First mental health talk in 2013 series: “Your brain on drugs”
For the second consecutive summer, the Mental Health Task Force is sponsoring a series of talks on issues related to emotional and mental well-being. The first of this year’s presentations, “Your Brain on Drugs,” highlighted the effects of chemical substances on the brain.
Drawing approximately 30 people, the program featured three speakers: Rico Warren, a former addict and presently a recovery coach at the Rhode Island chapter of the National Alliance of Mental Illness (NAMI); island resident Michael Brownstein, a physician, neuroscientist, former director of the National Institute of Mental Health, and Alice Brownstein, a physician in Seattle. The father and daughter team of doctors presented medical perspectives on substance abuse.
Introducing himself, Warren said, “I am an addict seeking recovery.” He then shared his personal story: a bright and athletic young man growing up in an abusive family, he found himself running away — from the harsh realities of a home in which his mother and three sisters were molested — taking refuge in drugs. He said, “My first drug of choice was alcohol.”
On graduation from high school, Warren was offered a scholarship to play baseball “wherever I wanted,” but he was drinking and doing drugs to such an extent that he was unable to take advantage of the opportunities. He chose instead to medicate himself with “a half-bottle of vodka straight … and a dose of heroin every day.”
He said, “I was always in search of a family,” and by 22 he married. However, after he and his wife had three children, they separated because, as he acknowledged, he could not participate appropriately in their care. He credits his ex-wife with raising them to become “the good kids they are today.”
Warren said he had been drug-free for a little over two years. “As of May 3, 2011, I have not put a substance in my body,” he said, choosing “to educate instead of medicate. Now I know who I am. As of last Tuesday, I became a freshman at CCRI (Community College of Rhode Island).”
Dr. Michael Brownstein pointed to the schedule of chemical substances created when Congress passed the Controlled Substance Act in 1970. The lists are intended as general resources and are not definitive of all controlled substances. The breakdown from more abusive to less abusive drugs comes in the following categories:
Schedule I drugs “are considered the most dangerous class … with a high potential for abuse and … psychological and/or physical dependence.” These include heroin, lysergic acid (LSD), marijuana, 3, 4-methylenedioxymethamphetamine (ecstasy), methaqualone and peyote. Brownstein said for drugs like these, there was generally “no safe medical use.”
Schedule II substances have a “high potential for abuse … [and] are also considered dangerous,” potentially leading to severe psychological or physical dependence. These include cocaine, methamphetamine, methadone, Dilaudid, Demerol, Oxycontin and other familiar ones like Adderall, Dexedrine and Ritalin. Michael Brownstein noted that “there have been some legitimate need and use of these drugs” for medical purposes.
Schedules III, IV and V drugs have decreasing abuse potential and are more likely to be prescribed for general medical uses.
Brownstein cited the Anti-Drug Abuse Act of 1986, which referred to chemical substances similar to a controlled substance listed with Schedule I drugs, and noted they were treated in a like manner (as illegal drugs) — but only if used for human consumption. He noted that “chemists have become adept at developing drugs” —known as designer drugs.
These have marked similarities to known hallucinogenics or narcotics. Brownstein explained that in 1982 six or more people ingested the drug MPTP, containing contaminated elements of another drug, MPPP, which induced symptoms of Parkinson’s disease. He said, “We later realized the drug was a neurotoxin.”
These designer drugs are dangerous, Brownstein said, but tracking them can be challenging. He said that our federal drug laws are “not universally accepted around the world” and even within the states the laws vary. Washington and Colorado allow marijuana for medical use, for example.
That acceptance has raised other questions, Dr. Brownstein noted: “Can you use pot and drive? Who can grow it legally?” He added, “Even on the island, you can see examples, like Harry’s [Restaurant] not being allowed to sell alcohol [because] it was too close to the church.” He said in this country “we’re inconsistent.”
However, Brownstein said the recent publication of the fifth edition of the American Psychiatric Association’s Diagnostic and the statistical Manual of Mental Disorders (DSM-5 — which he called the “bible of psychiatric billing” — ultimately “serves a useful purpose.” What used to be called substance use and abuse is now referred to as substance use disorder, depicting a “maladaptive pattern of substance use leading to distress,” lasting over a long period and leading to recurring drug use — particularly common in young people.
“Kids like to experiment with drugs, like to mix them,” indicating drugs and alcohol are often used together. Many of these drugs, Brownstein said, were originally prescribed for emotional and mental illnesses. In fact, he said, “Young people — particularly 15- to 18-year olds — are especially fond of prescription drugs,” to the point of what has been termed an epidemic within the country.
A gallon of vodka a day
Alice Brownstein, an emergency room physician in Seattle said that from her experience she had observed the consequences people inevitably suffer from over-consumption of drugs.
“With one of my first patients — I literally had been a doctor for about six hours when I was called in to examine him in the hospital — I asked him about his alcohol use.” She was surprised when he said he drank a gallon of vodka a day.
In fact, she explained she had been called in because he was going into withdrawal. A withdrawing patient, she said, was easily recognizable, as he or she was constantly moving, and “the sheets were often in a nest.”
In an attempt to assist the patient, Alice Brownstein said she began by administering small doses of Valium, which she increased from 5 milligrams when the patient began hallucinating to as much as 360 mg. “This just shows how much the system becomes drug tolerant,” she said, noting the patient was released but later readmitted.
Alice Brownstein said, “It’s rare that people want to quit alcohol.” She referred to another patient — a 42 year-old woman who had been drinking since she was 12 years old. When Alice Brownstein attended her, she had swelling in her abdomen (ascites) and there was considerable cirrhosis of her liver. Though she tried a number of approaches, including adding fluids, in the end, Alice Brownstein said, “The woman’s 19-year old son had to decide to take her off life supports.”
She added, “Emergency Room docs can get jaded because ER’s traditionally give out drugs. Patients come in to get pain killers. We don’t want to contribute to the problem. In fact, people inject themselves in the hospital. They do all sorts of crazy things. In looking for an answer, I’m not sure what the answer is.”
However, she suggested part of it might be societal and said she had seen the population of homeless alcoholics on the rise. She said, “They were constantly being brought into ERs and into shelters. It’s a revolving door.” However, she explained what Seattle did to attempt to resolve the problem of homelessness, particularly for alcoholics. It constructed a 70-room building for homeless alcoholics, offering them access to counselors, to Veterans Administration hospitals, tribal assistance and just to help in many ways.
The results within the first year were that “many people became sober, and the program saved the city three million dollars in one year.” Though the project generated lots of controversy, Alice Brownstein said, “It worked really well. We need to work outside the box.”
In a Q&A after the talks, the discussion turned to how much alcohol consumption is too much. Alice Brownstein recommended checking the published guidelines on recommended safe ratios.
These may be found in the “Physicians Guide to Helping Patients with Alcohol Problems.” The recommendations are as follows: for men, no more than two drinks a day; for women, no more than one; for those over 65, no more than one drink a day.
A standard drink is the equivalent of 12 grams of pure alcohol: for example, one 12-ounce bottle of beer or wine cooler; one five-ounce glass of wine or 1.5 ounces of distilled spirits.
The guide is a joint publication of the United States Department of Health and Human Services, Public Health Service, National Institute of Health and the National Institute of Alcohol Abuse and Alcoholism.
The next lecture date is to be announced.