Leslie Glass's Blog, page 299

Choosing To Accept The Unexpected

I like to say that I go to bed at 10:00 pm. The reality, however, is that when my 9:30 pm reminder to power down goes off, it is often ignored. Then I quickly give myself “just 5 more minutes” four, five or even six times over to complete whatever task I don’t want to stop doing.

It Is Instant Gratification At Its Finest

I also like to say I get up at 5:30 am. When Bad to the Bone goes off with a vengeance, it’s usually enough to get me up and around for the day, except when I start singing along. Snuggling deeper into the covers, my feet tapping along to the beat, I remember thinking to myself, “I love this song!” before drifting back to sleep for just a few minutes more. Or so I told myself.

I snapped awake to the barking dogs, what time was it? My alarm clock is glaring 6:37 am, mocking me. How did that happen? I launch myself out of bed in a way that a gymnast would envy, my mind already racing with all I have to do before walking out the door at 7:20 am for my 8:00 am class.

Suddenly, leaving 44 stacks of papers to staple in the morning when I have ‘lots of time’, didn’t seem like such a good idea. Nonetheless, I grab the stapler and begin in earnest until there are no more staples. More staples in the desk. Crisis averted. Put the water on for coffee, let the four-legged alarm clocks out and the stapling is flowing… until it jams. Backup stapler to the rescue! Until it dawns on me that it’s the backup for a reason. No problem, I rationalize, I’ll just do it when I get to work.

The usual wardrobe stare limited as I remind myself I have to get going, I dress, make the bed, do my hair (messy bun is in, right?) and head out to start the car and water the dogs. And that’s when the smell hits me. Whoa. Someone got sick in the garage. I didn’t have time for my normal morning routine let alone this unexpected mess. In a flash, the little hamster on the wheel in my head raced to finish everything I had to do in the non-existent amount time I had to do it in.

In a panic, I forgot my part in all of these unexpected events. Then, I made it about me. Why was this happening to ME?

And in a split second, my dad’s words crowded it out. He would say,

“When something shows up and it’s not what you want. Choose it anyway. Choice gives you power.”

So, I stopped and chose the morning just as it was. I got to the task of cleaning up the garage, checking the dogs, and I got to work in plenty of time to finish the stapling task before class started. Lesson learned, Dad.

The secret to life, after all, is playing the hand you were dealt like it’s the one that you wanted.

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I Know What ‘Dope Sick’ Feels Like & What It’s Like to Get Better

From Brian Rinker @ Men’s Health: “Quitting heroin was my plan every night when I went to sleep. But when morning came, I’d rarely last an hour.” Detoxing off heroin or opioids without medication is sheer hell. I should know.

For many users, full-blown withdrawal is often foreshadowed by a yawn, or perhaps a runny nose, a sore back, sensitive skin or a restless leg. For me, the telltale sign that the heroin was wearing off was a slight tingling sensation when I urinated.

These telltale signals—minor annoyances in and of themselves—set off a desperate panic: I’d better get heroin or some sort of opioid into my body as soon as possible, or else I would experience a sickness so terrible I would do almost anything to prevent it: cold sweats, nausea, diarrhea and body aches, all mixed with depression and anxiety that make it impossible to do anything except dwell on how sick you are.

You crave opioids, not because you necessarily want the high, but because they’d bring instant relief.

Quitting heroin was my plan every night when I went to sleep. But when morning came, I’d rarely last an hour, let alone the day before finding a way to get heroin. My first time in a detox facility, I made it an hour, if that. As I walked out, a staff member said something to the effect of “I didn’t think you’d last long.”

After my parents moved out of town, in part, to get away from me, I would show up at their new home five hours away with big hopes of kicking the habit and starting a new life. But after a night of no sleep, rolling on the floor convulsing while vomiting into a steel mixing bowl, I’d beg them for gas money to drive the 300 miles back to where I lived and a little extra cash for heroin. I did this so often my mother once told me in frustration, “You show up, throw up and then leave.”

Going through “cold turkey” withdrawal is, not surprisingly, impossible for many. That’s why the medical community has largely embraced the use of methadone and buprenorphine—known medically as medication-assisted treatment, or MAT—combined with counseling, as the “gold standard” for treating opioid addiction. As opioids themselves, these drugs reduce craving and stop withdrawals without producing a significant high, and are dispensed in a controlled way.

“Detox alone often doesn’t work for someone with an opioid use disorder,” said Marlies Perez, chief of substance use disorder compliance at the California Department of Health Care Services, who estimated that it might be a realistic option for only 15 out of 100 people.

Studies have also shown that MAT reduces the risk of overdose death by 50 percent and increases a person’s time in treatment.

Yet even with strong evidence for MAT, there is debate over whether to offer MAT for people struggling with opioids. Some states, like California, have vastly expanded programs: The Department of Health Care Services has 50 MAT expansion programs, including in emergency rooms, hospitals, primary care settings, jails, courts, tribal lands and veterans’ services; the state has received $230 million in grants from the federal government to help with these efforts. But many states and communities hew to an abstinence or faith-based approach, refusing to offer MAT as an option. In 2017, only about 25 percent of treatment centers offered it.

Just as each person’s journey into addiction is unique, different approaches work for people trying to find their way out. Public health experts believe they should all be on the table.

Diane Woodruff, a writer from Arizona who became addicted to opioid medication prescribed for a bad back, described withdrawal like this: “If you’ve ever had the flu it’s like that but times 100.” Woodruff went through the sickness every month for five days until she could refill her prescription of OxyContin.

Other people described the sickness as if ants were crawling under their skin or acid was being injected into their bones. Woodruff was able to quit for good after she went cold turkey, sort of. She used kratom and marijuana to help with the detox.

Noah, a 30-year-old from San Francisco who asked that his last name not be used, said that MAT was a “miracle” therapy,” adding, “It saved my life.” Noah spent five years on Suboxone, a brand-name formula of buprenorphine and naloxone, right around the time fentanyl began taking lives with impunity. Suboxone took away his craving for heroin, but he kept drinking alcohol and injecting cocaine and using other drugs for a while until joining a sobriety community. He finally weaned off MAT half a year ago.

“There’s no debate that MAT works — the evidence is clear,” said Dr. Kelly Clark, president of the American Society of Addiction Medicine. Opioid use changes the chemistry of the brain, sometimes permanently. Buprenorphine and methadone stop the withdrawals, diminish cravings and, when taken as prescribed, block the high from other opioids. These medications “tone down and reset the brain,” helping to “normalize” the individual, Clark added.

Within the nine years of my heroin use, I tried to get sober many times: detox, residential rehab, and with morphine and methadone under the guidance of a health care professional. For me, Suboxone didn’t prove the answer, although (to be fair) I never took it as prescribed under the supervision of a doctor. I was ambivalent and incapable of following directions, let alone a treatment plan. I didn’t want to be shackled to another opioid or have to check in with a health care professional every week or month or have to go to counseling — even if all that could have helped me to function better. (A common critique of methadone or buprenorphine is that it is just replacing one drug for another.)

But Suboxone ultimately kick-started me into sobriety. One day in December 2008, I tried one more time to detox successfully off heroin at my parents’ house. To make it easier, I had a couple of pills of Suboxone, illegally obtained. So, after the body aches and that weird feeling when I peed, the buzzing ball of anxiety began to grow in the pit of my stomach and, just when life began to seem unbearable, I crushed one of the Suboxone tablets up and snorted it off my dresser. Unbeknownst to me at the time, when Suboxone is crushed, it releases an anti-tampering chemical that sends the user into full-on withdrawal.

I spent the next three days shut up in a room as my body and mind began to unravel. I barely slept and there was plenty of diarrhea and vomiting. After the worst of it was over, I apathetically roamed my parents’ house, not sleeping for two weeks. Then, I joined a sobriety community and haven’t touched an opioid in 10 years.

MAT was not the escape route from addiction for me, personally, and I have mixed feelings about these medications. But with tens of thousands of opiate overdose deaths each year, it makes sense that people struggling with addiction and facing the terrifying specter of withdrawal have every option available.

The post I Know What ‘Dope Sick’ Feels Like & What It’s Like to Get Better appeared first on Reach Out Recovery.

Addiction: The High Cost Of Playing In NFL

From Ken Belson @ The New York Times: Earl Campbell, a former All-Pro running back in the N.F.L., said the first painkillers he took came in a small brown packet that a trainer gave him on the team plane. The former lineman Aaron Gibson received his first painkillers in his rookie year after undergoing shoulder surgery. Randy Grimes, a former center, started taking Vicodin and Halcion, a sleeping pill, in his second season to get through full-contact practices.

Like hundreds of former N.F.L. players, Campbell, Gibson and Grimes said they never took painkillers in college, or at any time before they entered the league. Yet as professionals, they regularly used the pills to continue playing, and even in retirement, their pill-popping habits persisted, sending them on haunting, shattering journeys into opioid addiction. It has taken years of struggle, money and anguish in order to heal.

Putting up with pain — a lot of it — has for decades been central to the bargain of playing for glory and money in the N.F.L., the biggest stage in American sports. To do that, countless players have long ingested far more pills than they should. In recent years though, N.F.L. players, especially linemen, have gotten significantly larger, and pain medication has become far more potent and addictive, with devastating consequences.

A study published last year in the Clinical Journal of Sport Medicine found that 26.2 percent of retired players said they had used prescription opioids within the past 30 days. Nearly half of those players said they did not use them as prescribed.

Seven percent of retired players — equal to about 1,500 men — said they had misused painkillers in the past month, according to a study conducted in 2011 by researchers at Washington University School of Medicine in St. Louis. That was more than three times the national rate for adults 26 and older at the time. Seventy-one percent of those surveyed had misused drugs during their N.F.L. careers, and some of them continued to do so after they left the league, the study found. Players who abused opioids in retirement were also more likely to be heavy drinkers.

In the past, players might have tried to manage their pain with a handful of Percocet, or by indulging in the over-the-counter medicines that used to be left in bowls in trainer’s rooms. Now, supersize men with crippling injuries and high tolerances for pain medication, such as Grimes and Gibson, seek out far stronger and more dangerous drugs, like high-dosage OxyContin, which cost about $500 for roughly 50 pills.

“I was running through those like nothing,” Gibson said. “One doctor who thought he was the only one treating me said, ‘Aaron, what I’m prescribing you is what I’d give a Stage 4 cancer patient.’”

The problems often grow worse after careers end, when the effects of injuries sustained while playing require interventions that can include multiple surgeries.

“When you get out of pro football, you start having these operations,” said Campbell, a running back for most of his career with the Houston Oilers who was confronted a decade ago by his family about his drug use. “I didn’t realize what I had until I got out of rehab.”

For decades, players have justified taking painkillers because the medication helped them earn big N.F.L. paychecks. Now, a growing number are saying the easy access to pills turned them into addicts.

“I absolutely said, ‘When I’m not playing, I’m not going to have to do this,’” said Gibson, a 6-foot-6 first-round draft pick who played in the N.F.L. from 1999 to 2004. After he retired, he took as many as 200 pills a day before he stopped taking painkillers three years ago. “If I didn’t play in the N.F.L., I know I wouldn’t have been in this situation,” he said, referring to his life as a “full-on pill addict.”

Asked what the N.F.L. was doing to reduce the reliance on highly addictive painkillers, Roger Goodell, its commissioner, said the league’s executives were consulting with pain management experts and seeking recommendations.

“We obviously put this as a huge priority for us, making sure that we are taking care of our current players as well as our former players,” Goodell said at a news conference during the lead-up to the Super Bowl. “Our players are cared for by the world’s finest medical professionals. The dedicated medical and training staffs of every N.F.L. club are and always have been committed to providing their patients with the best possible care.”

What Goodell did not say is that the distribution of drugs by team doctors and medical professionals has come under repeated scrutiny from federal regulators. It is also central to at least two active lawsuits brought by former players who accuse N.F.L. teams of, among other things, not warning them about the destructiveness of the painkillers they were given.

In the first case, led by the former Chicago Bears defensive end Richard Dent, a federal judge initially dismissed the suit on the grounds that the league’s collective bargaining agreement required the parties to contest this kind of dispute in arbitration, not the courts. The players appealed, and the United States Court of Appeals for the Ninth Circuit in San Francisco ruled in their favor, reinstating the case.

“The parties to a C.B.A. cannot bargain for what is illegal,” the appeals court panel wrote.

In the second case, the players sued the clubs that employed the team doctors, not the league, for improperly distributing painkillers. The same judge who dismissed the first case ruled that the statute of limitations had passed. The Ninth Circuit heard arguments in an appeal in December.

In 2017, the N.F.L. Players Association filed a grievance against the league for overprescribing painkillers, not keeping accurate records of the drugs that teams distributed and denying the union’s medical director access to meetings and documents relevant to the distribution of painkillers. The two sides are locked in arbitration.

Even before the legal action, the league’s pill culture had been well documented in tell-all books by former players and team doctors, and portrayed in books and films like “North Dallas Forty.”

What happens to players like Gibson when they leave the N.F.L. cocoon has been less explored. Like many players, his departure was abrupt, involuntary and wrenching. Although he no longer abused his body every week in practices and games, he could no longer rely on team doctors to help him cope with the lingering injuries he had to his neck, back, shoulders, knees and ankles that made getting out of bed in the morning a 30-minute ordeal.

So he coped on his own. He found new doctors, visited pain clinics and bought painkillers on the street and even from residents at retirement homes.

Addiction is expensive. Most pills are not covered by insurance. So like other addicts, retired N.F.L. players with addiction problems reach into their pockets. Spare cash disappears. Possessions are pawned. Homes are sold. Players are abandoned by their families, leaving men like Grimes sleeping alone on the floor in an empty house, as he recounted, with the utilities turned off, consumed by the pain of withdrawal.

An ingrained warrior mentality can prevent them from admitting weakness. Grimes finally sought help 17 years after his career with the Tampa Bay Buccaneers ended in 1992, when all the trappings of his N.F.L. life were gone.

“At that point, I had no excuse not to do it,” said Grimes, who has been off pills for almost a decade and now works for Transformations Treatment Center in Delray Beach, Fla., which helps former players and others battle substance abuse. “I was jobless, desperate, my family wanted nothing to do with me. I thought I hit a lot of bottoms, but that was the real bottom.”

The Player Care Foundation, which is run by the league; the union’s Player Assistance Trust Fund; and Gridiron Greats, a nonprofit group started by the former coach Mike Ditka, help retired players with substance abuse problems.

For Grimes, his addiction was formed in the N.F.L., but it intensified when he left the league.

In addition to the chronic pain from years of playing football, the shock of leaving the league — his coach simply tapped him on the shoulder and told him he was cut — and the struggle to find a job that could match the elation of running onto a field on Sundays sent him into an emotional tailspin.

“I just wanted to numb up because I couldn’t move on to the next step, and I didn’t know what that next step was,” Grimes said.

The injuries did not heal, and Grimes’s tolerance for Hydrocodone, Percocet, Vicodin and other painkillers grew. To feed his addiction, he visited an array of doctors with the X-rays from his playing days.

Later, he visited pain clinics where, he said, doctors requested only the briefest justification for writing prescriptions, at a time when many physicians accepted a sales pitch from drug companies, such as Purdue Pharma, the maker of several potent painkillers, that their pills were a safe and effective way to treat pain. These pills required more and more cash, though.

“He’d go to these loan places, and all of a sudden he’d have money,” Grimes’s wife, Lydia, said. “Before I knew it, my jewelry was missing. He was pawning things. Things were missing off the wall.”

Eventually, they sold the house and Lydia moved in with her parents. That’s when Grimes finally sought help, 10 years ago, at a treatment center in New Jersey.

Gibson, the former lineman, had a similar tale. He spent six years in the N.F.L. and several more in an indoor football league, where painkillers, he said, were even easier to get. In retirement he was left with a battered 400-pound body that he medicated with opioids. The abuse he endured in his career and his struggles with obesity left him with shoulders that barely move, chronic knee and back pain, and feet that are missing the big toe.

He also ran a company that provided bodyguards. But trying to find pills soon became his full-time job. Like Grimes, he found doctors willing to write prescriptions. When they realized he was also getting painkillers from other doctors, he found new doctors, then pain clinics. He was so hungry for painkillers, he found a senior center where the residents were willing to sell their pills to him.

“They can easily make $600, $700, off this one bottle of pills, so that would double their social security for the month,” he said.

Gibson tried to quit cold turkey, but the withdrawal symptoms overwhelmed him. Then he met Brigitte, a sports massage therapist who became his wife. She worked on addressing the pain that was driving him to take pills. Several times a week, she stretched his muscles and tendons in his neck, back and legs. As the pain eased, Gibson took fewer pills. After he stopped entirely, he leaned on Brigitte when he had cravings.

“There were a lot of talks at 3 a.m.,” she said.

Off painkillers, Gibson now sleeps better and eats healthier food. He has lost about 100 pounds. He has had surgery on his hip, feet and mouth, but has endured the pain without prescription drugs because he fears a relapse.

“It was an everyday battle to say no, I don’t want the pills,” said Gibson, who had a sign in his hospital room telling nurses and doctors not to give him painkillers. “They are a road that I will never go down again.”

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Quitting JUUL: Text Messages Help Addicted Teens

From Alexandria Hein @ Fox News: With e-cigarette use reaching “epidemic levels” among the nation’s youth and major health groups urging the government to step in, an anti-tobacco organization has launched a free text messaging service aimed at teens to help them quit their potentially harmful habits.

The Truth Initiative, a non-profit group mostly known for their youth-targeted anti-smoking campaigns, launched the tailored-by-age group program last month.

“This innovative and free text messaging program was created with input from teens, college students and young adults who have attempted to, or successfully quit, e-cigarettes,” a press release said. “The program … also serves as a resource for parents looking to help their children who now vape.”

The move comes after a federally funded survey found twice as many high school students were using nicotine-based cigarettes in 2018 compared with 2017, marking the largest single-year increase in the survey’s 44-year history.

Experts have pointed at easily disguisable devices like the JUUL and similar products for the uptick, while regulators have continued to press for measures to make it harder for kids to obtain them.

While e-cigarettes have been found to help adult smokers quit tobacco, the concern is that the products appeal to teens who wouldn’t otherwise be using tobacco products, or serve as a gateway to regular cigarette use.

Another recent study found that adolescents who experimented with e-cigarettes ended up smoking traditional cigarettes just as much as teens who never tried vaping.

“These findings did not provide strong evidence of transition away from cigarette smoking as a potential public health benefit of e-cigarette use,” Jessica Barrington-Trimis, of the Keck School of Medicine at the University of Southern California in Los Angeles, told Reuters. “Collectively, findings from this paper suggest that e-cigarette use may result in an overall adverse impact of the public health of youth and young adults.”

According to the Truth Initiative’s press release, users ages 13 and older simply text the word “QUIT” to 202-804-9884 to enroll in the program, which is part of the already popular “This is Quitting” and “BecomeAnEX” campaigns.

“More than 3.6 million youth who use e-cigarettes are now vulnerable to long-term nicotine addiction – largely because of JUUL – and those new e-cigarette users, most of whom weren’t smokers in the first place, are four times more likely to go on to smoke deadly cigarettes compared to their peers who don’t vape,” Robin Koval, Truth Initiative president and CEO, said in the press release. “This new e-cigarette program provides the much-needed tools to quit vaping before it has the chance to progress to smoking.”

The press release said the texting program provides an anonymous way for users to seek help and connect with support groups without having to involve their parents or friends. The company said it saw a need for such a program after noticing an increase in posts from teens on sites like Reddit for help on learning how to quit the devices.

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Drinking While Pregnant: An Inconvenient Truth

From Jen Gunter @ The New York Times: Pregnant women are given a long list of medical recommendations that can come across as patriarchal don’ts: Don’t eat raw fish. Don’t consume deli meats. Don’t do hot yoga! Don’t drink.

There’s scientific evidence that these activities can have negative impacts on the health of the fetus, but the one that seems to be the source of most debate is alcohol.

After All, The French Do It, Don’t They?

And many people born in the 1960s or earlier had mothers who drank. And we’re fine, right?

My mother had a fairly regular glass of rye and ginger ale when she was pregnant with me. And she smoked. And I graduated from medical school at the age of 23. So my opinion, especially as someone who believes strongly in a woman’s right to make decisions about her own body, may come as a surprise: It’s medically best not to drink alcohol in pregnancy. Not even a little. The source of that viewpoint? My training and practice as an OB/GYN.

Some attribute this abstinence approach to the patriarchy: Clearly we doctors know that moderate alcohol is safe (we don’t!), and we just don’t trust women with that knowledge. According to this theory, we think a woman who hears that an occasional drink is O.K. will blithely go on a bender. (We don’t think that.)

Some also say that, in an effort to avoid frivolous lawsuits, doctors advise against alcohol while using a nudge-nudge-wink-wink to insinuate that a glass or two is fine.

But this isn’t about sexism (not this time) or dodging litigation. This is about facts. How women use those facts is, of course, their choice.

The truth is that fetal alcohol syndrome is far more common than people think, and we have no ability to say accurately what level of alcohol consumption is risk free.

There have been many twists and turns in how we, medically and societally, view drinking while pregnant.

There was a time when doctors recommended alcohol to pregnant women for relaxation and pain relief, or even prescribed it intravenously as a tocolytic — meaning it stopped premature labor. One doctor who trained me spoke of a 1960s prenatal ward full of intoxicated women “swearing like sailors.”

Things began to change in 1973, when fetal alcohol syndrome, or F.A.S., was formally recognized after a seminal article was published in The Lancet, a medical journal. F.A.S. is a constellation of findings that includes changes in growth, distinctive facial features and a negative impact on the developing brain. We now know that alcohol is a teratogen, meaning it can cause birth defects.

With that knowledge, the pendulum swung hard. In 1988, Congress passed the Alcoholic Beverage Labeling Act, which would add the well-known “women should not drink alcoholic beverages during pregnancy because of the risk of birth defects” label to alcoholic beverages for sale or distribution in the United States. (A warning about drinking and driving was also added.) Many people unfortunately took this as an opportunity to police pregnant women in public.

Then, over the last 10 years, women have become more vocal — and rightly so — about patriarchal messaging in medicine. Was no-drinking-while-pregnant just one more way to speak down to us and control our bodies?

No, But I Can Understand The Confusion

Part of the issue is that the science on alcohol and pregnancy is tricky: Giving pregnant women alcohol for medical testing is not likely to be accepted by ethics committees.

And what about all those pregnant Frenchwomen who drink (while also apparently shedding their baby weight with ease and bringing up perfect bébés)? It turns out they aren’t, really. One study in Europe that surveyed pregnant women and new mothers during two months showed that only 11.5 percent of women reported consuming alcohol once they knew they were pregnant. Of these women, most (72 percent) had a single five-ounce glass of wine or less the entire pregnancy.

We now have new data in the United States telling us that rates of F.A.S. are higher than we knew. In 2018, a paper on F.A.S. was published in the medical journal JAMA. Researchers trained in identifying the distinctive physical characteristics of F.A.S. evaluated over 3,000 children in four communities across the United States.

The findings were staggering. The way we are consuming alcohol in pregnancy is resulting in a conservative estimate of 1.1 to 5 percent of children — up to 1 in 20 — with F.A.S. According to the American College of Obstetricians and Gynecologists, fetal alcohol spectrum disorders are more prevalent than autism.

And yet at least 10 percent of pregnant women still drink during pregnancy.

The best analogy for the risk associated with alcohol consumption in pregnancy is driving with your newborn unbuckled in the back seat. Maybe you’ll get into a car accident and maybe you won’t. And if you do, maybe it will be a fender bender or maybe it will be catastrophic.

Driving is also not the only factor at play, in the same way that differences in body chemistry can play a role in who develops F.A.S. There is also the ability of your newborn to withstand an impact, the weather, the number of cars and the state of mind of other drivers on the road.

While the chances of getting in a car accident while driving home from the hospital with your newborn are very small, most parents will recall how much they stressed over installing the car seat correctly. (I released a lot of pent-up rage in the hour it took me to get the car seats buckled the first time.)

And yet, even with such limited risk, I doubt a single pediatrician would say: “Sure, drive unbuckled just this once. It’s a celebration.”

Guidance To Not Drink While Pregnant Is Not Sexist

I’m all for smashing the patriarchy at each and every opportunity. And it’s true that medicine has been hopelessly patriarchal since, well, medicine started. But providing people with accurate information so they can make informed choices about their bodies is the antithesis of the patriarchy. It is power.

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Most Inmates With Mental Illness Still Wait For Decent Care

Ashoor Rasho has spent more than half his life alone in a prison cell in Illinois — 22 to 24 hours a day. The cell was so narrow he could reach his arms out and touch both walls at once.

“It was pretty broke down — the whole system, the way they treated us,” says the 43-year-old Rasho, who has been diagnosed with several mental health conditions, including severe depression, schizophrenia and borderline personality disorder.

Rasho says little things would trigger him, and he’d react violently. Although he’d been sentenced to prison initially for robbery and burglary, his sentence was extended over and over for assaults on prison staff.

“Even if they would label us schizophrenic or bipolar, we would still be considered behavioral problems,” Rasho says. “So the only best thing for them to do was keep us isolated. Or they heavily medicate you.”

He spent most of his 26-year prison sentence in restrictive housing, or solitary confinement, where he had hallucinations, engaged in self-mutilation and tried to kill himself.

In 2007, Rasho and 12,000 other inmates with mental illness sued the Illinois Department of Corrections, alleging that the agency punishes inmates with mental illness instead of properly treating them.

A settlement was reached in 2016, when the state agreed to revamp mental health care and provide better treatment.

But a federal judge has ruled that care remains “grossly insufficient” and “extremely poor.” The agency has not hired enough mental health staff to provide care to everyone who needs it, and inmates with mental illness suffer as they continue to wait for long-overdue treatment.

Punishment, not treatment

Dr. Stuart Grassian is a psychiatrist who spent 25 years at Harvard studying how the conditions in solitary confinement cause harm — especially for people who are mentally ill.

“You’re looking at the population of a state psychiatric hospital,” says Grassian, who has met hundreds of inmates like Rasho who have served long sentences in extreme isolation.

“They’re not the worst of the worst,” Grassian says. “They’re the sickest of the sick; the wretched of the Earth. Maybe they weren’t even that bad before they got in, and they just get worse and worse. It’s a tragedy — absolutely immoral — to see that happen to people.”

Inadequate treatment of mentally ill prisoners is a problem across the U.S. When psychiatric institutions began closing down in the 1950s, they weren’t replaced with mental health services in the community. So, many people with mental illness have scrapes with the law, and end up in prisons that are ill-equipped to treat them.

According to federal data on state and federal prisons from 2011 to 2012, nearly 40 percent of inmates reported having been told by a mental health professional that they had a mental health disorder.

Yet among those who met the threshold for having serious psychological distress at the time of the survey, only about half were receiving treatment — medication, counseling, or both — for their illness. And they were more likely to be written up or charged with verbal or physical assault against correctional staff or other inmates than prisoners without an indicator of a mental health problem.

Correctional facilities in the U.S. are considered the largest provider of mental health services. Yet many prison systems are facing fiscal crises and struggle to provide constitutionally adequate treatment, even after lawsuits lead to court mandates for access to mental health care.

The problem is particularly bad in Illinois, which has long ranked near last in terms of the amount of money it spends on health care for inmates,according to the Pew Charitable Trusts.

And when prison inmates don’t receive the mental health care they need, they’re more likely to cycle in and out of the criminal justice system.

Alan Mills, one of the attorneys representing inmates in the 2007 class-action lawsuit, has made numerous visits to Illinois prison facilities in recent years.

“When you walk through these galleries, you get overwhelmed by the pain and suffering that you see in front of you,” says Mills, director of the Uptown People’s Law Center in Chicago.

An obvious problem

Even state officials acknowledge the prison system has not done well for inmates with mental illness.

“Corrections in Illinois was a little slow to recognize we are the mental health system for Illinois,” says John Baldwin, who directs the state’s corrections department. “Whether we want to be or not, we are; and we have to start acting like it.”

Baldwin says since he took over in 2015, the department has hired more mental health staff and provided training to all employees on how to engage with people who are mentally ill.

Most inmates now spend at least eight hours a week out of their cell and see a therapist once a month.

And about 765 of the inmates who are most ill have been transferred to new residential treatment facilities — where they are finally receiving appropriate care, Baldwin says.

But Mills points out: That’s a small fraction of the 12,000 who are mentally ill.

“And for the vast majority of those, not a lot has changed,” Mills says. “They simply aren’t getting the kind of treatment they need in order to improve their situation at all.”

A sign of progress

The Joliet Treatment Center in the southwest suburbs of Chicago doesn’t look like a typical prison facility.

Half a dozen single-story buildings — called dorms — surround a big grassy area. Walking paths connect the dorms.

“I always refer to it as the quad,” Warden Andrea Tack says, as she takes me on a tour. “It reminds me of some of the college campuses that have [a] big center lawn area and then all the classrooms surround it.”

But, unlike a college campus, this facility is surrounded by two layers of barbed wire fencing.

A few years ago, Illinois spent $17 million to convert what used to be a youth detention center at Joliet into a mental health treatment facility for inmates with serious mental illness.

The dining hall is at the center of the quad; the gym is just to the east, and a building to the south houses a library, medical clinic and classrooms where inmates take GED courses and receive job training.

Tack says the inmates here spend about 30 hours a week out of their cell in various activities, according to their individual treatment plans.

She says she’s seen inmates who’ve been transferred to the Joliet facilitymake huge strides over the past year.

People who were attempting to hang themselves and acting out aggressively, “now, they’re out and about in the community — going to classes, going to meals, interacting with others,” Tack says. “Some are serving as mentors for other residents.”

Mills says he, too, has seen this transformation in some inmates.

“And it’s a difficult transition,” he says, “because you’ve been treated in a place where you’re continually traumatized, and then you get to a place where actually people care about you.”

It takes time, Mills says, for many to learn that they can trust and receive help, instead of acting out aggressively the way they’ve been conditioned to do for so many years.

‘Culture of abuse’

The atmosphere at the Joliet center stands in stark contrast to the experience atsome of the state’s other prisons, such as Pontiac Correctional Center, located about 60 miles south of Joliet.

There, inmates with mental illness are often kept isolated and are lucky to get even one hour of mental health treatment a month, says Dr. Pablo Stewart, a psychiatrist. He was appointed by the federal court to oversee the settlement in the lawsuit.

In his most recent report, Stewart singled out the prison at Pontiac for having a “culture of abuse and retaliation” against mentally ill inmates.

“Almost everyone at the mental health unit at Pontiac should be at Joliet,” Stewart says.

If they were getting that same level of mental health care, Stewart says, they wouldn’t have as many behavior issues.

The Pontiac prison has a high concentration of inmates with behavior problems; the most challenging inmates are transferred there from prison facilities across the state.

And the facility lacks the necessary mental health staff to provide treatment to everyone who needs it.

As a result, Stewart says, many mentally ill inmates are isolated from the rest of the prison population, with little or no meaningful social interaction. The conditions cause them to deteriorate, he says, making them more prone to acting out.

Mentally ill prisoners isolated this way “end up throwing feces or urine at staff; end up exposing themselves [or] masturbating in front of female staff,” Stewart says.

Inmates with untreated mental illness also often get into fights with other inmates and prison staff.

Stewart says the workers themselves are traumatized from their job, and that can make them prone to retaliate. Based on interviews with both inmates and staff, Stewart says he’s absolutely convinced that some staff members abuse inmates at Pontiac.

Asked about those abuse allegations, a spokesperson for the corrections department, Lindsey Hess, writes in an email that the agency takes allegations of excessive force seriously and investigates them.

In an interview prior to the latest court monitor’s report, Baldwin said he would “be surprised” if inmates with mental illness were being abused today.

“We take swift action to refer [any reports of abuse] we get to the state police or the state’s attorney,” he said. “We will not tolerate that.”

As for prison staff who may be traumatized by their job, Hess says the agency has implemented several initiatives in recent years to improve the mental, physical and emotional well-being of employees.

These include peer support groups for staff, access to professional counselors and a recurring class — called “From Corrections Fatigue to Fulfillment” — that teaches staff members about the psychological dynamics of working in the field of corrections.

Stewart says Joliet is one Illinois facility that is finally providing inmates with adequate mental health treatment. That should be the norm everywhere, he says. But it’s not.

“That’s the standard of care that’s required,” Stewart says.

A lingering problem

When I interviewed Rasho last May, he’d been out of prison for more than a year. But his many years spent in solitary confinement still haunt him.

“I don’t sleep right,” he told me. “Any little thing triggers something in me.”

Last fall, Rasho was arrested again, so he’s now back in the prison system.

Mills says the situation in Illinois shows that lawsuits don’t always solve the problems — at least not right away.

“A court order is great, but it’s a piece of paper,” he says. “It’s not actually treatment.”

The orders from U.S. District Judge Michael Mihm continue.

Days before Christmas, he ordered Illinois’ prison agency to correct widespread deficiencies. He gave the agency until March to hire enough mental health staff to provide adequate care to all inmates who need it.

The post Most Inmates With Mental Illness Still Wait For Decent Care appeared first on Reach Out Recovery.

A Gut Feeling For Mental Health

From Science Daily:

The first population-level study on the link between gut bacteria and mental health identifies specific gut bacteria linked to depression and provides evidence that a wide range of gut bacteria can produce neuroactive compounds. Jeroen Raes (VIB-KU Leuven) and his team published these results today in the scientific journal Nature Microbiology.

In their manuscript entitled ‘The neuroactive potential of the human gut microbiota in quality of life and depression’ Jeroen Raes and his team studied the relation between gut bacteria and quality of life and depression. The authors combined faecal microbiome data with general practitioner diagnoses of depression from 1,054 individuals enrolled in the Flemish Gut Flora Project. They identified specific groups of microorganisms that positively or negatively correlated with mental health. The authors found that two bacterial genera, Coprococcus and Dialister, were consistently depleted in individuals with depression, regardless of antidepressant treatment. The results were validated in an independent cohort of 1,063 individuals from the Dutch LifeLinesDEEP cohort and in a cohort of clinically depressed patients at the University Hospitals Leuven, Belgium.

Prof Jeroen Raes (VIB-KU Leuven): ‘The relationship between gut microbial metabolism and mental health is a controversial topic in microbiome research. The notion that microbial metabolites can interact with our brain — and thus behaviour and feelings — is intriguing, but gut microbiome-brain communication has mostly been explored in animal models, with human research lagging behind. In our population-level study we identified several groups of bacteria that co-varied with human depression and quality of life across populations.’

Previously, Prof Raes and his team identified a microbial community constellation or enterotype characterized by low microbial count and biodiversity that was observed to be more prevalent among Crohn’s disease patients. In their current study, they surprisingly found a similar community type to be linked to depression and reduced quality of life.

Prof Jeroen Raes (VIB-KU Leuven): ‘This finding adds more evidence pointing to the potentially dysbiotic nature of the Bacteroides2 enterotype we identified earlier. Apparently, microbial communities that can be linked to intestinal inflammation and reduced wellbeing share a set of common features.’

The authors also created a computational technique allowing the identification of gut bacteria that could potentially interact with the human nervous system. They studied genomes of more than 500 bacteria isolated from the human gastrointestinal tract in their ability to produce a set of neuroactive compounds, assembling the first catalogue of neuroactivity of gut species. Some bacteria were found to carry a broad range of these functions.

Mireia Valles-Colomer (VIB-KU Leuven): ‘Many neuroactive compounds are produced in the human gut. We wanted to see which gut microbes could participate in producing, degrading, or modifying these molecules. Our toolbox not only allows to identify the different bacteria that could play a role in mental health conditions, but also the mechanisms potentially involved in this interaction with the host. For example, we found that the ability of microorganisms to produce DOPAC, a metabolite of the human neurotransmitter dopamine, was associated with better mental quality of life.’

These findings resulted from bioinformatics analyses and will need to be confirmed experimentally, however, they will help direct and accelerate future human microbiome-brain research.

Jeroen Raes and his team are now preparing another sampling round of the Flemish Gut Flora Project that is going to start next spring, five years after the first sampling effort.

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What Should You Eat The Day After The Super Bowl?

From USA Today:

The Monday after the Super Bowl, some people will wake up with a hangover and regret for eating buckets of high-calorie foods. 

That’s because aside from football, food is a star player as 79 percent of watchers plan to buy food and drinks while glued to their screens Feb. 3, the National Retail Federation reports. Americans are expected to down more than 1.3 billion chicken wings, most dipping them in Ranch, according to the National Chicken Council. They’ll likely pair that with a few slices of pizza and wash it all down with beer, according to survey data cited by Pizza Hut.

So, after what the U.S. Department of Agriculture once called the second biggest day for eating in America, Monday is a time to detox. 

Here’s what nutrition experts recommend a day after overeating and drinking:

Get rid of leftovers

Those who hosted a Super Bowl party (as about 44 million people do) should send leftovers home with guests, registered dietician and spokesperson for the Academy of Nutrition & Dietetics Julie Stefanski told USA TODAY. 

“Don’t let one day of enjoyment turn into three (or more) days of overindulging,” Stefanski said.

Take time to eat a healthy breakfast 

Monday after game day isn’t the day to skip breakfast. Go for something hearty: Eggs, which contain vitamin D, are a good source of protein. A whole grain carbohydrate like a whole grain bread or muffin, healthy source of fat like avocado or nuts, vegetables (maybe in an omelet) and fruit could all be part of the mix, Dr. Donald Hensrud, Mayo Clinic Healthy Living Program and editor of the Mayo Clinic Diet, tells USA TODAY.

If you’re worried about having little time before your morning commute (hypothetically, say you oversleep), prepare overnight oats or chia pudding before the game, Stefanski said. Topping that with some fruit in the morning for additional fiber, taste and vitamins is enough to kickstart your day of detox, she said. 

Coffee or juice?

First, drink water. Lots of it. Hydration is key to recovering from a night of overindulging. Avoid citrus juices like orange juice, Hensrud said, because the acid could irritate stomachs. He said simple coffee drinks without too much sugar and cream are OK to provide an energy boost, but might not be best for everyone because of heartburn.

Have soup for lunch

Go for a brothy vegetable soup for lunch, Stefanski recommends. This will also help your digestive system recover from all of that buffalo sauce, she said.

“The fluid and sodium can help rehydrate and combat fatigue caused by dehydration,” she said. 

Say yes to whole veggies and fruits

Incorporate vegetables in the cruciferous family, including broccoli, cauliflower, Brussels sprouts and cabbage, into your day, Stefanski said, as they will support a natural detox. Antioxidants, like those found in strawberries, also help repair damage from alcoholic drinks, she said.

“Alcohol is a stressor, especially for our liver. As we break alcohol down, along with the other food we’ve eaten, it’s important to eat whole foods, like fruits and vegetables, which naturally help our body process the excess waste and chemicals our bodies don’t need.”

Pro tip for planners

Reading this ahead of the game? Experts say have a plan for how much alcohol you want to consume during Super Bowl festivities. Also, eat a balanced meal and drink plenty of water earlier in the day. Lastly, alternate drinks with water throughout the night. This all will help avoid that dreaded hangover.

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How To Talk To Your Boss About Your Mental Health (While Maintaining Credibility)

From MindBodyGreen.com

I’ll admit that many years ago, I’d be somewhat reticent strategizing with clients on having mental health conversations. I’d be worried about the possible stigma, especially since depression and anxiety weren’t discussed publicly and were usually seen as a sign of mental instability. Today, the culture has changed. Organizations are increasingly investing in staff well-being, making it far less taboo to openly talk about mental health at work.

Unfortunately, blanket well-being programs aren’t always effectiveand sometimes feel more about ticking HR KPIs than actually helping employees have better mental health. Often, these programs can be clichéd and feel like another thing added to our growing to-do lists, and the wrong mandated activities, even when well-intentioned, can actually make some people feel worse.

We need to evolve corporate cultures by making the conversation about mental fitness proactive and a two-way street. Feel-good group activities can be nice, but they don’t help employees who are actually struggling with mental health figure out how to balance their needs with their work—much less how to talk about them with their managers.

First of all, know that you have permission to take care of your mental fitness and have these important conversations. If you’re noticing that your mental health is affecting your work, talk to your boss about creating a game plan that better supports your needs and also allows you to perform well and effectively manage your responsibilities. Ultimately, you are helping yourself and your organization.

Here’s the truth: Good workers prioritize their mental health.

Why?

1. By honoring your mental fitness, you’re buying time back.

My type-A clients tell me they have no time. But when we crunch the numbers, they realize they spend at least three hours worrying every day, and it hits them how a simple three-breath meditation can reset their fear center, helping them make wiser decisions. This way, they buy back time. Taking time out to rejuvenate is not only healthier but objectively a faster process than crashing into a painful and long-drawn-out forced recovery from your anxiety and panic attacks.

Moreover, burnout can lead to learned helplessness and hopelessness, especially if you experience similar episodes regularly. Learning how to rejuvenate, you teach yourself that you are in charge of your mental fitness and can master the curveballs that life throws at you.

2. It creates a positive, productive work environment. 

The person who goes to work with the flu infects others, negatively affecting the bottom line. Similarly, emotions are contagious. Be around grounded people who feel good about life, and you’re likely to catch on. The same goes for negative emotions— it’s a vicious circle down the rabbit hole of pessimism and anxiety. Picture the last time you started your day feeling anxious or down—you likely saw the world through a negative filter and therefore reacted to life in the same way, which made you feel worse. You might have trouble sleeping that night and wake up feeling depleted. In cognitive behavioral therapy, we call it learning to be aware of how our perceptions may sometimes bias the way we interact with the world. If taking a mental health day can reset how you feel, then it creates a virtuous cycle internally and with the people in your circle.

3. If you’re a leader or manager, it sets a good example for your team.

Humans are social creatures; we learn by watching each other, even if we’re unaware of that happening. As leaders or managers, if we set the example of proactively taking care of our mental fitness, then we inspire our team and subordinates to do the same. You send this message that you don’t have to break down in order to break through.

4. It’s human to have ups and downs.

Often, people quip that they feel alone in their experiences. When we give them a label, such as “anxiety” or “panic attacks,” they start realizing that others have the same experience and feel less like a special snowflake condemned to a lifetime of feeling like they are breaking down. The label also separates the experiences from the person—you feel anxiety, but that doesn’t make you an anxious person unless you decide that’s part of your identity. Moreover, this helps you realize that there are ways to solve the problem and use your darkest periods to make you stronger. In other words, your experiences can either continue to cost you or pay you dividends. I often tell my clients this nugget of wisdom from a lecturer—that if you have not experienced some form of anxiety or depression by the time you are in your late 20s, then you are not living fully in this complex world. Therefore, it is not a badge of honor to say you have been free of mental health difficulties your entire life. Instead, you should be proud of how you have risen through, like the mythical Hydra who grows three heads when you cut off one.

5. Rest enhances your well-being and performance.

Downtime makes many of us feel as though we cannot justify our existence. We mistakenly perceive it as twiddling our thumbs and doing “nothing.” In reality, rest can be about doing lighter tasks instead. Famously, Darwin worked four hours a day, and as I tell my clients, “If it’s good enough for Darwin, it’s good enough for you.” Research has also shown that rest is mandatory for the most talented and valuable workers in any organization because they are likeliest to experience burnout. To make it optimal, they should be high in relaxation, control, and mental detachment.

How to have a conversation about mental health with your boss.

If your current work environment, pace, or responsibilities are in conflict with your mental health, you can and should talk to your boss about it. I get that having a conversation about your mental health with your boss is distressing and can make you feel vulnerable, but recognize that soldiering through your difficulties leaves both you and your employer worse off. It’s often the times in which we expect ourselves to simply push through that are actually the times when we need some time out.

Knowing how important it is for employees to prioritize their mental health, here’s exactly how to have that conversation with your boss in a way that shows you’re seeking to take care of yourself and your work:

1. Select the right setting.

Make sure to choose the right place, time, and mood. Block out an appropriate time and place with your boss. You’ll also want to ensure you feel sufficiently confident when you walk into the meeting; consider preparing yourself beforehand by writing a script, visualizing yourself doing it, and doing a “power pose” in the bathroom to reduce cortisol levels.

2. Own your experiences.

Tell your boss you’ve not been feeling as mentally strong lately, sharing briefly on the cause and triggers. Be confident but also honest. Owning your struggles demonstrates that you’re taking responsibility, and being vulnerable helps you connect as a human being. After all, your boss has likely had their fair share of ups and downs, too.

3. Get scientific.

Give your boss the facts about burnout. Specifically, that performance and well-being aren’t a zero-sum game. Most people think that you can either perform well or have high levels of well-being—that’s analogous to the dangerous myth that to be successful, you must be high-strung and sleep little. This plummets us down the rabbit hole of burning out. Working under these conditions is what leads to presenteeism—where employees show up for work but don’t perform at full capacity—which costs 10 times more than absenteeism. When you approach your mental health and productivity strategy from a performance angle, however, things change.

Tell your boss you’d like to create a strategy that ensures that you rest and recover and that’s tailored toward balancing your specific needs, lifestyle, and personality type with your specific work responsibilities and goals. In this way, your performance is sustained over time without having to burn out periodically. And because your lifestyle and work habits are optimized, you also enjoy the benefits of higher levels of well-being. The ultimate win-win.

4. Demonstrate your proactiveness.

Tell your boss your plan on reclaiming and enhancing your mental fitness—for instance, who you are hiring to help you and what you intend to do to address both the root and the symptoms. You could even ask if HR could provide some support. Don’t worry if your plan is brief—you’re not expected to come up with a 10-page comprehensive proposal. The point is that you are demonstrating proactiveness and a commitment to accountability.

You want to show how your request—whether that’s for a break, a schedule or workload adjustment, more flexible deadlines, or any other accommodation you have in mind—will actually benefit both your health and your productivity, which is what’s best for your employer in the long run as well. Demonstrate that you’re thinking about the company’s needs as you’re thinking about your own and assure them that your request will have no adverse effects on their bottom lines—in fact, it may even help them improve.

5. Be confident.

There is no shame in having conversations around your mental fitness or taking breaks. What you are doing is being the master of your life and head. You’re creating a life of sustained performance and authenticity, and that’s best for both you and everyone around you.

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Opioid Maker Considered Profiting Off Addiction Treatment

From The Boston Herald:

As the nation’s opioid crisis was deepening, the company that makes a powerful prescription painkiller considered marketing an anti-addiction drug to “an attractive market” of people with addictions, according to allegations in court documents made public Thursday.

The attorney general’s office in Massachusetts is suing Connecticut-based Purdue Pharma, along with some company executives and members of the family that owns it in an effort to hold them accountable for the toll of the drug crisis in the state.

On Thursday, the company lost a legal battle to keep some parts of the lawsuit confidential. The state made public for the first time a wholly unredacted version of the complaint it filed last year.

The newly public allegations portray Purdue as trying to profit off a crisis that it helped spark by having its sales force tell doctors that the prescription painkiller OxyContin had a low addiction risk.

The suit from Massachusetts is one of more than 1,000 by state and local governments pending against Purdue. A federal judge in Cleveland overseeing lawsuits filed in federal court is pushing for a settlement aimed at stemming the crisis.

Most of the lawsuits name multiple defendants in addition to Purdue, including other drug manufacturers, distributors or pharmacies. The Massachusetts case focuses solely Purdue and the family that runs it, the Sacklers.

It also is the first to make public many of the specific claims alleging that Purdue sought to profit from a crisis that has exploded since OxyContin came on the market more than 20 years ago.

Health officials say nearly 48,000 overdose deaths in the U.S. in 2017 involved some type of opioid, including illicit drugs.

Purdue said the lawsuit is taking pieces of company documents out of context.

“Massachusetts seeks to publicly vilify Purdue, its executives, employees and directors while unfairly undermining the important work we have taken to address the opioid addiction crisis,” the company said in a statement.

According to the lawsuit, the company in 2014 and 2015 considered selling suboxone, a drug used to treat addiction: “It is an attractive market,” an internal memo read, according to the suit. “Large unmet need for vulnerable, underserved and stigmatized patient population suffering from substance abuse, dependence and addiction.”

Purdue said in the statement that it was doing due diligence on buying rights to the anti-addiction drug, which was already on the market. Purdue never went into the suboxone business.

Years later, it was still looking for ways to profit from the crisis, according to the filing. In 2017, it considered selling naloxone, a drug that reverses overdoses.

Other claims revealed Thursday from company documents assert that members of the Sackler family paid themselves more than $4 billion from 2007 through last year and that they worked with McKinsey, a drug distribution company, to find ways to increase sales of opioids as authorities cracked down on pharmacies that made illegitimate sales.

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