Recovery Michigan

Michigan is almost exactly the national average, about  half of Montana which has the highest rate...

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Montana has highest rate of suicides among U.S. states, with 26 per 100,000 individuals, according to a Kaiser Family Foundation report.

The report used population data from the U.S. Census Bureau to determine age-adjusted suicide rates as well as data from the CDC's National Center for Injury Prevention and Control and its Web-based Injury Statistics Query and Reporting System.

The age-adjusted suicide rate for the U.S. as a whole was 13.4 per 100,000 individuals. 

Here are the suicide rates in each state and the District of Columbia for 2016 (the most recent available data), ranked by suicide rate per 100,000 individuals:

1. Montana — 26
2. Alaska — 25.4
3. Wyoming — 25.2
4. New Mexico — 22.5
5. Utah — 21.8
6. Nevada — 21.4
7. Idaho — 21.3
8. Oklahoma — 20.9
9. Colorado — 20.5
9. South Dakota — 20.5
11. West Virginia — 19.5 
12. North Dakota — 19
13. Missouri — 18.3
14. Arkansas — 18.2
15. Kansas — 17.9 
16. Oregon — 17.8
17. Arizona — 17.6
18. New Hampshire — 17.3
18. Vermont — 17.3
20. Kentucky — 16.8
21. Tennessee — 16.3
22. Maine — 15.7
22. South Carolina — 15.7
24. Alabama — 15.6
25. Indiana — 15.4
26. Washington — 14.8
27. Pennsylvania — 14.7
28. Wisconsin — 14.6
29. Iowa — 14.5
30. Louisiana — 14.1
30. Ohio — 14.1
32. Florida — 13.9
33. Georgia — 13.3
33. Michigan — 13.3 
35. Minnesota — 13.2
35. Virginia — 13.2
37. Nebraska — 13
37. North Carolina — 13
39. Mississippi — 12.7
40. Texas — 12.6
41. Hawaii — 12
42. Delaware — 11.5
43. Rhode Island — 11.1
44. Illinois — 10.7
45. California — 10.5
46. Connecticut — 10
47. Maryland — 9.3
48. Massachusetts — 8.7
49. New York — 8.1
50. New Jersey — 7.2
51. District of Columbia — 5.1

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Tell me the story of how you started Children of Peace Uganda. What brought you to this work?

What drove me to create Children of Peace Uganda was the passion that came from my work with the former child soldiers in Northern Uganda recruited by the LRA headed by Joseph Kony. I worked in a rehabilitation center receiving the children from the military and taking them through trauma therapy, [which] is so much needed, and just generally helping them to recover to some extent before we would do family tracing to try and reunite them with families—if we could find their families, that is. So, I worked there from 2004 to 2006.

Then, from 2007 to 2010, there was an attempted peace deal between the government of Uganda and the LRA rebels, but, unfortunately, it failed. Before the peace negotiations began, the LRA rebels were given a truce by the government of Uganda to cross over to the Congo while there was going to be a negotiation. The borders were closed, so, when the peace deal failed, they could not come back to Uganda. As a person who has worked with these children on a daily basis for all those years, though, I know that the work we did at the Rachele Rehabilitation Centre in Lira was a type of emergency response. Now that the guns had gone silent, there was a high need to follow up with these youth. I kept asking myself, “What becomes of them? They’ve gone back home, they’ve missed out on education, they don’t have gainful skills; so what happens to them then?” My heart knew that I had to do something, and I kept asking myself, what can I do to create a difference in their lives? That’s how I created Children of Peace Uganda.

I started alone. I talked to whoever whenever there was an opportunity for me to speak with somebody. Then this opportunity was presented to me to speak at the International Criminal Court Review Conference (ICCRC) in 2010 in Kampala. So, that then opened a door for me to speak about issues of child soldiers not only in Uganda but throughout Africa. And not only in Africa: look at Israel, look at Syria, and see also how it affects a child, how wars impact children profoundly across the globe.

So, just going back to the early stages; you did this child therapy work with a rehabilitation center for a few years and despite moving on from the center, you still had a strong moral imperative to continue the work. What were some of the technical steps that went into establishing Children of Peace in Uganda? You mentioned tapping into networks; can you tell me more about obstacles, challenges that came with establishing an NGO?

I started this alone. Just me. There was no money, but I had the heart to do this and I had to move on. I believed that if I have the compassion and if I have the heart, that means that another person somewhere in some part of the globe will too. It may be from my community, or wherever, but I knew someone out there would have the same heart as I do and I believed I would find those people one day. For sure, I’ve been able to meet a number of them who are very passionate about the work that I’m doing.

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Specific impairments within six large-scale brain networks during drug cue exposure, decision-making, inhibitory control, and social-emotional processing are associated with drug addiction behaviors, according to a systematic review of more than 100 published neuroimaging studies by experts at the Icahn School of Medicine at Mount Sinai and published Wednesday, June 6 in the journal Neuron.

While the involvement of these specific brain networks was task-specific, we generally observed that in a drug-related context (e.g., during exposure to drug cues) drug addicted individuals had increased engagement of the brain networks underlying decision making, inhibitory control, and social-emotional processing, but a blunted response during non-drug related tasks, as predicted by the iRISA model.”

Specifically, the Mount Sinai study team assessed brain function in drug addiction across a number of brain networks, including findings from whole-brain analyses of significant group differences. They organized the results across six large-scale brain networks that showed impairment of brain function in addiction, encompassing the “reward network,” which includes subcortical and cortical brain regions activated during the appraisal of subjective value; the striatal “habit network,” which underlies learning of automated behavior; the “salience network,” regions involved in (re)directing attentional resources toward salient stimuli; and the “executive network,” which supports the selection of possible behavioral responses (often also named the inhibitory control network).

Two additional networks, which were not discussed in prior reviews of the iRISA model, were found to be relevant to brain function in drug addiction: the “self-directed network,” which is activated during self-directed/referential cognitive processes, and the “memory network,” involved in flexible, multi-cue learning and memory.

“Our review is the first systematic approach to integrate what we know about the function of each of these networks into a comprehensive model underlying drug addiction symptomatology across the addiction cycle,” says Anna Zilverstand, PhD, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai and first author of the paper. “We demonstrated common deficits underlying drug addiction independent of the primary drug of choice, which are associated with measures of daily, real-life, drug use and which predict onset, escalation, and relapse into drug use. Our work could inform the development of treatments specifically targeted to alleviate these brain-behavioral deficits.”

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We had addiction in my family. 

Why does it seem to pass from mother to daughter, from father to son, as though it were some dark genetic twist?

I went on a long journey to find the answers to these questions – I describe it in my book ‘Chasing The Scream: The First and Last Days of the War on Drugs.’ My research was book-ended by two events that remind us why we need to urgently understand this.

On Feb. 11 2012, Whitney Houston was found facedown in a bathtub, with her bloodstream pumped by alcohol, cocaine, and prescription drugs. This year, almost exactly three years on, her daughter Bobbi Kristina Brown was found facedown in a bathtub, after talking publicly about her own drug addiction, and pleading: “What do I really do? God, Help me ignore and rebuke what these demons are saying.”  It now looks – according to most reports – as if Bobbi will never recover. Last month, her father Bobby Brown said she had opened her eyes, but her grandmother said she has “irreversible brain damage.”

This question is no longer a mystery. It is no longer shrouded in fog. We know the major reason why addiction is transmitted through families – and it is not what most of us think. There is a genetic factor; but there is another explanation that is even more significant – and that we can do something about. A major studyby the Center for Disease Control (CDC) and the healthcare provider Kaiser Permanente of 17,000 people has unlocked this – and its results have subsequently been replicated by over 20 studies funded by individual US states.(1)

It was discovered quite by accident – in part of a study of a totally different subject. A distinguished doctor in San Diego called Vincent Felitti was trying to find out the underlying causes of obesity, and he was overseeing the treatment of over 30,000 people. He spent long sessions talking with his patients about when they had started to over-eat – and what events had taken place at that point in their lives, at the apparent trigger-moment.

Dr Felliti noticed something striking. His patients seemed to have been sexually abused at a higher rate than the general population. Far higher. One woman explained that she gained 105 pounds after being raped. “Overweight is overlooked,” she said, “and that’s the way I need to be.”

Intrigued, Dr Felitti launched a major and detailed study to find out what role – if any – traumatic childhood events played in obesity. It became known as the Adverse Childhood Experiences (ACE) Survey. They questioned 17,000 people in San Diego, mostly middle class and professional, to find out if they had gone through any of ten traumatic experiences that can happen to a child – from neglect to violence to rape. They then followed them to see if they suffered any other problems later in life. At the same time as they looked to see if there was any correlation with obesity, they also included other factors – like drug addiction.

What they discovered seemed, at first, to be an error.

“A person who experienced any six or more of the categories” of childhood trauma, Dr Felitti tells me, “was 4600 percent more likely to become an IV [injecting] drug user later in life than a person who experienced none of them.” (2) He adds: “I remember the epidemologists at the CDC told me those were numbers a magnitude of which they see once in a career. You read the latest cancer scare of the week in the newspaper and something causes an increase of 30 percent in breast or prostate cancer and everybody goes nuts – and here, we’re talking 4600 percent.”

The published research showed that for every category of trauma that happens to a child, they are two to four times more like to grow up to be an addict – and multiple traumas produced a massive risk. The correlation for addiction was startling. Nearly two-thirds of injecting drug use, they found, is the result of early childhood trauma. (3)

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Suicide rates rose in all but one state between 1999 and 2016, with increases seen across age, gender, race and ethnicity, according to a report released Thursday by the Centers for Disease Control and Prevention. In more than half of all deaths in 27 states, the people had no known mental health condition when they ended their lives.

In North Dakota, the rate jumped more than 57 percent. In the most recent period studied (2014 to 2016), the rate was highest in Montana, at 29.2 per 100,000 residents, compared with the national average of 13.4 per 100,000.

[Suicide rates are on the rise across the nation but nowhere more so than in rural counties]

Nearly 45,000 suicides occurred in the United States in 2016 — more than twice the number of homicides — making it the 10th-leading cause of death. Among people ages 15 to 34, suicide is the second-leading cause of death.

“Research for many years and across social and health science fields has demonstrated a strong relationship between economic downturns and an increase in deaths due to suicide,” Sarah Burgard an associate professor of sociology at the University of Michigan, explained in an email on Thursday.

The dramatic rise in opioid addiction also can't be overlooked, experts say, though untangling accidental from intentional deaths by overdose can be difficult. The CDC has calculated that suicides from opioid overdoses nearly doubled between 1999 and 2014, and data from a 2014 national survey showed that individuals addicted to prescription opioids had a 40 percent to 60 percent higher risk of suicidal ideation. Habitual users of opioids were twice as likely to attempt suicide as people who did not use them.

“Historically, men had higher death rates than women,” Kaslow noted. “That's equalizing not because men are [committing suicide] less but women are doing it more. That is very, very troublesome.”

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Temper tantrums, the physical need for daily naps, or thumb sucking—these are things that children usually outgrow with time. However, there are certain things that don’t dissipate without plenty of the right help, including the effects of early traumatic experiences. Reactive attachment disorder (RAD) doesn’t just disappear with time, contrary to what some people believe. Children who aren’t effectively treated for RAD most often grow into adults with personality disorders.

Reactive attachment disorder is a brain disorder

Even though other people can’t see the differences on the outside, the brains of children with RAD look different from the brains of children who didn’t experience trauma. Reactive attachment disorder is a brain injury that typically occurs as a result of early abuse and neglect. Just as a person can’t simply “outgrow” the brain disorder of bipolar disorder, neither can a person simply outgrow RAD.

When people experience traumatic events, the stress hormone cortisol gets released in the brain. This biochemical reaction to chronic and extreme stress changes the formation of the brain. Consider this analogy—think of the human brain like the earth and water like trauma. Over time, the release of water over the earth begins to erode the soil into pathways. As pathways form, the water rushes down those pathways again and again until they become canyons. Like the earth, the brain begins to look physically different than it once did. Therefore, the brain reacts differently as a result. When the brain experiences a trauma trigger, fear becomes an overwhelming irrational emotion. The brain automatically goes into survival mode and the person fights, flees, or freezes in his own way. Such triggers only make the erosion and canyons deeper with time. It is not something people can just forget, outgrow, or “get over”.

RAD may look like just another developmental phase, but it’s not

For those who don’t understand RAD or haven’t raised a child with RAD, the disorder can look like just another developmental phase. That’s because children who were abused or neglected before the age of 5 didn’t get opportunities to experience normal early child development. Therefore, they essentially get “stuck” in the developmental stage of a toddler. Their behaviors can look similar to that of a younger child. They steal, lie, argue, throw temper tantrums, blame others for their mistakes, and have trouble regulating their emotions, for example. Yet, children who were abused or neglected during their youngest years don’t continue to develop normally and “outgrow” it like other children. Their brains are hard-wired to stay put.

The assumption on behalf of the general public that children with RAD might just be a bit behind developmentally makes sense. They believe that the children will just catch up eventually. Unfortunately, it’s not that simple.

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Research from the University of Illinois at Chicago has found that some of the genes affected by alcohol and inflammation are also implicated in processes that clear amyloid beta — the protein that forms globs of plaques in the brain and which contributes to neuronal damage and the cognitive impairment associated with Alzheimer’s disease.

Previous studies investigating the effects of alcohol consumption on Alzheimer’s disease have been controversial — some have indicated that alcohol has a protective effect, while others have pointed to a deleterious role for alcohol in the development of this neurocognitive disease. Recent research has suggested that alcohol consumption, and its impact on the immune system and inflammation in the brain, may be the vehicle through which alcohol might exert its influence on the development of Alzheimer’s disease, but no previous studies have directly evaluated which genes are affected by alcohol in cells in the brain involved in protecting against Alzheimer’s disease.

Dr. Douglas Feinstein, professor of anesthesiology in the University of Illinois at Chicago College of Medicine, along with other researchers conducted a cell-based study which suggests that alcohol may impede the clearance of amyloid beta in the brain.

http://bit.ly/2sJMaWR 

But you may be dealing with depression’s lesser known evil twin.

Whistling low through my teeth, I slurp my drink once more then smile. “Well the good news is it’s not quite depression.”

The disbelief on my friend’s face is clear. He’s spent most of his life battling depression. But I hold up my hand before he can object: “You’re dealing with depression’s twin cousin. It’s called acedia.”

“Ah-seed-e-what?”

The Noonday Demon

Acedia (pronounced ah-SEED-e-uh) is an old term coined by monks who lived in the desert during the fourth century. Before the Seven Deadly Sins became known to the world, the early Desert Fathers had a list of “Eight Bad Thoughts.” One of the most severe thoughts was that of acedia, which the church eventually rolled up under the sin of “sloth” when the seven sins became commonplace.

One would think “lust” would be the one they hammered on given the religious leanings of the modern church, but it was considered one of the most minor “bad thoughts.” The monks viewed lust as a lower form of greed in that you desired something you didn’t have. Acedia was one of the most severe and deadly thoughts because of the despair and absolute disdain for life it produced in a human being. It’s a shame the word has been lost to ancient textbooks and is no longer used, because acedia’s connotations carry far more weight in today’s cultural environment.

I first learned the term when I read author Kathleen Norris’s book, Acedia & me: A Marriage, Monks, and a Writer’s Life. In the book she quotes a monk who states:

“The demon of acedia — also called the noonday demon — is the one that causes the most serious trouble of all…He makes it seem that the sun barely moves, if at all, and…he instills in the heart of the monk a hatred for the place, a hatred for his very life itself.”

Many of the desert monks found themselves in the same place as my friend. Work in the morning, but by noon, they despised the repetitive nature of chores or work. After some time in this condition, they felt little zeal for life. Prayer stopped, sleeping increased, and they felt numb. Eventually, they despised life itself as they spiraled into a dark hole.

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New clinical practice guidelines have been published aimed at safely deprescribing benzodiazepine receptor agonists (BZRAs). Employing a systematic review of deprescribing trials and a separate investigation of the harms of long-term BZRA use, the researchers — Dr. Kevin Pottie from the University of Ottawa, Canada, and colleagues — recommend that tapering protocols be offered to all adults who take BZRAs, especially those older than 65.  An algorithm and client information pamphlet is provided to assist clinicians in the deprescribing process.

“Benzodiazepine receptor agonists are associated with harms, and therapeutic effects might be short term,” Pottie and colleagues write. “Tapering BZRAs improves cessation rates compared with usual care without serious harms. Patients might be more amenable to deprescribing conversations if they understand the rationale (potential for harm), are involved in developing the tapering plan and are offered behavioral advice.”

BZRAs are 1 of the 2 most common treatments for insomnia, along with cognitive-behavioral therapy (CBT), and are widely prescribed at a cost of up to $330 million per year. Yet, their efficacy can be limited to as few as 4 weeks.

Choosing Wisely Canada does not recommend BZRAs as a first-line treatment for elderly patients with insomnia, as common side effects include increased risk of falls and accidents, memory problems, and daytime sedation. Furthermore, long-term BZRA use is associated with heightened risk of developing a physical or psychological dependence. Canadian family physicians, pharmacists, nurses, and geriatricians classified BZRAs as the “most important medication class for developing a deprescribing guideline” due to the adverse effects found in long-term use.

Benzodiazepine receptor agonists attach to a site on a receptor (aminobutyric acid type A receptor), which, if blocked for extended periods of time, can physically change. This can lead to fewer sedative effects and more amnestic impact. The authors highlight that this information is mostly unknown to patients prescribed BZRAs. They note that patients are more prone to rate BZRA benefits higher and the risks lower than physicians do, on the premise that they must work or otherwise their doctor would not prescribe them.

As no other evidence-based guidelines for tapering BZRAs existed prior to this one, the authors define deprescribing as the “planned and supervised process of dose reduction or stopping a medication that might be causing harm or no longer providing benefit. The goal of deprescribing is to reduce medication burden and harm, while maintaining or improving quality of life.”

In the first attempt to draft guidelines for deprescribing BZRAs, the authors aimed at supporting primary care physicians, pharmacists, nurse practitioners, or other specialists who care for clients with insomnia (on its own or with comorbidities). To provide an evidence-based and up-to-date platform, the Guideline Development Team (GDT) is interdisciplinary, comprised of 8 clinicians, 1 family physician, 2 psychiatrists, 1 psychologist, 1 clinical pharmacologist, 2 clinical pharmacists with geriatric expertise, and 1 geriatrician, as well as a GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodologist.

The GDT team ultimately asked, “What are the effects (harms and benefits) of deprescribing BZRAs compared with continued use in adults with insomnia?” The systematic review evaluated outcomes related to sleep quality, the effect on cognition, adverse drug withdrawal events, cessation rate, and harms, as well as pill burden and patient satisfaction. Every team member is noted to have agreed with the final draft of guidelines.

The guidelines state:

• For elderly adults (at least 65 years old) who use BZRAs, we recommend the following: Taper the BZRA dose slowly (strong recommendation, low-quality evidence).
• For adults (18-64) who have used BZRAs most days of the week for more than four weeks, we suggest the following: Taper the BZRA dose slowly (weak recommendation, low-quality evidence).

Pottie and colleagues found the following as the two biggest concerns in deprescribing: (1) how to approach the client to get “buy-in” and (2) lack of knowledge of other options in place of BZRAs. In response, they found that while some clients may be reluctant, others are eager for the chance to regain control around sleeping behaviors and to diminish adverse side effects. The authors found that most clients were able to successfully discontinue BZRAs, mainly due to deprescribing interventions.

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More recently, practitioners and policy stakeholders have recognized the impact of trauma on learning, and healthy development. In efforts to support young people who experience trauma, the term “trauma informed care” has gained traction among schools, juvenile justice departments, mental health programs and youth development agencies around the country. Trauma informed care broadly refers to a set of principles that guide and direct how we view the impact of severe harm on young people’s mental, physical and emotional health. Trauma informed care encourages support and treatment to the whole person, rather than focus on only treating individual symptoms or specific behaviors.

Trauma-informed care has become an important approach in schools and agencies that serve young people who have been exposed to trauma, and here’s why. Some school leaders believe that the best way to address disruptive classroom behavior is through harsh discipline. These schools believe that discipline alone is sufficient to modify undesired classroom behavior. But research shows that school suspensions may further harm students who have been exposed to a traumatic event or experience (Bottiani et al. 2017). Rather than using discipline, a school that uses a trauma informed approach might offer therapy, or counseling to support the restoration of that student’s well-being. The assumption is that the disruptive behavior is the symptom of a deeper harm, rather than willful defiance, or disrespect.

While trauma informed care offers an important lens to support young people who have been harmed and emotionally injured, it also has its limitations. I first became aware of the limitations of the term “trauma informed care” during a healing circle I was leading with a group of African American young men. All of them had experienced some form of trauma ranging from sexual abuse, violence, homelessness, abandonment or all of the above. During one of our sessions, I explained the impact of stress and trauma on brain development and how trauma can influence emotional health. As I was explaining, one of the young men in the group named Marcus abruptly stopped me and said, “I am more than what happened to me, I’m not just my trauma”. I was puzzled at first, but it didn’t take me long to really contemplate what he was saying.