April 2008 Archives

Alcoholic avatars and penny pinching insurance companies - a match made in heaven.

None of us would complain about less time spent wasted in doctor's waiting rooms, or better and more affordable healthcare! Emerging internet based interactive platforms promise to increase our access to health information and healthcare participation, while allowing a finite number of doctors to treat as many patients - more comprehensively and effectively.

We are not the same group of patients we were 15 years ago. Who goes to the doctor now before taking a self diagnostic tour of internet medical sites? We often scare ourselves with misdiagnoses of terrible diseases, but we endeavor to get informed and by doing so we participate better in the healthcare process - and at its best, healthcare is not passive, but interactive.

The potential for positive change is great - but will the pendulum swing too far? As interactive net based communication between patient and provider improves, will financial pressures compel the e-sourcing of things that just don't make sense? Will we soon see virtual drug rehabs?

The Good - Where E-Care Makes Sense

www.reliefinsite.com is great. Not too fancy, no bells and whistles, just a simple and effective way for pain patients to communicate their symptoms in real time, and longitudinally, to their doctors. Pain patients can create what is essentially an online pain diary - and as they experience pain on a day-to-day basis, they can record information about their symptoms in their diary.

It's collaborative too. Doctor's can log on, and given permission, access a patient's diary, see what's really happening, and even write notes to the patient in their diary - on a day-to-day basis. Great stuff - It just makes sense. No need to try and explain a history of pain in a 15 minute office appointment, that's a pretty tough thing to do. Doctors get to see what's really happening, can make better diagnosis's and can react to changing symptoms in real time. It provides a way for more accurate information sharing, it saves money and everyone's time, and it allows doctors to treat their patients more effectively.

That's the kind of stuff we need. Platforms that improve healthcare efficiency while at best also improving the standard of care, or at the very least - not reducing it.

Except for the very rich, in any country you can name, healthcare systems are overburdened. Resources are finite and never enough to provide optimal care to all that demand it. It's a fact of life, and for now, it's just a case of managing the shortfall.

Internet healthcare systems could free up such enormous resources of time and money - ensuring that those that need a hospital bed and a doctor's care get it - and those that don't, stay home. How many parents, after some deliberation, make a midnight trip to the emergency room in search of treatment for something that they are 99% sure is not serious? For parents, a 1% chance of tragedy is more than enough to justify a few hours of inconvenience and 99 wasted trips out of a hundred.

On an individual basis, this makes perfect sense - but systematically, it strains resources - and strained resources mean lessened care for everyone.

E-based diagnostic platforms, staffed by doctors and nurses, serving as a front line operation would make sense, and in some jurisdictions, already exist. Get on the video phone, explain the situation, and a lot of the time, they are going to be able to tell you with certainty that there is no need to go to the hospital.

How about on the back end? How many hospital beds stay filled each year by doctors pretty sure that the patient could go home, but wanting one more day of observation - just to be certain. What if those patients that doctors were almost sure were going to be OK - were released one day earlier, but remained linked via web based diagnostics tools? The doctor could still monitor the symptoms in real time - could get someone back to the hospital if needed, but tens of thousands of beds a year would be free to people waiting for them. Better health care for all. Some people would die, but many more people would live - saving more lives for the same expenditure.

The Bad - When Only Face-to-Face Will Do

In the short to mid range future, you need not be terribly imaginative to envision the sort of benefits that interactive net based healthcare services could result in - the two suggested above are only the tip of that iceberg. But there are certain services that do not lend themselves well to distance interaction. Poisoning, trauma, pancreatitis - you can name thousands of conditions that, if you had one, you'd probably want in-person and face-to-face medical care for.

What about addiction counseling? I'd argue that although less obvious and dramatic, it also requires in-person treatment for any real odds of success. I'm not talking about detox, which obviously demands medical supervision; I'm talking about the nuts and bolts of long term treatment - group therapy, cognitive therapy, psychotherapy, etc. A case could be made that such forms of counseling could be provided more cheaply, and with little loss in efficacy, using internet communication technologies. Actually, a case will be made, and e-rehabs are likely on their way.

Addiction though, is tricky. It's a gestalt kind of disease, in which the sum of the parts never seem to equal the whole, and a disease that demands treatment of a psychological intensity that matches the cognitive manipulations of the disease.

You could arrange for an internet based group therapy session. It would be cheap and easy, but it wouldn't work very well. Group therapy works when participants are fiercely and honestly involved. You don't get that when tuning out is as easy as checking your email as you sit in therapy; and manipulations don't get spotted as they do when you squirm, lying, in person to a group.

You could conveniently get individual therapy at home, over the internet; but the trust building needed for effective counseling takes time in the best of cases, and a situation where the patient is miles removed from the therapist - is not the best of cases for relationship formation. And forget about what our non verbal communication would otherwise reveal.

Could you learn how to make sober friends again, online? Would you really do that yoga - if no one could see what you were up to? Would you tune out, when you didn't like what you were hearing - sometimes people need a little push to make a breakthrough, but it's a lot easier to close your browser window than it is to walk out of a therapy session.

Logistically, online addiction treatment is a cakewalk - online addiction treatment that works may be another story.

The Ugly - Financial Pressure

Interactive net communication will create savings opportunities. Ideally, healthcare e-sourcing never harms patient care. The selective application creates a higher standard of individual care in certain areas, and areas unsuited to the application of the e-sourcing benefit from increased funding from the savings - An opportunity for better healthcare, for all.

But if the potential savings in any area become significant enough, there will undoubtedly exist pressure to accept an erosion of healthcare quality in the face of savings - or to put it more bluntly - profit.

Already, consumers with excellent private health coverage who want to get residential drug treatment find that they are obliged to try outpatient first, for a long while, before their insurance company will fund a residential stay. Once insurance companies have an even cheaper option, it's hard to foresee how they won't compel us to use it first.

Addiction treatment isn't like a lot of other disorders. If you had cancer, and the insurance company forced you to try a less expensive procedure first, prior to allowing the more intensive treatment - if that first one didn't work, you'd be ready that next day to sign up for the better one. Alcoholics and drug addicts are more easily discouraged (or their disease is better at manipulating their behavior) and if the first treatment doesn't work, odds are it will take a while (if ever) before they approach a second round. A very cynical person might suspect that insurance companies are counting on this...

It will be interesting, and great changes in healthcare over the next decade are a certainty. Most will be positive. The potential for great advances in systematic levels of care exists through the selective application of resource saving distance treatments. There will, I suspect, be an ugly side to it though, and I'd wager virtual drug rehabs will be at the head of that, unfortunate, pack.

I hope I'm wrong though.

Prison is not a particularly safe place to live. For newly freed inmates however, the streets are even more dangerous.

Australian researchers examined the mortality rate of newly released prisoners, looking at the risk of death during the first two weeks after release. They call it carnage. Newly released men are 29 times more likely that the general population to die during that first 2 weeks - women are 69 times more likely to die - 69 times more likely.

What's killing them?

Drug overdoses mostly. It seems as though prison isn't doing much to break long dormant opiate habits, and the newly released addicted are soon back to their old ways - minus any real tolerance for the drugs.

They are shooting heroin, and what used to be a manageable dose is now a fatal dose, and that's the end of that story.

We think that a death sentence for non violent drug crimes is unreasonable - but what we give, when we sentence heroin addicts to prison - is pretty close to capital punishment anyway.

Read more about it in the February 2008 edition of the journal, "Addiction".

In Utah, 58% percent of women who sought out drug treatment had children living with them at home.

Women of childbearing age are the biggest users of meth, and they don't fit in well with our stereotypical perception of the typical meth addict. Moms are on meth, and unless we reduce the scale of this meth epidemic, the repercussions in a generation to come, when these meth-mom raised kids grow up, will be tragic.

Getting mothers into treatment saves everyone money. The cost to jail a meth using woman in Utah is $25 700 and if that woman has kids that need to be placed into foster care, the cost increases by $33 000, per year, per child.

In contrast, the cost to treat a meth using mom is $3500 per year, and in most cases, kids can safely remain in the home with their moms. Treatment beats incarceration hands down. It benefits society, it helps women beat terrible addictions, and it saves kids from an institutional upbringing.

Getting a meth using women into treatment is always the right thing to do.

Wondering if a woman you know is struggling with meth?

Be concerned if you witness symptoms of meth abuse, such as:

• Hyperactivity
• Erratic sleep patterns
• Irritability
• Isolation from friends and family
• Mood changes (includes hostility, abusive behavior, depression)
• Loss of appetite and weight loss
• Lack of interest in normal activities
• Poor judgment

Or take the warning signs quiz on meth addiction, at End Meth Now

A lot of people do things they wouldn't ordinarily do while drunk - and more than a few marriages have ended over the indiscretions of a drunken spouse. There is something magically horrible in alcohol, which makes us feel increased sexual desire, while losing the ordinary good sense to just go home at the end of the night.

But if you're wondering why alcohol makes you so weak - take some solace from the humble fruit fly - alcohol intoxication can actually turn him gay.

It's true, researchers have known that acute alcohol intoxication decreases sexual inhibition in fruit flies, but it turns out that when given repeated doses of alcohol, over a matter of days (designed to replicate the experience of alcohol abuse or alcoholism) male fruit flies, who are normally quite macho, will seek out other males for copulation.

The researchers say that fruit flies are a fairly accurate model for the neurobiological effects of alcohol on mammals, like humans, and research using them can help to explain human alcohol affected sexual behavior.

Yay Drug Courts!

It's hard to find anyone these days with much of anything bad to say about drug courts. These alternative sentencing vehicles are saving tax payers a huge amount of money, they are freeing up space in overcrowded jails, they are helping people in need beat terrible addictions, reuniting families and the recidivism rates for drug court graduates are far lower than for offenders processed through the traditional court system.

Yay!

Seriously, they work, and they save everyone money, and it's great news that drug courts are now in operation in all 50 states, with a total of 2000 in operation or in the works. But They have created a rather strange set of circumstances.

• If you are poor, addicted to drugs and alcohol and really want some help to get better - but are not a criminal - you are out of luck.
• If you are poor, addicted to drugs or alcohol, don't care if you get help or not, and commit crimes - then you get free drug treatment.

It's an absurdity, and I have spoken with a few people over the last months who find themselves in this frustrating predicament. It seems to them, that the only way they are going to be able to get drug treatment, is by being arrested for a crime.

Not ideal

 Drug courts aren't going away, nor should they. They work better than the traditional court system, they are more humane and they treat the root cause of such a lot of the criminal behavior in this country today. But why should we wait to provide funding for people only after they commit crimes? Why not give them a leg up before it gets to that stage?

Let's keep the drug courts, but expand the programming so that anyone in need can have access to the same sorts of treatment programs. Maybe that will cut down on the eventual need for courts and drug courts alike, while saving a great deal of tax-payer money on everything from law-enforcement to welfare to health care.

Besides, it's the right thing to do - and it's only fair.

Monkeys in nicer cages use less cocaine than monkeys in standard cages. That's one of the more interesting research findings coming out of Wake Forest University Medical School this month.

Monkeys are used as a good predicative animal model for the administration of drugs in humans. Essentially, if monkeys like something, then we probably will too. Researchers wondered what effect the monkey's environment would have on their desire to self administer cocaine.

They put some cocaine using monkeys in larger cages for three days and then gave them access to cocaine and food self administration - and the monkeys that were given access to larger (nicer) cages, administered less cocaine than the monkeys that didn't get the upgrade. The researchers stress that the environmental improvement was relatively minimal, and suspect that if the monkeys were given access to a larger cage, and also given interesting activities to do while in the cage, the decrease in cocaine self administration would be larger.

The human extrapolation suggests that environment plays a greater than previously thought of influence over drug use, and that people in more pleasant environments are likely better able to reduce their cocaine usage.

On the flip side, and not entirely surprisingly - monkeys that were subjected to three days of more stressful living, instead of more spacious accommodations, used more cocaine than before.

Hmm...I wonder why putting people in small jail cells doesn't seem to help them quit drugs very well?

Surfed across this today, and thought I would pass it along. It is a list ranking the addictive properties of various drugs. Drugs are ranked based on "how easy is it to get addicted?" and on "how tough is it to quit?"

These two questions were given to a community of addiction experts, who ranked each drug on a variety of measures. The scores below reflect the ranking scores offered by these addiction experts. The numbers are only relative opinions, and are based only on the experience and expertise of experts in the field. In other words - these are just opinion scores, but interesting none the less.

The Addiction Scores of Illicit or Abused Drugs

• 100 - Nicotine
• 99 - Ice, Glass (Methamphetamine smoked)
• 98 - Crack
• 93 - Crystal Meth (Methamphetamine injected)
• 85 - Valium (Diazepam)
• 83 - Quaalude (Methaqualone)
• 82 - Seconal (Secobarbital)
• 81 - Alcohol
• 80 - Heroin
• 78 - Crank (Amphetamine taken nasally)
• 72 - Cocaine
• 68 - Caffeine
• 57 - PCP (Phencyclidine)
• 21 - Marijuana
• 20 - Ecstasy (MDMA)
• 18 - Psilocybin Mushrooms
• 18 - LSD
• 18 - Mescaline

Research was conducted by John Hastings, and the full text article can be found at "In Health" journal.

Millions of people become someone else everyday on the internet. People lie about their age, gender and occupation as a matter of course on forums and e-communities, and shift identities even more intensely when playing virtual world video games like World of Warcraft. If you can be anything, you might as well be who you wish you were, rather than what limits you on this mortal realm. So if someone decides they like their online persona better, and decides to spend as much time in that persona as possible, living virtually – are they crazy? Should we label them video game addicts, and intervene? There is something incredibly seductive about this identity transformation, especially for people who feel somewhat dissatisfied with the life they live in the "real world". In MMPRPG's (Massively multi player Role Playing Games) you emerge into a truly egalitarian world. You can be as good looking as everyone else, brave and incredibly successful, no matter how lowly your real world realities. In a virtual world, shy teens become leaders of armies, and the body conscious and insecure, objects of desire. These games are addictive by design, and a lot of people get sucked into a virtual world existence, at the expense of their real life happiness. And surely a large part of the attraction is this ability to live an alternate, and in many ways, happier existence.

People get Addicted – But They Don’t Want to Quit

Millions of people around the world are whiling their lives away, largely within cyber identities, in virtual worlds. Many of these people recognize to some degree the costs incurred to their real world lives, yet an awful lot of these people seem to be making a conscious choice to keep playing. They choose virtual contentment and pleasure, knowing full well the price they pay for it. Now, some would argue that these people are just addicts in denial. That this is addicted thinking that keeps these gamers glued to their screens, and keeps them from taking the steps needed to restore some sanity to their worldly lives. And they may be right – the games certainly are addictive, and denial is always part and parcel of addiction. Or maybe they just choose a better life? Gamers don’t often want to quit – other people around them convince them to. Gaming addiction (if that's what it should be called?) certainly does create some real-world harms that can be hard for those around them to watch. After all, it's hard to keep a job, physical health and a healthy social life when all awakened hours are spent alone in a darkened room. But is it a form of mental illness to select an existence that brings you greater tangible pleasures? Gamers don’t complain of loneliness, they spend all day interacting with friends – those friends just happen to look like elves or dwarves, and they reside online. Are online friends less real than physical world friends? Gamers say they prefer the virtual world, that there they can be who they really want to be in life, and that it's a life with little pain, great adventure, and fulfilling rewards – a far cry from the tedium of real world living. Is that crazy? People are finding love and getting married within games, they are setting up full time occupations in virtual shop fronts (and earning real world money to do so), and they are living the life they choose, free from restraint. Is that crazy?

Are they Crazy?

I don't know – I think they probably are…Crazy in terms of exhibiting all of the signs and symptoms that would lead to a clinical diagnosis of a compulsive disorder, anyway. And there is no doubt that some people pay an incredibly high price for their gaming - Their real world lives in shambles at the expense of an alternate reality. And as good as online friends may be – they can’t make you soup when you’re sick, and online love affairs won’t bring the joys of children. So yes, I think they are probably crazy - but they're not stupid. They choose something different, something that brings them more happiness than real world living seems able to, and somewhere that lets them be what they want to be. They may be crazy, but you can understand where they're coming from. It's a tragic and fascinating phenomenon, just starting to really unfold – the tip of the coming iceberg, that's for sure. As things get more sophisticated, and virtual lives continue to enrich – who's to say what will become of all of us. Will there come a time when all of us choose the boundless possibilities of a virtual life over the limitations of physicality? Do you try to rescue someone who swears they're happy as they are? For now, I think you gotta'. It's too sad to watch someone give up on real world living, for what is still a pretty limited, albeit seductive, fantasy world life. It's a mental health disorder, and it can be treated, and most people will probably be happier and more fulfilled by striving towards what they want in real life, rather than taking the easy way out, virtually. But you can understand it, and one day, and maybe one day soon, those virtual worlds will start to legitimately compete with a real world existence, and that's when it's going to get truly and terribly interesting. Will we all be living virtually in 30 years?

There is some debate about whether technological addictions are real. Not a debate about whether or not people seem to have problematic compulsions to use the internet or text message, everyone seems to be able to agree that these problems exist, but it's less clear to clinicians that these compulsions are different enough to warrant their own classification as separate disorders. People with cybersex addiction, some would argue, are simply sex addicts using the internet and people who can't stop sending emails and check their blackberry in the middle of the night, don’t have an internet addiction, they are simply people with impulse control disorders and symptoms are manifested via technology. On the flip side - other professionals argue that you can't ignore the growing numbers of people complaining of technology compulsions, and that it's clear that we are dealing with something new here – something that needs to be classified uniquely. The debate continues, although it's looking more and more likely that internet addiction and other technological disorders will earn a place in the upcoming edition of psychiatry's bible, the DSM-V5. And it's a very important debate too. The recognition of these disorders as unique will mean that they gain legal status and recognition. It will mean that as insurance parity movements gain strength, people suffering an internet addiction will have a greater chance of claiming insurance benefits to treat their recognized "disease" and that employers will afford the technologically sick the same rights and protections as they would grant anyone sick with any other disorder. So it's important, and the scientists are taking a good hard look at the whole thing and in a few years anyway, we'll all probably understand technological compulsions a lot better. But for now, the ambiguity of it all is not helpful to those stuck in the middle - in never never land. It's not helpful to be suffering an uncontrollable compulsion to do something, to have that compulsion harm your health and happiness, and to have people say that what you're suffering – isn’t real. And it's not helpful to delay getting treatment for something that's giving you problems because you don't want to seem crazy or because your friends and family think it's ridiculous. Is it an addiction - is it something else? It doesn't matter! For now, the debate raging offers little benefit to those people whose online habits are causing them problems. It doesn’t matter at all whether someone else calls it internet addiction, or gaming addiction, or a big fat figment of your imagination – if you need help, then you need to get it.

3 Questions – and 3 Answers That Will Tell You All You Need to Know.

• Does your internet/gaming/texting habit cause you problems in life?

Answered yes? Then you have a problem. Seems obvious, but it's a fundamental part of the equation.

• Do you continue to use the internet/game/text devices even though you know it causes you problems?
• Have you tried to stop internet/gaming/texting, and failed?

If you answered yes three times, then you have a problem, a problem that affects your quality of life, and yet you continue, and when you try to quit – you can't. If you answered yes three times, then you need help, and it doesn’t matter at all what anyone else labels your disorder. There are therapies that work and techniques that you can learn to help you manage your compulsions to use the internet in a controlled and limited way. But unless you take some serious steps to change, then you have to accept that things aren’t going to change. This addiction (or whatever else you wanna' call it) seems to be like most other addictions, in that it's progressive and getting better takes a little effort. Don’t wait for someone else to recognize your problem to get help. If you know you have a problem, then you should know that you need, and deserve help.