Markham's Behavioral Health

Should the legal drinking age be lowered?

Since the drinking age was raised to 21 tens of thousands of lives have been saved not to mention injuries, rapes, property destruction. From a public health perspective, raising the legal drinking age from 18 to 21 has been a huge success. However, critics have been concerned about the amount of binge drinking that occurs especially in the first couple of years of college which has lead some opinion leaders to suggest that the drinking age should be lowered again to 18.

While this is a serious discussion, I think the arguments for lowering the drinking age are largely without merit. Here's a satirical piece from The Onion on Teenagers and Alcohol.

The Jacqui Saburdio story - consequences of drunk driving

Jacqui Saburido's story on Oprah. Video lasts about 7 minutes. Consequences of drunk driving that aren't so funny.

DUI test - Perfect score

My two kids were killed by a three time drunk driver. Drunk driving is no laughing matter.

Adult mentors may aid teens in foster care

Reuters reported on 02/18/08 on a study in the February, 2008 issue of the journal, Pediatrics, which found that "natural mentors" seemed to provide a protective influence on kids in foster care who might otherwise be at risk for substance abuse problems, teen pregnancy, and delinquency.

The Assett model from the Search Institute has pointed this out for years that kids who have adult role models outside of the immediate family who are involved in the kid's life for 4 years or longer has a very significant and positive influence. These natural mentors such as coaches, teachers, neighbors, youth ministers, scout leaders, etc. are much more influential than other more formal mentoring programs where volunteers are often involved for only a few months or a year or two.

Alice Miller, the Swiss Psychoanalyst, had a wonderful term for this role. She called it "the enlightened witness". This was the benevolent person who validated the child's experience and knew what was going on for the child over the long haul. Are you an enlightened witness in any child's life?

Here is a snippet from the Reuters article:

Teenagers in foster care seem to have a brighter future when there is an adult in their life they look up to, a study suggests.

The findings, taken from a national survey of U.S. teens, suggest that "natural mentors" -- teachers, coaches and other adults who are part of foster children's lives -- can make a difference in their future.

In fact, they may be more important than mentors who are connected to children through formal programs, researchers report in the journal Pediatrics.

This is because, unlike the typically temporary nature of formal mentorships, adults who are naturally part of foster children's lives may be around for the long haul.

Link: MedlinePlus: Adult mentors may aid teens in foster care.

Parental Drinking Boosts Teen Alcohol Risks

This is what teenagers call a "Well, duh............". Reuters HealthDay reported on February 4, 2008, on a study which appears in the February, 2008 issue of the journal, Alcoholism: Clinical and Experimental Research which found that parental and teenage alcohol problems are linked. It seems that parents that drink problematically themselves don't appropriately monitor and supervise their children's behaviors. This should come as a surprise to no one, but it is interesting that research supports what most people have observed and known about life. Here's a snippet from the Reuters' article:

"With respect to individual aspects of parenting, our analyses show that parental alcohol use, intoxication, and problem drinking symptoms are consistently associated with decreases in monitoring and increases in discipline," Lantendresse said.

"Decreases in monitoring are related to higher levels of adolescent alcohol use at age 14 and more frequent intoxication at both 14 and 17.5. Likewise, increases in discipline are linked to more frequent use and intoxication but only when adolescents are 17.5," Lantendresse said.

Link: MedlinePlus: Parental Drinking Boosts Teen Alcohol Risks.

Chantix May Raise Suicide Risk but smoking is still the far greater health risk

Reuters HealthDay reported on February 1, 2008 that the FDA has warned that the anti-smoking drug, Chantix, might contribute to suicidal ideas and behavior.

There's increasing evidence that the smoking-cessation drug Chantix is linked to serious "neuropsychiatric" side effects, including agitation, depressed mood and even suicide, U.S. health officials said Friday.

The U.S. Food and Drug Administration has asked Chantix's manufacturer, Pfizer Inc., to make the warning about these potential problems more prominent on prescribing information and on the drug's label. The agency is also working with Pfizer to produce a Medication Guide for patients, officials said.

"We have become increasingly concerned as we have seen a number of compelling cases that truly look as if they are the result of exposure to the drug and not to other causes," Dr. Bob Rappaport, director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products, said during an afternoon teleconference.

"These cases involve abnormal behaviors, changes in mood, and suicidal ideation and suicide," Rappaport said.

The FDA knows of 491 cases of suicidal behavior associated with Chantix, said Dr. Celia Winchell, a team leader in the FDA's Division of Anesthesia, Analgesia and Rheumatology Products.

"Of these, 420 are from the United States," Winchell said. "There are 39 that involve completed suicides, 34 in the United States."

According to Pfizer, 5 million patients have taken Chantix, whose generic name is varenicline.

Friday's warning follows a Nov. 20 FDA statement that the agency was "evaluating post-marketing adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior."

At that time, Pfizer said there had never been a cause-and-effect relationship shown between Chantix and these symptoms. The company also said that part of the problem may be due to nicotine withdrawal.

Pifzer who manufactures and markets Chantix says that part of the agitation and suicidal ideas might be linked to nicotine withdrawal. One thing seems clear, and cigarettes are a huge risk factor for premature death so stopping smoking, even with the use of Chantix, is well worth any minimal risk.

Link: MedlinePlus: Quit-Smoking Drug May Raise Suicide Risk.

Short Chat With Doc Can Curb Problem Drinking

Reuters HealthDay reported on January 9, 2008 on a study in the February, 2008 issue of the American Journal of Preventive Medicine which found that a ten minute chat with the primary care physician about drinking changed for the better 17% of people with problem drinking behaviors. This kind of prevention is very cheap, and in one out of five people with problem drinking problems, helpful. Here's a snippet from the Reuters article:

Ten minutes of discussion with a doctor about drinking may help at least one in six problem drinkers change their ways, but most physicians don't understand that, a new data review finds. The systematic review of 10 related studies is published in the February issue of the American Journal of Preventive Medicine. According to the researchers, brief alcohol screening and counseling may rank among the top five most cost-effective preventive services a doctor can offer, along with Pap smears and bowel cancer screening. Screening for problem drinking, combined with a doctor's advice, reduced problem drinking by 17.4 percent over a period that varied from six months to two years, according to the particular study.

Link: MedlinePlus: Short Chat With Doc Can Curb Problem Drinking.

Pot smoking contributes to lung disease

Reuters reported on December 13, 2007 on a study published in the December, 2007 issue of the Journal, Thorax, that pot smoking increases the risk of chronic bronchitis  2 times non pot smokers and asthma is increased 70%. Each joint seems to be the equivalent of 2.5 - 5 tobacco cigarettes.

Cannabis smokers had twice the risk of chronic bronchitis and a 70 percent increased risk of asthma diagnosed after age 16 years, they report in the medical journal Thorax.

Based on observed changes in lung function tests, the investigators calculate that one cannabis joint does as much harm as 2.5 to 5 tobacco cigarettes. "This provides patients with a good measure of the relative risks of cannabis and tobacco smoking," Beasley said.

Link: MedlinePlus: Pot smoking contributes to lung disease.

Smoking linked to teen alcohol and drug use

Reuters reported on October 23, 2007, on a report issued by CASA, the Columbia University's National Center on Alcoholism and Substance Abuse,  which got its data from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), that shows that cigarettes are indeed the gateway drug for alcolescent abuse of alcohol and marijuana. Here is a snippet of the Reuter's report:

Teenagers who smoke are five times more likely to drink and 13 times more likely to use marijuana than those who do not smoke, according to a report issued on Tuesday.

The report by Columbia University's National Center on Addiction and Substance Abuse presented further evidence linking youth smoking to other substance abuse and spotlighted research on how nicotine affects the adolescent brain.

"Teenage smoking can signal the fire of alcohol and drug abuse or mental illness, like depression and anxiety," Joseph Califano, who heads the center and is a former U.S. health secretary, said in a telephone interview.

The report analyzed surveys conducted by the U.S. Substance Abuse and Mental Health Services Administration and other data on youth smokers. Most smokers begin smoking before age 18.

Smokers ages 12 to 17 are more likely drink alcohol than nonsmokers -- 59 percent compared to 11 percent, the report found. Those who become regular smokers by age 12 are more than three times more likely to report binge drinking than those who never smoked -- 31 percent compared to 9 percent.

Link: Smoking linked to teen alcohol and drug use(Print Version).

State Hospitals Struggle to Give Up Smoking

There is an article in the November 16, 2007 issue of the Psychiatric News about how state hospitals across the nation are beginning to address the issue of smoking in their facilities.

It is an interesting observation that people with problems with alcohol, drugs, and serious psychiatric disorders smoke at rates 3 and 4 times the rates of people without those problems. For example, in New York State currently, the smoking prevalence rate in the general population is 16% but among alcoholics it is 85-90% and among people with serious mental illness it is about 75%.

In New York State all alcohol and drug treatment facilities and programs which are licensed by the New York State Office of Alcohol and Substance Abuse (OASAS) must be tobacco free by July 28, 2008. The 14 Alcohol Treatment Facility run by OASAS itself are already tobacco free and this requirement is now being extended to the nonprofit facilities licensed by OASAS. The Psychiatric facilities are still behind though even though they are catching up.

"Smoking kills, and it kills seriously mentally ill people early," Mary Diamond, D.O., said at the APA Institute on Psychiatric Services in New Orleans in October.

About 75 percent of seriously mentally ill people are tobacco dependent—over three times the rate among the general population—yet 59 percent of public mental health facilities still permit smoking, she said. Even some states that have banned cigarettes in prisons continue to allow smoking in their mental hospitals.

It still is not clear why substance abusers and psychiatric patients smoke at such high rates although there is some evidence that nicotine affects the biochemical balance in the brain. It seems a shame that substance abusers get into recovery, and psychiatric patients compensate and improve, and then cigarettes wind up killing them. Dr. Bob and Bill W. the founders of AA both died from smoking. 

Link: State Hospitals Struggle to Give Up Smoking -- Levin 42 (22): 4 -- Psychiatr News.