So 2012 is our year to get involved. The first thing to do is register to vote. If you’ve changed your name or address, please re-register. It’s so easy to do.

Second, get informed and get involved. To that end, I’m sharing two tools created by Faces & Voices of Recovery for just this effort:

2012 Reovery Voices Count Guide to Non-Partisan Civic Engagement has everything you need to run a civic engagement campaign that will register and educate voters and encourage individuals to vote on November 6. Click here to download.

Community Listening Forum provides guidance for modified town hall meetings to put experts — people in recovery, family members and allies — front and center to speak out about their own experiences and needs to formal listening panels composed of policy makers, program administrators and elected officials. Click here to access.

Mark your calendars to vote November 6 (if you live in the United States) and do whatever you can to get involved. Recovery voices count!

Poverty and Homelessness Among the Elderly
The way in which the government understands the problem of homelessness in the U.S. is through single night counts.  In a 2008 single night count, there were over 660 thousand homeless people in the United States; over 168,000 of those are believed to be elderly.  However, poverty is a more prevalent problem among the elderly than homelessness; this is understandable seeing as it is a direct cause of homelessness.  In 2008, there were about 3.7 million elderly people living below the established poverty line in the United States; this translates to about 22 elderly people living in poverty for every one elderly homeless person.

The Causes of Homelessness and Poverty
There are several reasons that the elderly are living in poverty or are homeless.  Some of the main causes are:

• Insufficient housing accommodations. The Baby Boomers’ elderly population is growing faster than facilities can accommodate it and Social Security does not provide enough benefits to cover housing costs.  As a result, there are wait lists for affordable nursing/elderly facilities and housing.

• Money problems.  High medical bills/expensive health problems, poor management of finances pre and/or post-retirement, and lack of income after retirement are often causes of poverty; and poverty is a cause of homelessness.

• Substance abuse.

Substance Abuse’s Affect on Homelessness
The United States Conference of Mayors conducted a survey of 25 U.S. cities in order to understand the top three reasons that homelessness occurs; 68 percent of the surveyed cities cited substance abuse as the number one cause for their cities’ homelessness population while 80 percent total put substance abuse in the top 3 causes.

According to the Substance Abuse and Mental Health Services Administration in 2003, 38 percent of homeless people abused alcohol while 26 percent abused other drugs.

The National Coalition for the Homeless states the following:

According to Didenko and Pankratz (2007), two-thirds of homeless people report that drugs and/or alcohol were a major reason for their becoming homeless….  Substance abuse is often a cause of homelessness.  Addictive disorders disrupt relationships with family and friends and often cause people to lose their jobs.  For people who are already struggling to pay their bills, the onset or exacerbation of an addiction may cause them to lose their housing….  Alcohol abuse is more common in older generations, while drug abuse is more common in homeless youth and young adults (Didenko and Pankratz, 2007).  Substance abuse is much more common among homeless people than in the general population.  According to the 2006 National Household Survey on Drug Use and Health (NSDUH), 15% of people above the age of 12 reported using drugs within the past year and only 8% reported using drugs within the past month.

The Future of the Problem
The National Alliance to End Homelessness (NAEH) recently conducted research that predicted that the elderly homeless population will increase 33 percent by 2020 and double by 2050 if the government continues its current housing and service programs in the future.

Thus, if the government and our society do not address elderly substance abuse and incorporate programs to help elderly citizens address and treat it, the problem of homelessness due to elderly substance will be exacerbated.

World AIDS Day is celebrated on December 1. The World AIDS Campaign’s goal is “to ensure that governments and policy makers meet the HIV targets they set, the commitments they made, and mobilise the necessary resources for a world where people do not die of AIDS and opportunistic infections like TB. At the heart of the global commitment is non-discriminatory and non-judgmental access to adequate HIV prevention, treatment, care and support for all.”  (source: http://www.worldaidscampaign.org/world-aids-day/)

This year marks the 24th World AIDS Day, first celebrated in 1988. In less than 25 years, the world has changed its views of HIV-AIDS (and you all remember those  mean-spirited, shame-filled views of the 1980s) and now understands it to be: 1) a disease spread through sharing “infected bodily fluids, most commonly via sex without a condom or by sharing infected needles, syringes or other injecting drug equipment,” 2) a disease that can be prevented by using a condom when having sex and not sharing needles or other drug-injecting equipment, 3) a disease that can successfully be treated, allowing people to live “positively with the virus,” although there is no cure nor vaccine at this time, and 4) a disease that can be diagnosed through a blood test.

Would a World ADDICTIONS Day, with a similarly stated goal “to ensure that governments and policy makers meet the Addictions (and Substance Abuse) targets they set, the commitments they made, and mobilize the necessary resources for a world where people do not die of Addiction and opportunistic happenstances like driving while impaired car accidents. At the heart of the global commitment is non-discriminatory and non-judgmental access to adequate Addiction (and Substance Abuse) prevention, treatment, care and support for all,” do the same for the disease of addiction?

Would it change the world’s perception of addiction from the centuries old, mean-spirited, shame-filled views (and you all know those views) still in place today, to recognize addiction (whether to drugs or alcohol) for what it is: 1) a chronic, often relapsing brain disease, 2) a disease that is caused by substance abuse (which changes the chemical and structural make-up of the brain), most often in combination with one or more of the five key risk factors (genetics, social environment, mental illness, childhood trauma, and early use), 3) a disease that can successfully be treated, allowing people to live positively with the disease, although there is no cure nor vaccine at this time, and 4) a disease that can be diagnosed through brain imaging technologies (e.g., SPECT, PET, fMRI) used in conjunction with a clinical evaluation?

Hundreds of millions of people worldwide have the disease of addiction; millions die of the disease every year. Isn’t it time the world embrace a view of addiction similar to its view of HIV-AIDS?

Like HIV-AIDS, addiction is just a disease (one that affects the brain, therefore changes a person’s “thinking” and behaviors when using their substance of choice), a disease that can be diagnosed, prevented and/or successfully treated, thereby saving lives and allowing those with addiction to live productively with the disease. Like HIV-AIDS, addiction knows no cultural, religious, sexual orientation, social class, ethnic boundaries. It too is an equal opportunity disease.

Health care reform is bringing a whole new way of intervening, preventing and treating addiction, EFFECTIVE  2014.

Thomas E. Freese, PhD, describes five of the key changes in his article, “Substance Abuse Treatment Providers: Act Now to Get Ready for Health Care Reform,” posted on by The Partnership at DrugFree.org’s Join Together’s Newsroom website on September 30, 2011. I have copied and pasted these below:

Another major change will be that substance abuse treatment providers will be seen as part of the larger health care system. Both substance abuse treatment providers and primary care providers will need to look for ways to be more integrated and collaborative with one another.

Substance abuse treatment providers will need to become much more familiar with the other medical problems that their clients often face, such as diabetes, high blood pressure and asthma. When they see clients who are exhibiting symptoms of these diseases, they will need to link them back to primary care for evaluation and treatment.

Primary care providers will need to become much more comfortable in giving screening and brief intervention for patients at risk of substance abuse, and in knowing where to refer patients who need further help at all levels of risk. This will mean that substance abuse treatment providers will start seeing a broader spectrum of patients—not just those with full-blown addiction, but also those with milder issues that nonetheless need treatment.

Both primary care providers and substance use disorder service providers will need to better integrate their services for medication-assisted treatment for substance abuse as well, in order to ensure that patients who are receiving medication for opioid or alcohol dependence are also receiving the behavioral services they need.

Health care reform will allow patients to have a much broader choice of providers for substance abuse treatment. They will begin to ask why they should choose Agency X over Agency Y. As a result, substance abuse treatment providers will have to engage and motivate clients to choose them, using data to measure success. They will have to become more visible and competitive in the health care field they will now be a part of, instead of the specialty realm of addiction treatment services. [Direct copy and paste from Thomas E. Freese, PhD's, article, "Substance Abuse Treatment Providers: Act Now to Get Ready for Health Care Reform

What Dr. Freese is describing represents a sea change in the world of addiction treatment, prevention and intervention. Be sure to read Dr. Freese's article in its entirety to learn the full extent of these coming changes, "Substance Abuse Treatment Providers: Act Now to Get Ready for Health Care Reform."

“All addictive substances send dopamine levels surging in the small central zone of the brain called the nucleus accumbens, which is thought to be the main reward center [located in the Limbic System]. Amphetamines induce cells to release it directly; cocaine blocks its reuptake; alcohol and narcotics like morphine, heroin and many prescription pain relievers suppress nerve cells that inhibit its release.”

______________________________

“Researchers now postulate that addiction requires two things. First is a genetic vulnerability, whose variables may include the quantity of dopamine receptors in the brain: Too few receptors and taking the drug is not particularly memorable, too many and it is actually unpleasant. Second, repeated assaults to the spectrum of circuits regulated by dopamine, involving motivation, expectation, memory and learning, among many others, appear to fundamentally alter the brain’s workings.”

The above are two direct quotes from Abigail Zuger’s, June 13, 2011, article, “Profiles in Science | Nora D. Volkow, A General in the Drug War.”

Dr. Volkow is the Director of the National Institute on Drug Abuse (NIDA). I urge you to read the entire article, hyperlinked above. The better we all understand addiction (whether it’s to drugs or alcohol) for what it is — a brain disease — the more able we will be to prevent and/or intervene in the progression of the brain disease of addiction.

This new brain research is truly amazing and goes a long way to helping clinicians, medical professionals, addicts/alcoholics, family member & friends and the lay person understand how the brain goes together (develops), how it works, and how it unravels. For the purposes of this post, I’m going to focus on two of the “pieces” that underpin all of what our brains can do and do — neural connections and neurotransmitters.

About Neural Connections
We are born with about 100 billion brain cells — billions of them — also known as neurons but only a relatively small fraction are ‘wired.’ From birth to around puberty, our brains are ‘wiring’ neural networks like crazy — a wiring process that allows neurons to “talk” to one another via neural connections. Neural connections in the brain control everything we think, feel, say and do.

A neural connection requires brain cells (neurons), synapses (the gap between the branchlike extensions of a brain cell) and neurotransmitters (the chemical messenger that takes a message from one brain

[Image Courtesy: Irene E. Yu]

cell’s branchlike extension, across the synapse, to receptors on the receiving brain cell’s branchlike extension). There is an expression sometimes used to describe this process — “neurons that fire together, wire together“ and this wiring together is sometimes called a “brain map.”  (Norman Doidge, M.D. The Brain That Changes Itself)

Over the course of our lives, we create neural connections (brain maps) for all of the functions our bodies and brains do. In other words, we create neural connections for riding a bike or typing on a computer or talking on the phone or reading a book or running, breathing, reciting multiplication tables, eating, talking with our hands — everything!

About Neurotransmitters
Neurotransmitters are the keys to moving the electrical signal (message) from one neuron to another. In other words, they are the “something” that converts the electrical signal from one neuron into a chemical that can cross the synapse (the gap between two neuron’s branchlike extensions) to bind to receptors on the receiving neuron, where it is converted back into an electrical signal to carry on the “message.” There are five primary neurotransmitters in the brain [and please understand this is a very BASIC explanation]:

Dopamine is our “feel good” neurotransmitter – in other words, it’s the one that connects the neurons responsible for motivation, interest and drive; the neural networks in the brain’s “pleasure/reward” system.

Serotonin is key to our moods, sexual desire and function, appetite, sleep, memory and learning, temperature regulation and some social behavior.

Norepinephrine works with the neural networks responsible for our sense of well-being.

Glutamate is the major excitatory neurotransmitter in the brain –the accelerator, if you will.

GABA (Gamma amino butyric acid) GABA is the major inhibitory neurotransmitter — the brakes.

What Throws Neurotransmitters Out of Balance?
Given neurotransmitters are one of the keys to successful, healthy neural networks in the brain, understanding what can change their levels can be key to a person’s understanding of what they might do to “heal” their brain — to feel better and thereby change their behaviors. Here are a few:

Genetics – some people are born with higher or lower levels of one or more neurotransmitters and/or receptors for a specific neurotransmitter. For this, a person may take medications that increase or inhibit specific neurotransmitters.

Metabolism – a faulty metabolism can impair how nutrients important to the cells that produce neurotransmitters. For this a person might wrest control of their diabetes or increase their exercise levels in order to increase their metabolism.

Nutrition – the body “makes” neurotransmitters from proteins and certain vitamins and minerals. When a person’s nutrition is poor (aka, they don’t eat a healthy, nutritionally balanced diet), their body cannot make the healthy levels of neurotransmitters needed for healthy neural networks. For this, a person might eat a healthier diet — the U.S. Department of Agriculture provides an excellent website, Choose My Plate, to help people customize a diet to meet their specific body needs.

Toxic Substances – drugs, alcohol, pesticides and other substances taken at a toxic level SEVERELY harm the production of neurotransmitters and thus neural networks in the brain. For this, a person might reduce the amount of alcohol they consume, restrict their drug use to only those prescribed under the care of a medical doctor, and/or find a treatment program that may help them recover from an addiction.

Hormonal Changes – such as those caused by conditions affecting the thyroid, adrenal, male and female sex hormones, for example, can cause neurotransmitter imbalances. For this, a complete physical with one’s doctor can help identify any problem areas and what courses of action may be taken to correct them.

Health Conditions - such as a head injury or mental illness or a sugar imbalance — anything that interrupts the brain’s natural ability to produce neurotransmitters, maintain, balance neurotransmitters. For this — especially a head injury or mental illness — a person should seek the help of a trained professional (neurologist, psychiatrist or psychologist, for example).

In Summary
There is a great deal we can do to heal our brains. The place to start is with understanding the importance of neurotransmitters to a neural network and then doing what we can to keep those neurotransmitters producing / working at optimum levels.

Here’s to brain health!

Tweet

QUALITY
Many measures touch upon the quality of a country’s healthcare services. I have chosen representative ones to review quality of care. One of the most important concerns for a country’s future is the rate of infant mortality. A high rate of infant mortality is a basic problem that may have several contributing factors such as poor prenatal care but regardless of contributing causes, it is one of the most difficult issues for families and a nation to suffer through. Death rates of heart disease and cancer (The number one and two deadliest general categories of disease respectively in America) are also important measures in gauging the overall effectiveness treatment with the rest of the developed world.

Life expectancy at birth and at retirement age (65) also tell part of the story on the relative effectiveness of healthcare services in the prevention and management of disease. Patient survey information is stale when comparing America to other developed nations but considering the relative constancy of the systems over time a fresh study with consistent structuring would likely show reasonably similar results. The most recent widely accepted study I have been able to find on America vs other developed countries is the study published in Health Affairs in 2001 by Robert Blendon, Minah Kim and John Benson from Harvard’s School of Public Health. The survey indicates a low ranking of patient satisfaction but the survey team questioned the relative weight of each category.

Infant Mortality (ODECD data)

Deaths – Heart Disease (ODECD data) Heart Attack                                   Stroke

Deaths – Cancer (ODECD data)

Life expectancy at age 65

Patient Surveys

In addition, We now have reasonably fresh information on another measure of that combines elements of cost, quality and access namely medical tourism thanks to the work of OECD which is constantly improving the quality of their data and introducing new relevant data

Medical tourism (ODECD data)

(Exports = Patients coming into listed country, Imports = Patients leaving country for care)

Then Again

Data alone does not tell the full story of America’s healthcare-system. There are fundamental differences between American healthcare and most other developed countries in approach and cultures. There certainly are significant differences in primary care services vs specialty services. However there are systems in America that are more familiar to our counterparts elsewhere. One that would not have been considered as such not so long ago is the VA system. It has suffered through rounds of bad publicity deserved and otherwise but it now ranks among the best if not the best system in America.

The metamorphosis of the VA has been chronicled by Phillip Longman. In his preface to the second addition of “Best Care Anywhere” he writes on January 20, 2010.

“By all rights, after all, the VA should offer the worst care anywhere: It’s a gigantic unionized bureaucracy, micromanaged by Congress and political appointees, and beset by an uncertain budget, an aging infrastructure, and a legacy of scandal. That it nonetheless outperforms the rest of the U.S. healthcare-system on metrics ranging from patient satisfaction to cost-effectiveness and the use of evidence-based medicine, suggests that much of what we think we know about healthcare simply isn’t true. The VA’s long-term relationship with its patients, it turns out, more than makes up for its built-in institutional liabilities, which offer a lesson for health-care reform that we ignore at our peril. I offer the second edition of Best Care Anywhere in the hope that more readers worried about their own health and that of the nation will consider the meaning of the VA’s paradoxical example and its implications for true health care reform.”

Certainly the obstacles the VA has overcome to elevate their services offers hope that positive change can happen even under difficult circumstances (or some might argue because of difficult circumstances).

Thanks for your time and input.

Peter

Peter Legge is formerly a Hospital CEO, Healthcare Consultant, and CFO/Founder of Healthcare Information Group. Peter can be reached through his website, LeggeWork™ – Healthcare.

It’s been 10 days, now, and Yahoo is still doing their best to fix the problems caused by spam commentors posting to this site.

I will try to put up new posts, but if they don’t appear, that is why. Please know that searching or spending time on the site will NOT harm your computer, nor will you experience a problem if you are linked in any way.

Thank you for your patience!

Lisa