Category Archives: Mental Health

Libby Stuyt at Oregon Mental Health and Law Conference

(An advisor to Parents Opposed to Pot, Dr. Libby Stuyt, an addictions psychiatrist in Colorado, spoke at the Oregon Mental Health and the Law Conference in Portland.  The Mental Health Association of Portland published a blog about it on August 13.) Here it is:

Libby Stuyt, MD spoke at the Oregon Health Forum with Drs. Esther Choo of OHSU and Katrina Hedberg who is the State Epidemiologist and State Health Officer at the Oregon Public Health Division, and at the Oregon Law & Mental Health Conference in June 2017 on the unintended consequences of marijuana legalization. Continue reading

Psychiatry at Crossroads: Learn from Addiction Medicine

Practicing psychiatry is very tricky.  Heavy-duty pills have serious side effects.  To some observers, psychiatric medications are prescribed only to make money and psychiatrists are seen as evil witches casting spells. The world is not so simple, as there are psychiatrists working to get patients off medications.

A number of websites such as Mad in America and Beyond Meds channel gripes against Psychiatry and its medications.  At the same time, there’s been a flood of people suffering from mental health and addiction problems in need of treatment.  Forbes Magazine recently reported that there’s a shortage of psychiatrists in the USA.

Politics of Mental Health Treatment

We suspect that veterans with PTSD* and marijuana use are promoting the increased demand for psychiatrists.  Back in 2005, SAMSHA and ONDCP tried to warn Americans that teen marijuana use can introduce mental health problems in those with no previous issues. The DSM manual, which is like a Bible for Psychiatry, gives guidelines for diagnosing and treating symptoms.

Parents Opposed to Pot recommends staying free from marijuana and other drug abuse as the best defense against having a psychiatric condition.  The turbo-charged marijuana of today puts a far greater number of people at risk than the weaker pot of the ‘70s.  In Colorado and Washington, dispensaries sell marijuana that averages 22 to 28% THC, compared to 1-4% back in hippy days.

Providence St. Peter’s Hospital in Olympia, Washington reports of 1-2 new psychotic patients every day because of “dabbing” mariju- ana extracts.  A standard treatment is to give an anti-psychotic medication, Risperdal, and then release the patients.  However, if there is underlying addiction, the brain needs to be off mind-altering drugs before a mental health assessment.

Changes in HIPAA Law could put more checks and balances on Psychiatry.  Because of HIPAA Law, families are not allowed to know enough.  An ideal system of mental health treatment would pull together families and psychiatrists and patients. When Representative Murphy introduced a mental health care reform bill two years ago, many people supported it because it promised to change HIPAA.   However, the ACLU and patients’ rights groups fought this provision and a bill passed without making this crucial change.

If the Affordable Health Care Act is revised, Congress should not allow insurance coverage for mental health care or addiction treatment to be cut!

Psychiatric Practices and System Called into Question

Often insurance will not pay for optimal addiction treatment unless there is an underlying mental health diagnosis.  Even when there is a mental health diagnosis, treatment also fails if patients are released from hospitals prematurely.

The Washington Post reports of a Maryland mother who suffocated two children after she was released from a psychiatric hospital too soon.  This unfortunate woman, Sonya Spoon, had suffered from abandonment at four months age, lived in orphanages and suffered from a head injury at age 18.  Her adoptive mother had warned the doctors against releasing her from the hospital too early, before an antidepressant could take effect.

Despite complete failure in the mental health care system, the criminal justice system sentenced her to 45 years in prison.   It is tragedy on so many levels for both her and the two toddlers she killed.  Unfortunately, the prison system is filled with both addicts and those suffering from untreated mental health disorders.

Beginning in the Kennedy Administration, a movement to de-institutionalize mental health patients began.  Psychiatry hoped that medications could replace institutions.  Pharmaceutical companies jumped at the opportunity, produced new drugs and marketed them vigorously.  It would be nice if “magic pills” really did work all the time, but they often cause additional problems and outlive their usefulness.

Everyone admits there are failures in the mental health care system, and many of Psychiatry’s critics want to eliminate all pills and forced treatments. However, plenty of people believe psychiatric pills help them. (Please see comments below by Jane Thompson whose medications bring relief to Bipolar Disorder.)   Believing that all psychiatric medications are bad is as flawed as thinking that all mental illness develops because the parents are evil.   Amateurs should never tell others not to take their psychiatric meds.

Psychiatry Lags Behind Other Branches of Medicine

Some branches of medicine, such as those that treat cancer and heart disease, have made great strides in the past century. Unfortunately, Psychiatry has not.  Many doctors besides psychiatrists are known to prescribe too many pills.  Books by Robert Whitaker, Joanna Moncrieff, MD and others call into question the overuse of psychiatric drugs.   Whitaker’s Anatomy of an Epidemic, 2010, won the IRE award for investigative journalism.  Whitaker is not totally anti-psychiatry as some people maintain. He has stated: … “It (Psychiatry) has a duty to develop selective-use protocols, which seek to minimize long-term use of antipsychotics (and other psychiatric medications). I also believe that our society should provide the resources to enable this rethinking of the drugs.”

No doubt Bipolar Disorder has been overdiagnosed.  Some individuals and professionals have classified drug and alcohol abuse as “medicating an underlying bipolar disorder.”  This interpretation excuses and dismisses the serious consequences of substance abuse.  At the same time, it may be hooking some people into taking pills, without getting them off substances of abuse.

The “chemical imbalance” or neurotransmitter deficiency model of depression has never been proven.  In fact, this theory was never accepted by Psychiatry.  Some people conclude that psychiatrists and pharmaceutical companies have pushed this notion only for the purposes of making money and selling pills.  Today the marijuana industry is pushing marijuana for most mental health conditions, including depression, bipolar autism and ADHD in children.  Unfortunately, many with schizophrenia use pot, although it makes their problems worse.

The brain isn’t understood as well as other organs, and many times mind-body solutions are called for, instead of “medications.”

In Saving Psychiatry, Addictions Psychiatry Can Help

If Psychiatry became better at distinguishing the underlying roots of mental health issues, our treatments could be better.  British journalist Patrick Cockburn writes eloquently as to why he believes his son, Henry, became schizophrenic.  The diagnosis was precipitated by heavy marijuana use between the ages of 14 and 19.  After years of trial and error, and Henry’s refusal to take medication, the son has been stabilized with Clozapine.

Perhaps, because of a focus on pills for insurance purposes, Psychiatry often falters, despite the DSM Manual.  There needs to be better discernment of root causes.  Which illnesses are a result of substance use,** or trauma, and/or a combination of both?***  Treating trauma and Adverse Childhood Experiences (ACEs) before people resort to substance abuse would bring down the number of people needing psychiatrists. However, the most adverse cases of trauma or extreme psychosis may need to be medicated, including foster children whose parents suffered from drug abuse.   Even when psychiatric pills cause side effects, the alternative can be worse.

Addictions Psychiatry can help the psychiatric field when the “biological” model fails.  Addictions psychiatrists are trained to think more holistically, addressing the mind, body and spirit of a person.  If Psychiatry certifies more doctors in Addictions Treatment, it can make a difference and become a force for much good.

As for epidemic of Heroin, Fentanyl and opioid pill overdoses, policies focused on harm reduction have failed to stem the number of deaths by overdose.  Most states have passed making it easier for doctors and law enforcement to stop the overdoses.   Yet, this policy doesn’t treat the underlying addiction. Cost and insurance companies should not determine matters of mental health, or life and death.

Notes

*  PTSD is very real but only professionals should diagnose it.  At times, “bipolar disorder” and ADHD were also used too loosely and over-diagnosed.

**A NAMI (National Alliance for Mental Illness) Minnesota publication gives special attention to marijuana among the drugs that can cause psychosis, as well as legal drugs such as steroids and ADHD drugs. Epidemiological research of nearly 19,000 drug abusing Finnish subjects showed that marijuana most consistently led to a diagnosis of long term schizophrenia (Niemi-Pynttäri JA, Sund R, Putkonen H, Vorma H, Wahlbeck K, Pirkola SP. Substance-induced psychoses converting into schizophrenia: a register-based study of 18,478 Finnish inpatient cases. J Clin Psychiatry. 2013 74(1):e94-9).

*** Victims of PTSD who turned to marijuana with deadly results:  Cascade Mall shooter Arcan Cetin, an early marijuana user with PTSD killed five people at a Macy’s in Washington.  Stephen Bourgoin who recently killed five teens in a wrong way crash also suffered from childhood trauma, too.  Eddie Routh was a veteran with PTSD who smoked marijuana before killing Chris Kyle and Chad Littlefield.  NBC Nightly reported that Richard Rojas, the veteran who rammed into several people and killed a teen in Times Square, used marijuana before driving into the crowds.

Legal Marijuana Imperils Traffic Safety, Adds Mental Health Burden

By Dean Whitlock, a freelance writer from Thetford, Vermont, writes about safety as it relates to marijuana.  The article appeared in Vermont Digger on May 2, 2017.

The discussions of H.170, which would legalize possession and home-growing of small quantities of marijuana, have focused a lot on the danger to teenagers, which is appropriate since adolescents are in a stage of neural development that makes them much more likely to become addicted, develop mental health conditions, and suffer decreases in cognitive processing and memory retention. The problem with this focus is that people over 21, particularly up to the age of 25 or 26, are still susceptible to all of these effects, just at a lower level of risk.

That point aside, the area where every age runs the same risk is on the highway. Again, teens and young adults are more at risk because they tend to take more risks in the first place. They are also less experienced with driving and with the use of alcohol and drugs. But adults do make the same stupid mistake of driving under the influence.

According to the best data we have available, drinking alcohol before driving increases the risk of accident five-fold at the still-legal .08 blood level. Driving under the influence of marijuana doubles your risk. That being the case, we would expect to find considerably more people dying on the roads because of alcohol then because of marijuana. The data on traffic accident fatalities that we have from the Vermont Department of Safety tell a somewhat different story:

This data is based on blood tests that measure active THC, so we can be reasonably sure that the drivers had used marijuana recently enough to still be DUI.

Driving Under the Influence of Marijuana Imperils Safety

Note the small difference between the number of deaths due to alcohol and the number due to marijuana. The most likely reason for this is that many marijuana users think it’s OK to drive after using. For teenagers, we have clear evidence for that from our Youth Risk Behavior Survey.

Here’s the 2015 data:

Reports from both Colorado and Washington indicate that the same must be happening there. While accidents and fatalities involving drunk drivers went down in recent years, the numbers involving marijuana went up.

Why is this happening? Because we are not teaching people – young or old – that marijuana impairs your ability to drive. At a well-attended forum on marijuana effects held in Burlington last month, one attendee stood up and insisted that marijuana helps people drive more carefully, and this message pervades the popular websites that cater to people interested in learning more about marijuana from sources “untainted” by officials like police officers and scientists.

It’s important to note that the traffic fatality data shown above only includes deaths in accidents. It does not include the five Harwood teenagers killed on I-89 last October. The driver of the car that hit theirs, Steve Bourgoin (36, hardly a teen), has been charged with second-degree murder, so their deaths are not considered to be due to a traffic accident.

Addiction is Not a Crime

Addiction is not a crime, it is a mental health issue, and the behavior of users who suffer acute or chronic psychotic episodes goes far beyond the usual definition of addiction.

When Bourgoin’s blood toxicology report was completed, authorities withheld the contents pending trial; however, Vermont investigative reporter Mike Donoghue, writing for Vermont News First, quoted several sources in saying that there was active THC in Bourgoin’s blood at the time of the accident. Since then, Vermont Rep. Ben Joseph, D-Grand Isle-Chittenden, a retired judge, has reported being told the same thing by contacts of his in the state legal apparatus.

As reported on VTDigger, Bourgoin told friends that he suffered from anxiety and PTSD due to childhood trauma, and his former girlfriend told detectives that he self-treated with marijuana for “mood spells.” Court documents quote her saying, “It was always very evident when he was out [of marijuana], as he would be more angry and violent during those times.”

Anger is one of marijuana’s withdrawal symptoms, and it is a more addictive drug than most people think. A review of several studies of treatment methods for marijuana addiction found that one-year abstinence rates for adults, even under the most effective treatments, ranged only from 19 to 29 percent.

In a 20-year study involving more than 2000 U.S. war veterans being treated for PTSD, the vets who used medical marijuana along with the standard therapy reported more violent behaviors and worse outcomes after treatment than vets who didn’t use marijuana. The heaviest users showed the strongest effects. Another study found that marijuana use resulted in increased suicidal ideation among marijuana users.

Marijuana and Mental Health Problems

There are other correlations between marijuana and serious mental health problems. Since 2002, a series of studies in Europe have reported that individuals who use cannabis have a greater risk of developing psychotic symptoms. Not only does marijuana bring on symptoms earlier and make them worse, it is a causative factor.

A Finnish study published this past November compared sets of twins where one used marijuana heavily and the other did not. Heavy use increased the risk of developing psychosis by a factor of 3.5. Again, the data indicated that, in many cases, marijuana abuse caused the psychosis, not the other way around. The newly released report on marijuana from the U.S. National Academies of Sciences agrees with these findings.

Addiction is not a crime, it is a mental health issue, and the behavior of users who suffer acute or chronic psychotic episodes goes far beyond the usual definition of addiction. These sufferers needs effective treatment far more than jail time. And these new research findings, combined with Vermont’s recent traffic fatality data, highlight the fact that marijuana is not harmless. Legalizing recreational marijuana in Vermont would not be a simple matter.

Vermont has already decriminalized marijuana use. What we haven’t done is provide a mental health system that can deal with the thousands of cases of addiction, psychosis, and other mental illnesses that we already have in our state, nor have we done nearly enough to educate Vermonters about marijuana’s harms, in order to prevent tragedies from happening.

Legalizing marijuana – whether like alcohol or tobacco – will only make our mental health burden worse, while it makes our highways far less safe.

A former supporter of legalization, Whitlock is now opposed. He is a member of Smart Approaches to Marijuana (SAM-VT)

The Persistence of Trauma, Problems in Adulthood

Time conceals rather heals wounds, and traumatic experiences convert to disease later in life.  Adverse Childhood Experiences (ACEs) cause diseases that carry into adulthood, as well as numerous psychological issues and addiction.  (Read about the mind-body connection, part 1 and mind-based healing solutions, part 2)

A long-term study from Denmark, explored a number psychological factors that may or may not have adverse outcomes on the children.

The Danish study determined that parental factors most likely to create either violent or suicidal tendencies in adulthood are 1) parents who used marijuana; 2) having parents who are sociopaths or 3) having parents who attempt suicide.   In other words, marijuana abuse is far more serious in predicting adverse behavioral outcomes than other parental mental health conditions such as bipolar disorder and alcoholism.

Salvador Dali , The Persistence of Memory, 1931: Time goes on, but the conscious mind may not know how memories hidden in our body and brain persist. The effects of early trauma are carried into adulthood. Photo: MoMA, New York

What is Known about ACEs?

Because the research is so extensive, we are coming to understand some of the precise mechanisms by which biography turns into biology.  Heart disease, diabetes, all forms of auto-immune disease (a growing problem), addiction and obesity are connected to high ACE scores.   While choices such as smoking, maintaining a good or bad diet and exercise are within a person’s control, ACEs are not.

Today there are more than 1500 studies about how ACEs affect the mental and physical health.  The exploration into ACEs began with an accidental discovery by Dr. Vincent Feletti of Kaiser Permanente in San Diego.  His obese patients who had high rates of cancer and heart disease also had high rates of childhood trauma.  Dr. Feretti teamed up with Dr. Robert Anda of the Center for Disease Control (CDC) whose specialty was the link between heart disease and depression.

Drs. Anda and Feretti conducted a huge study on childhood trauma and disease between 1995 and 1997.    The information they discovered can be revolutionary in terms of treatments linking mental and physical health.   They found that 2/3 of those who suffer chronic disease had traumatic childhoods. In other words, genetics is not the only predictor of susceptibility to disease; experiences also play a crucial role.

It is interesting that two causes of death — strokes and diabetes — do not correlate with high ACE scores.   However, chronic pain and addiction are highly correlated to traumatic childhoods, just like autoimmune diseases, heart disease and obesity.

There’s Also Substance Abuse

Victims of trauma will often use marijuana, alcohol and other drugs to create a numbing effect, and to allow disassociation.   Marijuana and heroin have the greatest numbing effect, writes Janina Fisher, PhD., in a paper on Traumatic Abuse and Addiction. 

When the numbing is too much and the victims need to feel energized and alive again, stimulants such as cocaine and opiates can be used.  Other chronic marijuana users become anxious and get prescriptions for Xanax to cope with anxiety. The need to use multiple drugs becomes a cycle, and the addicts of today tend to develop multiple addictions.

This fragile coping mechanism often blows up when drugs users must deal with another person and raise children. Raising children and needing to care for another person will expose the inability of drug-abusing parents to maintain an equilibrium.   There are additional risks as well.

Multigenerational Drug Abuse

Yasmin Hurd of New York University spoke about neuroepigenetics and addiction vulnerability at the recent Neuroscience conference on November 16.  She believes marijuana is much more addictive than most people acknowledge. Her research demonstrates that both adolescent marijuana use, as well as exposure to THC in utero, makes epigenetic changes to the brain, priming it for greater susceptibility for later addiction to opiate drugs.

Hurd’s study explains one way marijuana use primes the next generation for addiction to their children.  Another way is when children of drug users carry the legacy of abuse by neglecting or abusing their children. Those who grew up in homes where drug use is normalized end up using and abusing, too.

Another problem is that medical marijuana practitioners are encouraging pregnant women to smoke pot for morning sickness and for breastfeeding.  Dr. Steven Simerville explains the reasons why we should be concerned about the mental development of children whose mothers did not protect them from THC during crucial stages of life.

Today, it’s not ‘just’ marijuana.  The marijuana of today is at least five times stronger than it was in the 1970s.   (Read Part 4 to understand more about how we are creating new generations of traumatized children.)