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The fat-burning heart-rate zone is a myth: How exercise and weight loss really work.

Fat-burning zone is a myth in weight loss, but calories do matter

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Drew Angerer / Getty Images

Scott Douglas

The Washington Post

If you’re the kind of exerciser who constantly checks your heart rate to ensure you’re in the fat-burning zone, you should stop. You’ll probably never meet your weight-loss goals that way. That’s because there’s no special fat-burning zone that’s key to getting lean. Here’s what you need to know about the myth and about the true relationship between exercise and weight loss.

Yes, we know. If you look at the wall charts or cardio equipment in a gym, or listen to many personal trainers, you’ll be indoctrinated about the “fat-burning zone.” The standard advice for getting in this zone is to workout at about 60 percent of your maximum heart rate. That level of exertion is relatively low intensity; most people can talk in complete sentences while exercising at it. Working in this zone, it’s said, will burn more fat and result in greater long-term weight loss, compared with doing the same exercise at higher intensities.

There’s substance to part of this claim. Your body primarily fuels itself by burning a mix of stored fat and carbohydrates. The less active you are at a given moment, the greater the percentage of that fuel mix comes from fat. As your intensity of activity increases, the percentage of carbohydrates in that fuel mix also increases. At rest, fat constitutes as much as 85 percent of calories burned. That figure shifts to about 70 percent at an easy walking pace. If you transition to a moderate-effort run, the mix becomes about 50 percent fat and 50 percent carbohydrates, and it moves increasingly toward carbohydrates the faster you go.

So it’s true that at some workout intensities, you’re burning a higher percentage of fat than at other intensities. But that doesn’t mean this biological process is the key to losing weight from exercise. Experts explain that those who believe in a lard-melting zone simply aren’t seeing the forest – i.e., what it really takes to lose weight – for the fat-burning trees. They’re forgetting about calories.

First, although it might sound better for weight loss to burn a higher percentage of fat, the real-world effect of that intensity on your body composition is next to nil. “The idea that all of a sudden when you hit this zone the fat is just being sucked out of your system is simplistic,” says Christopher Breen, an exercise physiologist and online coach in Long Island. “That completely ignores that losing or maintaining weight is basically a matter of calories in versus calories out.”

If the key determinant of weight loss were the percentage of fat you’re burning, then your best bet would be to remain still, because that’s when you’re burning the highest percentage of fat relative to carbohydrates. But, as Breen says, total calories burned is what matters, and that fact leads to the second big problem with the fat-burning zone.

“If you’re exercising at this lower intensity, you’re burning fewer calories per minute,” says Christine Brooks, a University of Florida adjunct instructor and the coaching science coordinator for USA Track & Field. “The average person walking for an hour is going to burn only a couple hundred calories.” In that time, you could burn more than twice as many calories running, cycling or using an elliptical machine at a moderate intensity.

Let’s be real: When you schedule a workout, you probably think in terms of time, not number of calories burned. So, in the likely scenario that you have 30 or 45 minutes for exercise before or after work, you’re just not going to burn that many calories if you spend that time in the would-be fat-burning zone. “I’m all for people being more active, but most aren’t going to regularly put in the time at a lower intensity to create a calorie deficit,” Brooks says.

Also, if you want to get all geeky, the math argues against the fat-burning zone. Walk two miles in an hour, and you’ll burn about 200 calories, with roughly 140 of them fueled by fat. Cycle moderately for that time, and you’ll burn about 500 calories, with roughly 250 of them fueled by fat – so you’ll burn more calories and more fat. “When I worked with people in a gym, I would tell them, ‘Ultimately, it’s a matter of calories; the fat burn will take care of itself,’ ” Breen says.

Another chit for more vigorous workouts: You get an after-burn effect. “You maintain a higher metabolic rate after higherintensity exercise,” Brooks says. “The reason is that more damage is being done to various systems, so you have an increased heart rate while the body is making its necessary repairs.”

“I have a real beef with the way this fat-burning idea is promoted,” Brooks says. “It’s a very strange way to talk about exercise.” She and Breen agree that the myth persists because it’s an easy concept to grasp. “It’s a way of making exercise machines more appealing – if I’m working at this speed, I’ll burn more fat than at another speed,” Breen says.

None of this is to suggest low-intensity exercise is a waste of time. Even the top athletes in the world regularly and purposefully workout at a light effort. A gentle jog or easy spin is a great way to clear your head, get reenergized, improve your health, spend time with friends and family, and, yes, burn some calories.

“Mix it up,” Breen says about structuring your workouts. “Have some harder, high-intensity days, followed by easier, low-intensity recovery days.” Also aim for different durations. When you have the time, do longer workouts at a comfortable level of effort. When you’re pressed for time, work a little harder. The table in our guide to heart-rate training will help you construct a well-rounded exercise program.

Variety in your workouts will keep you fresher physically and mentally than if you do the same thing day after day after day. That freshness will make it more likely that you exercise consistently. And that’s the zone that will result in long-term weight loss.

By Scott Douglas from The Washington Post

Douglas is a contributing writer for Runner’s World and the author of several books, including “Running Is My Therapy.”

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Juuling: The Addictive New Trend Teens Are Hiding

From Healthline.com: Here’s what you need to know about Juul, the e-cigarette brand that contains double the nicotine and is vaped from a device that looks like a USB drive.

Forty years ago, nearly 29 percent of high school seniors reported smoking cigarettes daily, according to the U.S. Department of Health and Human Services. By 2015, that number was at an all-time low of 5.5 percent.

The Centers for Disease Control and Prevention (CDC) reports a similar decline, with 4.3 percent fewer middle schoolers and 15.8 percent fewer high schoolers admitting to smoking cigarettes between 2011 and 2017.

However, as cigarette smoking seems to be on the decline, another method of nicotine use has managed to hook today’s youth.

The same CDC report that discussed the decline of cigarette use revealed an increase in vaping.

In 2017, 3.3 percent of middle schoolers reported using electronic cigarettes, and 11.7 percent of high schoolers reported the same.

“By their senior year, over 25 percent of high schoolers are current e-cigarette users,” Dr. Jonathan Winickoff, a pediatrician at Massachusetts General Hospital in Boston and member of the American Academy of Pediatrics (AAP) Section on Tobacco Control, told Healthline.

What Parents Need To Know About Juuling, The Vaping Device In Disguise

When it comes to tobacco use, cigarettes are considered a combusted or burned product. The cigarette has to be lit, the tobacco burned, and the smoke inhaled.

Vaping, on the other hand, involves no combustion or burning. Instead, vaping products release an aerosol that is inhaled.

While many people make the mistake of assuming this aerosol is as harmless as water vapor, it actually consists of fine particles containing toxic chemicals, many of which have been linked to cancer, as well as respiratory and heart diseases.

Vaping devices, which include e-cigarettes and vape pens, were first introduced to the commercial market in 2007. They typically have to be plugged in or powered by battery so a heating component can warm an e-liquid cartridge that then releases the aerosol to be inhaled in the lungs.

“A lot of these cartridges are actually marketed as health products,” Winickoff explained. “They have ‘healthy’ flavors, things like mango and berry that are associated with high antioxidants. But they’re just flavors. There are no actual health benefits.”

The CDC has found that these flavors are a big part of the reason teens are latching onto these products. Even worse, Winickoff told Healthline about a study where 60 percent of kids believed that pods used in Juuls (a specific brand of e-cigarette) were nicotine free — when the reality is that 99 percent of these products contain nicotine.

In 2018, Juuls accounted for about 40 percent of the e-cigarette market, grossing 150 million in retail sales the last quarter alone. The appeal of this product specifically is that they don’t look like e-cigarettes. Juuls are small, can be mistaken for a USB drive, and are easily concealed in a person’s hand.

In other words, this is a product teens are able to use more discreetly, without drawing as much attention from their parents and teachers.

With the introduction of Juuling, e-cigarette use among teens is on the rise. So much so that both Time and The Washington Post recently had reports on Juuling and what parents need to be aware of.

“These products are really creating a resurgence,” Winickoff said. “All the work that happened, all the public health campaigns, the billions of dollars spent to try to eliminate tobacco use for kids has been undone. Now we have millions of adolescents currently addicted to nicotine.”

The Risks

A large number of people believe e-cigarettes are simply a safer way to consume nicotine, and that nicotine isn’t harmful by itself. But that’s not true.

Research has found numerous negative impacts of nicotine alone: on metabolism, increased cancer risks and respiratory problems, as well as more asthma attacks and symptoms experienced by those who vape.

“We know based on Juul’s own published testing that these products contain carcinogens. Group 1 carcinogens — the most potent carcinogens known,” Winickoff revealed.

There’s also another risk that parents should be aware of when it comes to teens and e-cigarette use — the addiction may be harder to kick.

According to AAP, Juul pods contain nearly double the concentration of nicotine compared to other e-cigarette cartridges. This is especially concerning because the risk for addiction is already higher among teens.

Winickoff explained, “The younger the developing brain is exposed to nicotine, the stronger and more rapid the addiction. The earlier you become addicted, the harder it is to quit.”

But that’s not all. According to Winickoff, addiction to nicotine at a young age actually causes brain remodeling, changing the threshold for addiction to other substances.

In other words, kids who use nicotine earlier are more likely to fall in love with other drugs later on.

Tips For Talking To Kids Before They Start Vaping

The risks of Juuling and vaping for kids are real, making it all the more important for parents to begin addressing these issues before their children decide to try these products.

A licensed clinical psychologist from Connecticut, Dr. Elaine Ducharme, PhD, told Heathline, “Parents really need to start talking to their kids in elementary school about this issue.”

She offered these tips for engaging in those discussions:

Educate yourself first. Get the facts on these products so you know what you’re talking about when you approach the discussion with your kids.
Be a role model. Parents are responsible for shaping many of their children’s ideas and behaviors, so set the tone with your own actions.
Establish a safe environment where your kids can talk about their feelings and opinions without feeling judged.
Really listen and let them tell you what they know.
It can sometimes be helpful to give them something to read that you can then discuss together.
Help them figure out ways to handle situations where they may be pressured to engage in these behaviors.
Create a plan, even specific things for them to say like, “I have asthma and my doctor says I could become very ill if I try this,” or, “I just don’t think it looks cool.”
Help them understand that using willpower to stand up to peers is really hard, but willpower is like a muscle — the more you use it, the stronger it gets.

Winickoff had this to add, “What the research says about tobacco use, which we can apply to Juuling and vaping, is that parents expressing how they feel about these products — their strong negative opinions — actually can make a difference. Kids may protest, but they do internalize their parent’s belief system.”

Winickoff says this is true even if a parent uses the product themselves. Talking about the negatives of that product, and about how the addiction has taken hold and why parents can’t quit (even though they want to) can still send a strong message to teens about why they shouldn’t start.

What To Look For

While the legal age for purchasing these products is 18 in some states and 21 in others. Winickoff explained that many kids are ordering them online — simply checking a box to verify they are of legal age. For this reason, parents should pay attention to their teen’s online purchases and packages that may arrive in the mail.

Juul pods also look very similar to an average USB flash drive. Examine any questionable device closely.

Addressing A Real Problem

If you discover that your teen is already Juuling, Winickoff is clear that it’s important to recognize this as more than just a “bad habit.” It’s a medical problem that requires a major response from the family, the child’s pediatrician, and possibly a therapist to help get that teen out from under the nicotine addiction.

“It’s not easy to get kids to stop. Their body craves it. They need it just to get through the day. I can tell you from anecdotal experience just from my office, I’ve had a terrible time getting kids to give up electronic cigarettes. It’s that young brain and extra susceptibility. They’re locked in.”

Ducharme added, “If the situation seems out of control, it’s time to speak with a psychologist or other mental health professional trained in working with teens and addictions.”

Currently, there aren’t any addiction programs specifically geared toward teens and nicotine use, which makes prevention and enforcement of existing rules all the more important.

Winickoff recommends advocating for zero-tolerance policies in schools and tobacco-free zones around every school, middle grade through college. He also recommends parents get involved in the Tobacco 21 movement, which aims to increase the legal age for purchasing tobacco products to 21. So far, six states have adopted such laws.

With the help of active and informed parents, yours could be next.

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Children of Alcoholics Marry Young To…People With Drinking Problems

Children of parents who have alcohol use disorder are more likely to get married under the age of 25, less likely to get married later in life, and more likely to marry a person who has alcohol use disorder themselves, according to a new study by researchers at Virginia Commonwealth University and Lund University in Sweden.

“There are many pathways through which a parent’s alcohol problems can influence our own risk for alcohol problems. One important pathway, of course, has to do with the genes that parents pass to their children,” said the study’s lead author, Jessica E. Salvatore, Ph.D., an assistant professor in the Department of Psychology in the College of Humanities and Sciences at VCU. “But another important pathway, which we demonstrate here, is through the social environment.”

The study, “Parental Alcohol Use Disorder and Offspring Marital Outcomes,” was published in the most recent issue of the journal Addiction. It is based on data from legal, medical and pharmacy registries with detailed information on 1.17 million people in Sweden who were born between 1965 and 1975.

“Although there have been many studies along these lines in the past, there were some key methodological limitations to these prior studies, including the reliance on small samples,” Salvatore said. “We were able to leverage the Swedish national registries to look at these questions in a large sample of over 1 million people.”

The researchers set out to discover if alcohol use disorder (AUD) — which affects an estimated 16 million people in the United States — among parents would predict their adult offspring’s likelihood of marriage and marriage to a spouse with alcohol use disorder.

“We know from previous research that who you marry plays a big part in whether you develop an alcohol problem,” Salvatore said. “What we found in this study is that who you marry is not random — and, in fact, the people who are at greatest risk for developing an alcohol problem (because they have an affected parent) are most likely to end up with a spouse who is going to exacerbate this risk.”

Researchers found that parental alcohol use disorder is associated with a higher probability of marriage at younger ages, a lower probability of marriage at older ages and a higher likelihood of marriage to an affected spouse compared with no parental alcohol use disorder.

“In this case, we found that you do marry someone who is like your parents,” Salvatore said.

The researchers also found that most of these effects become stronger when the number of parents with alcohol use disorder increases from one to two. Most effects also held after statistically controlling for parents’ socioeconomic status, marital history, other externalizing disorders, and the offspring’s own alcohol use disorder status.

Additionally, daughters of affected mothers are more likely to have an affected spouse, the researchers found.

The researchers were interested in their findings because previous research has shown that forming and maintaining romantic relationships with “prosocial” spouses reduces one’s risk of developing alcohol use disorder.

“And what we find here is that people who are at risk of developing AUD (by virtue of growing up with an AUD-affected parent) are less likely to find themselves in these types of protective marital environments,” Salvatore said.

From a practical standpoint, she said, the study’s findings could be useful for clinicians and others who work with the offspring of parents with alcohol use disorder to raise awareness of how parental AUD can influence the types of social environments that can increase one’s risk for alcohol use disorder.

“There are large international organizations, like Al-Anon and Alateen, that are geared towards helping and supporting the family members, and in particular children of people affected by alcohol use disorders,” Salvatore said. “I think that there is a role for findings like ours as part of these types of family education programs. Specifically, becoming aware of how a parent’s alcohol problem might shape one’s own likelihood of ending up in the kind of marriage that will increase risk for alcohol problems may help people choose differently.”

Originally published by Science Daily

Story Source:

Materials provided by Virginia Commonwealth University. Note: Content may be edited for style and length.

Originally published by Health.com

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Pete Davidson & Kanye West: Mental Illness In The Limelight

From Joshua David Stern @ Mens’ Health: Pete Davidson on Saturday posted a troubling message on his since-deleted Instagram page that led to concerns about his well-being:

“i really don’t want to be on this earth anymore,” he wrote. “i’m doing my best to stay here for you but i actually don’t know how much longer i can last. all i’ve ever tried to do was help people. just remember i told you so.”

The note prompted a well-being check by police and an outpouring of support from other celebrities, including Davidson’s former fiancée, Ariana Grande. He was found accounted for on the set of Saturday Night Live and briefly appeared on that evening’s episode to introduce musical guest Miley Cyrus, but the note put mental health awareness and online bullying front and center.

As far as spectacle goes, the image of Kanye West embracing Donald Trump in the Oval Office this past October fell somewhere between the Krispy Kreme backflip Vine and the series finale of The Sopranos. It was confusing. It was compelling. It was unhinged. It was, in short, irresistible. The rapper’s widely broadcast ten-minute soliloquy was as rambling as it was enticing, touching on everything from male energy to Montessori to the 13th Amendment. West in the West Wing was the perfect storm of celebrity, power, and—for lack of a better word—content. You would not be alone if you periodically said, “Man, he’s crazy!” as you watched.

And you wouldn’t be wrong, either. In fact, you might be a little too right. West, who not too long ago discussed his diagnosis of bipolar disorder with the world, joins a list of celebrities who are open about their struggles with mental health and also struggle with their mental health openly. They include SNL’s Pete Davidson, who courageously (and hilariously) mined his borderline-personality-disorder diagnosis for material before engaging in a public, brief, and somewhat torrid love affair with Ariana Grande; Tesla cofounder Elon Musk, who tweeted about the corrosive effects of stress on his mental health even as he bore those out in a series of ill-advised (and possibly illegal) tweets about his company; and Roseanne Barr, who was diagnosed with dissociative identity disorder years before she sent a racist tweet in May that scotched her comeback show. Their struggles have played out in the white water of popular culture, and it’s been a crazy ride indeed.

But when used to describe a person, crazy is halfway between a common adjective and an informal diagnosis. Toss it out with little thought and it’s fun and flirty. Think about it more—what it really means, what’s really going on when we say it, and what’s going on with those we say it about—and the word becomes heavier and heavier.

For the millions of Americans who, like me, live with mental illness, crazy is a heartbreaking and terrifying reality. Living in the tide pools of sanity, I can confidently say that whatever glimpse of crazy you catch in public is vastly outstripped by the private suffering you’ll never see. That’s the suffering that rends the fabric of primary relationships, that barges into the cockpit of the self and messes with the dials; it’s a suffering that doesn’t care if you’ve got a blue verified badge on Twitter, a sitcom, Yeezys, or millions in the bank. If you know what that suffering is like, there’s no way to just sit and watch a public meltdown with popcorn.

But that’s not to say we should simply look away, change the channel, or fasten ourselves to a different trending hashtag. Any of these episodes can be an opportunity to spur a genuine and much-needed discussion about mental health. Granted, this is a whole lot less fun, and it pries open a can of morally slippery worms. Does the fact that Roseanne has been diagnosed with dissociative identity disorder absolve her of her racism? Does the fact that Kanye may be bipolar render his opinions about minorities invalid? This conversation becomes even more difficult in light of the silence of mental-health professionals, who, bound by what’s called the Goldwater rule, are barred from offering a professional opinion about the mental health of individuals they have not examined personally. Thus an illness goes unnamed and, in the silence, dangerous and dismissive confusion grows.

These incidents and others like them also provide an opportunity to develop empathy. You don’t have to suffer from mental illness like I do to have compassion for those who do. There’s a Buddhist practice, meant to foster loving-kindness for all creatures, in which one visualizes that all sentient beings were, at some point, your mother or will, at some point, become your mother. Now, you might have a complicated relationship with your mother—I know I do—and you might not believe in rebirth. But that way of thinking, of considering another person as a loved one, even for a second, is like catching a glimpse of a set of keys that fell into the sidewalk grate. It’s heartbreaking. It’s eye-opening.

Ultimately, no one can deny the brilliance of the sparks as someone—especially a high-profile someone—runs off the rails. Such a spectacle will never be ignored and probably shouldn’t be. But try not to marvel at the sparks and then ignore the passenger in danger. What’s there isn’t just a celebrity self-immolating but a person suffering, too. Take it from one who has also suffered. Crazy deserves our compassion, not just our clicks, and we owe it to ourselves to see through the spectacle to the human—on both sides of the screen.

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How Do You Recover After Millions Have Watched You Overdose?

From The New York Times:

The first time Kelmae Hemphill watched herself overdose, she sobbed. There she was in a shaky video filmed by her own heroin dealer, sprawled out on a New Jersey road while a stranger pounded on her chest. “Come on, girl,” someone pleaded.

Ms. Hemphill’s 11-year drug addiction, her criminal record, her struggles as a mother — they were now everybody’s business, splashed across the news and social media with a new genre of American horror film: the overdose video.

As opioid deaths have soared in recent years, police departments and strangers with cameras have started posting raw, uncensored images of drug users passed out with needles in their arms and babies in the back seats of their cars. The videos rack up millions of views and unleash avalanches of outrage. Then some other viral moment comes along, and the country clicks away.

But life is never the same for the people whose bleakest, most humiliating moments now live online forever. In interviews with The New York Times, they talked — some for the very first time — about the versions of themselves captured in the videos.

Ms. Hemphill’s mother watched the 2016 video of her overdose. Her friends saw it. Even her daughter, now 11, watched the images of Ms. Hemphill passed out beside a guardrail in West Deptford, N.J., her stomach exposed as the medics rushed in. “Why bother saving her?” asked one YouTube commenter. “I would’ve let her die,” said another.

“When you type my name in, that’s the first video that pops up — an overdose video,” Ms. Hemphill said.

A Public Way to Hit Bottom

Before the videos, Ms. Hemphill and other users shuffled unnoticed from the streets to rehab to jail and back in a cycle of use and arrests. Their anonymity disappeared afterward as news cameras showed up at their front doors and reporters attended their court dates on charges including drug possession and child endangerment.

Angry Facebook messages arrived months, even years, later, when strangers stumbled across the videos.

But for others, the viral attention also became their emergency flare. Rehab centers and drug counselors reached out, waived fees and helped them bypass waiting lists to get into treatment.

In October 2016, Ron Hiers and his wife, Carla, feeling despondent after years of addiction, had made a suicide pact to get high until they were dead, and ended up passed out by a bus stop in Memphis. A bystander live-streamed footage of the couple, and the video of them being mocked and laughed at was viewed by hundreds of thousands of people.

One of them was Mr. Hiers’s estranged daughter. Mr. Hiers, 62, said they had not spoken in months or years, but his daughter told him that she had been in touch with a rehab facility that was willing to give him the treatment he needed.

For some, the public shaming was a new way to hit bottom.

“If that video never happened, I probably would have never went to treatment at all,” Ms. Hemphill, 28, said.

A Florida drug treatment center offered to pay her fees, and Ms. Hemphill flew down and stayed for a month. But she felt as if she was just playing a part in a news media narrative about addiction and recovery. As soon as she returned home to New Jersey, she got high again.

“I didn’t want to be clean,” she said. “I was doing it for the news.”

She enrolled in a long-term treatment center in Newark, and then moved to a halfway house, where people smoke crack and shoot up in a park across the street. She says she has no desire to join them, and has not used in nearly a year.

Addiction experts say the videos are doing little else than publicly shaming drug users, and the blunt horror of the images may actually increase the stigma against them. Users themselves disagree on whether the humiliation helped them clean up their lives.

“We’re showing you this video of them at the worst, most humiliating moment of their life,” said Daniel Raymond, deputy director of policy and planning at the Harm Reduction Coalition, an advocacy group. “The intent is not to help these people. The intent is to use them as an object lesson by scapegoating them.”

But police departments say they are simply trying to reveal the brutal reality of what they see every day.

The sheriff’s office in Volusia County, Fla., posted a video of two adults passed out in the front seat of their car, with a sweating, hungry baby boy strapped into the back seat. In Macomb County, Mich., the sheriff’s office created a video that played a Demi Lovato ballad over body-camera footage of deputies reviving people in their living rooms.

‘You’re a Spectacle’

In Lawrence, Mass., a former mill town at the heart of New England’s opioid crisis, the police chief released a particularly gut-wrenching video. It showed a mother who had collapsed from a fentanyl overdose sprawled out in the toy aisle of a Family Dollar while her sobbing 2-year-old daughter tugged at her arm.

“It’s heartbreaking,” James Fitzpatrick, who was the Lawrence police chief at the time, told reporters in September 2016. “This is definitely evidence that shows what addiction can do to someone.”

Mandy McGowan, 38, knows that. She was the mother unconscious in that video, the woman who became known as the “Dollar Store Junkie.” But she said the video showed only a few terrible frames of a complicated life.

As a child, she said, she was sexually molested. She survived relationships with men who beat her. She barely graduated from high school.

She said her addiction to opioids began after she had neck surgery in 2006 for a condition that causes spasms and intense pain. Her neurologist prescribed a menu of strong painkillers including OxyContin, Percocet and fentanyl patches.

As a teenager, Ms. McGowan had smoked marijuana and taken mushrooms and ecstasy. But she always steered clear of heroin, she said, thinking it was for junkies, for people living in alleys. But her friends were using it, and over the last decade, she sometimes joined them.

She tried to break her habit by buying Suboxone — a medication used to treat addiction — on the street. But the Suboxone often ran out, and she turned to heroin to tide her over.

On Sept. 18, 2016, a friend came to Ms. McGowan’s house in Salem, N.H., and offered her a hit of fentanyl, a deadly synthetic painkiller 50 times more potent than heroin. They sniffed a line and drove to the Family Dollar across the state line in Lawrence, where Ms. McGowan collapsed with her daughter beside her. At least two people in the store recorded the scene on their cellphones.

Medics revived her and took her to the hospital, where child welfare officials took custody of her daughter, and the police charged Ms. McGowan with child neglect and endangerment. (She eventually pleaded guilty to both and was sentenced to probation.) Two days later, the video of her overdose was published by The Eagle-Tribune and was also released by the Lawrence police.

The video played in a loop on the local news, and vaulted onto CNN and Fox News, ricocheting across the web.

“For someone already dealing with her own demons, she now has to deal with public opinion, too,” said Matt Ganem, the executive director of the Banyan Treatment Center, about 15 miles north of Boston, which gave Ms. McGowan six months of free treatment after being contacted by intermediaries. “You’re a spectacle. Everyone is watching.”

Ms. McGowan had only seen snippets of the video on the news. But two months later, she watched the whole thing. She felt sick with regret.

“I see it, and I’m like, I was a piece of freaking [expletive],” she said. “That was me in active use. It’s not who I am today.”

But she also wondered: Why didn’t anyone help her daughter? She was furious that bystanders seemed to feel they had license to gawk and record instead of comforting her screaming child.

“I know what I did, and I can’t change it,” she said. “I live with that guilt every single day. But it’s also wrong to take video and not help.”

Nobody recorded the chaos that unfolded next. After Ms. McGowan was released from treatment, the father of her daughter died of an overdose. Two months later, that man’s 19-year-old son also died of an overdose.

Reeling, Ms. McGowan had a night of relapse with alcohol. She checked herself into treatment the next day. But at the same time, she had stopped reporting to her probation officer, a violation of parole that led to 64 days in jail. She was kicked out of a halfway house and stayed briefly at a shelter. She said she was raped this year. She checked herself into a hospital psychiatric ward for five weeks.

Ms. McGowan finally felt ready to start actively rebuilding her life. This spring, she moved to a halfway house in Boston, where her days were packed with appointments with counselors and clinicians, and meetings of Narcotics Anonymous and Alcoholics Anonymous. She had weighed just 90 pounds when she overdosed; now she was happily above 140.Just after Thanksgiving she moved in with relatives, and now hopes to find a place of her own. Her treatment continues. If she stays sober and shows progress, the charges against her will be dropped in April.

She spends part of her day doing volunteer outreach along the open-air drug market in Boston known as Methadone Mile. One recent drizzly afternoon, as she made her way down the sidewalk, she hugged old friends, asked them whether they had eaten, if they were O.K. On her rounds, she picks up hundreds of used needles that carpet the streets.Mandy McGowan, 38, walked along “Methadone Mile” in Boston, picking up used drug needles. “It’s going to be a long road for me,” she said.

She writes letters to her two teenage sons, who live with her former husband in New Hampshire. Her daughter, now 4, lives with the girl’s uncle. Ms. McGowan knows she will probably not regain custody, but hopes to develop a relationship with her and supplant the image embedded in her own mind of the sobbing girl in the pink pajamas.

“I know if I do the right thing, I can be involved in her life,” Ms. McGowan said. “It’s going to be a long road for me. You don’t just get clean and your life is suddenly all put back together.”

Still, the video lives on, popping up online almost constantly.

Ms. McGowan is bracing herself for the day when her daughter sees it, when her daughter lashes out at her for it, when she throws it back in her mother’s face when Ms. McGowan tries to warn her not to use drugs.

“That video is PTSD for my children,” she said. “The questions are going to come as my daughter gets older. And I have to be prepared for it. I did this. And it cost me my children.”

Overdosing on TV

In October 2017, June Schweinhart and a friend snorted lines of heroin in a S.U.V. in Boynton Beach, Fla., and then began to pass out. Their infant children were strapped in the back seat when the police and paramedics showed up in a bank parking lot, body cameras rolling.

The women’s children were placed with relatives, and Ms. Schweinhart and her friend were each charged with child neglect. An officer told Ms. Schweinhart that the video of their overdoses would be on the news. She decided to watch.

“It looked like a whole different person,” Ms. Schweinhart said. “It was a reality check. Some people have different rock bottoms in their life and they get to the point where they just can’t do it anymore — that was it for me.”

She had been hiding her heroin use from her family and friends — even from people at her addiction-support group, who believed she was only abusing prescription painkillers.

Nobody had known. And suddenly, everybody knew.

People on Facebook sent her messages calling her an abusive mother for jeopardizing the life of her month-old daughter. They told her to just die. They asked: How could you do something like that?

Remembering the video, recalling the babies’ cries and watching the responding officer slip a pacifier into one of their mouths, Ms. Schweinhart did not have an answer.

“It made me sick to my stomach,” she said. “It still does.”

She said that every day was a battle with herself — the good June against the bad June — and she came to think of the video, with all its shame and humiliation, as a divine intervention to force her to get treatment and confront her addiction.

It didn’t proceed like a movie. She repeatedly struggled with the demands of drug court, failed a drug test and spent one night in jail. Last month, Ms. Schweinhart left the program.

She said she had been making progress and believed she could beat the child-neglect charge if she could tell a jury the story about what happened after the one that millions had already seen. Or she could plead out.

Either way, she felt she had nothing left to hide.

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Can Psychology Apps Help the Health System?

With greater pressure placed on public health systems—due to increased life expectancy and poor life-style choices—governments are turning to technology to ease the burden. Many leaders have suggested that utilising digital technologies may be a way forward. New research shows that such platforms benefit psychological support for health behaviours, but that it’s also important to assess potential risk. Will the harms outweigh the benefits?

Recently, a behaviors research study conducted by Apple Watch suggested that exercise behaviors could be increased by participants using an app on a smartwatch.1  The app monitored their activity, and, if they reached utilizing exercise goals, they did not have to pay a monthly fee for the smartwatch.  In fact, those participants who used the app exercised significantly more than those who did not.  The increased level of exercise attributed to the use of the app, and its motivation to exercise, was said to be the equivalent of an extra two years of life.  The study seems to be a reasonable one, and this is good news for the innovative use of a platform to deliver a reward-based system.

The UK Minister for health, Matt Hancock, seems to agree1: “We’re better off and healthier because of technological progress…That’s why I believe in tech…and I’m optimistic that with the right tools in the NHS we can improve people’s lives by improving people’s health.”1

So far, so good.  However, there are a number of issues that we should think carefully about before adding exercise apps to the list of potential positives to arise from digital technology, and further strengthen the hand of those who believe that this is the future of health care.

We should remember that the reward system employed in this study was essentially one motivated by negative reinforcement; participants were rewarded for avoiding something nasty.  In this case, the participants who reached their exercise targets were not charged money.  It has long been known, since Skinner’s analysis of punishment, that this form of aversive control will eventually lead to negative emotions, and to attempts to counter-control the controller.3  The easiest way to counter-control in this instance is simply to not sign up for the monthly fees that come with the watch—by far the easiest way to save the money in the first place!

Of course, it can be countered that there are many other apps that also come with fees, not just the exercise monitor, and exercising buys you access to these apps for free.  However, herein lies the real potential problem.  What are the effects of all of those other apps on the person’s psychological and physical health?

There is increasing evidence that over-use of digital technologies such as smartphones can be detrimental to people’s mental and physical health.  Some studies have shown a link between over-use of digital technology and harmful effects on the immune system, such as that published by myself and colleagues in PLOS ONE in 2015,4 and others have shown that overuse of such technology is associated with poor lifestyle choices (bad diet, poor sleep).5  How these negative influences interact with the benefits of exercise remains to be seen. 

Leaving aside the direct problematic effects of such technology on health, many other studies have suggested a clear link between mental health concerns and the over-use of digital technology.  Ultimately, it is this association that may be the most troubling for the use of smartwatch apps, and the like, to promote health.  The more we promote people using their apps, then the more likely we are to see a rise in such mental health problems.  If we are talking in terms of life expectancy, then an equally good study as the Apple Watch study, charting the benefits of smartwatch exercise apps, was conducted by Chesney, Goodwin, and Fazel and published in 2014 in World Psychiatry.  This study found that depression can take 11 years off a person’s life expectancy—just as much as smoking.  Indeed, all mental health problems negatively impact life expectancy.  So, in the context of a digital exercise app, a possible 2 years gained for a possible 11 years lost doesn’t seem like a good deal by any standards.

Now, here are the imponderables.  How many people get the benefit, and how many get the harms?  How do these multiple impacts interact with one another—does the exercise rush overcome the depressive tendencies, or does the depression swamp the motivation to exercise?  Can we more clearly identify the ‘whos’ and ‘whys’ associated with these benefits and harms?

Until the answers to these questions emerge more clearly, then it may well be prudent to refrain from a headlong rush into digital health care.  For all we know, it’s like saying nicotine improves your attention, so here, have a cigarette!

From Psychology Today

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4 Ways Alcohol Can Trash Your Holidays

Haven’t we all been to that holiday party where a coworker or family member drank too much, tried to ride the inflatable lawn ornaments and hit on Santa? 

Well, if you haven’t yet, its probably coming. Research shows alcohol use during the holidays spikes, starting with Thanksgiving and continues until New Years Day. According to research by the Caron Center (a national substance treatment center):

16% of adults will drink more than their usual during the holidays22% have felt pressured to drink at a work party.A staggering 96% admitted to going to work hungover after a holiday party, or knew someone who did.

End of year celebrations frequently have alcohol present or even encourage it. Work parties can be seen as sanctioned times to drink with your boss during the day. At least 53% of families report alcohol plays a significant role in their holiday celebrations.

So what are the risks of making the season merry and bright?

1. Financial: Money talks. A surprising amount can be spent on alcohol during the weeks from Thanksgiving to New Years. A new survey by OnePoll/Morning Recovery found that Americans double their alcohol intake during the holidays. This adds up to on average $537 spent on socializing during the week from Thanksgiving through New Years versus an average of $241 per month the rest of the year.

The cost can be higher for companies and employers. In the same survey, adults called in sick at least twice during the Christmas holidays due to alcohol use, with a reported average of 3 ‘rough mornings’ per week after drinking. An additional 7 out of 10 admitted to lower productivity at work during this same period.

2. Brain effects: Alcohol initially acts as a stimulant, with the user generally feeling relaxed, happy and excited. At a higher level, alcohol inhibits the prefrontal cortex, which is the ‘brake’ of the brain. Taking that brake offline can cause out of character, impulsiveand aggressive behaviors. At even higher levels, slurred speech, impaired coordination and sedation occur. Some report blackouts, which is not loss of consciousness but loss of memory formation. The person may be speaking and walking but will not create any memories during this time period. Extremely heavy, long term alcohol use can cause  permanent memory loss and brain injury, which can be seen on brain imaging. 

3. Social Embarrassment: Self explanatory given what happens in the brain. No one can ‘unsee’ your antics with the Xerox machine or the hot mess you started with Mrs. Claus. A #metoo moment fueled by alcohol can be even more sinister to your career and family relationships.

4. Relapse: The holidays can be particularly hard on those who are struggling with addiction. The end of the year is considered a time to reflect, celebrate and enjoy friends and family. This puts a lot of pressure on those with addiction to join the celebrations. “Having just one” is a certain path to relapse. Additional pressure comes with holidays in general; stress, grieving and isolation are all too common triggers for relapse.

So given all this, you must be asking, can I have any fun and still do the safe thing? 

Answer: Yes! Here are 5 strategies to avoid total carnage:

1. Know safe limits: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has published guidelines on safe drinking: No more than one drink an hour and no more than 4 drinks per day for men and 3 drinks per day for women. 

2. Measure your drinks: You will be surprised to know that 5 ounces of wine is a standard drink, as is 12 ounces of beer and 1.5 ounces of hard liquor. That means that large wine glass full to the brim probably equals closer to 2 and a half glasses, not one.

3. Ignore the myths: Coffee does not ‘sober you up’. It just makes you more alert while you are drunk. Instead of that cup of joe, try water, and lots of it. In fact, space your drinks with water between to avoid a rapid increase in your blood alcohol level.

4. Eat: Make sure to eat something before you go to a party and eat while you are there. Never drink on an empty stomach; this will spike your blood alcohol levels and accelerate brain effects.

5. Watch out for your family and friends: Be aware of others who are more vulnerable with alcohol. This includes those in recovery, women and teens.  Alcohol can be dangerous or fatal for these folks.

The holiday season can be joyous. Be smart to make sure yours is safe as well.

From Psychology Today

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Boys Need Better Access To Mental Health Care. Why Aren’t They Getting It?

From NBC News:

“If you can’t turn to someone in your life and say how you are really feeling, then you’re only going to end up hurting yourself somehow down the road.”

Throughout high school, Alexander Sanchez was severely depressed. He thought about suicide, and he didn’t know how to explain what was wrong or ask for help. Instead, Sanchez said that whenever he wasn’t in school, he would lie in bed all day, “not eating, not being happy, being almost not there.”

It wasn’t until Sanchez, who grew up in College Station, Texas, got to college that a friend convinced him to see a psychologist, who diagnosed him with depression. In hindsight, Sanchez said he did not reach out for help sooner because he believed that men should be self-reliant— an idea he believes he picked up from Tom Cruise and other macho characters on TV and in movies.

“I think I had really internalized this emotional stoicism that I know I was supposed to have,” said Sanchez, 21, who is now a senior studying psychology at New York University.

Mental health has become a crisis among America’s youth, and experts say the unique challenges and needs of young men are not receiving enough attention. Doctors, teachers and family members may not recognize the symptoms of depression, which in men can include anger, irritability and aggressiveness, according to the National Institute of Mental Health. Men are also less likely than women to “recognize, talk about and seek treatment” for depression, which is sometimes stereotyped as a women’s problem, the agency said.

While teenage girls attempt suicide more often than teenage boys, according to the American Foundation for Suicide Prevention, boys are more likely to die by suicide. Suicide rates for teenage boys and girls rose steadily from 2007 to 2015. In 2015, there were 1,537 suicides documented for boys ages 15 to 19 and 524 for girls, according for the Centers for Disease Control and Prevention. 

Boys see seeking help as “a sign of weakness,” said Dennis Barbour, president of the Partnership for Male Youth, a group of organizations that focus on the health of young men.

Compounding the issue, almost half of adolescents with mental health issues don’t receive care, according to a 2016 report from the federal Substance Abuse and Mental Health Services Administration. The report, which looked at data from 17,000 adolescents ages 12 to 17, also found that girls were more likely than boys to receive mental health care in both schools and medical settings.

Around puberty, girls typically begin to see a gynecologist, who may spot mental health issues and refer them to other services, Barbour said. He said teenage boys tend to see doctors less frequently, particularly if they no longer see a pediatrician.

“In terms of depression, they don’t usually have a place for health care,” Barbour said of boys, “so that any depressive symptoms can be overlooked, even by parents.”

DIFFICULTY ACKNOWLEDGING DEPRESSION

When Sanchez was in high school, his mother, Jennifer Sanchez, 46, a bookkeeper, suspected something was wrong, but she couldn’t persuade him to talk to her about it.

“I’d sit there a lot,” she recalled, “just hoping he’d let me know anything.”

Sanchez said reaching out to adults, including his mother, was “complicated.” “I didn’t know how they would respond to something like mental health,” he said.

He was also unwilling to acknowledge his own depression, which he described as “a rock that wouldn’t move.”

“All that I’ve noticed is that men are only supposed to have anger,” he said, “but it really is kind of in direct contradiction to our nature as people.” 

A recent national survey commissioned by Plan International, a global network of organizations focused on ending poverty, polled over 1,000 youth ages 10 to 19 and found that a third of boys thought society expects them to “be a man” and “suck it up” when they feel sad or scared. Another third said they believed they should “hide or suppress their feelings when they feel sad or scared.” About half of boys polled said “they want to learn more about having the ‘right to feel any way you want.’”

After high school, Sanchez moved to New York to attend NYU. He suffered what he called a “major depressive episode” during his sophomore year, and saw a psychologist for the first time at the urging of a friend.

Sanchez said therapy helped him learn to identify difficult feelings, like hopelessness and guilt, and talk about them. He said he now speaks to his parents almost every day.

“Depression feels like a wave — everything is just completely clouding how you can articulate thoughts,” Sanchez said. “Being able to think through what I’m feeling, talking to my parents, telling them really exactly what’s going on, it’s been good for our relationship, and for them to be able to help me better.”

‘THEY HAVE TO DISCONNECT FROM THE CORE PART OF WHO THEY ARE’

Depression is on the rise across the U.S., and it is climbing fastest among teens and young adults, according to data from health insurance federation Blue Cross Blue Shield, based on 41 million health records. In 2016, 2.6 percent of children ages 12 to 17 were diagnosed with major depression — a 63 percent increase from three years earlier. While it’s not entirely clear why, some experts blame the rising influence of electronics and social media.

Social media plays a complicated role in the friendships of teenagers. According to the Pew Research Center, many American teens believe social media helps them feel more connected to friends, but six in 10said most of their daily interactions with friends were online rather than in person. Forty-one percent said the main reason they didn’t spend more face-to-face time with friends was that they had “too many other obligations.”

Young men may be shouldering the brunt of the despair associated with a lack of close friendships, according to Niobe Way, a professor of applied psychology at NYU and author of “Deep Secrets: Boys’ Friendships and the Crisis of Connection.” Over 15 years, Way conducted hundreds of interviews with teenage boys across the U.S. She found that 85 percent wanted close friendships with other boys, but typically stop forming these relationships around puberty. 

“To value relationships and emotional intimacy is to so-called ‘not be a boy’ or ‘not be a man,’ and so they have to disconnect from the core part of who they are,” Way said.

Adam Neville’s mother brought him to Mount Sinai’s Adolescent Health Center in New York when he was 14 because he had difficulty communicating his emotions, with “unexplained outbursts of crying,” he recalled.

Neville, now 16, said he didn’t feel “at all” comfortable talking about his feelings with others, particularly his friends.

“With my counselor it’s different because it’s literally what that relationship is for,” Neville said. “That’s a little bit different, but in all of my personal life relationships, it’s very difficult to ask for help, and the idea that I have to be or should be independent weighs on me constantly.”

“If you can’t turn to someone in your life and say how you are really feeling,” the high schooler added, “then you’re only going to end up hurting yourself somehow down the road.”

A SOLUTION: CONNECTION

When young men don’t get the help they need, the consequences can be devastating. Echoing the suicide pattern for boys and girls, men are about 3.5 times more likely to die by suicide than women, though women are more likely to attempt suicide.

Earlier this year, the American Academy of Pediatrics updated its guidelines on depression to urge that all teenagers be screened for symptoms by their pediatricians.

But Barbour said few guidelines exist in the U.S. to help parents, educators and clinicians understand young men’s needs, so the Partnership for Male Youth is working to fill the void. The organization created a guide for health providers that details boys’ unique needs around health, including how they may express mental health issues.

“The fact is that very little work has been done to develop practical solutions for young men and mental health issues, including depression,” Barbour said. 

One solution, according to Way, is for adults to encourage kids to connect — especially boys.

Way and her colleagues created “The Listening Project,” which aims to build connections among seventh-graders in New York City’s public schools.

Under the program, students are trained to interview their peers to “enhance listening, challenge stereotypes, build relationships, and foster a greater sense of humanity,” according to a press release.

“As they’re being trained, what I’m really doing is nurturing their natural capacities to connect,” Way said, noting that America’s education system typically doesn’t foster these types of skills.

The program began in 2014 at George Jackson Academy, an all-boys school in New York, and has since expanded to six co-ed middle schools in the city, with two more joining in the spring. Teachers are trained to make the program a permanent part of their curriculums. Way hopes to bring the grant-funded effort to other states as well, but it’s not yet clear when.

Sanchez, a student of Way’s at NYU, said he no longer thinks “being a man” is about stoicism or self-reliance — noting that both men and women need to express their feelings and reach out to others to be mentally healthy.

“I think it’s less about what it means to be a man,” Sanchez reflected, “and more what it means to be human.”

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‘Ben Is Back’ Writer-Director Peter Hedges on Why the Drug Addiction Drama Hits Close to Home

This story about Peter Hedges and “Ben Is Back” first appeared in the Actors/Directors/Screenwriters issue of TheWrap’s Oscar magazine. 

In “Ben Is Back,” writer-director Peter Hedges tells the story of one day in the life of a family whose oldest son has been battling an opioid addiction. Fresh from a stint in rehab, Ben Burns (Hedges’ real-life son Lucas) makes an unexpected appearance at his family’s house for Christmas, leading his mother (Julia Roberts) on a descent into the drug underworld to help save him. 

“I come from a family that has been ravaged by alcoholism,” Hedges said. “But more recently, a good friend overdosed and died, my favorite actor ever [Philip Seymour Hoffman] overdosed and died and a family member nearly died.

“This was untenable loss, so I started exploring why heroin and opioids were impacting so many many people I love. And it’s happening to people everywhere in America. I knew I wanted to write about the epidemic in a very personal way.” 

Most films about addiction show us the course of the disease, the ups and downs, the rehabs and relapses. But in “Ben Is Back,” those stories come out in passing as Ben and his mother struggle through a nightmarish Christmas night in which his past comes back to haunt them.

“The epidemic itself felt way too big to take on,” Hedges said. “But I felt that I could explore one family over the course of one day — and if I did that in a truthful way, I could perhaps explore many aspects of the epidemic in a very intimate way. And for anyone in recovery, ‘one day at a time’ is a mantra.”

Hedges thought about other films he liked, including Thomas Vinterberg’s 1998 drama “The Celebration,” which were set over the course of a single day or a weekend. “I love films that take place over a short period of time, and I feel that those films are in our cinematic DNA,” he said. “But I hadn’t seen an addiction story told over a short period like that.”

For Hedges, it was also important that Ben be in rehab when the film starts, not in the throes of addiction. “I liked that Ben had some recovery when the story starts, that he was beginning to do well,” he said. “From the research I did and the people in my life, I know that in those early days of recovery, people are vulnerable to ‘the pink cloud,’ the feeling that everything’s OK.”

And the writer-director wanted to show glimpses of happier times, to find lighter notes before “Ben Is Back” plunges into darkness. “Part of what makes the epidemic so tragic is that really remarkable people are transformed by the drugs,” he said. “So getting a sense of what life would be like without the disease also gives you a sense of how damaging it is.

“And that’s been my own experience: Many of the most remarkable people I know are in recovery, and they’re vital and dynamic and funny and full of life. I wanted that to be evident in the story, I wanted to feel the love in the family, the potential they have for a full life together.” 

But the love in the family also has a dark undercurrent — because while they want to believe that Ben is back in every sense of the world, they can’t really ever trust him no matter how desperately they want to believe him.

“I received tremendous help from a handful of people who have lived Ben’s life, and who challenged me on Ben’s truthfulness after they read the screenplay,” he said. “In my first draft, I believed everything Ben said. And they encouraged me to consider that while we may like to believe what he’s saying, he’s still sick and he is not always going to tell the truth.

“And that shifting question throughout the story — ‘Can I believe him?’ —  ended up adding enormous tension to the story, and actually reflects what people go through every day.”

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Eight Addiction Myths

Harm reduction treatments and strategies like long-term MAT and reducing painkiller prescriptions have been accepted across the board, from the AMA and the National Institute on Drug Abuse (NIDA) and other leading addiction-as-disease advocates to prominent harm reduction groups.

Yet these so-called harm reduction approaches have failed to stem the tide of drug deaths. Their failure is because they identify and address addiction as a brain disease to be treated medically. There is no sign that the failure of this perspective is causing or will cause any prevailing actors to change their thinking. They simply can’t.

In my recent presentations, I have begun by warning audiences that I will undercut all of their fundamental beliefs about addiction — but that if that prospect seemed alarming, they shouldn’t worry. They wouldn’t change their thinking no matter what evidence I presented, even if the consequences of their not doing so took the form of continuing spiraling drug death rates.

I began speaking in Galway before the Western (Ireland) Region Drug and Alcohol Task Force by establishing four criteria on which to decide the truths of addiction: common-sense logic, evidence, personal experience, and meaning. I then confronted eight myths about addiction imported largely from the U.S.

Myth I: Opioids Are the Lone Cause of Opioid Addiction

I asked the group of 180 people whether any of them had ever taken a painkiller. Virtually every person in the audience raised their hand. I then asked if any of them had become addicted. No one raised their hand.

“Isn’t that remarkable?” I asked. “Opioids are the sine qua non of addiction. Experts like Sam Quinones in his bestseller Dreamland detail how the opioid molecule envelops the receptors in the brain and nervous system, trapping even the most resilient people in addiction. Yet not one person here who was exposed to this molecule became addicted. WHY didn’t you become addicted?”

I got less of a response – none – than I had hoped for. I prodded further: “Isn’t the question of who becomes addicted, and under what circumstances, the fundamental question we need to ask? Do you have no ideas about why none of you became addicted?”

One man finally said, “I stopped taking the painkiller when my pain went away.”

“You mean people quit using painkillers when they no longer feel pain?” I reacted, with mock incredulity.

That was all I got. Later, my host at the conference, Liam O’Loughlin, told me over dinner how he had badly hurt his hand, but stopped taking the powerful opioid and anti-inflammatory he had been given after just three days. “I didn’t like becoming groggy at two in the afternoon.” In other words, he had other matters to attend to with which narcosis interfered, and therefore he wasn’t inclined to savor the drugs’ effects.

Back to my interacting with the audience, I asked, “So why, then, do you believe opioids are special agents of addiction to which everyone must succumb?  After all, not you nor anybody you know – if this audience is typical of your acquaintances – became addicted when they consumed an opioid.”

I offered the audience my one-word explanation for their resistance to opioid addiction – their “connectedness.” They had too many points of contact with life to allow them to sink under the drug’s effects; instead, they found ballast from the world around them to hold to their life course.

Myth II: People Can’t Quit Addictions On Their Own

I then asked the group to name the most difficult substance addiction to quit. They (correctly) shouted “tobacco” or “smoking.”

“Has anyone here quit smoking?”

From a third to 40 percent of the audience – 60 to 70 people – raised their hands.

“How many of you relied on a medical treatment – like Chantix or a nicotine gum or patch – to quit?”

Three or four people raised their hands – say five percent of quitters.

There was the usual grumbling that cigarettes are not “really” addictive, reversing decades of addictionology history because they aren’t mind-altering. In fact, on the evidence provided by the massive NESARC study of recovery from substance dependence, smoking was the least likely and slowest to remit:

Lifetime cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis, and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, 

“Given that smoking is the hardest substance addiction to quit, haven’t you just disproved in your own lives the two basic received opinions about addiction; first that opioids are irresistibly addictive, and in this instance that treatment is required to overcome addiction?”

Myth III: America is the Leading Edge in Thinking About and Dealing With Addiction

“The reason I ask these questions is that ideas you have about addiction, which come largely from America, control your thinking. Yet how well would you say that we in the U.S. are doing vis-a-vis addiction?”

I then presented the NIDA’s chart of drug deaths in America through 2017: As I summarized: ”Last year, deaths from every major class of drug peaked in the U.S.: that’s synthetic opioids, heroin, natural opioids, cocaine, and methamphetamine. In fact, they left out another major category of drug for which that was true: benzodiazepines.”

Myth IV: Pill-Pushing Is Still Causing the Current Drug Epidemic in America

“Why did this occur? Before answering that, please note that deaths began skyrocketing in 2012-13. Do you know what has happened to painkiller prescriptions since that time? They’ve plummeted.”

Three people then gave the same explanation for this unhalting rise in drug fatalities – the go-to-one in America – “drug companies are pushing pain pills and doctors are overprescribing them.”

I responded, skeptically, “Overprescription of opioids accounts for why the number of prescriptions has fallen dramatically, and yet drug deaths of all types have accelerated – really?”

Finally, one woman answered that people were turning to street drugs when they failed to get prescribed painkillers.

I answered that this was a logical and true answer, since getting drugs on the street was always more deadly than taking drugs under medical supervision. But I added that this was not a sufficient explanation for drug deaths due to everything from stimulants to the whole array of depressant-analgesic drugs rising in lockstep.

Myth V: Public Health and Addiction Groups Are Driven By Bottom-Line Success in Attacking Addiction

But return to my claim that no one would change their minds due to logic, evidence, experience, and the lack of efficacy of our efforts to curtail drug addiction and death, as indeed my audience wasn’t prepared to do.

So what of policy-makers? I quoted the head of the AMA’s task force on opioids, Dr. Patrice Harris.

Reckoning that between 2013 and 2017, there was a 22% decrease in opioid prescriptions nationwide, Dr. Harris noted that, “While this progress report shows physician leadership and action to help reverse the epidemic [by limiting prescriptions], more than 115 people in the United States die daily from an opioid-related cause.”

In other words, doctors were doing wonderfully, although opioid and other drug deaths continued to surge. The clear path forward based on Dr. Harris’s remarks was for physicians to redouble their efforts to curtail painkiller prescriptions.

How could I fault my audience for their unwillingness to accept logic, evidence, experience, and lack of efficacy as spurs to reconceive addiction and how we respond to it when the leading medical body in America refuses to do so?

Myth VI: All People Are Equally Susceptible to Drug Addiction

I then turned to a popular myth brought over to Ireland in a reverse migration: that addiction is “an equal opportunity destroyer.” This is the fantasy that the socioeconomically well-off become addicted to opioids as readily as the poor and disenfranchised do.

I cited a comprehensive study by West Virginia’s health commissioner, Dr. Rahul Gupta, who examined every drug fatality in his state, one that leads the country in opioid deaths by a wide margin.  Gupta found a shockingly prevalent template for such deaths: “If you’re a male between the ages of 35 to 54, with less than a high school education, you’re single and you’ve worked in a blue-collar industry, you pretty much are at a very, very high risk of overdosing.”

I asked the group what it meant that those dying were nearly always older rather than younger: “Are these fatalities due to drug overdose, which would be more likely for young and naive users? This profile instead tells us that those who are dying are isolated people on the underside of society who are suffering long declines in spiritual and physical health.”

In fact, other data sources have highlighted this deep association between drug deaths and social class and education, to wit: “deaths have grown increasingly more concentrated among those with lower levels of education, particularly among non-Hispanic whites.”

“Why,” I then asked, “do we insist on ignoring this profile? Because doing so allows us to believe the first myth, that drugs themselves cause addiction, which has the side advantage of removing for society any need to examine and to improve the conditions of the lives of people most susceptible to addiction and death. And, frankly, we don’t seem to care that much if these people die. We worry only about our own.”

The easy solution we seek instead of facing reality is to label addiction a medical problem. The one thing I and two distinguished speakers also presenting to the group – Dr. Shane Butler, sociology professor emeritus at Trinity University and Pauline McKeown, CEO of Coolmine TC in Dublin – were unified around was that any treatment for addiction must embody a holistic approach that attends to the human essentials of health, housing, purpose (as through education and work), and community. And it is these things that my online Life Process Program for addiction addresses.

By not doing so, and instead focusing on some imagined brain mechanism to account for addiction, one that neuroscience not only has failed to find but that research indicates cannot possibly exist, we have lost any chance of helping the most susceptible populations.

Myth VII: MAT is the Solution to Drug-Related Mortality

Which returns us to the subservience of even supposedly radical drug policy reformers who buy the medical model hook, line, and sinker – most notably in proposing MAT, medicine-assisted treatment, as a remedy for addiction. MAT replaces street opioids for illicit drug users with prescribed Suboxone, buprenorphine, or methadone.

And while it is true that people maintained medically on narcotics are less likely to die, this substitution in no way addresses their addictions, leaving them perpetually vulnerable to relapse and drug crises when they depart from their medical drug regimens.

In fact, drug reformers and mainstream agencies now argue that MAT would end our drug crisis were it not, they claim, for the unfortunate difficulty of administering MAT in rural settings. Nonetheless, according to a study of ten leading opioids, “prescription opioid use peaked in 2011 and has declined rapidly since then. . . But buprenorphine bucked the trend by being the only opioid that showed an increase.”

And it is the largest American cities — which are most thoroughly served with MAT options – that are experiencing the greatest rise in opioid deaths (in this case due to heroin and fentanyl, et al.), thus balancing the findings of Gupta and others that the opioid epidemic is concentrated in poor white regions of the U.S. With both vulnerable populations, black and white, dismal failure is the constant companion of our “best” efforts in the addiction field.

Myth VIII: A Medical Approach to Addiction is Effective Because it Removes Human Agency As a Factor

I ended my talk by noting, “Underlying a recovery model based on health, home, purpose and community – a model created through the Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) surveying mental health and addiction researchers — is the crucial, essential role of personal agency: ‘Recovery is person-driven. Self-determination and self-direction are the foundations for recovery as individuals define their own life goals and design their unique path(s) towards those goals.’”

And nothing refutes personal agency like the so-called medical model that addiction is a disease invading from outside the person, a point of view propounded for decades by the National Institute on Drug Abuse. Standing for the government position through Democratic and Republican administrations, the NIDA defines addiction “as a chronic, relapsing disorder characterized by compulsive drug seeking … It is considered a brain disorder.” This too is the view on which the leading drug reform organizations now base their own “best” practices, such as MAT. And no one in a power or policy advocacy position in the U.S. seems to notice, or care about, the negative consequences of this approach.

Contra the NIDA, addiction is a disorder of the lives and lived experience of human beings, the remedy for which is that people must develop a sense of personal agency within a supportive setting and community.  Unless and until we recognize and approach addiction in this light, we will never reverse its lethal hold on America and its most vulnerable citizens.

In the December 4 issue of NYRB, Harvard Medical School faculty and former editor-in-chief of NEJM, Marcia Angell, addressed America, “Opioid Nation.” Angell reviewed four books, Pain Killer, Dope Sick, American Overdose, and American Fix. She found all of them inadequate to the task of explaining America’s 2017 72,000 plus drug deaths – the first three because their “pill pusher” account (Myth IV) fails, and the fourth because it relies on the author’s addictive “disease” as an explanation. (Let it be noted that Angell is a critic of the pharmaceutical industry.)

Angell is especially concerned to refute the idea that drug availability, rather than the demand for drugs among disillusioned whites, is the cause of our epidemic (Myth VI). Instead, she believes “As long as this country tolerates the chasm between the rich and the poor, and fails even to pretend to provide for the most basic needs of our citizens, such as health care, education, and child care, some people will want to use drugs to escape.”

This is a critical insight that America misses – “to end the epidemic of deaths of despair, we need to target the sources of the despair.” But Angell too embodies many of the myths of addiction. She considers drug use itself – as universal as it is – to be the result of despair (Myth I). This is no truer than saying drinking alcohol, shopping, playing video games or using mobile phones, sex, or love are signs of despair.

Addiction, not its various manifestations in activities that may or may not be used addictively, is a sign of despair.

From Psychology Today

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