By Joe Schrank
The night that Whitney Houston died, I received a frantic request from a stretched thin TV production intern asking if I could come on the air to comment. As an addiction specialist, I was eager throw my two cents into the pundit ring, so I put on a jacket and headed out the door. Not so fast, Joe! When I arrived on set, I was sternly warned by the producer not to suggest that she had died from drug use as, there was no coroner’s report at that point—and thus only speculation regarding the circumstances of her death.
“Why call me,” I thought, “if we weren’t going to be talking about the end game of addiction?” The point I would have made would have made reference to cancer. In my view, Houston had been in “stage IV” addiction for a long time and her death, while jarring, was not a surprise. But the producer was adamant that I not go there—and I was adamant that it was the only thing I had to say—and they never put me on the air. That Whitney Houston died of addictive disease was no less tragic than if she had died of any other disease, but the media insisted on dancing around the issue (at least in those early days), not wanting to speak ill of the dead. In my world, calling someone an addict is no more an insult than calling someone a diabetic. But in the broader culture, shame and judgment still hover over addiction. Have you ever read an obituary that stated the cause of death as acute alcoholism? Neither have I.
When the news hit that James Gandolfini had died last week, I was once again jarred but not surprised. There have been stage-whispered rumors about his abuse of alcohol and other drugs for years. And then there was The Gaslight, a meatpacking haunt where Gandolfini was known to hold court, often noticeably impaired and rumored to be doing coke in the bar’s downstairs VIP lounge.
The official autopsy report is that Gandolfini died of a heart attack. And the world mourns the loss of a beloved character, Tony Soprano. But little seems to be known about the inner demons that plagued the man who breathed life into the American icon. Addiction is often described as “four garbage cans and three lids.” Simply by looking at Gandolfini, we can see that he struggled with food, something that pesters many of us in recovery. And should the rumors regarding Gandolfini’s use of alcohol and other drugs be true, we can surmise that he had a very serious addiction problem, the Holy Trinity of the death by “heart attack”: cocaine for the razor focus when acting or staying out late partying, alcohol to relax and sleep, and food for a host of emotions beyond just meals. So why is it that we’re calling this a “heart attack?” It’s akin to saying it wasn’t the fall that killed him, but the sudden stop when he hit the ground.
If we continue to be dishonest about addiction in our culture, things are never going to really change. There was a time not long ago when families cited “cancer” for a death by AIDS. But that changed, the community and families demanded more, and the crisis got a whole lot better. It could be the same with addiction. “Beloved actor dies of heart failure after long battle with addictive disease.” Does it make his cultural contribution any less if he were an addict? Would you have enjoyed the Sopranos any less? Is this less of a painful legacy for his young son?
What the Hell’s Wrong with Don Draper?
Five psych experts offer their diagnoses and treatment plans. Though Don would surely have none of it.
BROOKLYN, NEW YORK 11249
Traditional therapy alone does not give us all of the tools required to help us succeed and thrive in our modern world. We have so much information, so many options for transforming ourselves, and so much intelligence yet it seems harder than ever to create a life of center, connection and meaning. First we must understand who and where we are in our lives and maybe something about how we got where we are today. That is what therapy usually focuses on. Next we need to decide where we want to go, what would make things better for us, what would have us thriving. Then, we need lots of practice and support for doing our lives differently, learning new perspectives, practices and tools that help us. Approximately 10% of this journey is about insight. Continuing on is about unwinding habits and beliefs that we may not know we have that keep us from being whole and happy with who we are. Equine therapy uses the very nature of the horse to help us identify and work through deeply held patterns on an energetic level.
Animals have much to teach us about authenticity, communication and leadership.Horses are particularly suited to helping us. As animals preyed upon in the wild, horses are sensitive and responsive to subtle shifts in their surroundings. As social creatures, they seek out connection and partnerships with other beings. Interactions with horses provide a non-judgmental mirror that reflects our blind spots so that we become conscious of behavior that once protected us but no longer serve us. This knowledge gives us the opportunity to rework these survival patterns , creating new and more effective and authentic ways of being. This experience often reveals hidden strengths and inner resources and lays down new neural pathways to powerful change. If we allow them, these magnificent creatures touch forgotten places in our hearts and reawaken our connection to a larger life force.
— Elizabeth S. Fagan, LCSW
CHICAGO — Among teenagers with substance abuse, those who also have social anxiety disorder are significantly more likely to start using marijuana at an earlier age than those without the anxiety disorder, new research shows.
Teenagers with social anxiety disorder, also known as social phobia, start using marijuana at a mean age of 10.6 years, an average of 2.2 years earlier than other adolescents with substance use disorders, according to a study conducted by investigators at Case Western Reserve University School of Medicine, Cleveland, Ohio.
“This finding surprised us,” said principal investigator Alexandra Wang, a third-year medical student at the university, in an interview with Medscape Medical News. “It shows we need to start earlier with prevention of drug and alcohol use and treatment of social phobia [in children].”
Wang presented the research as a scientific poster here at the American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference.
Which Comes First?
The researchers conducted the study to determine associations between anxiety disorders and substance use disorders, and which disorder started first in adolescents with this comorbidity.
The study included 195 youths (102 girls, 52%), aged 14 to 18 years, who met the current diagnosis of substance use disorder and had received medical detoxification if needed. Participants had no major health conditions requiring hospitalization.
Assessment involved semistructured interviews, medical chart review, and reports from the adolescent, parent, and clinician. Using the Mini–International Neuropsychiatric Interview, the investigators assessed the participants’ history of drug and alcohol use and their history of any of 3 anxiety disorders: social anxiety disorder, panic disorder, and agoraphobia. A clinician verified the participants’ recalled age at onset of symptoms or substance use in 83% of cases, according to the poster. Each participant received $25 for completing the interview.
The drug most often used was marijuana. Of the 195 participants, 92% had marijuana dependence, with a mean age at onset of use of 13 years, the investigators reported; 61% were alcohol dependent, having started to drink at 13.5 years on average.
Teenagers with either social anxiety disorder or panic disorder were significantly more likely to have marijuana dependence (for each, P < .01, logistic regression), Wang said. Both of these disorders reportedly were likelier to occur before marijuana dependence (P < .01).
Approximately 80% of adolescents with social anxiety disorder and 85% with panic disorder had symptoms of that disorder before the onset of their substance abuse, the poster data showed.
In addition, panic disorder tended to start before alcohol dependence (P < .05) and occurred in 75% of alcohol-dependent adolescents.
There was no clear pattern as to whether agoraphobia preceded or followed either marijuana use or the first drink, according to the authors.
The investigators also evaluated whether presence of substance abuse lowered the age at onset of an anxiety disorder, but they noted no significant difference.
Rule, Not the Exception
A limitation of the study, according to the research team, was that 128 (66%) of the particpants were juvenile offenders who had received court-referred treatment of their substance abuse. In their poster, the authors wrote that their findings might not generalize to a less severely addicted population.
Still, coinvestigator Christina Delos Reyes, MD, told Medscape Medical News that interventions to reduce social anxiety might help prevent adolescents’ marijuana use.
“We need to treat these young patients initially with nonpharmacologic means, such as cognitive behavioral therapy or mindfulness meditation,” said Dr. Delos Reyes, a psychiatrist specializing in addictions at University Hospitals Case Medical Center, in Cleveland.
Asked to comment by Medscape Medical News, Patrick Bordeaux, MD, a child and adolescent psychiatrist in Quebec, Canada, said it is well known that “comorbidities tend to be the rule in adolescents, not the exception.”
“Adolescents are more likely to have social and mental disorders that make them more likely to use drugs,” said Dr. Bordeaux, who was not involved with the study.
Grants from the National Institute on Alcohol Abuse and Alcoholism and from the John Templeton Foundation in West Conshohocken, Pennsylvania, partly funded this study. Alexandra Wang and Dr. Delos Reyes disclosed no relevant financial relationships.
American Society of Addiction Medicine (ASAM) 44th Annual Medical-Scientific Conference. Poster 4. Presented April 26, 2013.
Today’s ride was excellent!
1. Standing On The Shore – Empire Of The Sun
2. European Me – Johnny Marr
3. Dilly – Band Of Horses
4. Inner City Pressure – Flight of The Conchords
5. Battle of Who Could Care Less – Ben Folds Five
6. There’s A Silence – Electric Soft Parade
7. Right Here, Right Now – Fatboy Slim
8. Stacy’s Mom – Fountains of Wayne
9. Do You Want To – Franz Ferdinand
10. Baby Got Back – Jonathan Coulton
11. California Gurls – Katy Perry
12. Dashboard – Modest Mouse
Posted: 07 May 2013 01:43 PM PDT
Here’s an easy recipe for a full-flavored Asian dish—Vietnamese green mango and pork salad—that requires no crazy cooking skills and no ingredients that you have to travel to Hanoi to buy.
Feel free to substitute ground chicken or ground turkey for the ground pork. Fish sauce can be found in most standard supermarkets. The following recipe, accompanied with brown rice and a vegetable, should serve six.
VIETNAMESE GREEN MANGO AND PORK SALAD
2 Green (unripe) mangoes, peeled and diced
2 tsp. Salt (preferably unrefined sea salt)
1/3 cup Lime juice
2 Tbs. Olive or high-quality canola oil
2 to 3 Tbs. Garlic, thinly sliced
2 to 3 Tbs. Shallots, thinly sliced
1 tsp. Crushed red pepper flakes
1.5 lbs. Ground pork
To taste Fresh ground pepper
¼ cup Fish sauce
2 Tbs. Brown sugar
4 Tbs. Peanuts, chopped (for garnish)
2 Tbs. Cilantro or parsley (for garnish)
Rock and Roll
Let it Rain
Please, please let me get what I want The Smiths