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Emotional

Fighting for the Brain Disease Model Model can complicate messaging in treatment plans

Eating

GIVING ADDICTS A RESET

Developers working on first digital therapy app for addi ction

More Than Skin Deep Implant represents revolutionary approach to treating opioid addiction

Redefining recovery One Day at a Time takes a holistic approach to overcome addiction

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By Heather Hateld | WebMD Feature | Reviewed by Charlotte E. Grayson Mathis, MD EMOTIONAL EEAATTIINNGG EMOTIONAL AT

ere are several di erences between emotional hunger and physical hunger, according to the University of Texas Counseling and Mental Health Center web site: 1. Emotional hunger comes on suddenly; physical hunger occurs gradually. 2. When you are eating to ll a void that isn’t related to an empty stomach, you crave a specic food, such as pizza or ice cream, and only that food will meet your need. When you eat because you are actually hungry, you’re open to options. 3. Emotional hunger feels like it needs to be satised instantly with the food you crave; physical hunger can wait. 4. Even when you are full, if you’re eating to satisfy an emotional need, you’re more likely to keep eating. When you’re eating because you’re hungry, you’re more likely to stop when you’re full. r e

Are You an Emotional Eater?

You are an emotional eaters if you answer yes to any of the following questions: Do you ever eat without realizing you’re even doing it? Do you often feel guilty or ashamed after eating? Do you often eat alone or at odd locations, such as parked in your car outside your own house? After an unpleasant experience, such as an argument, do you eat even if you aren’t feeling hungry? Do you crave specic foods when you’re upset, such as always desiring chocolate when you feel depressed? Do you feel the urge to eat in response to outside cues like seeing food advertised on television? Do you eat because you feel there’s nothing else to do? Does eating make you feel better when you’re down or less focused on problems when you’re worried about something? If you eat unusually large quantities of food or you regularly eat until you feel uncomfortable to the point of nausea, you have a problem with binge eating. Please speak to your health care professional.

5. Emotional eating can leave behind feelings of guilt; eating when you are physically hungry does not. COMFORT FOODS When emotional hunger rumbles, one of its distinguishing characteristics is that you’re focused on a particular food, which is likely a comfort food. “Comfort foods are foods a person eats to obtain or maintain a feeling,” says Brian Wansink, PhD, director of the Food and Brand Lab at the University of Illinois. “Comfort foods are often wrongly associated with negative moods, and indeed, people often consume them when they’re down or depressed, but interestingly enough, comfort foods are also consumed to maintain good moods.” Ice cream is rst on the comfort food list. After ice cream, comfort foods break down by sex: For women it’s chocolate and cookies; for men it’s pizza, steak, and casserole, explains Wansink. And what you reach for when eating to satisfy an emotion depends on the emotion. According to an article by Wansink, published in the July 2000 American Demographics, “ e types of comfort foods a person is drawn toward varies depending on their mood. People in happy moods tended to prefer … foods such as pizza or steak (32%). Sad people reached for ice cream and cookies 39% of the time, and 36% of bored people opened up a bag of potato chips.”

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By Jennifer R. Scott | Updated February 15, 2014 Emotional eating can be a di£cult challenge when you are trying to lose weight. It’s a di£cult habit to break once it’s a part of your life, but by understanding what causes it and nding ways to cope that don’t involve food, you can overcome it. Read on to learn how to prevent and Prevent and Cope with Emotional Eating Before you can learn to cope with emotional eating, you must rst understand what it is. As the name implies, emotional eating is characterized by repeatedly eating in response to feelings rather in response to hunger to gain physical nourishment. Emotional eaters often consume large amounts of food at one sitting, which is sometimes referred to as a binge. Understand the Emotional Cues Many emotional eaters eat in response to ve common cues, which include boredom, loss of control and anger. Only you can know if these cues prompt you to eat emotionally: Eating a snack a few times a week because you are bored may not be a problem; eating a container of ice cream each time you’re angry probably is. Understanding these cues and learning how to choose another response — such as exercising to release pent-up anger —will help you end the cycle of eating in response to these feelings. Identify Your Triggers While many emotional eaters share cues in common, there may be certain feelings or situations that trigger you to eat that do not a ect someone else. One of the best ways to understand your own personal emotional eating triggers is to keep a “food and feelings” food diary. In it, you simply record what you eat and how you were feeling before, during and after your binge. Stress A ects Your Eating Habits Stress is one of the most common reasons that women in particular overeat. Stress is alleviated by eating certain foods and many women get in the habit of reducing tension by enjoying these foods rather than dealing with the source of their tension. By creating self-care skills that allow you to identify non-food solutions to tension-causing situations, you will be much less likely to cope with emotional eating. What is Emotional Eating?

(Please note: Extreme feelings of hopelessness are typical of chronic depression. Please talk to a mental health professional if you nd yourself feeling perpetually hopeless.) Lack of Control You think: My life is out of control. ere is nothing in it that I am in charge of. Everyone and everything around me rules my life. Except for eating…I can eat whatever I want, whenever I want it. So I will. Feeling Unappreciated Perhaps you’ve accomplished something exceptional at work and no one has noticed. Or maybe you’ve made a personal achievement you’d dreamed of for years. But no one at home shares your pride. You nd yourself tempted to congratulate yourself by “treating” yourself to a binge. Boredom ere’s nothing to do. Nowhere to go. Perhaps you feel lonely, too. ere’s nothing at home to occupy your mind or your hours. But there is a pantry full of comfort food that will kill some of that empty time. If you t into any one of these ve proles, try sitting down with a piece of paper and brainstorming to nd alternative behaviors to eating. You may be surprised at the solutions you come up with…and at just how well they work once you try them. en, write your ideas on notecards and post them where you will see them in your moment of need — how about on the refrigerator door or next to the pantry? Accepting why you eat the way you do can be a big step towards breaking the cycle of emotional eating.

eat emotionally after a stressful day. Let Go of All or Nothing inking

All or nothing thinking means you feel like you must do something perfectly or you should not do it at all. We often are either “on” our diets or “o ” of them. e sense of failure this brings can cause negative emotions that in turn trigger a binge. By allowing yourself the freedom to face every day as a fresh start and see every decision as independent of the one before it, you may nd emotional eating is much easier to avoid.

5 Common Emotional Eating Cues

By Jennifer R. Scott | Updated February 15, 2014

Emotional eating is the practice of consuming large quantities of food — usually “comfort” or junk foods — in response to feelings instead of hunger. Some of the common emotional eating cues are: Anger Whether you’re angry at yourself, another person or a situation, you stiªe your feelings using food rather than confronting them and releasing them. It’s easier to smother a problem than to

deal with it. Hopelessness

You think: Nothing really matters anyway. Nothings ever going to change or get better for me. So, why should I care about my health or weight? Besides, eating makes me feel better.

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Nicasa CONTACT US! 847.634.6422 nicasa.org 2900 Main Street, Buffalo Grove, IL 60089

Giving addicts a “reset ” Developers working on first digital therapy app for addiction One reason the opioid addiction epidemic has taken hold in many rural areas is that many Americans with substance use disorder live long distances from the nearest treatment providers. But a new tool may provide hope.The U.S Food and Drug Administration (FDA) is currently reviewing a new tool that may help remedy that geographical problem: the first prescription digital therapy designed to treat SUD. Boston and San Francisco-based Pear Therapeutics developed reSET, a mobile app used as a treatment tool concurrently with outpatient therapy centered on SUDs.The project has demonstrated better abstinence and treatment retention when applied alongside face-to-face therapy focused on SUD-related treatments for alcohol, marijuana, cocaine and stimulants.The therapy also includes a web-based program for healthcare providers. An app to help opiate addicts Pear is also developing reSET-0, an app specifically designed to help opiate addicts. Both apps consist of a patient-facing smartphone application and a clinician-facing web interface. The company raised $20 million last year with the aid of various venture companies including Arboretum Ventures, an Ann Arbor, Mich.-based venture capital firm. “(reSET) will give patients and clinicians a new tool to improve therapy specifically in an area right now that is a true health epidemic in the U.S,” Dr.Thomas Shehab, managing director at Arboretum Ventures, told DrugAddictionNow.com. “It’s an extremely novel approach to central nervous system and behavioral health diseases that we didn’t see anyone else addressing in that way.”

Pear submitted reSET for review by the FDA during the first half of 2016 and says it is expected to be approved this year. Dr. Shehab said his firm is “particularly intrigued by their approach because it’s a combination of a very well-studied digital therapy being used in conjunction with other therapies.” He says, “We thought the unique makeup of the Pear team and their unique approach to digital therapies really made us feel it had the highest likelihood of success in really helping address these issues.”

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According to data provided by Pear Therapeutics, 507 people with SUD from 10 treatment centers nationally received either face-to-face therapy or reduced volume of face-to-face therapy with reSET.They were given 12 weeks of outpatient therapy with or without using the app; if without, a portion of the digital therapy was replaced with face-to-face therapy. Abstinence was calculated two times weekly through a breathalyzer, urine samples and self-reports. Of the participants dependent on alcohol, marijuana, cocaine and stimulants, 58.1 percent of them receiving treatment with reSET were abstinent during weeks nine through 12, versus 29.8 percent of participants receiving only face-to-face therapy. Of the participants who started the study with a positive drug test, 26.7 percent of them who received reSET were abstinent during weeks nine through 12 of the study; only 3.2 percent of those that received traditional face-to-face therapy reported abstinence during the same time period. Participants using reSET presented statistically significant advancement in retention rates compared to those not using the app. After 12 weeks, 59 percent of participants that received face-to-face therapy retained sobriety in comparison to the 67 percent of those that used reSET.The reSET-O app has shown promising results in

three independent and randomized clinical trials, the company says. A study of 465 participants that completed outpatient methadone or buprenorphine treatment for opioid addiction was conducted, in which the participants were given standardized face-to-face therapy or shortened standardized treatment with reSET-O.Their abstinence was determined by self-reporting and urine tests. The developers plan to submit reSET-O to the FDA for approval, pending approval of reSET. “With all that’s going on, this is a very exciting company that we’re very enthusiastic about because it benefits a group of patients in great need,” Dr. Shehab said. “We think that reSET has a lot of potential.”

Maker receives NIDA grant In July, Pear announced it

has received a Small Business Innovation Research (SBIR) Fast-Track award funded by the National Institute on Drug Abuse (NIDA). PEAR will collaborate with CleanSlate Research and Education Foundation and Columbia University Medical Center Department of Psychiatry’s Division on Substance Use Disorders on the project. The grant will support the application of “enhanced engagement and gamification mechanisms” to reSET and reSET-O, the company says.

“It benefits a group of patients in great need.” - Dr.Thomas Shehab, Arboretum Ventures

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“The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility.” – Dr. Nora Volkow, Dr. George Koob, Dr. AThomas McLellan

INSERT 3 Fighting for the Brain Disease Model Model can complicate messaging in treatment plans

Fighting public opinion can be an uphill battle, sometimes even a futile one. Despite years of progress and scientific advancements, researchers and treatment providers still find themselves having to convince the general public that substance use disorder is a disease. But it’s a message that can often complicate treatment plans as much as it seeks to inform.

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Setting the Record Straight Earlier this year, three of the nation’s leading drug experts wrote a paper seeking to explain, once and for all, how substance use affects the brain in the same way as similar diseases. In an article published in the New England Journal of Medicine, NIDA Director Dr. Nora Volkow, NIAAA Director Dr. George Koob, and Treatment Research Institute founder Dr. AThomas McLellan say they hope to reaffirm the brain disease model while simultaneously addressing common misconceptions about addiction. “The concept of addiction as a disease of the brain challenges deeply ingrained values about self-determination and personal responsibility that frame drug use as a voluntary, hedonistic act,” the authors write. The authors argue that public skepticism about the brain disease model comes from researchers’ inability to articulately describe the relationship between changes in neurobiology and the behaviors associated with addiction. Although countless scientific studies have proven the brain disease model to be accurate and effective, the authors admit more work may be needed to change public perception. “A more comprehensive understanding of the brain disease model of addiction may help to moderate some of the moral judgment attached to addictive behaviors and foster more scientific and public health–oriented approaches to prevention and treatment,” the authors write.

“You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” – Bob Rohret, MARRCH executive director

 Scientific studies attest that a person’s brain chemistry can be altered as a result of addiction.This fact can provide a needed explanation as to why continued use can still be a problem for people who clearly desire to get clean. “When you start to apply an explanation of why certain behaviors occur,” Rohret says, “it provides people some comfort in understanding why they’re doing what they’re doing.” Mixed Messages But as confident as many in the medical community are about the nature of substance abuse disorder, the idea that addiction is a disease presents something of a double-edged sword for treatment providers. “The messaging has to be sort of finessed,” says Bob Rohret, executive director of the Minnesota Association of Resources for Recovery and Chemical Health (MARRCH). “You have to emphasize the responsibility on the part of the person, but you also have to explain why the behaviors are happening.” Rohret says treatment providers have to inform those in recovery about the nature of their disease, while also making sure knowledge of that disease doesn’t become a crutch or an excuse for inaction. When presented correctly, Rohret says patients should understand their addiction and responsibility toward it in much the same way someone with heart disease may understand their affliction. Although they cannot change the biological makeup of their body immediately, they can make behavioral changes and take actionable steps that lead to more positive outcomes.

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More Than Skin Deep Implant represents revolutionary approach to treating opioid addiction

M edication-assisted treatment is growing in popularity and acceptance among addiction recovery professionals. And now it’s taken a revolutionary step forward that could offer renewed hope to thousands of people struggling with an addiction to opioids. The U.S. Food and Drug Administration approved a new buprenorphine implant to treat opioid depen- dence. Buprenorphine had previously been available only as a pill or a dissolvable film placed under the tongue. But the new implant, known as Probuphine, can administer a six-month dose of the drug to keep those dependent on opioids from using by reducing cravings and withdrawal symptoms. "Opioid abuse and addiction have taken a devastating toll on American families,” FDA Commissioner Dr. Robert M. Califf said in a statement. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” The implant comes in the form of four one-inch rods that are placed under the skin on the upper arm. The implant must be administered surgically and comes with the possibility of certain side effects, but experts say it could be more convenient and more effective for patients. They say by eliminating the need to take pills, fill prescriptions and generally manage their medication, it makes it easier for people to focus on the other areas of their recovery while making it less likely someone will lapse in their treatment plan.

Sign of the Times Experts say the newly approved implant also provides a big boost to the concept of medication-assisted treat- ment (MAT) in general. For years, the idea that someone could achieve recovery through the use of drugs like methadone and buprenorphine was rejected by many professionals in the field who saw complete abstinence as the only true sobriety. Many still hold that belief, but attitudes appear to be changing. Top government officials say they want to increase the amount of MAT taking place at the country’s treatment centers. Several states as well as the federal government have enacted laws making it easier for physicians to pre- scribe medications like buprenorphine, but they say too few patients receive the medication they need. “Scientific evidence suggests that maintenance treat- ment with these medications in the context of behavioral treatment and recovery support are more effective in the treatment of opioid use disorder than short-term detoxification programs aimed at abstinence,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, in a statement. “This product will expand the treatment alternatives available to people suffering from an opioid use disorder.” ] [ "Opioid abuse and addiction have tak- en a devastating toll on American families.” - Dr. Robert M. Califf, FDA Commissioner

“We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.” - Dr. Robert M. Califf

Although the implant is certainly a new alternative, it has yet to show any increased success in keeping people from relapsing compared to the pill or film tablet. In a study of the implant’s effectiveness, they found that 63 percent of people given the implant were free of illicit drugs at six months, compared to 64 percent of people who took buprenorphine by pill. Still, those rates are much higher than the success rates of people who follow abstinence-only treatment plans. And officials hope the new implant will lead more people to get MAT, increasing the number of successful recoveries across the country.

CONTACT US! 847.634.6422 nicasa.org 2900 Main Street, Buffalo Grove, IL 60089

Redefining Recovery One Day at a Time takes a holistic approach to overcome addiction

Recovery can be a tricky word. For some it’s short- hand for overcoming chemical dependence, while others distinguish it from words like “abstinence” or “sobriety.”The word represents what an individ- ual does with a new life — how one uses past expe- riences to overcome hardship and thrive spiritually. One Day at a Time (ODAAT) recognizes that this distinction applies to populations beyond addicts and alcoholics, and aims to serve anyone in need of a fresh start. “When we say ‘recovery,’ we’re not just talking about drugs and alcohol,” says President Mel Wells. “We mean any challenges in life.”The support for addiction recovery is there, Wells says, but it rep- resents just one of ODAAT’s holistic services; they also address homelessness, HIV/ AIDS, poverty, and violence and gang prevention, to name a few. Historically speaking, ODAAT’s primary services give shelter and supportive housing to those in need. They have 60 beds for recovering addicts and alcoholics, a men’s and women’s house, each hold- ing 14 residents, and a 38-bed homeless shelter known as Safe Haven. The men’s and women’s homes work with clients to afford them low-cost, supportive housing; Safe Haven and the drug and alcohol facilities are state- and cityfunded, and do not charge rent.

“When we say ‘recovery,’ we’re not just talking about drugs and alcohol. We mean any challenges in life.” - Mel Wells president of One Day at a Time (ODAAT)

“In a lot of cases, the person who has been through those struggles is going to be more driven in life and more successful.” - Mel Wells president of One Day at a Time (ODAAT)

No one left behind Wells takes pride in ODAAT’s “no one turned away” ethos. He says instead of turning people away, the organization has always made room or given referrals to prospective cli- ents on the spot. ODAAT has reach spanning as far away as London and Cambodia, Wells says. In Philadel- phia, ODAAT reaches up to 56,000 people annually, a figure Wells hopes to increase to 70,000 in the coming years. The city of Philadelphia and state of Pennsylvania have picked up on ODAAT’s efficacy, Wells says, and approved increased funding, allowing ODAAT to reach more and more people every day. Not only does ODAAT welcome everyone, it does it fast. ODAAT has staff on hand at all hours to handle incoming clients who often have nowhere else to go. There’s a narrow time frame in which some- one is ready and willing to receive help, and Wells doesn’t want to miss it. “They might change their mind, or they might not even have the chance to. They might not make it another day,” Wells says, speaking to the fatality of life on the streets and in active addiction.

Learning from each other Clients at ODAAT benefit from its widespread acceptance, and Wells says they gain a rare opportunity to grow from others’ stories. With an open, empathetic ear, clients gain insight to struggles they might not know firsthand. For instance, Wells describes the scenario of a recovering addict getting to know an AIDS patient — the addict might have no idea what a person with AIDS goes through every day to stay well, and vice versa. A new perspective can change a client’s attitude toward recovery. And for someone to survive and prosper through any number of life’s challenges, Wells notes, there is no telling what they are capable of. “In a lot of cases, the person who has been through those struggles and comes out is going to be more driven in life and more successful,” he says.

Nicasa CONTACT US! 847.634.6422 nicasa.org 2900 Main Street, Buffalo Grove, IL 60089

Nicasa CONTACT US! 847.634.6422 nicasa.org 2900 Main Street, Buffalo Grove, IL 60089

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