Singing the national anthem at the NFL Championship game is considered a great honor, even if it can be rather unforgiving in terms of criticism. This year the honor was given to Demi Lovato, singer, pop-culture icon, mental health activist, and, perhaps most notably, a person in recovery for substance abuse.
Of Singing and Substance Abuse
It appears as though the media and the public have had a positive reaction to Lovato’s singing of the national anthem. Her release of a new single, “Anyone,” a few weeks earlier have marked a sort of career revival for Lovato. This is significant, considering that the musician was considering leaving her music career behind after a near-fatal overdose two years ago.
Before the overdose, Lovato had been in recovery for nearly six years. In various interviews, she admitted to abusing alcohol and cocaine, mentioning that she frequently smuggled it onto planes and into other venues. Lovato’s addiction problem became so bad that it began to affect her career and her ability to perform. Regardless, the singer’s return to the public scene provides a stark lesson regarding the nature of recovery. Relapses may be devastating, but they are not always absolute. One can come back from a relapse and still live and flourish in recovery.
A History of Substance Abuse
From the start of her career, Demi Lovato struggled with mental health challenges. She ultimately found herself in an inpatient rehab facility. Following her treatment, Lovato maintained sobriety and went on to hit several career highs. While in recovery, Lovato released some of her top-selling albums, built a loyal and energetic fanbase, and became involved with mental health activism, even going on to speak about the topic at the 2016 Democratic National Convention.
In July of 2018, Lovato suffered an overdose from oxycontin laced with fentanyl. She was rushed to a hospital and revived with Naloxone. The overdose occurred after six years of sobriety for Lovato. Following the overdose, Lovato thanked her fans for her support, but went on an extended hiatus. Her performance at the NFL Championship game marks her return to her music career, and is a testament to the process of recovery.
People Like us…
Demi Lovato is an example of how living in recovery can be empowering. Despite various mental health and substance abuse challenges, and a near-fatal relapse, Lovato has chosen to reclaim her career and her life in recovery. While her continuing involvement in mental health activism remains unconfirmed, Lovato’s story provides an honest snapshot of the recovery process.
Yet, Lovato is but one example of a person making their way in recovery. Everyday people face the specter of relapse, the niggling little temptations to break sobriety. It’s important to remember that recovery is a journey. Sometimes the journey gets tough. But the will to keep going, regardless of the challenges, is the key to finding peace and freedom from addiction.
War, disasters, trafficking and immigration are tearing millions of children from their parents all around the world. A psychologist explores how to help them recover.
Q&A with Developmental Psychologist Hirokazu Yoshikawa
The US immigration policy that has separated more than 5,400 children from their parents had spurred psychologists and pediatricians to warn that the young people face risks ranging from psychological distress and academic problems to long-lasting emotional damage. But this represents just a tiny part of a growing global crisis of parent-child separation.
Throughout the world, wars, natural disasters, institutionalization, child-trafficking, and historic rates of domestic and international migration are splitting up millions of families. For the children involved, the harm of separation is well-documented.
Hirokazu Yoshikawa, a developmental psychologist at New York University who codirects NYU’s Global TIES for Children, recently looked into research on the impacts of parent-child separation and the efficacy of programs meant to help heal the damage. Writing in the debut issue of the Annual Review of Developmental Psychology, he and colleagues Anne Bentley Waddoups and Kendra Strouf call for an increase in mental health training for teachers, medical doctors or other frontline service providers who can help fill the gap left by the lack of mental health providers available to cope with the many millions of children affected.
Knowable Magazine recently spoke with Yoshikawa about the crisis and what can be done about it. This conversation has been edited for length and clarity.
Are there any good estimates of the number of children throughout the world who’ve been separated from their parents?
Exact numbers are hard to pin down, especially because several of the categories involved — like child soldiers and child-trafficking — aren’t well reported. What we know for sure is that the number of people around the world being displaced from their homes is at a historically high level. In 2018, some 70.8 million individuals were forcibly displaced due to armed conflicts, wars and disasters. That’s a record, and given that these phenomena often result in family separations and that more than half of these individuals were children under the age of 18, it suggests that historic numbers of children have been separated from their parents.
Why have such family separations become more common?
Many factors are driving it, but climate change is playing an increasing role in displacement and armed conflict all over the world. Climate change reduces access to dwindling resources and contributes to natural disasters, like floods, droughts, crop failures and famine. All of this increases conflicts, drives migration and breaks up families. This is not a blip in history; it’s a trend we will have to live with for generations to come.
What’s most important to know about the damage that comes from children being separated from their parents?
There are thousands of studies on the power of disruptions of children’s early attachments to their parents to cause longstanding problems. We’re talking about cognitive, social-emotional and other mental health impacts.
The developmental study of the mechanisms that may explain why these separations are so harmful goes back to before World War II, with the work of psychoanalysts and scholars such as Anna Freud, John Bowlby and Mary Ainsworth. In 1943, Anna Freud and Dorothy Burlingame studied children who’d been evacuated from London and learned that in many cases being separated from their mothers was more traumatic for them than having been exposed to air raids. When families left London but stayed together, the children behaved more or less normally. But when children were separated from their mothers, they showed signs of severe trauma, such as wetting the bed and crying for long periods of time.
Later on, Bowlby and Ainsworth published their more well-known studies of how infants form attachments with their mothers, and how sensitive and responsive parenting is key to forming secure attachments both with parents and later on with others. Researchers have found that this process can be disrupted in prolonged separations — say of more than a week — before the age of 5.
More recently — for example, in the ongoing and high-profile studies of Romanian children who were raised in abysmally low-quality orphanages — researchers have shown how children in institutional care have suffered from poorer learning and social and emotional behavior due to the lack of intellectual and emotional stimulation and the opportunity to engage in relationships with caregivers.
How seriously children are affected can depend on factors such as whether the separation was voluntary or not, how long it lasts and what kind of care exists in its wake. Permanent loss of parents can create some of the most severe consequences, while long periods of parent-child separation, even if followed by reunification, can seriously disrupt a child’s emotional health. Children are generally more vulnerable to long-term harm to their social-emotional development in early childhood, up to five or six years, but no period of development is immune.
One major problem we see is that most children who are separated from their parents have already experienced some other trauma along the way, which then makes the separation even harder. When parents are present, they can often help buffer the impact of extreme adversity from bad experiences.
What did you learn that most surprised you as you reviewed the scientific literature?
The sheer range of outcomes was surprising to me — beyond learning and achievement and mental health outcomes, they include very basic human functions like impaired memory, auditory processing and planning. They also include a range of physiological outcomes related to stress that are themselves related to long-term disease and mortality. So parent-child separation as it is currently experienced can shorten lives and increase the chances of physical disease.
Meanwhile, something that didn’t surprise me because I’m immersed in this literature all the time, but will probably surprise your readers, is that there are now about 8 million children in the world living in institutional care. This is a problem that reflects the lack of robust foster care and capacity of governments to facilitate placement with relatives, who will generally give more stable care than strangers. As we state in our review, even in otherwise good-quality institutional care, children suffer due to the high turnover of caregivers.
What relevance does your work have for US policies that have led to many parents and children being separated at the border?
US officials should know that there’s a global consensus, expressed in the UN Convention on the Rights of Children, on how to respond to children’s needs in this context. Primarily that means avoiding separating children from parents whenever possible and, when it must happen, keeping it as short as possible. An overwhelming amount of research, going back to Bowlby, supports these guidelines.
Unfortunately, we don’t have a lot of research findings on children separated from their parents while awaiting detention. And it doesn’t make it any easier that the Department of Homeland Security has had so much trouble keeping track of the kids involved.
Yet there are hints of the kind of negative effects you might expect to see if you look at the research on children whose parents have been detained without warning, for example in large workplace raids to arrest undocumented workers. In these cases, researchers have found that children have missed school and suffered behavior problems and depressive symptoms.
This brings up the fact that, in the United States, we’re talking about many more than 5,000 children being separated from parents. While the separations at the Mexican border have gotten a lot of media attention, millions of other children across our country are affected by the relatively recent harsher, sweeping policies resulting in more detentions and deportations of immigrants already living in the US. This has created a climate in which the threat of family separation is omnipresent.
We’re particularly concerned that many children separated from their parents stop going to school, perhaps from lack of supervision or from the need to support themselves or family members. The humanitarian sector tends to focus on basic needs and that’s understandable — they want to save lives. But from a developmental perspective, we have to focus on whether children thrive, not just survive.
Unaccompanied children who are trying to migrate are an increasing part of this global problem. What kind of special risks do they face?
It’s true that there has been a significant increase in recent years in unaccompanied minors trying to migrate internationally. At the US border, this increase has been happening since the 1990s, due to both economic crises and increases in urban violence in Mexico and in Central American countries. But the trend is now accelerating. From 2015 to 2016, there were five times as many children estimated to be migrating alone than from 2010 to 2011. In 2017, more than 90 percent of undocumented children arriving in Italy were unaccompanied.
Compared with refugee children who flee with their families, unaccompanied children are at greater risk for trauma and mental illness. One study of refugee children attending a clinic in the Netherlands found that the unaccompanied children were significantly more likely than those traveling with their families to have been victim to four or more traumatic events in their lives, including during their travels. They also had a higher rate of depressive symptoms and even of psychosis than refugee children living with their families.
What are some of the best ways that governments and nonprofit organizations can help these children?
Whatever can be done to avoid the separation from parents in the first place and to avoid detention and institutionalization of children whenever possible is in the children’s best interests. (That’s the guidance from the Global Compact for Refugees, Article 9 of the Convention on the Rights of the Child, and other global rights documents.) After that, it’s a matter of limiting the time away from parents or other caring adults as much as possible. The earlier and younger that children leave institutional care for stable foster care or adoption, the better it is for them.
You can see this in some of the follow-ups of the study of children in Romanian orphanages. Children who left the orphanages for foster care by 15 months of age had trouble speaking and understanding in early childhood, but not later. Children placed before 30 months showed growth in learning and memory so as to be indistinguishable from other children by age 16. So recovery from early institutionalization is possible, but it may take longer if a child spent more time in the orphanage.
What kinds of programs for children, if any, can help lessen the impacts of being separated from their parents?
In general, programs that help equip children for their daily lives can be useful. That includes education in decision-making, problem-solving, communication and stress management.
Teachers and doctors can play a major role, at minimum by identifying children who need mental health services and directing them to programs. The fact is we’ll never have enough mental health providers, so it makes sense to train members of the education and basic health systems that are already in place.
In the review, we describe a few of these efforts. One that stood out for us took place in two schools in London where children on average aged 12 to 13 had been separated from one or both parents due to war or migration. They came from Kosovo, Sierra Leone, Turkey, Afghanistan and Somalia. Teachers identified children who needed services, and who then spent one hour a week for six weeks with a clinical psychology trainee doing cognitive behavioral therapy. The treatment helped reduce PTSD symptoms, and the children’s teachers later reported that the children were behaving better in the classroom.
Granted, this was a very small study with no longer-term follow-up, so you can’t draw very strong conclusions, but it hints that even such a short-term intervention can be helpful in addressing children’s traumas. Studies have shown that even as few as 12 sessions of counseling from people trained in cognitive behavioral principles can help many people.
Do we have any idea of how many kids are being helped by these sorts of interventions? Are we still mostly talking about small experiments?
We’re not anywhere close to meeting the need for services. Unfortunately, health systems worldwide continue to overlook all kinds of mental health needs, particularly in low-income countries, even as depression and other mental illnesses take an economic toll, leading to reduced lifespans and reduced economic activity. The economic costs of mental health problems are huge, yet this may be one of the most underinvested areas in terms of health care.
The largest program you describe is in China, which isn’t that surprising, given how many internal immigrants China has.
Yes, there are potentially tens of millions of Chinese children and youth whose parents travel to cities to work and leave them behind, in the care of grandparents or other relatives. Between one-third and 40 percent of children in rural areas of China are in this situation. And there’s a lot of research documenting that these children are doing less well than children who are being raised by parents.
We describe one community-based program involving 213 rural villages with nearly 1,200 left-behind children. For three years, each village designated a space for after-school activities for the youth and hired a full-time employee to provide welfare services. The findings suggest the approach helped reduce disparities between the left-behind and non-left-behind groups.
What if anything gives you hope that this situation may improve?
The outcry over the US policies has increased awareness about a very vulnerable population of children. That could be a silver lining of the crisis. These parent-child separations are going on not only at the border, but also all over the country. The hope is that the attention will increase support for organizations, such as the national Protecting Immigrant Families Coalition, that are working to make a difference.
When it comes to children throughout the world who’ve been separated from their parents, we need a lot more people to be aware and concerned so as to provide the attention, stimulation and care that can help them recover.
Editor’s note: This article was updated on January 24, 2020, to clarify that in addition to teachers and medical doctors, Dr. Yoshikawa and his colleagues also recommend mental health training for all frontline service providers.
Here, we’ll review who is best served by rehab and what you can expect during a typical stay. Then, we invite your questions about drug rehab centers at the end. In fact, we try to respond to all questions personally and promptly.
Who needs drug treatment rehab centers?
If you need to use drugs (any psychoactive substance) to get through the day, you may need addiction treatment. In fact, one of the best indications that a person needs a drug rehab center is psychological dependence on your drug of choice. Psychological dependence is characterized by:
Physical dependence on a drug can also signal need for drug treatment. This occurs when a person’s brain and body become accustomed to functioning with the drug. When a physically dependent person stops taking the drug, they will typically experience withdrawal symptoms that can be relived by using the drug again.
Who else can benefit from a drug treatment rehab center?
have decreased work or school performance because of drugs
neglect other responsibilities in favor of using drugs
see an increase in health problems related to drug use
spend a great deal of time using, trying to find, or recovering from their drug of choice
Going to drug rehab treatment centers
The goal of drug rehab treatment is to ultimately live a drug-free life. An effective treatment program will help you understand addiction and give you the skills you need to resist the temptation to use again. For many, going to rehab centers is much less intimidating when you know what to expect from a drug rehab program. So what happens in a drug rehab treatment center?
1. Initial intake
When you first start drug rehab, you will undergo an intake assessment. This is used to determine the severity of the addiction, and will ultimately be used to create an addiction treatment plan. Assessments usually include interviews, urine/blood tests, and a medical exam. During intake, you will be assigned a lead counselor (usually a certified psychologist) who will be your main contact throughout treatment. Additionally, you will be shown the facilities and be introduced to patients currently enrolled in rehab. This begins your stay at a drug rehab treatment center.
2. The treatment itself
Your addiction treatment plan will include several psychological treatments, including therapy and counseling. Medications are also sometimes used to treat certain drug addictions. In fact, a combination of pharmacological and behavioral interventions often shows greater success than either used alone.
3. Daily or weekly sessions
If you choose an inpatient drug rehab treatment center, you will be required to reside in the treatment facility. This intensive drug rehab treatment can last anywhere from a month to a year and is organized around a strict daily routine. Expect to be present and accounted for multiple times throughout the day for individual sessions, group sessions, educational sessions, exercise, and meal time.
In comparison, outpatient drug rehab often requires 1-3 hours of attendance per day or multiple sessions per week. While less rigorous in terms of time requirements, outpatient drug treatment rehab is often most successive when it is intensive in nature, 9+ or more hours per week.
Reasons to go to drug rehab treatment
There are several reasons to go to drug rehab for addiction treatment. Of course, it can sometimes be difficult to think of these reasons when you’re struggling with a drug addiction, so we’ve put together a list for you. Once you overcome addiction, you’ll be able to
be more productive
enjoy a healthier lifestyle
regain your loved ones’ respect and trust
repair broken relationships
stay away from legal troubles
stop wasting your money on drugs
Who is affected by drug addiction?
An addict as well as everyone around him or her is affected by drug addiction. After using drugs for a period of time, a person’s health will often start to decline. Drug abuse can also cause a number of financial, family, and social problems for an addict.
An addict’s family is also strongly affected by drug addiction. They will often feel helpless and frustrated in the face of addiction. In many cases, a drug addiction can cause family members to lose trust in and respect for their loved ones.
Drug rehab centers truly help addicts as well as their loved ones. After overcoming their addictions, addicts can live much healthier lives. They can also work toward reconciling with their family and friends that they hurt while they were doing drugs.
Drug treatment rehab center questions
Do you still have questions about the benefits of drug treatment and attending a rehab center? Please ask us in the comments section below. We do our best to respond to each question personally and promptly.
You know about Kratom addiction potential -you want to stop using Kratom! So, what can you expect during Kratom withdrawal? And how can you cope? We explore here, and invite your questions about withdrawal from Kratom at the end.
Severity of Kratom withdrawal
From personal and anecdotal experience, the nature of withdrawal from Kratom and Kratom effects on body in terms of severity and occurrence seem to depend on a number of factors. The factors that contribute to Kratom withdrawal include:
1. Duration of use – The length of time you have been taking Kratom. The longer you have been using it the more severe the symptoms.
2. Type of Kratom – The type of Kratom you have been taking. Withdrawing from highly concentrated extracts of the alkaloids found in Kratom results in a worse withdrawal experience. Method of administration usually contributes to withdrawal symptoms, but as Kratom snort is not recommended, we assume that you are taking oral doses of Kratom.
3. Previous mental health issues – Anecdotal evidence from online forums suggests that those who suffered from depression prior to becoming dependent on Kratom find withdrawals particularly difficult.
4. Personal pain tolerance -It also seems that some people just manage Kratom withdrawals better. There are many who claim quitting Kratom even after more than a year’s daily use is no more difficult than quitting caffeine, while others talk about it like being hell on earth. So there certainly is a subjective element.
My Experience withdrawing from Kratom
I have personally withdrawn from Kratom after more than a year’s use and can therefore talk about my own withdrawals which I have been led to believe mirror those of others but not necessarily in their severity or duration.
I took Kratom leaf twice a day, ever day for over a year. I decided one day to quit cold turkey; I used up the last of my supply and held my breath. I knew what was coming, I had tried to quit in the past but had always given up due to the crippling sadness that had enveloped me.
Psychological Kratom Withdrawal
Within 8 hours of my last dose of Kratom, I began to feel anxious and incredibly sad, despondent and plain depressed. It is difficult to describe the sense of loneliness and desolation I felt, everything seemed amazingly bleak. For me, this aspect of withdrawals was by far the most difficult to cope with and it continued for over a month. I must stress again that this was my experience others state that all their symptoms including the despondency disappeared after 4 or 5 days.
Physical Kratom Withdrawal
The other symptoms I experienced during Kratom withdrawal were all physical and ‘only’ lasted for 3 or 4 days. These self-reported symptoms during Kratom withdrawal are similar to those seen in individuals undergoing opiate withdrawal but are far less severe. If you have experienced other symptoms, please share them in the comments section of this article. The symptoms of physical withdrawal from Kratom included:
anxiety
cold-like symptoms
insomnia (the tick-tock of the clock just went on and on, night seemed as if it would never end)
lethargy/apathy
RLS – restless leg syndrome (it felt as if my legs were electrified and this contributed to insomnia)
sweating
Coping with Kratom Withdrawals
You can get through Kratom withdrawals. Kratom withdrawal can be a mere inconvenience for some and difficult for others. Here are some tips and suggestions based on my own experience about how you can cope during the period of Kratom withdrawal. Again, if you have other ideas, please leave them at the end.
I would advise anyone planning to withdraw from Kratom to seek the advice of a sympathetic physician. A prescription for a sedative like diazepam can help with the anxiety and insomnia. The problem is, though, that many doctors have never heard of Kratom and so will not know what to do.
You might want to take time off work/responsibilities during the initial stages of withdrawal as it can be very difficult to find the motivation to get tasks done.
It is also good to have a friend/loved one with you during the first few days as you can get quite despondent. This should be someone who knows that you are going through Kratom withdrawals and who knows what to expect as you go through the process of withdrawal.
If you are prone to depression anyway, then you really need to see a mental health care professional prior to quitting Kratom.
Kratom withdrawal questions
If you are going through Kratom withdrawal, you are not alone! We invite your questions about Kratom withdrawal. Or maybe you have an experience or feedback to share with other readers. Please let us know. We try to reply to all questions and comments with a personal and prompt response.
In terms of addiction, enabling has a negative connotation. It refers to a dysfunctional way of helping someone else in such a way that hurts the enabler and the person they think they are helping. In the article, “8 Signs You are a Co-addict“, we discussed many types of enabling. Whichever type you engage in, there are consequences to each.
So, how can you end the enabling and move towards a healthier relationship…a healthier you? We review here. Then, we invite your questions at the end. In fact, we try to respond to all legitimate questions or comments with a personal and prompt response.
Are you ready to hear the truth?
Some women will post on my blog about how they want to stop enabling their husband’s addiction. Their posts seem so desperate and so imminent. I know what they are going through because I have been there; I was married to an addict, too. So, I spend time and energy crafting a heartfelt and realistic response. I try to address their needs and personalize the advice for them and then … weeks will go by and … nothing. Months and … nothing. Some of these women never reply.
I thought about this for a while and tried to put myself in their shoes. When they are reading online for answers and posting their frustrations and their stories they are usually in a crisis situation, either the addict is binging on drugs, disappeared, or done some other inexcusable act. Just because they are posting on my blog does not mean that they are ready to hear what I have to tell them.
When I explain what is most likely to happen or what will help them in the long run, they do not answer back because that is not the answer they were looking for. Most women are not ready to hear that they need to change. Perhaps telling their stories just helps them purge all of their anxiety or they still believe I can tell them how they can fix their partner.
STOP enabling
When I was married to an addict, the only advice I hoped to hear from my therapist and from other support people was that I could do “X,Y, and Z” and that would help me fix my husband and his addiction. I wanted to know that living with an addict was possible, and that he could change. When people suggested I had issues or that I should leave my husband I was mortified. I thought I could not live without him so I continued on the same path hoping something would happen that would change him.
Twelve years passed and nothing happened.
I still wanted to fix him, until one day an event forced me to fix myself. It was like I was tuning out all of the advice I needed to hear until one day I heard it because I was ready to listen.
My husband was not forcing me to enable him; I was taking it upon myself to help him because I felt bad for him and I loved him. I realized when I did things that I knew made his addiction and life easier, even if it was acting crazy so he could feel justified to abuse drugs more, that I was not only enabling him but hurting myself. If he ever had a chance to stop using drugs, I had to realize it was not going to be because of me.
Most enablers already know that being married, having children, and responsibilities are not enough reason for an addict to get sober. But, they still think one day they will say something and the addict might all of a sudden realize they are.
It’s about boundaries
Most addicts have no boundaries. An enabler eventually loses their own boundaries and their lives become convoluted and controlled by addiction. Enablers lose their identity and do not understand why they keep on doing what they are doing. So, how can you pull yourself back up to stand on your own two feet?
Start empowering yourself!
How to stop enabling a drug addict?
To stop enabling a few things need to happen:
You need to make a commitment to change.
You must commit to stop your part in enabling 100%, not just some of the time.
You must stop negative patterns and behaviors and replace them with positive ones.
You need to get support from someone with experience and someone you trust to help you.
You need to stop enabling him and start empowering you.
Enablers feel the illusion of control when they help their partner. Once you let it go, you can stop trying to fix and control your partner, take that energy, and fix yourself. You can start asking yourself the questions:
Why am I allowing this person and his addiction control my life?
Why do I not feel good enough about myself to want to be treated better?
Why am I so afraid to leave?
Why do I have fears of abandonment, of being alone, of standing on my own two feet?
If you focus on you, there is less of a chance you will have the time to focus on him. If you change your life and start doing things that bring back your self-confidence then it is less likely you will want to repair him.
Addiction is a selfish condition because it usually involves the complete attention of more people than just the addict. It can draw in the wife, the children, the parents, and the friends if you allow it. Nevertheless, enabling is a choice even though it does not feel like one. The best way to stop enabling is to learn your enabling behaviors and make a conscious choice to STOP.
Need some help?
We invite you to leave your questions in the comments section below. We do our best to respond to each person individually and promptly!
Suboxone and Bunavail are Schedule III narcotics that contain a combination of buprenorphine and naloxone as active ingredients. Both these meds are prescribed in the treatment of opioid addiction. The buprenorphine in these medications is an opioid, while the naloxone is substance that reverses the effects of opioid drugs. The combination is made to lower the chances for abuse and addiction to buprenorphine.
They may seem to be the same drug under a different brand name, but Suboxone and Bunavail have their significant differences. Continue reading as we get into the details about these medicines and compare their effects. If you have any questions and comments, you can post them in the section at the end of the page.
Bunavail and Suboxone similarities
Suboxone and Bunavail are different from current medications (like methadone) used in the maintenance phase of opioid addiction treatment. They are more convenient, are prescribed in doctor’s office, and are available in most commercial pharmacies. As patients progress in therapy, they may even be allowed to take a supply of the medication and use it at home.
Note here that both Bunavail and Suboxone are not intended to be used as stand alone treatments. Instead, medication should be combined as a part of a complete treatment program that includes counseling, individual, group or family therapy sessions, cognitive-behavioral and educational classes, psychological support, and adopting new, positive life-style practices.
Bunavail and Suboxone: How supplied and dosing
Suboxone is supplied in the form of sublingual tablets, taken by placing the tablet under the tongue and waiting for it to dissolve. Suboxone is available in two strengths:
Bunavail, on the other hand, is made of a buccal film that stick to the mucosa on the inside of the cheek and are then quickly dissolved. Bunavail is available in three different strengths:
2.1 mg buprenorphine/0.3mg naloxone
4.2 mg buprenorphine/0.7mg naloxone
6.3 mg buprenorphine/1mg naloxone
Bunavail and Suboxone differences
1. Mode of administration/delivery mechanism
One of the main differences between these two medicines is that Bunavail buccal film delivers buprenorphine through the buccal mucosa, while Suboxone is taken sublingually (put under the tongue). Bunavail offers delivers a dose of buprenorphine to the bloodstream via a polymer film that attaches to the buccal mucosa at the inside of the cheek. The film will disappear within 15-30 minutes, it has a pleasant taste and doesn’t disrupt swallowing or speaking while dissolving. However, speaking is not as easy with Suboxone sublingual.
2. Bioavailability
You have probably noticed that Bunavail comes in lower dose strengths than Suboxone. Taking one Bunavail 4.2 mg/0.7mg buccal film will provide equivalent level of buprenorphine in the system as taking 8mg/2mg Suboxone sublingual tablet. The level of naloxone supplied with Bunavail buccal film is about 33% lower than naloxone levels supplied by Suboxone sublingual.
It doesn’t make Bunavail less effective in the maintenance treatment for opioid dependence. Instead, Bunavail buccal film is designed with the new BEMA delivery technology or BioErodible MucoAdhesive drug delivery mechanism. This allows Bunavail to be absorbed more quickly than Suboxone, so patients need a lower dose to achieve the same effects.
However, this difference in bioavailability between Bunavail and Suboxone requires a different dosage strength to be administered by patients who are switching from one to the other (generally from Suboxone to Bunavail). It’s important for doctors to prescribe dosage strengths that will correspond to the amount and strength in which the other medication was taken.
3. Less risk
Taking your maintenance medication in lower doses, while achieving the same medical effects is great because you have less chances of developing cross-addiction and getting unwanted side-effects.
Bunavail v.s. Suboxone questions
We hope we answered all you wanted to know about the similarities and differences between Suboxone sublingual tablets and Bunavail buccal film. Keep in mind that a doctor’s clearance and approval are crucial for prescribing either one of these medications, and for switching from one to the other.
If you have any further questions you’d like to ask us, please post them in the section below and we’ll do our best to provide a personal and prompt response.
Algorithms seem to be taking over our lives. Every time we hit the search button on Google, buy a train ticket online or use social media we are expanding the scope and range of algorithms. Instead of letting a string of computer code increasingly decide our preferences for us, how can we fight back and retain some element of control over our online experiences?
An ‘Algorithm’ is simply a set of instructions, and today it just describes the automated steps a computer follows in operating different functions. But, after repeated reference in the context of social media giants such as Facebook, and privacy scandals such as that of Cambridge Analytica, the concept has taken on very many negative connotations. ‘Algorithm’ has almost become a dirty word.
Now, algorithms are treated with suspicion and, in true apocalyptic sci-fi style, we are even becoming fearful of their power.
An algorithm in itself is not sinister, and they have some fantastic applications in our day-to-day lives, such as suggesting the quickest route home or saving us from having to type the full question into Google through suggestions.
However, algorithms need to be demystified. We need to understand how they gather and use data on us so that we can limit the control they have over us.
What’s so harmful about social media algorithms?
Social media algorithms are central to online advertising. To be cost-effective, companies want to ensure their advertisements are being shown to the right people. That’s where algorithms come in: by analysing the issues and subjects we interact with positively on social media they can determine what sort of products and services we may be interested in. Brands and businesses then pay social media platforms like Facebook to push their services to us, and suddenly we’re inundated with online advertisements tailored exactly to our interests.
Ultimately, an algorithm aims to override human thought and decision making process, telling and showing us what we want to see, before we may have even decided this ourselves. However, the problem is not that the algorithms exist, it’s that we’ve invested too much trust in them. We need to remember that what content we seek out and view should be up to us. You may love discovering new music through Spotify’s personalised suggestions, but you know that sometimes you’ll want to explore new genres: music that is not in any way similar to what you listen to now. Because this won’t be like any music you’ve listened to thus far, you probably value the freedom to seek this out yourself.
Are algorithms biased?
Yes, inevitably. An algorithm reviews the content we like and then pushes similar content towards us.
This is supposedly all to guarantee a positive user experience, but surrounding ourselves purely with things that we know you like and agree with is dangerous – that way echo chambers lie. And it limits imagination and caps our powers of exploration. The web is a vast jungle of information and opinions, but if we rely on algorithms too much, browsing the web will become a rather stagnant and passive experience, more like watching television than searching for and discovering things ourselves.
How can we limit algorithms’ power over us?
We need to be careful that we do not become puppets of algorithms and subsequently victims of sophisticated, big budget, online marketing.
Cut down the time you spend on social media
The less information you provide algorithms with, the less they will know about you. It’s as simple as that. Spend less time on Instagram, Facebook and Twitter and become less reliant on social media sites for your news. The nature of an algorithm means it is inevitably biased: do you really want your news to be provided by a source with an agenda?
Confuse the algorithms
Anyone who doesn’t want social media algorithms gathering too much personal data needs to start disrupting them. That is, go against what they think you want. This means ‘liking’ and ‘following’ posts and communities that you really have no interest in (or even disagree with!) and resisting the urge to click on pages promoted to you. Consciously spend some time each day confusing the profile of information that’s been built up about you by behaving unpredictably online. A less certain algorithm will provide a greater diversity in the content pushed to you, reinstating the power of choice.
If this feels too counter-intuitive, Go Rando is a web browser extension that can do it for you!
Even some of the newest, most expensive brand-name medicines have been plagued by quality and safety concerns during production, a Kaiser Health News analysis shows.
After unanimously voting to recommend a miraculous hepatitis C drug for approval in 2013, a panel of experts advising the Food and Drug Administration gushed about what they’d accomplished.
“I voted ‘yes’ because, quite simply, this is a game changer,” National Institutes of Health hepatologist Dr. Marc Ghany said of Sovaldi, Gilead Science’s new pill designed to cure most cases of hepatitis C within 12 weeks.
Dr. Lawrence Friedman, a professor at Harvard Medical School, called it his “favorite vote” as an FDA reviewer, according to the transcript.
What the panelists didn’t know was that the FDA’s drug quality inspectors had recommended against approval.
They issued a scathing 15-item disciplinary report after finding multiple violations at Gilead’s main U.S. drug testing laboratory, down the road from its headquarters in Foster City, Calif. Their findings criticized aspects of the quality control process from start to finish: Samples were improperly stored and catalogued; failures were not adequately reviewed; and results were vulnerable to tampering that could hide problems.
Gilead Foster City doesn’t manufacture drugs. Its job is to test samples from drug batches to ensure the pills don’t crumble or contain mold, glass or bacteria, or have too little of an active antiviral ingredient.
Recent news reports have focused public attention on poor quality control and contamination in the manufacturing of cheap generic drugs, particularly those made overseas. But even some of the newest, most expensive brand-name medicines have been plagued by quality and safety concerns during production, a Kaiser Health News analysis shows.
More disturbing, even when FDA inspectors flagged the potential danger and raised red flags internally, those problems were resolved with the agency in secret ― without a follow-up inspection ― and the drugs were approved for sale.
Erin Fox, who purchases medicines for University of Utah Health hospitals, said she was shocked to hear from KHN about manufacturing problems uncovered by authorities at the facilities that make brand-name products. “Either you’re following the rules or you’re not following the rules,” Fox said. “Maybe it’s just as bad for branded drugs.”
The pressure to get innovative drugs like Sovaldi into use is considerable, both because they offer new treatments for desperate patients and because the medicines are highly profitable.
Against that backdrop, the FDA has repeatedly found a way to approve brand-name drugs despite safety concerns at manufacturing facilities that had prompted inspectors to push to reject those drugs’ approval, an ongoing KHN investigation shows. This happened in 2018 with drugs for cancer, migraines, HIV and a rare disease, and 10 other times in recent years, federal records show. In such cases, how these issues were discussed, negotiated and ultimately resolved is not public record.
For example, inspectors found that facilities making immunotherapies and migraine treatments didn’t follow up when drug products showed evidence of bacteria, glass or other contaminants. At a Chinese plant making the new HIV drug Trogarzo, employees dismissed “black residue” found to be “non-dissolvable metal oxides,” assuming it “did not pose a significant risk,” federal records show.
Without a follow-up inspection to confirm drugmakers corrected the problems inspectors found, these medicines eventually were approved for sale, and at list prices as high as $189,000 a month for an average patient, according to health data firm Connecture. The cancer drug Lutathera was initially rejected over manufacturing problems at three plants but was approved a year later without a fresh inspection and was priced at $57,000 per vial.
John Avellanet, a consultant on FDA compliance, said data integrity problems, like those at Gilead’s lab in Foster City, should have sparked further investigation, because they raise the possibility of “deeper issues.”
Dr. Janet Woodcock, the director of the FDA’s Center for Drug Evaluation and Research, said an inspector’s recommendation to withhold approval can be “dealt with” without a follow-up. Woodcock said the agency can’t comment on specifics, and companies are reluctant to discuss them because the details of the resolution are protected as a corporate trade secret.
“That doesn’t mean that there’s anything wrong with the drug,” Woodcock said.
Dinesh Thakur, a former drug-quality employee turned whistleblower, called the secrecy a “red flag.” A follow-up inspection is critical, he said: “I’ve seen many times paper commitments are made but never followed through.”
What worries Fox is that a faulty drug could get through and nobody would know.
“In general, very few people suspect that their medicine is the problem or their medicine is not working,” Fox said. “Unless you see black shavings or something horrible in the product itself, the drug is almost the last thing that would be suspect.”
The Market Beckons
If the FDA finds problems at preapproval inspections for generics, the agency is likely to deny approval and delay the drug’s launch until the next year’s review cycle, according to industry and agency experts.
In fact, just 12% of generics were approved the first time their sponsors submitted applications from 2015 through 2017.
The calculus appears different for heralded new therapies like Sovaldi. In 2018, 95% of novel drugs ― the newest of the new ― were approved on the first try, the FDA said.
Woodcock said the agency has “the same standards for all drugs,” but she emphasized that many of the manufacturing issues “are somewhat subjective.”
For new brand-name drugs, she said, the FDA “will work very closely with the company to … bring the manufacturing up to snuff.”
The manufacturer submits written responses and commits to resolve quality concerns, but the details are kept confidential.
An estimated 2.4 million Americans have hepatitis C and, before Sovaldi, treatment came with miserable side effects and a strong chance it wouldn’t work. Sovaldi promised up to a 90% cure rate, though it came with an eye-popping $84,000 price tag for a 12-week course, putting it out of reach for most patients and health care systems.
But corporate pressure to get such therapies into the marketplace is also considerable.
Pharmaceutical firms pay hefty fees for FDA review and lobby the agency to speed products to market. For Gilead, time lost is money.
“If approval of sofosbuvir were delayed, our anticipated revenues and our stock price would be adversely affected,” Gilead wrote in an SEC document filed Oct. 31, 2013, using the generic name for Sovaldi.
Since its debut in 2013, Sovaldi has been widely criticized for its price but recognized as a medical breakthrough. Gilead has never recalled it.
However, hundreds of patients who have taken the drug have voluntarily reported cancer or other complications to the FDA’s “adverse event” reporting database, including concerns that the treatment doesn’t always work. One in 5 Sovaldi patients and health care professionals who reported serious problems to federal regulators said the drug didn’t cure the patients’ hepatitis C.
“The FDA approved these products after a rigorous inspection process, and we are confident in the quality/compliance of these products,” Gilead spokeswoman Sonia Choi said.
Problems at Foster City
Gilead’s Foster City facility has been cited for an array of problems over the years. In 2012, FDA inspectors said the facility had failed to properly review how the HIV drugs Truvada and Atripla became contaminated with “blue glass” particles; some of that tainted batch was distributed. The company “made no attempt to recover” the contaminated drugs, according to FDA inspection records.
Gilead had just filed its application for Sovaldi’s approval when FDA inspectors arrived at Foster City for an unrelated inspection in April 2013. Inspectors slapped the facility with nine violations in what’s called a 483 document and said that the reliability of the site’s methods for testing things like purity were unproven and that its records were incomplete and disorganized, according to FDA inspection documents.
As a result, the FDA initially rejected two HIV drugs, Vitekta and Tybost. Gilead had to resubmit those applications, and it would take 18 months before the FDA approved them in late 2014.
On Sept. 19, 2013, FDA officials met to discuss Sovaldi with Woodcock, agency records show. Meeting minutes show inspectors recommended hitting Gilead Foster City with a formal warning letter based on the April inspection. (A warning letter is a disciplinary action from the FDA that typically includes a threat to withhold new approvals or place a foreign facility on import alert and refuse to accept its products for sale in the U.S.)
At the same meeting, FDA inspectors said their recommendation to approve Sovaldi would be “based on” removing an unnamed drug ingredient manufacturer from the application and “a determination that Gilead Foster City has an acceptable cGMP [current good manufacturing practices] status.”
Records show the FDA didn’t issue a warning letter or otherwise delay the approval process when Foster City failed its inspection.
Instead, the Sovaldi preapproval inspection started four days later and lasted two weeks. At the end, inspectors issued Foster City another 483, this time with 15 violations, formally outlining problems and requiring a written plan to fix them. Inspectors said they couldn’t recommend Sovaldi’s approval.
FDA officials gave Gilead two options during an Oct. 29 teleconference: Remove Foster City, a “major testing site” for Sovaldi, from the application, and use a third-party contractor instead; or use Foster City but hire another firm to monitor the site and sign off on its testing work.
Gilead was optimistic. “Based on recent communications with the FDA, we do not expect these [inspection] observations to delay approval of sofosbuvir,” the company said in its Oct. 31 SEC filing.
Gilead chose to replace the Foster City plant with a contract testing site, federal records show. By December, Sovaldi was approved for distribution, and the company soon announced its $1,000-per-pill price tag.
Not Just Generics
Recent media reports, and the ongoing recall of the widely used blood pressure medicine valsartan, have led consumers ― and members of Congress ― to question whether generics are manufactured safely. Valsartan pills made in China and India were found to contain cancer-causing impurities.
Branded-drug quality, in large part, has been spared from congressional scrutiny. But many factories ― overseas and in the U.S. ― make branded and generic drugs.
In January 2018, FDA inspectors hit a Korean manufacturing plant that makes Ajovy, a migraine drug, with a warning letter. With the problems still unresolved in April, an agency reviewer recommended withholding approval. When they returned in July, inspectors wanted to give the plant the worst possible classification: “Official Actions Indicated.” Among other problems, inspectors found that glass vials sometimes broke during the manufacturing process and that the facility lacked protocols to prevent the particles from getting into drug products. The FDA’s Office of Manufacturing Quality eventually downgraded the inspection to just “Voluntary Actions Indicated.”
The drug was approved in September 2018 and priced at $690 a month. FDA records indicate no further disciplinary action was taken. Teva, the maker of Ajovy, did not respond to requests for comment.
Similarly, when FDA inspectors visited a contract manufacturing facility in Indiana used to make Revcovi, which treats an autoimmune disease, they noted that a redacted drug lot had failed a sterility test because the vials tested positive for a bacterium called Delftia acidovorans, which can be detrimental even in people with healthy immune systems, studies show. But the drug-filling machine stayed in use after the contaminant was discovered, the FDA determined. Inspectors recommended withholding approval.
The drug was approved in October 2018 even after another inspection turned up problems, with a list price of $95,000 to $189,000 per month for an average patient, according to health care data firm Connecture.
Revcovi’s manufacturer, Leadiant Biosciences, said through an outside public relations firm that its contract manufacturer’s written responses to the FDA observations were considered “adequate” by two FDA offices, adding, “We do not have any more information to share with you at this time as pharmaceutical manufacturing processes are confidential.”
Problems with drugs can take years to discover ― and then only after patients are injured. So, many health researchers say, more caution is warranted.
“They’re doing so few of these [FDA] inspections pre-market,” said Diana Zuckerman, president of the nonprofit National Center for Health Research. “The least they can do is listen to the ones they’re doing.”
This story was originally published at Kaiser Health News on November 5, 2019
As we begin the new year, we all have ideas as for how we would like to improve ourselves. Perhaps we would like to learn to manage and use our time more efficiently, or be more productive at work or even just in our daily lives. Perhaps we would like to give ourselves the opportunities to find and release ourselves in activities we truly love.
However, often the most difficult part of bringing about change to our lifestyles is deciding how we can start. That’s where digital decluttering comes in. Think of it as Spring cleaning for your tech! Throwing out junk and sweeping away the cobwebs of past interactions and causes of stress.
Digital decluttering essentially entails organising your technology by clearing it of all the unnecessary documents, emails and other forms of information no longer of any use. We find that digital decluttering is not only the first step towards improving productivity, but also enables us to release ourselves from the stresses and pressures of daily life – by allowing us to concentrate and focus on doing the things we love when we have time off. Here are six steps to help you do just that.
Organise your files
I find that a messy desktop is enough to discourage me and thus limit my productivity before I have even started my work! It is a fairly soothing and mindless activity to tidy your files into navigable folders so they are easily accessible, and the stress relief that comes as a result is well worth the task. Furthermore, try to make it a practice to save files into an organised area as you work.
Manage your inbox
An office worker receives on average 121 emails every day! That’s 600 emails coming into their inbox every working week. Having this much information facing you can be overwhelming and thus hinder productivity. So, clear out your inbox: delete past conversations, unmark those flagged emails you never managed to chase up and unsubscribe from those irrelevant newsletters you never read anyway!
Keep your tech up to date with you
By this, we mean both keeping your devices technically up to date with the latest software and security, as well as keeping it up to date with your lifestyle. Delete applications you no longer use – these just take up both visual and memory space and slow your device. Take back control over your device so that its function is suited to you and your life today.
Turn off unrelated notifications during working hours
There’s no point responding to non urgent personal messages whilst trying to work. Productivity, and the quality of interaction with the person contacting you, both benefit from you concentrating on work and then knowing you can use your well earned break to commit yourself to stress-free social interaction. Trying to do both simultaneously won’t help either.
Even just a quick check of your phone will break your concentration, hindering your progress.
Avoid online distractions whilst working
A well earned break from work can do wonders for productivity, but too often all we do on our break is check social media or open YouTube whilst still trying to concentrate on a project (the average user checks their smartphone every 12 minutes!), These distractions make it even more difficult for us to resume focus, and almost always leave us feeling even more unproductive and worse about ourselves. (We offer specific advice here if you actually feel that you are addicted to your phone).
Limit your use of technology
The quantity of information being uploaded to social media and the rate at which we are exposed to new content and information can be overwhelming. By choosing to engage in real time face-to-face social interaction, rather than dedicating hours of our day to social media, we’re giving ourselves an emotional breather and decluttering our brains, allowing them to recharge by focussing on the truly enriching and important moments of social interaction. For more help on distancing yourself from your technology, take a look at our upcoming retreats. View the original article at itstimetologoff.com
The U.S. presidential impeachment inquiry has added another layer of uncertainty to an already unstable situation that includes political polarization and the effects of climate change.
As a clinical psychologist in the Washington, D.C. area, I hear people report being stressed, anxious, worried, depressed and angry. Indeed, an American Psychological Association 2017 survey found that 63% of Americans were stressed by “the future of our nation,” and 57% by the “current political climate.”
Humans dislike uncertainty in most situations, but some deal with it better than others. Numerous studies link high intolerance of uncertainty to anxiety and anxiety disorders, obsessive-compulsive disorder, depression, PTSD and eating disorders.
While no one person can reduce the uncertainty of the current political situation, you can learn to decrease intolerance of uncertainty by implementing these scientifically sound strategies.
When unsure how to best proceed with a work assignment, you might either immediately seek help, over-research or procrastinate. As you prepare for the day, uncertainty about the weather or traffic is quickly short-circuited by checking a phone. Similarly, inquiries about family or friends’ whereabouts or emotions can be instantly gratified by texting or checking social media.
Tolerance for uncertainty is like a muscle that weakens if not used. So, work that muscle next time you face uncertainty.
Start gradually: Resist the urge to reflexively check your GPS the next time you are lost and aren’t pressured for time. Or go to a concert without Googling the band beforehand. Next, try to sit with the feelings of uncertainty for a while before you pepper your teenager with texts when he is running late. Over time, the discomfort will diminish.
2. Connect to a Bigger Purpose
Rita Levi-Montalcini was a promising young Jewish scientist when fascists came to power in Italy and she had to go into hiding. As World War II was raging, she set up a secret lab in her parents’ bedroom, studying cell growth. She would later say that the meaning that she derived from her work helped her to deal with the evil outside and with the ultimate uncertainty of whether she would be discovered.
Focusing on what can transcend finite human existence – whether it is religion, spirituality or dedication to a cause – can decrease uncertainty-driven worry and depression.
3. Don’t Underestimate Your Coping Ability
You might hate uncertainty because you fear how you would fare if things went badly. And you might distrust your ability to cope with the negative events that life throws your way.
It turns out that humans are generally resilient, even in the face of very stressful or traumatic events. If a feared outcome materializes, chances are you will deal with it better than you could now imagine. Remember that the next time uncertainty rears its head.
4. Bolster Resilience by Increasing Self-Care
You have probably heard it many times by now: Sleep well, exercise and prioritize social connections if you want to have a long and happy life.
Possibly the best tool for coping with uncertainty is making sure that you have an active and meaningful social life. Loneliness fundamentally undermines a person’s sense of safety and makes it very hard to deal with the unpredictable nature of life.
In spite of civilization’s great progress, the fantasy of humankind’s absolute control over its environment and fate is still just that – a fantasy. So, I say to embrace the reality of uncertainty and enjoy the ride.
