Viewpoint: Impaired Physicians and the ADA The Journal of the American Medical Association This brief article cites cases to discuss the implications of disability, impairment, and accommodations, in both medical practice and mundane settings. It is not intended as a decisional algorithm. The year 2015 marks the 25th anniversary of the Americans with Disabilities Act (ADA), which prohibits disability-based discrimination and requires reasonable accommodation in employment, public accommodations, and public services. Many physicians, however, have been protected from disability-based discrimination since 1973 under the Rehabilitation Act, which has comparable provisions but less comprehensive coverage and remedies for physicians. This Viewpoint explores disability discrimination law in the context of impaired physicians.
Editor’s Comments William Haning, MD, FASAM, DFAPA The role of the Weekly has been as a digest, to serve as a collection of articles screened for pertinence to those in the addiction community. The articles are chosen on the bases of salience and currency, and are drawn from principally national but also some international sources. As you are by now familiar, the source material is not limited to conventional medical journals, or even to printed publications. However, by attempting to subsume one or more articles under each of the classifications below, we have managed to weekly offer a whopping big, high-yield homework assignment for our colleagues.
Within-Family Discussion on Harmful Effects of Smoking and Intention to Initiate Smoking Among European Adolescents Journal of Addiction Medicine (free ASAM member resource) In the tradition of validation studies for commonly-held beliefs, this article suggests that parenting can have beneficial effects. It demonstrated that within-family discussion about the harmful effects of smoking may contribute to reduce the intention to start smoking among adolescents in the long term. Such a discussion was associated with reduced intention to smoke even when adjusting for parent/friend and classmate smoking.
Perspective: Protection or Harm? Suppressing Substance-Use Data New England Journal of Medicine This editorial challenges the regressive and largely legalistic restrictions now being placed uniquely upon the study of SUDs. It centers upon the misguided over-protection of personal data of the SUD population, as being from a protected class. The consequences are summarized in a series of questions: What if it were impossible to closely study a disease affecting 1 in 11 Americans over 11 years of age — a disease that's associated with more than 60,000 deaths in the United States each year, that tears families apart, and that costs society hundreds of billions of dollars? What if the affected population included vulnerable and underserved patients and those more likely than most Americans to have costly and deadly communicable diseases, including HIV–AIDS? What if we could not thoroughly evaluate policies
designed to reduce costs or improve care for such patients?
Cannabis, Tobacco Smoking, and Lung Function: A Cross-Sectional Observational Study in a General Practice Population British Journal of General Practice Spoiler: Smoking tobacco + cannabis is worse than smoking cannabis alone. ...Health concerns around cannabis use have focused on the potential relationship with psychosis but the effect of cannabis smoking on respiratory health has received less attention. The aim of this study was to investigate the association between tobacco-only smoking compared with tobacco plus cannabis smoking and adverse outcomes in respiratory health and lung function.
Effects of Quitting Cannabis on Respiratory Symptoms European Respiratory Journal Another spoiler: Smoking cannabis makes you cough; stopping reduces the cough. ...Smoking cannabis is associated with symptoms of bronchitis. Little is known about the persistence of symptoms after stopping cannabis use. The authors assessed associations between changes in cannabis use and respiratory symptoms in a population-based cohort of 1037 young adults.
SBIRT as a Vital Sign for Behavioral Health Identification, Diagnosis, and Referral in Community Health Care Annals of Family Medicine The purpose of this quasi-experimental design study was to examine the effectiveness of the behavioral health Screening, Brief Intervention, and Referral to Treatment (SBIRT) program at a community health center. The study group was twice as likely (25.3%) to have depression and substance abuse diagnosed compared with the control group (11.4%) (P <.001). Referral rates for the study group were more likely to occur (12.4%) compared with referral rates for the control group (1.0%) (P <.001); however, the kept appointment rates by patients for behavioral health problems referrals remained low for both groups. It appears to demonstrate SBIRT’s effectiveness in capturing diagnoses, but not in yielding therapeutic engagement.
Approaches for Controlling Illicit Tobacco Trade — Nine Countries and the European Union Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report This extensive MMWR report on illicit tobacco trade (smuggling) yields a useful policy analysis, recommending among other actions that coordination of the tobacco tax rates between states may maintain or improve the deterrent effect of a high tax rate. An estimated 11.6% of the world cigarette market is illicit, representing more than 650 billion cigarettes a year and $40.5 billion in lost revenue. Illicit tobacco trade refers to any practice related to distributing, selling, or buying tobacco products that is prohibited by law, including tax evasion (sale of tobacco products without payment of applicable taxes), counterfeiting, disguising the origin of products, and smuggling. Illicit trade undermines tobacco prevention and control initiatives by increasing the accessibility and affordability of tobacco products, and reduces
government tax revenue streams.
Generalized Anxiety Disorder is Under-Recognized in Clinical Practice in Patients with Alcohol Dependence in France Progress in Mind: Focus on Alcohol Use Disorders Resource Centre Generalized Anxiety Disorder (GAD) is a frequent disabling disorder that often occurs with alcohol dependence. However comorbidity between substance use disorders and psychiatric disorders is often under-diagnosed. This study tried to evaluate under-recognition of GAD by clinicians in alcoholic inpatients. Two groups of alcohol-dependent inpatients, hospitalized in the same non-academic psychiatric hospital in France, were included. The first group (Group 1) (n
= 205) was included retrospectively within all patients hospitalized for alcohol dependence from May to November 2007. A record review was performed to determine the number of GAD (and other psychiatric disorders) diagnosis which was reported on these files by the clinicians. While one conclusion was that comorbidity between substance use disorders and psychiatric disorders is often under-diagnosed, it is not clear that the study’s findings satisfactorily discriminated between GAD per se and anxiety secondary to SUD.
Presidential Candidates are Actually Talking About America’s Heroin Issue The Washington Post Drug addiction and treatment are no longer problems acknowledged only with infrequent stump lines. They are driving a sustained conversation on the presidential campaign trail. And that conversation revolves around ending — not stepping up — the war on drugs. It centers on the language of addiction and treatment, on the sharing of deeply personal experiences and on calls from candidates for the criminal-justice system to be restructured to make the government’s response to illegal use less punitive...
Neurogenetic Variations in Norepinephrine Availability Enhance Perceptual Vividness The Journal of Neuroscience This study intimates a future capability to assign individual variations in perception to genetic coding. This could have implications for phenomenology, the symptomatic expression of mental illness. Emotionally salient aspects of the world are experienced with greater perceptual vividness than mundane ones; however, such emotionally enhanced vividness (EEV) may be experienced to different degrees for different people. We examined whether BOLD activity associated with a deletion variant of the ADRA2b gene coding for the α2b adrenoceptor modulates EEV in humans. Relative to noncarriers, ADRA2b deletion carriers showed higher levels of perceptual vividness, with the ventromedial prefrontal cortex (VMPFC) showing greater modulation by EEV.
A Review of Potential Pharmacological Treatments for Cannabis Abuse ASAM Magazine This is a brief and useful digest of cannabinoid (agonist) and non-cannabinoid medication-assisted treatment (MAT) strategies for cannabis use disorders (CUD). Currently, only psychosocial therapies, such as cognitive-behavioral therapy, motivational enhancement therapy, contingency management and family-based therapies, are indicated for CUD (see research from 2007 and 2013). Although the efficiency of these treatments has been shown in scientific studies, not every individual is responsive to such treatment, and the rate of relapse and drop out rates remain high (about 70%). Therefore, medications that can be combined with these therapies are being studied to improve the efficacy of CUD treatment, as reviewed recently by Balter et al.
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Articles included are reviewed on their merit at the discretion of ASAM Weekly’s Editor-in-Chief. Any relationship that exists with products or services advertised with content is coincidental and not an endorsement, guarantee or condemnation of said products or services. Similarly, the views and positions of any content published in ASAM Weekly are not necessarily endorsed by ASAM nor a reflection of ASAM's beliefs and policies. The features are presented as a summary of the contemporary issues being represented and expressed in scientific, governmental, commercial, and media sources across the specialty field of addiction medicine. Contact ASAM Weekly with any comments or feedback.