Stress Management Training for Cancer Patients

A self-administered stress management training program did a better job of helping patients cope with the adverse effects of chemotherapy than a one-hour program in which training was given by mental health professionals, according to a study published in the Journal of Clinical Oncology on June 15, 2002 (see the journal abstract).

Other studies have shown that cancer patients undergoing chemotherapy can benefit from stress management training that helps them cope with pain, fatigue, anxiety and depression. Typically, stress management training is provided in one-on-one sessions between a mental health professional and a patient. However, because such one-on-one sessions are costly and because relatively few mental health professionals work in cancer treatment settings, stress management training is not widely available to cancer patients.

The results of the new study suggest that most cancer patients do not need one-on-one stress management training sessions with a mental health professional, said Michael Stefanek, Ph.D., chief of the Basic Behavioral Research Branch at the National Cancer Institute: "A self-administered stress management program, with some guidance from a mental health professional, works well for many patients who have moderate levels of depression and anxiety."

Although the study findings need to be replicated, they may ultimately help to make stress management training available to more cancer patients by making it less costly to provide, Stefanek added.

The study, whose lead author is Paul B. Jacobsen, Ph.D., involved 411 patients with several types of cancer who were being treated at the H. Lee Moffitt Cancer Center in Tampa, Florida. Before they received chemotherapy for the first time, the patients were randomly assigned to one of three treatment groups.

One group received "usual care," consisting of an evaluation by an oncology social worker. Patients who showed signs of depression or a substance abuse problem were referred to a specialist for treatment. The social worker also provided patients with information about support groups and other resources at the cancer center and in the community.

A second group, in addition to usual care, received one hour of training in stress management techniques from a psychologist. The third group, in addition to usual care, had a 10-minute meeting with a psychologist who gave them a self-study package consisting of a videotape, a booklet, and an audiotape that provided instruction in the same stress management techniques.

At entry to the study and after each of four rounds of chemotherapy, the patients filled out questionnaires in which they rated their general physical and mental health, vitality, pain, nausea, anxiety, depression, and perceptions of role limitations due to emotional problems.

Compared with patients who got usual care, patients who received the self-study package reported better physical functioning, greater vitality, fewer role limitations, and better mental health. Patients who received an hour of stress management training from a psychologist fared about the same as those who got usual care. The self-administered training package cost about two-thirds less than the average cost of professionally delivered stress management training for patients starting chemotherapy.

The better results seen with the self-administered training package might be explained in part by the inclusion of testimonials from other cancer patients about the benefits they got from using the stress management techniques, Stefanek said. "Many cancer patients actively look for information from other patients about what chemotherapy is like and what coping strategies have helped them," he said. "These testimonials may have been a powerful component of the self-administered program that was missing in the professionally led program." MFT Continuing EducationThe hour of training received by patients in the professionally led program may also have been insufficient to enable patients to apply the techniques effectively, Stefanek said. Most professionally taught stress management programs involve multiple sessions. By contrast, patients in the self-administered program could replay the audiotape and videotape and reread the booklet as desired to reinforce their mastery of the stress management techniques.

Even the usual care provided in this study was better than that offered at most cancer centers, Stefanek said. "Most centers would not typically provide an evaluation of each patient by a social worker, who identifies and refers those patients who may have more severe emotional problems."

Emotional Intelligence Continuing Education CEUs

SUMMARY

Emotional intelligence refers to the expansion of the conventional view of intelligence and IQ to include social and emotional aspects. In recent years, many school districts have attempted to incorporate emotional intelligence into the school curriculum with programs or teaching methods that focus on social and emotional learning (SEL). Although there are no specific state-level SEL guidelines, there are a number of these programs in Connecticut, with certain districts working to meaningfully incorporate SEL into the whole curriculum.

EMOTIONAL INTELLIGENCE DEFINED

The term “emotional intelligence” appears to have been coined in 1990 by psychologists John D. Mayer and Peter Salovey (current dean of Yale College). (However, there is earlier research that touches on the concept. ) They describe emotional intelligence as “a form of intelligence that involves the ability to monitor one's own and other's feelings and emotions, to discriminate among them, and to use this information to guide one's thinking and action. ” The psychologists have authored texts, conducted numerous studies, and, along with another psychologist, developed one of the more commonly used emotional intelligence assessments.

Psychologist Daniel Goleman built on their research and in 1995, published Emotional Intelligence, one of the most cited texts on the subject. Goleman's book was on the New York Times bestseller list for a year-and-a-half, with more than 5 million copies in print worldwide. Goleman later authored a book on emotional intelligence in the workplace, joining with other scholars that championed the importance of emotional intelligence in schools, the workplace, and interpersonal relationships in general.

Goleman co-founded the Collaborative for Academic, Social and Emotional Learning (CASEL), which was initially housed at the Yale University Child Studies Center and is now at the University of Illinois at Chicago, with a mission to help schools introduce emotional literacy courses. CASEL defines social and emotional learning as the process by which children and adults acquire knowledge, attitudes, and skills they need to recognize and manage their emotions, demonstrate caring and concern for others, establish positive relationships, make responsible decisions, and handle challenging situations constructively.

CASEL has conducted extensive research on the benefits of SEL programs and how they impact academic performance, including literature reviews, longitudinal studies, and program evaluations. The following are examples of research presented by the organization in their support of SEL programs:

• A meta-analysis of 165 studies of school-based prevention activities found interventions with SEL components significantly decreased rates of student drop out/non-attendance.

• Well-designed evaluations of several SEL programs have demonstrated that SEL instruction can produce significant improvements in school attitudes, school behavior, and school performance.

• Longitudinal studies of a preschool program designed to foster social-emotional competence documented numerous positive outcomes for program participants, including less time in special education programs, higher literacy and high school graduation rates, higher incomes and rates of homeownership, fewer arrests, and (for females) fewer children outside of marriage.

Faith, Spirituality & Mental Illness CEUs

Evidence is growing of the value that faith-based organizations offer to people with mental illnesses.

Faith-based communities often contribute to recovery by promoting hope and by offering solace and comfort in troubled times; and many consumers acknowledge the positive impact of spirituality and faith on their recovery and ability to cope with life's stresses.

However, not all faith-based organizations are equally knowledgeable about how best to serve people with mental health disorders.

The information available on this Web page can help faith-based communities - both clergy and congregants - increase their awareness of mental health issues and find ways to welcome and support people with mental illnesses, thus reducing discrimination and increasing social inclusion.

1 in 4 households in your church is afraid to tell you this secret
By Carlene Hill Byron

How many families in your church have a loved one who struggles with mental health problems? That’s kind of a trick question. People don’t talk about mental health problems. You’re more likely to hear
them describe their child’s condition as “something like autism,” as the elder of one church we know says. Or they might cover up entirely, as does an elder’s wife in another congregation. When her bipolar disorder swung into mania after childbirth, her family, already managing the added responsibilities of a newborn, had
to manage her condition as well. But because her condition is a secret, they did so without any support beyond the usual “new baby” dinners. The answer to the question is, if your congregation is representative of the U.S. population, one in four
households will struggle with someone’s mental health problems over their lifetime. That’s schizophrenia, bipolar disorder, obsessive compulsive disorder, disabling chronic depression,and various anxiety disorders. Look at the faces seated around you this Sunday. Someone is probably hurting. And they’re probably afraid to tell you.

The least acceptable disability
A study where people ranked disabilities by their “acceptability” returned these results, in order--most acceptable: obvious physical disabilities, blindness, deafness, a jail record, learning disabilities, and alcoholism. Least acceptable: mental health problems. People with mental health problems frighten us because when people become mentally ill, they become someone we don’t know. A bright boy who was his family’s bright hope may find he just can’t cut it anymore as schizophrenia turns him paranoid, disoriented, unmotivated in the extreme, and overwhelmed by
delusional voices that tell him, over and over, how worthless he is. Or, in the case of bipolar disorder, a girl who was a well-liked and active member of her Teen Challenge group may suddenly turn promiscuous, run away from home, and make a new home in the streets of a strange city. Laziness. Promiscuity. Violence. Sin.
That’s what many people see when they look at those with mental health problems. It’s hard to believe that people may behave in such unacceptable ways and not be in control of their behavior. Having a mental health problem is a lot like being on alcohol or drugs, without being able to stop. Medications “work” for
about two-thirds of us. That means that a third of us can’t ever get off the chemical ride that our brains produce. For those of us who can use medications, the side effects can be daunting. Many people become so frustrated with side effects that they stop taking medications. Only about half of us
accept treatment. Even when we are treated, not everyone regains their status as a fully functioning adult.

The challenging good news is that when people with mental illness turn to someone outside “the system” for help, the church is first to get the call 40 percent of the time. Is your church ready?
MFT CEUs, LCSW CEUs
Carlene Hill Byron is the former Director of Communications for Vision New England. Through NAMI—the Nation’s Voice on Mental Illness, she and her husband, James, train churches to effectively serve people within the congregation with mental health problems and also teach NAMI’s class for families of people
with mental health problems. They are members of Asbury United Methodist Church in Raleigh, North Carolina, where James serves on staff.
First published by Vision New England’s Ministries with the Disabled, Acton, Massachusetts.

Are There Different Types of Stress?

Stress management can be complicated and confusing because there are different types of stress: acute stress, episodic acute stress, chronic stress, and posttraumatic stress, each with its own characteristics, symptoms, duration, and treatment approaches.

Acute stress is the most common form of stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Because it is short-term, acute stress does not have enough time to do the extensive damage associated with long-term stress. Acute stress can crop up in anyone's life, and it is highly treatable and manageable.

Those who suffer acute stress frequently are dealing with episodic acute stress. It is common for people with episodic acute stress to be over-aroused, short-tempered, irritable, anxious, and tense. Interpersonal relationships deteriorate rapidly when others respond with real hostility. Work becomes a very stressful place for them. Often, lifestyle and personality issues are so ingrained and habitual with these individuals that they see nothing wrong with the way they conduct their lives. They blame their woes on other people and external events. Frequently, they see their lifestyles, patterns of interacting with others, and ways of perceiving the world as part and parcel of who and what they are. Without proper coping strategies, episodic acute stress develops into chronic stress.

Chronic stress is the grinding stress that wears people away day after day, year after year. It destroys bodies, minds, and lives. It is the stress of unrelenting demands and pressures for seemingly interminable periods of time. The worst aspect of chronic stress is that people get used to it. They forget it is there. People are immediately aware of acute stress because it is new. Chronic stress is ignored because it is familiar and almost comfortable.

Posttraumatic stress disorder (PTSD) stems from traumatic experiences that become internalized and remain forever painful and present. Individuals experiencing PTSD could exhibit signs of hypervigilance (an easily triggered startle response). People with an exaggerated startle response are easily startled by any number of things (e.g., loud noises, doors slamming, shouting). They usually feel tense or on edge. Along with hypervigilance, people experiencing PTSD symptoms also could be dealing with avoidance issues including staying away from places, events, or objects that are reminders of the experience; feeling emotionally numb; feeling strong guilt, depression, or worry; losing interest in activities that were enjoyable in the past; and having trouble remembering the dangerous event. People experiencing PTSD symptoms wear down to breaking points because physical and mental resources are depleted through long-term attrition. The symptoms of posttraumatic stress are difficult to treat and may require the help of a doctor or mental health professional. mft continuing education, social worker continuing education

PBS’s This Emotional Life: Documentary Launches a Campaign of Hope

PBS’s This Emotional Life: Documentary Launches a Campaign of Hope

Millions of Americans struggle to find more meaning in their lives every day.

To help, Vulcan Productions and NOVA/WGBH brought together a number of public and private organizations around a nationwide, multi-faceted project launched in conjunction with the recent PBS series, This Emotional Life.

The 2-year campaign aims to bring help and hope to those trying to improve their lives. The campaign includes SAMHSA, the National Alliance on Mental Illness, the Mayo Clinic, Blue Star Families, and other organizations.

"This is a unique opportunity to leverage the power of media to effect societal change — in this case, in the area of mental health and emotional well-being,&rquot; said A. Kathryn Power, M.Ed., Director of SAMHSA’s Center for Mental Health Services. "SAMHSA is working closely with the This Emotional Life team to make sure that the information, stories, and resources that make up this unprecedented project get to the people who need them most."

Documentary & Web Site
What do an uncontrollably angry teen and a misunderstood lottery winner have in common? Or how about a young husband misunderstood by his wife and an elderly woman on her way to a senior center? They were all interviewed for the PBS series This Emotional Life, which premiered in early January 2010.

This Emotional Life is a multi-platform endeavor that explores the science behind the human quest for emotional well-being, the barriers that stand in the way of this pursuit, and the importance of social relationships in surmounting life’s challenges and finding happiness.

"The TV series is the cornerstone of a broader project to help people form better, deeper, and more profound human connections," said Richard Hutton, Senior Executive Producer of Vulcan Productions.

This Emotional Life is complemented by a Web site, which provides vetted resources to build social support networks around topics highlighted in the series, such as the importance of early attachment, how to heal strained or damaged relationships, post-traumatic stress disorder (PTSD), stress, depression, grief, resilience and our pursuit of happiness.

Toolkits
Vulcan Productions is developing two toolkits, one that addresses early attachment for parents of infants and a second that addresses the emotional challenges faced by military service members and their families during the deployment cycle.

SAMHSA is distributing and assembling the "Early Moments Matter" toolkit designed to educate parents and caregivers of infants about what attachment is and why it's important.

The toolkit also provides parents concrete advice on ways to build attachment, a key to healthy social and emotional development. It will be distributed in high-birthrate hospitals, pediatric doctors' offices, and community-based clinics, as well as through partners who serve expecting and new parents.
mental health and social work continuing education ceu
"The Family Guide to Military Deployment," will provide tangible resources and tools to the families and friends of some of the 1.8 million servicemen and women who have been deployed, helping them face the emotional challenges typical of pre-deployment, deployment, and post-deployment.

For details about the documentary and campaign, visit the PBS Web site.

Resilience

What Is Resilience?

Resilience is the ability to:
Bounce back
Take on difficult challenges and still find meaning in life
Respond positively to difficult situations
Rise above adversity
Cope when things look bleak
Tap into hope
Transform unfavorable situations into wisdom, insight, and compassion
Endure

Resilience refers to the ability of an individual, family, organization, or community to cope with adversity and adapt to challenges or change. It is an ongoing process that requires time and effort and engages people in taking a number of steps to enhance their response to adverse circumstances. Resilience implies that after an event, a person or community may not only be able to cope and recover, but also change to reflect different priorities arising from the experience and prepare for the next stressful situation.

Resilience is the most important defense people have against stress.
It is important to build and foster resilience to be ready for future challenges.
Resilience will enable the development of a reservoir of internal resources to draw upon during stressful situations.
Research (Aguirre, 2007; American Psychological Association, 2006; Bonanno, 2004) has shown that resilience is ordinary, not extraordinary, and that people regularly demonstrate being resilient.

Resilience is not a trait that people either have or do not have.
Resilience involves behaviors, thoughts, and actions that can be learned and developed in anyone.
Resilience is tremendously influenced by a person's environment.
Resilience changes over time. It fluctuates depending on how much a person nurtures internal resources or coping strategies. Some people are more resilient in work life, while others exhibit more resilience in their personal relationships. People can build resilience and promote the foundations of resilience in any aspect of life they choose.

What Is Individual or Personal Resilience?
Individual resilience is a person's ability to positively cope after failures, setbacks, and losses. Developing resilience is a personal journey. Individuals do not react the same way to traumatic or stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies to build their resilience. Because resilience can be learned, it can be strengthened. Personal resilience is related to many factors including individual health and well-being, individual aspects, life history and experience, and social support.

Individual Health and Well-Being Individual Aspects Life History and Experience Social Support These are factors with which a person is born.

Personality
Ethnicity
Cultural background
Economic background

These are past events and relationships that influence how people approach current stressors:
Family history
Previous physical health
Previous mental health
Trauma history
Past social experiences
Past cultural experiences

These are support systems provided by family, friends, and members of the community, work, or school environments:
Feeling connected to others
A sense of security
Feeling connected to resources
(Adapted from Simon, Murphy, & Smith, 2008)


Along with the factors listed above, there are several attributes that have been correlated with building and promoting resilience.

The American Psychological Association reports the following attributes regarding resilience:
The capacity to make and carry out realistic plans
Communication and problem-solving skills
A positive or optimistic view of life
Confidence in personal strengths and abilities
The capacity to manage strong feelings, emotions, and impulses

What Is Family Resilience?
Family resilience is the coping process in the family as a functional unit. Crisis events and persistent stressors affect the whole family, posing risks not only for individual dysfunction, but also for relational conflict and family breakdown. Family processes mediate the impact of stress for all of its members and relationships, and the protective processes in place foster resilience by buffering stress and facilitating adaptation to current and future events. Following are the three key factors in family resilience (Wilson & Ferch, 2005):

Family belief systems foster resilience by making meaning in adversity, creating a sense of coherence, and providing a positive outlook.
Family organization promotes resilience by facilitating flexibility, capacity to adapt, connectedness and cohesion, emotional and structural bonding, and accessibility to resources.
Family communication enhances resilience by engaging clear communication, open and emotional expressions, trust and collaborative problem solving, and conflict management.

What Is Organizational Resilience?
Organizational resilience is the ability and capacity of a workplace to withstand potential significant economic times, systemic risk, or systemic disruptions by adapting, recovering, or resisting being affected and resuming core operations or continuing to provide an acceptable level of functioning and structure.

A resilient workforce and organization is important during major decisions or business changes.
Companies and organizations, like individuals, need to be able to rebound from potentially disastrous changes.
The challenge for the incorporation of resilience into a workplace is to identify what enhances the ability of an organization to rebound effectively.
Measuring workplace resilience involves identifying and evaluating the following:
Past and present mitigative mechanisms and practices that increase safety
Past and present mitigative mechanisms and practices that decrease error
Necessary redundancy in systems
Planning and programming that demonstrate collective mindfulness
Anticipation of potential trouble and solutions to potential problems

What Is Community Resilience?
Community resilience is the individual and collective capacity to respond to adversity and change. It is a community that takes intentional action to enhance the personal and collective capacity of its citizens and institutions to respond to and influence the course of social and economic change. For a community to be resilient, its members must put into practice early and effective actions so that they can respond to change. When responding to stressful events, a resilient community will be able to strengthen community bonds, resources, and the capacity to cope. Systems involved with building and maintaining community resilience must work together.
mental health and social work ceus

How Does Culture Influence Resilience?
Cultural resilience refers to a culture’s capacity to maintain and develop cultural identity and critical cultural knowledge and practices. Along with an entire culture fostering resilience, the interaction of culture and resilience for an individual also is important. An individual’s culture will have an impact on how the person communicates feelings and copes with adversity. Cultural parameters are often embedded deep in an individual. A person’s cultural background may influence one deeply in how one responds to different stressors. Assimilation could be a factor in cultural resilience, as it could be a positive way for a person to manage his/her environment. However, assimilation could create conflict between generations, so it could be seen as positive or negative depending on the individual and culture. Because of this, coping strategies are going to be different. With growing cultural diversity, the public has greater access to a number of different approaches to building resilience. It is something that can be built using approaches that make sense within each culture and tailored to each individual.

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What Factors Promote Resilience?
Resilience involves the modification of a person's response to a potentially risky situation. People who are resilient are able to maintain high self-esteem and self-efficacy in spite of the challenges they face. By fostering resilience, people are building psychological defenses against stress. The more resources and defenses available during a time of struggle, the better able to cope and bounce back from adverse circumstances people will be. A person’s ability to regain a sense of normalcy or define a new normalcy after adverse circumstances will be partially based on the resources available to him/her. Resilience building can begin at any time. Following is information regarding applicable ways to implement resilience practices, as well as situations that could inhibit resilience, situations that enhance resilience, and people who help facilitate the growth of resilience.

Resilience


Demonstrating Resilience Vulnerability Factors Inhibiting Resilience Protective Factors Enhancing Resilience Facilitators of Resilience
Individual Resilience
The ability for an individual to cope with adversity and change
Optimism
Flexibility
Self-confidence
Competence
Insightfulness
Perseverance
Perspective
Self-control
Sociability
Poor social skills
Poor problem solving
Lack of empathy
Family violence
Abuse or neglect
Divorce or partner breakup
Death or loss
Lack of social support
Social competence
Problem-solving skills
Good coping skills
Empathy
Secure or stable family
Supportive relationships
Intellectual abilities
Self-efficacy
Communication skills

Individuals
Parents
Grandparents
Caregivers
Children
Adolescents
Friends
Partners
Spouses
Teachers
Faith Community

Organizational Resilience
The ability for a business or industry, including its employees, to cope with adversity and change
Proactive employees
Clear mission, goals, and values
Encourages opportunities to influence change
Clear communication
Nonjudgmental
Emphasizes learning
Rewards high performance
Unclear Expectations
Conflicted expectations
Threat to job security
Lack of personal control
Hostile atmosphere
Defensive atmosphere
Unethical environment
Lack of communication

Open communication
Supportive colleagues
Clear responsibilities
Ethical environment
Sense of control
Job security
Supportive management
Connectedness among departments
Recognition

Employers
Managers
Directors
Employees
Employee assistance programs
Other businesses

Community Resilience
The ability for an individual and the collective community to respond to adversity and change.
Connectedness
Commitment to community
Shared values
Structure, roles, and responsibilities exist throughout community
Supportive
Good communication
Resource sharing
Volunteerism
Responsive organizations
Strong schools

Lack of support services
Social discrimination
Cultural discrimination
Norms tolerating violence
Deviant peer group
Low socioeconomic status
Crime rate
Community disorganization
Civil rivalry
Access to Support services
Community networking
Strong cultural identity
Strong social support systems
Norms against violence
Identification as a community
Cohesive community leadership
Community leaders
Faith-based organizations
Volunteers
Nonprofit organizations
Churches/houses of worship
Support services staff
Teachers
Youth groups
Boy/Girl Scouts
Planned social networking events

(Adapted from Kelly, 2007)
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How Is Personal Resilience Built?
Developing resilience is a personal journey. People do not react the same way to traumatic events. Some ways to build resilience include the following actions:

Making connections with others
Looking for opportunities for self-discovery
Nurturing a positive view of self
Accepting that change is a part of living
Taking decisive actions
Learning from the past
The ability to be flexible is a great skill to obtain and facilitates resilience growth. Getting help when it is needed is crucial to building resilience. It is important to try to obtain information on resilience from books or other publications, self-help or support groups, and online resources like the ones found in this resource collection.

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What Can Be Done to Promote Family Resilience?
Developing family resilience, like individual resilience, is different for every family. The important idea to keep in mind is that an underlying stronghold of family resilience is cohesion, a sense of belonging, and communication. It is important for a family to feel that when their world is unstable they have each other. This sense of bonding and trust is what fuels a family's ability to be resilient. Families that learn how to cope with challenges and meet individual needs are more resilient to stress and crisis. Healthy families solve problems with cooperation, creative brainstorming, openness to others, and emphasis on the role of social support and connectedness (versus isolation) in family resiliency. Resilience is exercised when family members demonstrate behaviors such as confidence, hard work, cooperation, and forgiveness. These are factors that help families withstand stressors throughout the family life cycle.

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How Is Community Resilience Fostered?
Fostering community resilience will greatly depend on the community itself and involves the community working as a whole toward preparedness. It is the capacity for the collective to take preemptive action toward preparedness. Community resilience involves the following factors:

Connection and caring
Collective resources
Critical analysis of the community
Skill building for community members
Prevention, preparedness, and response to stressful events
Resilience is exercised when community members demonstrate behaviors such as confidence, hard work, cooperation, and resourcefulness, and support of those who have needs during particular events. These are factors that help communities withstand challenging circumstances. There are other tips about how to foster community resilience in this resource collection.

Developing resilience is a personal journey. All people do not react the same to traumatic and stressful life events. An approach to building resilience that works for one person might not work for another. People use varying strategies. Resilience involves maintaining flexibility and balance in life during stressful circumstances and traumatic events. Being resilient does not mean that a person does not experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. Stress can be dealt with proactively by building resilience to prepare for stressful circumstances, while learning how to recognize symptoms of stress. Fostering resilience or the ability to bounce back from a stressful situation is a proactive mechanism to managing stress.

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References
Aguirre, B. (2007). Dialectics of vulnerability and resilience. Georgetown Journal of Poverty Law and Policy, 14(39), 1–18.

American Psychological Association. (2006). The road to resilience. Retrieved March 20, 2009, from " target="_blank">http://www.apahelpcenter.org/featuredtopics/feature.php?id=6.

Bonanno, G. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59, 20–28.

Kelly, S. (2007). Personal and community resilience: Building it and sustaining it. Retrieved March 23, 2009, from the University of California Los Angeles Bureau for Behavioral Health and Health Facilities at " target="_blank">http://www.wvdhhr.org/healthprep/common/resiliency.ppt#256.

Simon, J., Murphy, J., & Smith, S. (2008). Building resilience: Appreciate the little things in life. British Journal of Social Work, 38, 218–235.

Wilson, S., & Ferch, S. (2005). Enhancing resilience in the workplace through the practice of caring relationships. Organization Development Journal, 23(4), 45–60.

OxyContin® Abuse and Addiction Continuing Education CEUs

The media have issued numerous reports about the apparent increase in OxyContin® abuse and addiction. Some of these reports include the following:

• In Madison, Wisconsin, a task force reported a dramatic increase in OxyContin cases since 2003. Most OxyContin making its way onto the streets of Madison and nearby communities was believed to have been stolen from local pharmacies.1
• The police chief in Billerica, Massachusetts, reported a “dramatic increase in OxyContin abuse.”2
• The distribution of OxyContin in Virginia was reported to be well above the national average. In the counties of far southwest Virginia, where the hard physical labor of coal mining and farming leads to a higher incidence of injuries, OxyContin prescriptions were generally 500 percent above the national average.3
• Sixty-nine percent of police chiefs and sheriffs said they have witnessed an increase in the abuse of painkillers such as OxyContin. The areas most affected are eastern Kentucky, New Orleans, southern Maine, Philadelphia, southwestern Pennsylvania, southwestern Virginia, Cincinnati, and Phoenix.4

These reports may reflect some of your experiences: We know many of you are treating clients addicted to OxyContin.

OxyContin has been heralded as a miracle drug that allows patients with chronic pain to resume a normal life. It has also been called pharmaceutical heroin and is thought to have been responsible for a number of deaths and robberies in areas where its abuse has been reported. Patients who legitimately use OxyContin fear that the continuing controversy will mean tighter restrictions on the medication. Those who abuse OxyContin reportedly go to great lengths—legal or illegal—to obtain the powerful drug.

At the Center for Substance Abuse Treatment (CSAT), we are not interested in fueling the controversy about the use or abuse of OxyContin. As the Federal Government’s focal point for addiction treatment information, CSAT is instead interested in helping professionals on the front line of substance abuse treatment by providing you with the facts about OxyContin, its use and abuse, and how to treat individuals who present at your treatment facility with OxyContin concerns. Perhaps these individuals are taking medically prescribed OxyContin to manage pain and are concerned about their physical dependence on the medication. Perhaps you are faced with a young adult who thought that OxyContin was a “safe” recreational drug because, after all, doctors prescribe it. Possibly changes in the availability or quality of illicit opioid drugs in your community have led to abuse of and addiction to OxyContin.

Whatever the reason, OxyContin is being abused, and people are becoming addicted. And in many instances, these people are young adults unaware of the dangers of OxyContin. Many of these individuals mix OxyContin with alcohol and drugs, and the result is all too often tragic.

Abuse of prescription drugs is not a new phenomenon. You have undoubtedly heard about abuse of Percocet®, hydrocodone, and a host of other medications. What sets OxyContin abuse apart is the potency of the drug. Treatment providers in affected areas say that they were unprepared for the speed with which an OxyContin “epidemic” developed in their communities.

We at CSAT want to make sure that you are prepared if OxyContin abuse becomes a problem in your community. This revised issue of the original Substance Abuse Treatment Advisory on OxyContin will help prepare you by

• Answering frequently asked questions about OxyContin
• Providing you with general information about semisynthetic opioids and their addiction potential
• Summarizing evidence-based protocols for treatment
• Providing you with resources for further information

For more information about OxyContin abuse and treatment, see our resource boxes and end of this document. Feel free to copy the information in the Substance Abuse Treatment Advisory and share it with colleagues so that they, too, can have the most current information about this critically important topic.

OxyContin® Frequently Asked Questions

Q: What is OxyContin?

A: OxyContin is a semisynthetic opioid analgesic prescribed for chronic or long-lasting pain. The medication’s active ingredient is oxycodone, which is also found in drugs like Percodan® and Tylox®. However, OxyContin contains between 10 and 80 milligrams (mg) of oxycodone in a timed-release tablet. Painkillers such as Tylox contain 5 mg of oxycodone and often require repeated doses to bring about pain relief because they lack the timed-release formulation.

Q: How is OxyContin used?

A: OxyContin, also referred to as “Oxy,” “O.C.,” and “Oxycotton” on the street, is legitimately prescribed as a timed-release tablet, providing as many as 12 hours of relief from chronic pain. It is often prescribed for cancer patients or those with chronic, long-lasting back pain. The benefit of the medication to people who suffer from chronic pain is that they generally need to take the pill only twice a day, whereas a dosage of another medication would require more frequent use to control the pain. The goal of chronic pain treatment is to decrease pain and improve function.

Q: How is OxyContin abused?

A: People who abuse OxyContin either crush the tablet and ingest or snort it or dilute it in water and inject it. Crushing or diluting the tablet disarms the timed-release action of the medication and causes a quick, powerful high. Those who abuse OxyContin have compared this feeling to the euphoria they experience when taking heroin. In fact, in some areas, the use of heroin is overshadowed by the abuse of OxyContin.

Purdue Pharma, OxyContin’s manufacturer, has taken steps to reduce the potential for abuse of OxyContin and other pain medications. Its Web site lists the following initiatives: funding educational programs to teach healthcare professionals how to assess and treat patients suffering from pain, providing prescribers with tamper-proof prescription pads, developing and distributing more than 1 million brochures to pharmacists and healthcare professionals to help educate them about medication diversion, working with healthcare and law enforcement officials to address prescription drug abuse, and endorsing the development of State and national prescription drug monitoring programs to detect diversion. In addition, the company is attempting to research and develop other pain management products that will be more resistant to abuse and diversion. The company estimates that it will take significant time for such products to be brought to market. For more information, visit Purdue Pharma’s Web site at www.purduepharma.com or call the company at 203–588–8069.

Q: How does OxyContin abuse differ from abuse of other pain prescriptions?

A: Abuse of prescription pain medications is not new. Two primary factors, however, set OxyContin abuse apart from other prescription drug abuse. First, OxyContin is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other prescription pain relievers. By crushing the tablet and either ingesting or snorting it, or by injecting diluted OxyContin, people who abuse the opioid feel its powerful effects in a short time, rather than over a 12-hour span. Second, great profits can be made in the illegal sale of OxyContin. A 40-mg pill costs approximately $4 by prescription, yet it may sell for $20 to $40 on the street, depending on the area of the country in which the drug is sold.5

OxyContin can be comparatively inexpensive if it is legitimately prescribed and if its cost is covered by insurance. However, the National Drug Intelligence Center reports that people who abuse OxyContin may use heroin if their insurance will no longer pay for their OxyContin prescription because heroin is less expensive than OxyContin that is purchased illegally.6

Q: Why are so many crimes reportedly associated with OxyContin abuse?

A: Many reports of OxyContin abuse have occurred in rural areas that have housed labor-intensive industries, such as logging or coal mining. These industries are often located in economically depressed areas, as well. Therefore, people for whom the drug may have been legitimately prescribed may be tempted to sell their prescriptions for profit. Substance abuse treatment providers say that the addiction is so strong that people will go to great lengths to get the drug, including robbing pharmacies and writing false prescriptions.

Q: What is the likelihood that a person for whom OxyContin is prescribed will become addicted?

A: Most people who take OxyContin as prescribed do not become addicted. The National Institute on Drug Abuse reports: “Long-term use [of opioids] can lead to physical dependence—the body adapts to the presence of the substance and withdrawal symptoms occur if use is reduced abruptly. This can also include tolerance, which means that higher doses of a medication must be taken to obtain the same initial effects. . . . Studies have shown that properly managed medical use of opioid analgesic compounds is safe and rarely causes addiction. Taken exactly as prescribed, opioids can be used to manage pain effectively.”7

One review found, “A multitude of studies indicate that the rate of opioid addiction in populations of chronic pain sufferers is similar to the rate of opioid addiction within the general population, falling in the range of 1 to 2 percent or less.”8

In short, most individuals who are prescribed OxyContin, or any other opioid, will not become addicted, although they may become dependent on the drug and will need to be withdrawn by a qualified physician. Individuals who are taking the drug as prescribed should continue to do so, as long as they and their physician agree that taking the drug is a medically appropriate way for them to manage pain.

Q: How can I determine whether a person who uses OxyContin is dependent on rather than addicted to OxyContin?

A: When pain patients take an opioid analgesic as directed, or to the point where their pain is adequately controlled, it is not abuse or addiction. Abuse occurs when patients take more than is needed for pain control, especially if they take it to get high. Patients who take their medication in a manner that grossly differs from a physician’s directions are probably abusing that drug.

If a patient continues to seek excessive pain medication after pain management is achieved, the patient may be addicted. Addiction is characterized by the repeated, compulsive use of a substance despite adverse social, psychological, and/or physical consequences. Addiction is often (but not always) accompanied by physical dependence, withdrawal syndrome, and tolerance. Physical dependence is defined as a physiologic state of adaptation to a substance. The absence of this substance produces symptoms and signs of withdrawal. Withdrawal syndrome is often characterized by overactivity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. Opioids often cause sleepiness, calmness, and constipation, so opioid withdrawal often includes insomnia, anxiety, and diarrhea.

Pain patients, however, may sometimes develop a physical dependence during treatment with opioids. This is not an addiction. A gradual decrease of the medication dose over time, as the pain is resolving, brings the former pain patient to a drug-free state without any craving for repeated doses of the drug. This is the difference between the patient treated for pain who was formerly dependent and has now been withdrawn from medication and the patient who is opioid addicted: The patient addicted to diverted pharmaceutical opioids continues to have a severe and uncontrollable craving that almost always leads to eventual relapse in the absence of adequate treatment. This uncontrollable craving for another “rush” of the drug differentiates the patient who is “detoxified” but opioid addicted from the former pain patient. Theoretically, a person who abuses opioids might develop a physical dependence but obtain treatment in the first few months of abuse, before becoming addicted. In this case, supervised withdrawal (detoxification) followed by a few months of abstinence-oriented treatment might be sufficient for the patient who is not addicted who abuses opioids. If, however, this patient subsequently relapses to opioid abuse, then that behavior would support a diagnosis of opioid addiction. If the patient has several relapses to opioid abuse, he or she will require long-term treatment for the opioid addiction. (See the section titled Treatment and Detoxification Protocols to learn more about treatment options.)

Q: I work at a facility that does not use medication-assisted treatment. What treatment should I provide to individuals addicted to or dependent on OxyContin?

A: The majority of U.S. treatment facilities do not offer medication-assisted treatment. However, because of the strength of OxyContin and its powerful addiction potential, medical complications may be increased by quickly withdrawing individuals from the drug. Premature withdrawal may cause individuals to seek heroin, and the quality of that heroin will not be known. In addition, these individuals, if injecting heroin, may also expose themselves to HIV and hepatitis. Most people addicted to OxyContin need medication-assisted treatment. Even if individuals have been taking OxyContin legitimately to manage pain, they should not stop taking the drug all at once. Instead, their dosages should be tapered down until medication is no longer needed. If you work in a drug-free or abstinence-based treatment facility, it is important to refer patients to facilities where they can receive appropriate treatment. (See SAMHSA Resources.)

Treatment and Detoxification Protocols

OxyContin® is a powerful drug that contains a much larger amount of the active ingredient, oxycodone, than other prescription opioid pain relievers. Whereas most people who take OxyContin as prescribed do not become addicted, those who abuse their pain medication or obtain it illegally may find themselves becoming rapidly dependent on, if not addicted to, the drug.

Two types of treatment have been documented as most effective for opioid addiction. One is a long-term, residential, therapeutic community type of treatment, and the other is long-term, medication-assisted outpatient treatment. Clinical trials using medications to treat opioid addiction have generally included subjects addicted to diverted pharmaceutical opioids as well as to illicit heroin. Therefore, there is no medical reason to suppose that the patient addicted to diverted pharmaceutical opioids is any less likely to benefit from medication-assisted treatment than the patient addicted to heroin.

Some patients who are opioid addicted who have very good social supports may occasionally be able to benefit from antagonist treatment with naltrexone. This treatment works best if the patient is highly motivated to participate in treatment and has undergone adequate detoxification from the opioid of abuse. Most patients who are opioid addicted in outpatient therapy, however, do best with medication that is either an agonist or a partial agonist. Methadone is the agonist medication most commonly prescribed for opioid addiction treatment in this country. Buprenorphine is the only partial agonist approved by the Food and Drug Administration for opioid addiction treatment.

The guidelines for treating OxyContin addiction or dependence are basically no different than the guidelines the Center for Substance Abuse Treatment (CSAT) uses for treating addiction to or dependence on any opioid. However, because OxyContin contains higher dose levels of opioid than are typically found in other oxycodone-containing pain medications, higher dosages of methadone or buprenorphine may be needed to appropriately treat patients who abuse OxyContin.

Methadone or buprenorphine may be used for OxyContin addiction treatment or, for that matter, treatment for addiction to any other opioid, including the semisynthetic opioids. Medication-assisted treatment for prescription opioid abuse is not a new treatment approach. For instance, in 2002, Alaska estimated that 15,000 people abused prescription opioids in the State and that most patients receiving methadone were not addicted to heroin. In addition, a significant percentage of patients in publicly supported methadone programs were not being treated for heroin addiction but for abuse of semisynthetic opioids (e.g., hydrocodone). The Substance Abuse and Mental Health Services Administration (SAMHSA) Drug Abuse Warning Network emergency room data show that both oxycodone and hydrocodone mentions increased dramatically in the United States between 1995 and 2002.9 And when Arkansas opened its first methadone maintenance clinic in December 1993, the vast majority of its clients were not admitted for heroin addiction but for semisynthetic opioid abuse. These individuals had been traveling to other States for treatment because methadone treatment was not available near their homes.

Using the criteria above describing the difference between addiction to and dependence on OxyContin, you may be able to determine whether a patient requires treatment for opioid addiction. If this is the case, methadone or buprenorphine may be used for withdrawal. For certain patient populations, including those with many treatment failures, methadone or buprenorphine is the treatment of choice.10

“As substance abuse treatment professionals, we have the responsibility for learning as much as we can about OxyContin and then providing appropriate treatment for people addicted to it. Appropriate treatment will nearly always involve prescribing methadone, buprenorphine, or, in some cases, naltrexone,” says H. Westley Clark, M.D., J.D., Director of CSAT. “Programs that do not offer medication-assisted treatment will need to refer patients who are addicted to OxyContin to programs that do,” he adds.

It is important to assess an individual’s eligibility for medication-assisted treatment with methadone or buprenorphine to determine whether he or she is eligible for this type of treatment and whether it would be appropriate. The assessment may take place in a hospital emergency department, central intake unit, or similar place. Final assessment of an individual’s eligibility for medication-assisted treatment must be completed by treatment program staff. The preliminary assessment should include the following areas:11

• Determining the need for emergency care
• Diagnosing the presence and severity of opioid dependence
• Determining the extent of alcohol and drug abuse
• Screening for co-occurring medical and psychiatric conditions
• Evaluating an individual’s living situation, family and social problems, and legal problems

“. . . we have the responsibility for learning as much as we can about OxyContin, and then providing appropriate treatment for people who are addicted to it.”

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director, CSAT

Treatment Improvement Protocols (TIPs) and Collateral Products Addressing Opioid Addiction Treatment

TIP 40 Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction BKD500

Quick Guide for Physicians Based on TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction QGPT40

KAP Keys for Physicians Based on TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction KAPT40

TIP 43 Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs BKD524

Quick Guide for Clinicians Based on TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs QGCT43

KAP Keys for Clinicians Based on TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs KAPT43

SAMHSA Resources

To find a substance abuse treatment facility near you, visit the Substance Abuse Treatment Facility Locator at www.findtreatment.samhsa.gov. Call the Substance Abuse and Mental Health Services Administration Substance Abuse Treatment Hotline at 800–662–HELP for substance abuse treatment referral information.

For More Information About Treatment for Opioid Addiction

Sign up for SAMHSA’s Information Mailing System (SIMS) to receive information about the following topics:

• Grant announcements
• Funding opportunities such as competitive contract announcements
• Prevention materials and publications
• Treatment- and provider-oriented materials and publications
• Research findings and reports
• Announcements of available research data sets
• Policy announcements and materials

To sign up for this free service, use one of the following methods to contact SIMS:

Web: http://sims.health.org
Mail: SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI)
Attn: Mailing List Manager
P.O. Box 2345
Rockville, MD 20847–2345
Phone: 800–729–6686
Fax: 301–468–6433
Attn: Mailing List Manager

Three Ways To Obtain Free Copies of All CSAT Products:

1. Call SAMHSA’s NCADI at 800–729–6686; TDD (hearing impaired) 800–487–4889
2. Visit NCADI’s Web site, www.ncadi.samhsa.gov
3. Access TIPs on line at www.kap.samhsa.gov


Substance Abuse Treatment Advisory

Substance Abuse Treatment Advisory—published on an as-needed basis for treatment providers—was written and produced under contract number 270-04-7049 by the Knowledge Application Program (KAP), a Joint Venture of JBS International, Inc., and The CDM Group, Inc., for the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The content of this publication does not necessarily reflect the views or policies of SAMHSA or HHS.

Public Domain Notice: All material in this report is in the public domain and may be reproduced or copied without permission; citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication: This publication can be accessed electronically through the Internet at www.kap.samhsa.gov. Additional free print copies can be ordered from SAMHSA’s National Clearinghouse for Alcohol and Drug Information at 800–729–6686.

Recommended Citation: Center for Substance Abuse Treatment. “OxyContin®: Prescription Drug Abuse—2006 Revision.” Substance Abuse Treatment Advisory, Volume 5, Issue 1. Rockville, MD: Substance Abuse and Mental Health Services Administration, April 2006.

DHHS Publication No. (SMA) 06-4138
Substance Abuse and Mental Health Services Administration
Printed 2006

Notes

1. WISC-TV. OxyContin: The Good, The Bad, The Deadly. Broadcast transcript. Madison, WI: WISC-TV, February 14, 2006. www.channel3000.com/health/7013912/detail.html [accessed March 2, 2006].
2. Crane, J.P. Drug use by young raises flag. The Boston Globe, February 5, 2006. www.boston.com/news/local/articles/2006/02/05/drug_use_by_young_raises_flag [accessed March 2, 2006].
3. Hammack, L. Painkiller prescriptions up significantly in region. The Roanoke Times, March 28, 2004. www.roanoke.com/roatimes/news/story164817.html [accessed March 2, 2006].
4. Reuters. Powerful painkillers fueling U.S. crime rate. Redmond, WA: MSNBC.com., March 10, 2005. www.msnbc.msn.com/id/7141313 [accessed March 2, 2006].
5. National Drug Intelligence Center. Intelligence Bulletin: OxyContin Diversion, Availability, and Abuse. Johnstown, PA: National Drug Intelligence Center, U.S. Department of Justice, August 2004. www.usdoj.gov/ndic/pubs10/10550/10550p.pdf [accessed March 3, 2006].
6. National Drug Intelligence Center. Pharmaceuticals. In: National Drug Threat Assessment 2004. Johnstown, PA: National Drug Intelligence Center, U.S. Department of Justice, April 2004. www.usdoj.gov/ndic/pubs8/8731/8731p.pdf [accessed March 3, 2006].
7. National Institute on Drug Abuse (NIDA). NIDA Infofacts: Prescription Pain and Other Medications. Washington, DC: NIDA, National Institutes of Health, 2005. www.drugabuse.gov/infofacts/PainMed.html [accessed March 3, 2006].
8. Fisher, F.B. Interpretation of “aberrant” drug-related behaviors. Journal of American Physicians and Surgeons 9(1):25–28, 2004.
9. Substance Abuse and Mental Health Services Administration (SAMHSA). Emergency Department Trends From the Drug Abuse Warning Network: Final Estimates 1995–2002. DAWN Series D-24. DHHS Publication No. (SMA) 03-3780. Rockville, MD: SAMHSA, 2003. dawninfo.samhsa.gov/old_dawn/pubs_94_02/edpubs/2002final [accessed March 2, 2006].
10. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series 45. DHHS Publication No. (SMA) 06-4131. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2006.
11. Center for Substance Abuse Treatment. Initial screening, admission procedures, and assessment techniques. In: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment Programs. Treatment Improvement Protocol (TIP) Series 43. DHHS Publication No. (SMA) 05-4048. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005, pp. 43–61.