studies indicate that professional programs which offer both moderation and abstinence have higher success rates than those that offer abstinence only.  Clients tend to self-select the behavior change options which will work best for them.

What is Moderation Management?
Moderation Management (MM) is a behavioral change program and national support group network for people concerned about their drinking and who desire to make positive lifestyle changes. MM empowers individuals to accept personal responsibility for choosing and maintaining their own path, whether moderation or abstinence. MM promotes early self-recognition of risky drinking behavior, when moderate drinking is a more easily achievable goal.

Please note: Neither BreakingTheCycles, www.breakingthecycles.com, nor Lisa Frederiksen endorses any specific treatment program over another, nor any particular method for stopping, controlling or changing drinking patterns, rather strives to bring the latest information on various treatment options to readers’ attention.

The following is a guest post by Bill White, M.S., a counselor, author, mentor, blogger and speaker specializing in depression, anxiety and general mental health issues. He hosts a blog, http://chipur.com, and does a lot of E.R. psychiatric emergency work in Chicago’s suburbs where he also spends time with his two teenage children.

“S.A.I.L.” Stop-Assess-Interpret-Logic

Here’s a technique I came up with that’ll be easy to etch upon your mind, allowing it to be there for you at a moment’s notice. The next time you begin to sense the tiptoeing of a panic attack in your immediate vicinity…stop everything. Now, slowly take a few refreshing abdominal breaths and begin whispering to yourself, “S.A.I.L.”…”S.A.I.L.”…”S.A.I.L.” And as you’re saying it, imagine feeling warm and gentle breezes of relief upon your skin. And here’s the magic of the acronym…

STOP everything in your life right now.

ASSESS exactly what’s going on within, and outside of, you.

INTERPRET if the situation is truly threatening and merits alarmed reaction.

LOGIC your way to an appropriate emotional and behavioral response.

Of course, I could go on and on with more details on the technique; however, newsletter constraints won’t allow it. But I think you get the idea. Give it a go, and if you want to learn more about S.A.I.L. and tons of other panic and anxiety tidbits of relief, check out Panic! …and Poetic Justice.

by Lisa Frederiksen

What do you say when someone you care deeply about keeps telling you time and again they’re sorry.

They’re sorry, but they were drunk; or they’re sorry, but they must have blacked out; or they’re sorry, but they don’t remember; or they do remember and they’re so very, very  sorry for…

- vomiting in your car (”Ah man… I don’t feel so good…”)
- peeing in your closet (”Hey… I thought it was the bathroom.”)
- picking a fight with your sister at your mother’s birthday dinner (She started it…it was none of her business whether I was having another beer, and what about you? You went along with her.”)
- trashing your house (”What do you mean I did this. What happened?”)
- trying to pick up your best friend  (”Hey, she kept coming onto me,  and that’s the last I remember.”)

I don’t have any answers, other than to say, as long as a person drinks more than their brains and body can process, there will always be a next time, sometime, and once again, they’ll be sorry, but…

by Lisa Frederiksen

One of the more confounding aspects of all this is why some people who drink too much and behave terribly and cause problems within their families because of their drinking can learn to “re-drink,” get their drinking and lives back under control, and why others, who do all of the same things, can’t.

This fact is what causes so many alcoholics and family members, alike, to go along with, “This time, it’ll be different. I’m going to only drink on Friday nights and holidays, but that’s it!” (or some variation thereof). And, sometimes that promise lasts for a while. Sometimes the person even stops drinking all together — for years. But, then “it” starts, again… the glasses get larger and the sneaking creeps back in and pretty soon, it’s right back where it started.

Why?

The reason it works for some — and some can be very heavy drinkers — and not for others is the disease of addiction. Alcoholism is one of the diseases of addiction, which is a chronic relapsing brain disease. This means an alcoholic’s neural networks have been so corrupted – hijacked – by their addiction, the chemical and structural changes that have occurred in their brains makes it impossible for them to EVER drink ANY amount of alcohol, if they want to be able to stop their drinking behaviors long-term.

Watch these two videos to better understand (Note: when Dr. Volkow refers to “drugs,” that includes alcohol):

• The Hijacked Brain — found in the right column, top video.
• Brain Imaging (You can stop watching this one when Dr. Volkow starts her interview with a patient.)

So how can a person (family member or the drinker) tell whether a person should stop trying for “controlled drinking” and get treatment for alcoholism?

One thought is to understand the Risk Factors for developing the disease. The more Risk Factors a person has, the more likely they are to develop the disease of alcoholism; one of the diseases of addiction. Risk Factors include:

• Early use – because of the critical brain development that occurs from ages 12–25, alcohol affects the developing brain DIFFERENTLY than it affects an adult brain. The developing brain is especially vulnerable to the chemical and structural changes caused by alcohol misuse. (See this related link for more information.)
• Genetics – persons whose parent or sibling are alcoholics are 4-7 times more likely to become alcoholics themselves.
• Social environment – people who live, work or go to school in an environment in which the heavy use of alcohol is common – such as growing up in a home where heavy drinking is seen as ‘normal’ or living in a school setting where it is viewed as an important way to bond with fellow students – are more likely to abuse alcohol themselves. That abuse of alcohol causes chemical and structural changes in the brain.
• Mental illness – just over one-half of persons diagnosed as alcoholics or alcohol abusers have also experienced a mental illness (e.g., depression, PTSD, ADHD, bipolar) at some time in their lives. With mental illness there are also chemical and structural changes in the brain. Persons with a mental illness may turn to alcohol to self-medicate and/or their alcohol misuse may make their mental illness worse.
• Childhood trauma – abuse (such as verbal, physical or mental abuse) or neglect of children, persistent conflict in the family (such as that surrounding a family member’s unacknowledged alcohol abuse or alcoholism), sexual abuse and other traumatic childhood experiences can shape a child’s brain chemistry — especially during the early development ages of birth to about 12 — and subsequent vulnerability to alcohol misuse.
• Alcohol Abuse – binge drinking, for example, is alcohol abuse, and it is the kind of drinking that causes drinking behaviors — which in turn causes problems. It is also the kind of drinking that can change the chemical and structural make up of the brain, which is a contributing factor to the developing the disease of alcoholism.

Bottom line…. if a person has tried repeatedly to control their drinking but keeps finding it does not work for one reason or another, it might help to determine how many Risk Factors they have.  If a person can “see” any, they may be able to better “see” the problem and thus more inclined to get help or talk to a professional. Equally as important is for the family member to do this exercise, as well. That way the family member can give up believing that this time the controlled drinking plan will work and instead, do what they need to do to help themselves.

One last suggestion…. a person (family OR drinker) can always go to NIAAA’s website, Rethinking Drinking, to do an anonymous assessment of their drinking patterns and find suggestions for further help.

________________________________________
©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source.

by Lisa Frederiksen

Alcohol enters the bloodstream through the walls of the small intestine. Because alcohol dissolves in water, the bloodstream carries it throughout the body (which is 60-70%) water, where it is absorbed into body tissue in proportion to the body tissue’s water content.  [The brain is mostly water, by the way.]

Alcohol is metabolized by the liver, thanks in large part to enzymes produced in the liver. This is the process by which alcohol leaves the body. The liver can only metabolize a certain amount of alcohol per hour, which means alcohol leaves the bloodstream more slowly than it enters. This is why a person’s BAC can continue to rise after they have stopped drinking.

A very GENERAL rule of thumb is that it takes about one hour for the liver to metabolize one standard drink. A standard drink is defined as 5 ounces of table wine, 12 ounces of beer or 1.5 ounces of hard liquor. Using this very GENERAL rule of thumb, it will take two hours to metabolize two drinks — even if the drinks were consumed back-to-back, and it’s been over an hour.

BUT, no two people will necessarily metabolize alcohol in the same manner. People who weigh less, for example,  have less body water as compared to someone who weighs more, and thus drink for drink a person who weighs less will have more alcohol concentration in their body water than someone who weighs more. People who have lower amounts of the liver enzymes that metabolize alcohol will take longer to metabolize the same amount of alcohol as someone else. There are other factors that influence how much is “too much” for one person as compared to another.

The key message is the liver can only metabolize a certain amount of alcohol per hour. Until the alcohol is metabolized, a person still has alcohol in their bloodstream.

_____________________________

©Lisa Frederiksen, www.breakingthecycles.com. The information contained in this post may be freely used and copied for education and other non-commercial and non-promotional purposes, provided any use or reproduction of the information be accompanied by an acknowledgment of Lisa Frederiksen, Breaking the Cycles.com, as the source.