Confused about healthcare financing and where it's headed?  What about future access to addiction treatment?  These days it's hard not to be confused; the experts can't even agree on what's happening now, never mind on what will happen next.  For example, analysts concur that the United States spends far more on healthcare—dollars per capita and percent of gross domestic product—than 12 other industrialized countries.  But beyond that, they disagree on which statistics are appropriate to measure the return on that investment and whether the money is well spent.  Some say the United States has tens of millions of people without health insurance; others say those numbers are misleading, a myth. Besides conflicts of opinion, there are conflicts of interest.  In the United States, modern health insurance emerged in the 1930s to enable the sick to pay their bills and healthcare providers to get paid for their services.  Employers began incorporating health...

As we approach the holiday season—the time of year from Thanksgiving through New Years when "joy" is the word but not necessarily the reality—it's worth reflecting on ways we can protect ourselves and those we care about from inconvenience and tragedy due to use of alcohol or other mood-changing substances. Start by believing that some measure of holiday joy and fulfillment, provided we are open to it, is available to us all. But stay mindful that if we are not cautious about the use of mood-changing substances, we leave ourselves open to indelible regret. Caution is needed. But the holidays evoke strong feelings, and strong feelings often override caution. Strong feelings could include the stress of keeping up with the seasonal parade of expectations and events such as shopping, travel, cooking, social gatherings, and so forth—or the stress of not having any of those to keep up with. Strong feelings also...

Addiction treatment and other mental health professionals are accustomed to applying the diagnostic criteria published by the American Psychiatric Association (APA) in the 1994 Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) and the 2000 "Text Revision" version of the same compendium (DSM-IV-TR), which updated the narrative material but kept the same diagnostic criteria. Criteria in the substance-related disorders section of DSM-IV are all the more familiar to veterans in the addiction field because they were barely changed from the criteria in the previous DSM, the 1987 "Revision" of the Diagnostic and Statistical Manual Version III (DSM-III-R).   The names we give diseases are no more than useful categories for grouping individuals whose ailments have similar physical or behavioral manifestations or similar causes, and that respond to similar therapeutic or preventive efforts. Disease names and criteria to diagnose them evolve because scientific knowledge and technology evolve. Revisions of classifications...

Search the Internet or type in "falling dominoes" on YouTube and you will be deluged with opportunities to watch videos, often set to music, of vast numbers of colorful rectangles knocking one another over. These productions are extravagant examples of the original "domino effect." They show domino tiles arranged in both straight lines and intricate patterns, each tile balanced on a narrow end with its rear flat facing the front flat of the next. As long as the distances between the tiles are shorter than their length, once the first domino is toppled, all the rest must fall. Or more accurately, all the rest usually fall; once in a while a chain reaction jams, the audience sighs, and the videographer cuts to dominoes that are falling. The middle and last dominoes in these arrangements fall because they are subject to laws of nature. Physics and gravity may not yield the results...

The phenomenon of "bath salts" abuse and dependence is hard to believe. Nevertheless, since late 2010 young people and adults have been swallowing, smoking, sniffing, and injecting dangerous white or colored powders that they purchase from head shops, convenience stores, or the Internet.[NIDA Message] Colorful packages with catchy names such as Arctic Blast, Cloud 9, Ivory Wave, Snow Leopard, Vanilla Sky, and White Lightning may contain 50 milligrams or more of powder and sell for $25-50. They are labeled as bath additives (or glass cleaner or plant food) that are "not intended for human consumption." How this can be happening? Neurobiology helps explain it. Basically, addiction doesn't make sense: people with addiction pursue their relationship with a mood-changing chemical even when it ruins their body and other relationships. This happens because: (1) addictive substances provide reward and escape that condition the user to seek the substances over and over; (2) stopping...

Popular belief does not expect women to "hold their liquor" as well as men, and this is one of those instances when science agrees with popular belief. If a man and a woman drink the same amount of alcohol, even if they are equal weight, the woman will have a higher concentration of alcohol in her blood. That's because a greater proportion of the man's body weight is water, which dilutes the alcohol; and also because the stomach walls of women compared to men contain less alcohol dehydrogenase, an enzyme that breaks down alcohol. Therefore, repeatedly drinking the same quantity of alcohol is likely to damage a woman's organs—liver, heart muscle, brain—more quickly than a man's. (Alcohol Metabolism) Published dietary guidelines reflect these differences and, for example, define moderate drinking as up to 1 drink per day for women and up to 2 drinks per day for men. (Dietary Guidelines)  ...

Many individuals with a personal or professional stake in addiction recovery consider recovery a spiritual process and diligently defend the right of everyone in need of recovery to practice spirituality in whatever non-hurtful ways are meaningful for them. When it comes to how these people in need practice "recovery" itself, there is no such unanimity among stakeholders—except for possible agreement that the process won't go very well if everyone pursues their recoveries with the same diversity as their spiritualities. Decades of accumulated practical wisdom and medical-scientific knowledge inform how various stakeholders think about addiction and recovery. But their individual knowledge bases and points of view differ as well as overlap. They debate definitions of recovery and what the willing person must do or not do to achieve recovery. For a generous sample of discourse on these matters, look at the consensus document from the Betty Ford Institute Consensus Panel, the updated...

Misuse of prescription opioids is the fastest growing drug problem in the United States. And it will only get worse unless the population, especially youth, realizes that nonmedical use of these potent pain relievers is uncool and dangerous. A common misconception is that these substances are safe because they are prescribed by physicians and dispensed through pharmacies. Drug buyers can indeed be more confident of the "product" when it's a trademarked tablet rather than white powder in a plastic bag. A 26-year-old said, "My drug of choice is pharmaceutical heroin." But, just like heroin, these trademarked substances present the same deadly dangers of overdose and addiction. And buying, selling, or giving away these substances is against the law—even if they were prescribed for you.   The Centers for Disease Control and Prevention (CDC) reports 100 people die from drug overdoses every day in the United States. The CDC also says drug...

As we commemorate Alcohol Awareness Month, we are reprinting the Addiction Medicine Update, "Intervening on Alcohol? Style Matters!," originally published in April 2012. The World Health Organization identifies "The harmful use of alcohol [as] a global problem which compromises both individual and social development. It results in 2.5 million deaths each year. Alcohol is the world's third largest risk factor for premature mortality, disability, and loss of health." (WHO) Yet, perhaps because of our collective affection for beverage alcohol, we don't get alarmed. As Frank Bruni points out in his commentary on the death of Whitney Houston, it's other drugs that make the headlines. (New York Times) But some of us are too close to the dangers of alcohol to be complacent—perhaps because we witness alcohol problems as a family member or treat addiction as a clinician. Fortunately, our roles give us opportunities to help people at risk to better see...

Epidemic misuse of prescription pain medication in the United States is partly due to the availability of opioid analgesics (medication in pills, patches, injections, nasal sprays, and even lollipops that contain natural or synthetic substances that cause pain relief and euphoria by stimulating endorphin receptors in the brain). Can individuals and communities possibly do anything to reduce or reverse this deadly problem? The answer is yes. Specific actions by individuals, healthcare professionals, and others can reduce the supply of opioids available for misuse and addiction without denying pain relief to those in need. National surveys show 60 to 70 percent of people who used opioids nonmedically obtained them from a friend or relative. About 11 percent took them without asking. At home, securely lock up any prescription opioids you may need and get rid of any you don't need.Visitors who are drug-experimenters or opioid-addicted—these could be relatives, teenage friends, repairpersons, real...