Depression Thwarts Attempts to Quit Smoking

By RICK NAUERT PHD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on January 3, 2011


New research suggests diagnosed or undiagnosed depression can hinder an individual’s efforts to stop smoking.

In the study, published in the January 2011 edition of the American Journal of Preventive Medicine. scientists determined approximately 24 percent of surveyed callers to the California Smokers’ Helpline currently suffered from major depression and 17 percent of callers had mild depression.

Over half the surveyed callers, depressed or not, made at least one attempt to quit after calling the helpline.

At the two-month mark, however, the success rate of those with major depression was much lower than that of mildly depressed or non-depressed callers. Nearly one in five callers with major depression reported success, but of others, nearly one in three was able to remain smoke-free.

Most quit-lines do not assess smokers for depression, even though mild depression already is known to reduce the success of quitting. This study suggests that major depression reduces the success rate even farther.

That is important because the California quit-line receives a high number of calls from heavy smokers and smokers on Medicaid – two circumstances associated with depression. Since more than 400,000 smokers call U.S. quit-lines every year, the authors believe that up to 100,000 depressed smokers nationally are not getting the targeted treatment they need.

“Assessing for depression can predict if a smoker will quit successfully, but the assessment would be more valuable if it were linked to services,” said lead study author Kiandra Hebert, Ph.D., of the University of California at San Diego.

Hebert said an integrated health care model is a potential solution. Depressed smokers could have better quitting success if they receive services that address both issues. Quit-lines, which are extremely popular, are in a good position to offer such services to a large number of depressed smokers and to pass on the services they develop to quit-lines across the country.

Treatment programs, including quit-lines, report that a growing number of callers have other disorders, such as depression, said Wendy Bjornson, co-director of the Oregon Health & Science University Smoking Cessation Center, who was not involved in the study.

“The results of this study are important. They show the scope of the problem and point to the need for protocols that can lead to better outcomes.”

Source: Health Behavior News Service

Addiction during the holidays: Recovered or not, it’s important to be prepared

by Adi Jaffe


The holidays are a stressful time for everyone. Between gift-giving, travel, and keeping up with all parts of the ever-complicated modern family unit, nearly anyone can find themselves driven towards the nearest coping mechanism, whatever that may be. However, for recovering addicts, or those still struggling with an active addiction, the holidays can be a particularly troubling season that can invite a destructive relapse. As with all mental and physical health issues, education and awareness are a powerful first line of defense. By going over some of the most frequently asked questions about addiction and the holidays, we can attempt to shed some light on these issues for addicts and their families to help combat them before, not after, they become bigger problems (like a relapse).

Why Are The Holidays So Difficult For Addicts?

Obviously, as just mentioned, the pressures of the holidays are difficult for everyone. But for addicts, these same issues of money, family and general stress are amplified, often because they are the same age-old issues that lie at the root of the addiction and the beginning of drug use and abuse in the first place. If the recovering addict has not had the opportunity to openly confront family issues in the past, either with the family itself or with a therapist or counselor, the potential for relapse can be great. A vast amount of research shows how stress can bring even long-dormant behavior back to the surface, which should serve as a warning to substance and behavioral addicts alike (like sex addicts or compulsive gamblers). On the other end of the spectrum, addicts without a stable family or group of friends are often left feeling alone and isolated during the holidays, another powerful source of the shame and boredom that can drive addictive behavior.

What Are Some Of  The Hidden Struggles That Can Intensify Addiction/Trigger A Relapse?

Most often, these struggles emerge from one of two likely scenarios. In the event of a still active addiction, attempts to hide the problem from friends and family and the resulting stress can, paradoxically, intensify the addictive behavior. And whether the addiction has been treated or not, gathering with family in a familiar place can frequently cause someone to face many of the underlying issues that can be the root causes of a drug addiction or compulsive behavior. To paraphrase Tolstoy, all unhappy families are unhappy in their own unique way, and whether one’s particular family is overly judgmental, enabling, angry, or whatever else, it can serve to restart self-destructive patterns of behavior. For some recovering addicts, there may be a family-imposed secrecy around the recovery itself, which can be trying at a time when the whole family is gathering, ostensibly to celebrate one another. Even the house (including the room where an addict used to act out) and certain family members (like that cousin they used to smoke weed with) can be important cues that may re-trigger cravings and old behavioral patterns. Additionally and importantly, if there is a family history of any kind of past abuse, this can obviously serve as a particularly powerful and insidious trigger for addicts, whether recovering or not. In fact, recent research suggests that these old, root stimuli may be much more powerful for drug addicts than re-experiencing the drug itself.

What Are Some Strategies For Surviving The Holidays?

First and foremost, one must be prepared. Since most people at least know and are aware of the potential issues that might arise within their own families, it is crucial not to try to “wing it.” If you know that your family is going to be asking lots of uncomfortable questions, practice some appropriate answers and don’t feel obligated to discuss any aspect of your recovery that you’re not comfortable discussing. If your family is overly focused on achievement or likes to bring up stories from the past that are triggering or shameful, rehearse your reactions to them. If you have a friend or significant someone who can help, do a little role-play trying out different answers and see how they feel as you actually say them out loud. It will never be exactly the same as you practice, but being prepared can go a long way towards taming the body and brain’s natural stress responses. Just as importantly, if you know you’re liable to encounter events or people that formerly facilitated addictive behavior, role play those likely scenarios and know how you plan on turning down or avoiding those substances or behaviors. For instance, figure out how exactly you’re going to tell your cousin you aren’t going to smoke in the basement with him before you have to actually do it. It will sound a lot less forced and strange the second time around and you will have already experienced some of the associated anxiety. If you’re going to be alone, make distinct plans for your activities and do the best you can to find healthy situations to participate in, even if they seem new or slightly uncomfortable at first. For instance, go ahead and join that group of strangers for a Christmas eve dinner or Christmas day movie instead of spending those times along. After all, uncomfortable or not, a new, healthy experience will be vastly preferable to sliding back into the same old destructive patterns of the past.

Should I Use New Years To Confront My Addiction?

Most everyone is familiar with the New Year’s Resolution as a method of planning major life changes. Of course, most everyone is also familiar with the limited success rate of these resolutions, and of the effectiveness of “going cold turkey” in general. Depending on the addiction, there are certainly things that individuals can do to help themselves- for example, research suggests that when trying to quit smoking setting a quit date and beginning to use replacement patches or supplements in anticipation of that date (in other words, while still smoking) can help reduce the amount of smoking while approaching that quit date, making it easier when the day finally arrives. If you’re planning to quit a “harder” drug than nicotine, you may want to set a whole schedule for reducing drug use prior to the quit date itself. The important thing is to be completely realistic in order for the change to stick. If you’re drinking a bottle of vodka a day, attempting to go completely dry within a week can be extremely dangerous to your health, and will not likely result in a permanent change. Once again, education and preparation are key. Prepare for any sort of quitting by looking online on sites like AllAboutAddiction and WebMD, and identify the medical and psychological issues that are likely to accompany your attempt. Look to see if your problem is one that you can handle alone, or if it is recommended that a doctor help you with the process. Remember that your goal should be lifetime change, not a temporary one. Though it might seem counter-intuitive, if your holidays promise to be especially difficult or stressful, you may want to hold off on trying to quit during them and look at them as a time to lay the groundwork for your post New Year quit attempt rather than going for a full on cold turkey try. Such pragmatism may well help you achieve your true goal.

Popping a Pill Can Help Some Alcoholics Curb Drinking

ScienceDaily (Dec. 16, 2010)


A little-used medication can help treat alcoholism, an updated review of studies confirms. At any given time, about 5 percent of the population suffers from an addiction to alcohol, often with devastating consequences to work, family, friends and health. Twelve-step programs have been the mainstay for helping alcoholics to quit drinking, but a significant number of people who try these programs do not find them helpful or suffer relapses.

The Cochrane review finds that the medication naltrexone — brand names are Depade and ReVia — when combined with counseling or interventions like Alcoholics Anonymous, can help cut the risk of heavy drinking in patients who are dependent on alcohol.

Naltrexone works by blocking the pleasurable feelings, or “high,” a person gets from drinking alcohol, thereby reducing motivation to drink. Naltrexone can be taken daily as a pill and is available as a long-acting injection.

The review was published by the Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

“Hundreds of drugs have been tried for relapse prevention [in alcoholism] and basically all others have failed,” said Michael Soyka, M.D., senior author of the review. “From a clinical point of view, there are few pharmacologic options for the treatment of alcohol dependence, so it is important to study those options that look promising.” Soyka and lead review author Suanne Roesner are associated with the psychiatric hospital at the University of Munich.

Alcohol dependence is different from alcohol abuse or misuse. The symptoms of alcohol dependence include craving for alcohol, an inability to control drinking, the presence of withdrawal symptoms if one tries to quit and tolerance — the need to increase alcohol amounts to feel the same effect. People who only abuse alcohol and are not dependent on it have no trouble controlling their drinking, once they decide to do so.

Soyka and colleagues examined the results of 50 previously published high-quality studies on naltrexone and alcohol dependence. Overall, the studies enrolled nearly 7,800 patients diagnosed with alcohol dependence. Of these, about 4,200 patients took naltrexone or a similar drug called nalmefene. The rest of the patients took a placebo or had some other type of treatment. Treatment with naltrexone ranged from four weeks to a year, with most patients receiving about 12 weeks of treatment. Most patients also received counseling.

Researchers found that patients who received naltrexone were 17 percent less likely to return to heavy drinking than were patients who received a placebo treatment. “That would mean that naltrexone can be expected to prevent heavy drinking in one out of eight patients who would otherwise have returned to a heavy drinking pattern,” Soyka said.

Naltrexone also increased the number of people who were able to stay abstinent by 4 percent.

While at first glance that might not seem like a miracle cure for alcoholism, Soyka said that the effectiveness of naltrexone is on par with medications used for other psychiatric conditions.

“Naltrexone is moderately effective in reducing alcohol intake. It’s about as effective as antidepressants in depressive disorders,” he said. “From a safety point of view, there are few safety concerns. Nausea is the most frequent side effect.”

Carlton Erickson, Ph.D., director of the Addiction Science Research and Education Center at the University of Texas in Austin, says naltrexone can help a person with alcohol dependence move toward the goal of abstinence.

“Anytime you reduce the severity of drinking, the individual is more open to treatment for abstinence,” he said. “It’s almost like putting them through a series of steps if you can get them to cut down; once they start to cut down they are more likely to become abstinent with continued treatment and continued exposure to 12-step programs.” Erickson is not associated with the review or any of its authors.

Despite its possible benefits in treating alcohol dependency, naltrexone is not widely used in the United States or elsewhere, Erickson said. Some addiction specialists fear that the widespread use of naltrexone or other medications will result in patients not receiving the counseling or psychological interventions they need.

There is also a lingering attitude that the treatment of alcohol dependency must rely solely on psychological or spiritual methods.

“People in 12-step programs typically don’t believe in medications for the treatment of alcoholism,” Erickson said. “Therefore they are unlikely to accept anyone into their 12-step meetings who is on a medication like naltrexone. Secondly, they would not want to accept it for themselves, unless a physician talked them into it as part of their treatment plan.”

In addition, most large alcohol treatment centers, with the exception of Hazelden, do not advocate for the use of medications in the management of addiction, he said.

However, Erickson said that naltrexone is FDA-approved only as an adjunct to abstinence-based therapies, like Alcoholics Anonymous. “Naltrexone is not something you give to someone who says ‘I want to stop drinking, give me a pill.’ Naltrexone is only a helper to that process. The medication itself is not a magic bullet.”

The review discloses that two authors received speaker/consultancy/advisory board honoraria from pharmaceutical companies.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by Health Behavior News Service, part of the Center for Advancing Health. The original article was written by Katherine Kahn

Salvia: Miley Cyrus Brought This ‘It’ Drug Into the Spotlight, Is it Dangerous?

Adi Jaffe, Ph.D.

Posted: December 14, 2010 01:45 PM


It causes hallucinations and impairs coordination. The high is almost immediate when smoked. Within five minutes it causes uncontrollable laughter or panic.

While this could be a description for LSD or even marijuana, it can also be used to describe the new “it” drug, salvia. But there is one important difference to note — salvia is legal, at least for now.

Before last week, many people had never heard of the herbal drug salvia, let alone thought about smoking it recreationally. But a leaked video of pop princess Miley Cyrus changed all that, bringing salvia to the mainstream.

As early reports began circulating that there was a video of Miley smoking out of a bong, her camp immediately went on the defense stating that she wasn’t smoking marijuana, rather the herb salvia, which they stressed is legal in California.

Legal or not, the video has stirred up heavy controversy and left many parents wondering what exactly is salvia and whether it is something they need to worry about.

Salvia divinorum is a highly potent herb from the mint and sage families. But unlike its relatives, salvia’s leaves are sold as an alternative to marijuana because of the hallucinogenic effects it produces.

While the drug is currently legal in many of the states, Florida, Virginia and Illinois are among the 15 that have prohibited the substance.

In addition to controversy, the video has stirred up sales for the herbal drug. TMZ is reporting that salvia sales have surged since the release of the video last week.

This increased interest is causing several states, including California, to reconsider their stance on its legal status. Politicians, doctors and parents are concerned about the impact the video will have on kids and young adults, especially considering the accessibility of salvia. Because it is considered a legal substance, in some cases it can be easier for minors to buy salvia than cigarettes.

But again, simply because it’s legal doesn’t mean there isn’t cause for concern. Salvia is often compared to illegal drugs; it is smoked and has a similar appearance to marijuana, and brings on hallucinations, a similar effect to LSD. The high is intense but the trip is substantially shorter than that of other hallucinogens. Often the effects are gone within 20 minutes. Even with the relatively short trip time, the experience can be intense and even scary for some.

Unlike LSD and mushrooms, which act like serotonin, salvia acts through opioid receptors and even more specifically through Kappa opioid receptors. This is in contrast to the receptors that morphine and heroin act on. These receptors are responsible for the feelings of paranoia and anxiety that can lead to dysphoric effects like unease and depression. Despite the increased likelihood that negative side effects will be produced, not all users experience them and they are subject to the individual and dependent on the actual amount consumed.

The number of hits, as with other drugs, has been found to closely correlate with the amount of functionality problems exhibiting themselves in diction and fluency of movements.

The effect salvia has on an individual is subjective, but additional effects that have been tied to the drug include revisiting past memories, sensations of motion, visions of membranes, merging with or becoming objects and a sense of overlapping realities.

Although evidence seems to show that salvia use is relatively safe in the short-term, little is currently known about the long-term effects of salvia and studies are underway to find out if it holds any medicinal value. Studies are also being conducted to learn whether or not the drug holds any addictive properties.

But in the meantime, the medical community stresses caution, as there are still a lot of unknown variables with the drug and its effects, both short and long-term. What we do know is that salvia puts teenagers at high risk for a “bad” trip, which could mean anything from extreme anxiety attacks to sadness and depression. And while the high doesn’t last a significant period of time, the intensity is severe and can lead to severe reactions.

Importantly, the hallucinations and distortions of reality make one thing pretty clear — this drug should NEVER be tried when driving. As for Miley, it seems she has introduced salvia to a new following with her endorsement — so expect this drug to become increasingly popular in the coming months.

New CEUs: HIV, Eating Disorders and Addiction

The Science of Addiction
Standard CEU/NBCC CEU: 2
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This is a pamphlet published by the National Institute on Drug Abuse aimed at filling the knowledge gap about why people become addicted to drugs and how drugs change the brain to foster compulsive abuse.  It provides scientific information about addiction, including harmful consequences of abuse and basics on approaches to prevent and treat the disease.

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Standard CEU/NBCC CEU: 2
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