CASA, the Center for Alcohol and Substance Abuse at Columbia University, is acknowledged as the leader in research and education in alcoholism and other addictions. CASA reports that 40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs. That is more than the number of people with heart conditions, diabetes or cancer. Meanwhile, another 80 million Americans fall into the category of risky substance users, defined as those who are not addicted, but use tobacco, alcohol and other drugs in ways that threaten public health and safety.

CASA Columbia’s work for this report involved:
• A review of more than 7,000 publications
• Analyses of 5 national data sets
• Interviews with and suggestions from 176 leading experts in a broad range of fields relevant to the report
• Focus groups and a national general population survey of 1,303 adults about their attitudes and beliefs related to addiction and its treatment
• Two New York State surveys of addiction treatment providers
• An online survey of 1,142 members of professional associations involved in addiction care
• An online survey of 360 individuals with a history of addiction
• Analyses of state and federal governments’ and professional associations’ licensing and certification requirements for treatment providers
• A case study of addiction treatment in New York State and New York City 

This 5-year study found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment. 

Of those who do receive treatment, few receive anything that approximates evidence-based care. This compares with 70% to 80% of people with such diseases as high blood pressure and diabetes who do receive treatment. This report exposes the fact that most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat the disease, and most of those providing addiction care are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of effective treatments. Misunderstandings about the nature of addiction and the best ways to address it, as well as the disconnection of addiction medicine from mainstream medical practice, have undermined effective addiction treatment.

CASA Recommendations: The time has come for addiction medicine to be fully integrated into health care systems and medical practice. Health care providers, especially physicians, are our front line in disease prevention and treatment. They must understand the risk factors for addiction, screen for risky substance use and intervene when needed, and diagnose, treat and manage addiction just as they do all other diseases.

Other health care providers, including nurse practitioners, physician assistants, psychologists and social workers, are critical parts of the solution as well. We need national, evidence-based standards that stipulate who may provide addiction treatment, and core competencies for all health care providers integrated into their education and licensing requirements. We must regulate addiction treatment facilities and programs as health care providers and hold them accountable for treatment consistent with medical standards and proven practices.

Tags: drug abuse, alcoholism

From Huffington Post and Dr. Rick Nauert at PsychCentral:

Porn "addiction" has been a subject of considerable debate among psychologists and in pop culture. Some argue that porn encourages sexual violence and harms relationships. Others say it may have a place in a healthy sex life.

Describing someone as a porn addict may make for catchy headlines, but in reality, there is no strong scientific research that shows such addictions actually exist. Experts say that labeling the habit of frequently viewing images of a sexual nature only describes it as a form of pathology.

“Moreover, these labels ignore the positive benefits it may hold,” said David Ley, Ph.D., a clinical psychologist. Dr. Ley is the author of a review article about the so-called “pornography addiction model,” which is published in the journal Current Sexual Health Reports.

“Pornography addiction” is not included in the recently revised Diagnostic and Statistical Manual because of a lack of scientific data.

Ley said that fewer than two in every five research articles (37 percent) about high frequency sexual behavior describe it as being an addiction. And, only 27 percent (13 of 49) of articles on the subject contained actual data, while only one related psychophysiological study appeared in 2013. Ley’s review article also highlights the poor experimental designs, methodological rigor, and lack of model specification of most studies explaining the behavior.

All told, the research found very little evidence — if any at all — to support some of the purported negative side effects of porn “addiction.” There was no sign that use of pornography is connected to erectile dysfunction, or that it causes any changes to the brains of users.

New research suggests that there's one thing porn isn't, and that's addictive.

A large study from neuroscientists at UCLA found that when people are shown erotic images, the brain's normal addiction reactions are reversed. In the brain, porn "addiction" looks the opposite of addictions like cocaine, smoking cigarettes and gambling -- and therefore should be treated with different therapies.

Typically, addicts show increased brain reactions to the object of addiction. However, the new findings, which were published this week in the journal Biological Psychology, showed that people who struggled with excessive pornography consumption had decreased brain reactions when viewing porn.

For the study, researchers recruited 122 men and women. Some of them struggled to control their pornography use, while others watched porn but said they did not have any problems with their viewing habits. The participants viewed a variety of images -- some sexual, some non-sexual -- while their brain waves were monitored using electroencephalography technology.

Using EEG, the researchers measured late positive potential (LPP) in the brain, which reflects "the intensity of an emotional response," study co-author Dr. Dean Sabatinelli explained.

"This means that their brain was not sensitized to sexual images, which is important because every other substance and behavioral addiction show sensitization in the LPP," Dr. Nicole Prause, a neuroscientist at the university and the study's lead author, told The Huffington Post in an email.

Ley's article, titled "The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model," offers the following summary:

"The addiction model is rarely used to describe high-frequency use of visual sexual stimuli (VSS) in research, yet common in media and clinical practice. The theory and research behind ‘pornography addiction’ is hindered by poor experimental designs, limited methodological rigor, and lack of model specification. The history and limitations of addiction models are reviewed, including how VSS fails to meet standards of addiction. These include how VSS use can reduce health-risk behaviors. Proposed negative effects, including erectile problems, difficulty regulating sexual feelings, and neuroadaptations are discussed as non-pathological evidence of learning. Individuals reporting ‘addictive’ use of VSS could be better conceptualized by considering issues such as gender, sexual orientation, libido, desire for sensation, with internal and external conflicts influenced by religiosity and desire discrepancy. Since a large, lucrative industry has promised treatments for pornography addiction despite this poor evidence, scientific psychologists are called to declare the emperor (treatment industry) has no clothes (supporting evidence). When faced with such complaints, clinicians are encouraged to address behaviors without conjuring addiction labels."

Working families are having difficulty bearing the stress and strain of modern living, despite the many advances that make our lives (so we say) easier and better. The problem, according to a Pew Research study cited in the New York Times, is "the difficulty of balancing it all." The "stress gap" is also notable owing to the correlation with race and education. White college-educated parents are significantly more likely to say that balancing family life and the workplace is difficult. As more mothers have joined the workforce, the share of two-parent households in which both parents work full time now stands at 46%, up from 31% in 1970. At the same time, the share with a father who works full time and a mother who doesn’t work outside the home has declined considerably; 26% of two-parent households today fit this description, compared with 46% in 1970, according to the Pew Research Center analysis of Current Population Survey data.

Working mothers (60%) are somewhat more likely than fathers (52%) to say it’s difficult for them to balance work and family, and this is particularly the case for mothers who work full time. In fact, one-in-five full-time working moms say balancing the two is very difficult for them, compared with 12% of dads who work full time and 11% of moms who work part time.

Overall, relatively few working parents (9%) say parenting is stressful for them all of the time. But a significant share say that parenting is stressful all or most of the time, and that sentiment is much more common among parents who say they have difficulty balancing work and family life (32% compared with 15% of those who say achieving a work-life balance is not difficult for them). In addition, four-in-ten (39%) of those who say it is hard for them to balance their responsibilities at work and at home find being a parent tiring at least most of the time; of those who say it’s not difficult for them to strike a balance, 23% say being a parent is tiring at least most of the time.

Fifty-six percent of all working parents say the balancing act is difficult, and those who do are more likely to say that parenting is tiring and stressful, and less likely to find it always enjoyable and rewarding. For example, half of those who said the work-family balance was not difficult said parenting was enjoyable all the time, compared with 36 percent of those who said balance was difficult.

In her 1989 book The Second Shift, the sociologist Arlie Russell Hochschild described the double burden employed mothers face because they are also responsible for housework and child care. Last year she said that despite some changes in society, the workplace had not changed enough to alleviate the problems. In another widely praised book, All Joy and No Fun, the journalist Jennifer Senior described how little had improved: Working parents face similar stresses, but they are now exacerbated by the expectations of modern parenthood and shared by fathers, too.

Senior draws on the psychologist Daniel Kahneman’s distinction between the “experiencing self” that exists in the present moment and the “remembering self” that constructs a life’s narrative. “Our experiencing selves tell researchers that we prefer doing the dishes — or napping, or shopping, or answering emails — to spending time with our kids. But our remembering selves tell researchers that no one — and nothing — provides us with so much joy as our children. It may not be the happiness we live day to day, but it’s the happiness we think about, the happiness we summon and remember, the stuff that makes up our life-tales.” She talks about parents’ pride in their children, not only in their accomplishments but even in their basic development as human beings, their growth into kindness and generosity. “Kids may complicate our lives,” she writes. “But they also make them simpler. Children’s needs are so overwhelming, and their dependence on us so absolute, that it’s impossible to misread our moral obligation to them. We bind ourselves to those who need us most, and through caring for them, grow to love them, grow to delight in them, grow to marvel at who they are.”

Tags: psychiatry, Family Therapy

Dan Harris makes a really good point in this article from Mindfulness, one of my favorite journals. I've been practicing mindfulness for almost 30 years, and I've found the discipline extremely helpful. I'm a bit shy, however, in urging others to investigate mindfulness practice. Like many other fields of study (nutrition, psychology, education, psychiatry, religion, etc.) there are about as many ideas out there as there are people. Go to dinner with four or five fitness instructors or yoga practitioners from different "schools" and your hair may catch on fire. So it is with discussions of meditation and mindfulness.
Mindfulness is not simply sitting still in a chair with your eyes closed, nor is it necessarily connected with religion, although all sacred traditions are associated with the value of contemplative life, periods of silence, and centering prayer. Mindfulness is an experience, not a theory or an idea or concept. Mindfulness happens within ourselves, within the mind or—as some would say—within the spirit. Whatever we choose to call the experience, or however we define it, science clearly shows the benefit of mindfulness practices.

In his book Mindful Work, David Gelles (New York Times reporter) makes a good case for mindfulness: "One of the most surprising and promising trends in business today is the rise of mindfulness in the workplace. At first, the notion of yoga and meditation in the office seems like the province of Silicon Valley startups where employees bring their dogs to work and play football in the lobby. But in recent years, mindfulness has gone mainstream. Many of America’s largest companies, such as General Mills, Target, Google, and Aetna, have built extensive programs to foster mindful practices among their workers. This is because—as employees and employers are discovering, and psychologists and cognitive scientists have confirmed—mindfulness has tangible benefits. For workers, meditation lowers stress, increases mental focus, and alleviates depression. For companies, a more mindful workforce is more productive."

1. Don’t foist it on anyone
Nobody loves a noodge who is intent on telling you what’s wrong with you and what you have to do to fix it. While you may feel that someone who is telling you how stressed out they are would benefit from meditation, it’s better to bide your time and let them ask you about it. Resist the urge to gush about your new favorite thing.
An exception: There’s nothing wrong with suggesting it to your employer. It’s not as awkward to bring it up in an organizational context. You’re not really imposing on anyone. You can talk about the science, about how lots of successful organizations are using it (See David Gelles’ Mindful Work), and suggest someone to contact. If possible, it’s good to note that any successful mindfulness program must be voluntary.
2. It’s not about stopping thinking or clearing the mind
Lots of people have picked up the truly crazy idea that meditation somehow vacuums out your head and makes you into a brainless zombie. Let people know that it’s about focusing the mind, not blanking it out. Emphasize that it’s an inherent, innate ability, a skill, not a gauzy, zoned-out place to drift off to.
3. It’s not just another damn thing on a to-do list to not do
People are naturally afraid to take on yet another self-improvement project to feel guilty about. Their life probably has a few exercise machines they’re not using, books they’re not reading, and club memberships going unused. Let them know that there are lots of ways to fit meditation into their existing life, and that it might actually help them use time better.
4. Let them know it’s hard, but not too hard
There’s no point in blathering on about how simple and easy it is, because if someone tries it for even five minutes, one of their first thoughts will be, “I cannot do this.” Staying with your breath in the moment can just seem impossible. Let people know this, but let them know it does get better.
5. If you can tell someone is interested, find out why, and listen
There’s a great New Yorker cartoon where a woman tells her lunch companion, “I’ve only been gluten-free for a week, but I’m already really annoying.” The essence of proselytizing and preaching is talking at, not with, someone. It’s important to hear what someone has to say and be ready to learn. It also sends the authentic message that mindfulness is about being continually curious about the mind—your own and everyone else’s.
6. Remind them about what really is annoying: the ceaseless voice in your head
 When you talk about the nattering voice in the head, you get right into the heart of people’s internal lives, which they may or may not have considered before. If you point out that most of our internal dialogue is negative and self-referential, most people will recognize that in themselves. The notion of having a tool to better manage that will seem appealing.
7. Stick with what you know and be honest
What could hurt about telling someone here’s what I’ve done and what it’s done for me. It makes no promises and it allows you to have a real human discussion at eye level, rather than elevate yourself onto the pedestal of “great and learned meditator.”

Tags: meditation, mindfulness