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HOUSE CALL WITH DR. SANJAY GUPTA
Troubling Rise In Abuse Of Prescription Drugs; Dr. Robert Millman Interview; Food Addiction; Getting Active In Iowa
Aired April 1, 2006 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DR. SANJAY GUPTA, CNN SENIOR MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta. Millions of Americans are struggling with addictions. In this half hour, we're going to talk about breaking free of that dependence, everything from drugs and alcohol, to food and gambling.
We start with Christy Feig, who reports on the troubling rise in the abuse of prescription drugs.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): After finally kicking a six year addiction to painkillers, Brenda, who asked that her last name not be used, is so afraid to use them again, she says she went through two surgeries without pain medicine.
BRENDA, PRESCRIPTION DRUG ABUSER: I'm so adamant that I don't want the stuff in my system, because I have a fear of what my reaction will be.
FEIG: But the stigma associated with addiction is why you don't see her face. She's a nurse and clean and sober for four years now. Still, her employer was concerned about what her patients might think.
It started with a prescription for pain pills to treat migraines, but there were pressures at home and stress at work.
BRENDA: It was helping me cope with my day-to-day life.
FEIG: Within a year, she was writing her own prescriptions on pads she had taken from surgeons she worked for. She was up to 15 to 20 pills every day. She didn't seek help because she says she was ashamed.
BRENDA: I'm a middle class medical professional. I am not supposed to be a drug addict.
FEIG: Painkillers and sedatives are among the most commonly abused drugs. And experts say there are several signs that someone may be hooked.
CHARLES CURIE, SAMHSA: Are they isolating themselves more? Do they have a new circle of acquaintances? Are they not as connected with family and friends as they've been?
FEIG: But Curie says treatment works and recovery is real. CURIE: Many people do not understand that if you receive treatment for addiction, you're committed, you can have a life of hope.
FEIG: Brenda spent five weeks in methadone detox and now attends four 12-step meetings a week. She says it has definitely saved her life.
I'm Christy Feig reporting from Washington.
GUPTA: All right, Christy, thanks.
In the non-medical use of prescription is second only to marijuana used by those 12 and older in the United States. And if you look just at 12 to 13-year-olds in their lifetime, nine percent have used inhalants. And more than five percent have used pain relievers for non-medical reasons with Vicodin and Oxycontin being some of the most popular.
Now joining us to talk about overcoming addictions, Dr. Robert Millman. He's director of alcohol and substance abuse services at the Psychiatric Clinic of New York Presbyterian Hospital Weil Cornell Medical Center.
Doctor, first of all, thank you very much for joining us.
DR. ROBERT MILLMAN, ADDICTION SPECIALIST: Thank you for inviting me.
GUPTA: Sure. Now are you seeing any changes in who is abusing various substances out there?
MILLMAN: Well, we're seeing a remarkable rise in the abuse of the prescription drugs, as the woman said. Most of the other drugs are stable and pretty high numbers often. But there's a remarkable rise in the use of prescription drugs, particularly in kids, the ages 16 to 20. Vicodin, Oxycontin, Xanax, so it's painkillers and sedatives.
GUPTA: Are they getting them from parents? Or where are they getting them from?
MILLMAN: I think that they were getting them from their parents. And I don't think they realized the dangers involved.
But now there's a new way they're getting them. They're often getting them on the Internet. It turns out there are thousands of sites, Web sites that badger you to order. Most people think you can't get it that way, or it's not real. But the truth is, there are many sites that actually provide the drugs if you order them.
GUPTA: That's remarkable. And kids getting those hands - getting their hands on those drugs. Lots of questions coming in. Let's start with now Will in Texas, who writes this question. "For several years, I had a pain pill addiction. I've been clean for a year and a half now thanks to Subutex. Will I have a craving for my drug of choice for the rest of my life?"
You know, doctor, once addicted, always addicted?
MILLMAN: Addiction is not just the drug. It has to do with psychological, and biological, and genetic components. And some people will have life-long cravings, though they've licked the taking of the drugs. But their cravings remain life-long.
In many other people, who were able to put it aside, the cravings become much less prominent. But often, we say people are in a recovering stage rather than they're cured. So it is something you have to watch.
The other I thing is that Subutex, which is Buprenorphine, is a remarkably good drug that's offering a lot of promise to people who are dependent on pain killers.
GUPTA: Well, good luck to Will for sure on that.
Another e-mail now from Shrey in Minnesota. "I've heard a lot of differing opinions. Is marijuana addictive or is it more due to the person's state of mind that creates the dependency?" What do you say about that, doctor?
MILLMAN: Same thing I said before. Addiction is not just the drug. It's the psychology and the social circumstances of taking it.
MILLMAN: Many people are addicted to...
GUPTA: There are certain drugs that have an addictive quality, though, let's be clear on that though, right.
MILLMAN: Yes. There are people who are addicted to the use of marijuana, meaning they have to smoke it every day, and they're totally involved with getting it, and thinking about it, and talking about it. And it gets in the way of their lives in a significant sense. So I'd say that's addiction.
GUPTA: But when people talk about addiction, doctor, to be clear, we're talking about physical symptoms that you might have if you don't take the drug as well.
MILLMAN: Physical and psychological. They're inextricably intertwined. So for example, marijuana has some withdrawal symptoms and signs, but less, for example, than heroin or alcohol. But -- and heroin and alcohol are much more addictive, but marijuana can be extremely dependency producing.
GUPTA: OK, let's see if we can squeeze in one more question now. It's a good one. Bud in Michigan asks this. "Is there any scientific evidence that addiction or the ability to get addicted is genetic?"
MILLMAN: There's a great deal of evidence that there are genetic influences. Sometimes they're oversold, but brothers and sisters have an increased rate. Twins have a much increased rate. Brothers and sisters -- twins separated at birth turn out to have an increased rate of concordance with respect to addiction. There's certainly genetic influences.
Some people are able to tolerate the drugs, for example, alcohol better than others. If you can tolerate the drug, you're more liable to get addicted.
GUPTA: Interesting stuff. We're having a good discussion with Dr. Robert Millman. More of your addiction questions answered, coming up.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: I would have a good 10 a day. And sometimes more.
UNIDENTIFIED FEMALE: Alcoholism, how to help yourself and others. And later...
UNIDENTIFIED FEMALE: How many times have I been with a friend who said, oh, just one piece of pie won't hurt. But they don't realize is it's my cocaine. It's my drug.
UNIDENTIFIED FEMALE: Overcoming food addiction. Stay tuned.
(END VIDEO CLIP)
GUPTA: More than 50 percent of the population drinks. That, of course, doesn't mean everyone has a problem, but millions do, from binge and heavy drinking, to alcoholism or alcohol dependence.
Here's some signs to look for if you think someone you know might be in trouble. If they drink alone or in secret, they have trouble remembering or experiencing blackouts. Also, becoming annoyed if they can't have a drink or seem to have a built up tolerance to alcohol, so they need much more to get that euphoric feeling. Other signs might be losing interest in hobbies or storing alcohol in unusual places, like the car.
Answering our questions about addiction this morning is addiction specialist Dr. Robert Millman.
Doctor, we're having a good discussion. Let's jump back into some of our questions with an e-mail from Kathy in Texas. She writes this. "My younger sister is an alcoholic and I'm trying to get her to understand that she cannot overcome this disease without help. Is there some medication that will help her?"
First of all, doctor, some terms. Alcoholism, is it a disease? Is that what you would call it? And what advice would you give to Kathy about trying to get some help for her sister?
MILLMAN: Alcoholism is a disease. And it's marked by physical and psychological dependence. And it's a difficult one to lick because alcohol is everywhere. And it's OK in this society to drink at cocktail parties, or with your boss.
It is difficult to do it alone. And you often do need help. The first line of defense is probably not medication, but it's groups like AA or are support from family so that you can -- you can get off and stay off.
But then there are medicines, for example, Disulfiram, Antabuse, which if you take, you can't drink. You'll get sick. And there's newer medicines like Acamprosate and Naltrexone that either decrease the craving or the power of the drink. So the future actually is looking much better.
GUPTA: Let's keep on topic here. What you were just talking about, a question now from someone who's in recovery. Jill in Los Angeles writes this. "I just recently stopped drinking alcohol, and am having a difficult time with cravings. Is there anything that would help?"
And first of all, let me just say, Jill, congratulations on stopping on what can become a deadly habit.
Doctor, you were talking about cravings. Are there ways to block the high that you get? Anything to help with the cravings afterwards?
MILLMAN: Well, I mentioned the drugs. Acamprosate and Naltrexone have proven somewhat useful. But also, interestingly, Antabuse cuts down the craving, because if you're taking a drug that you know you can't drink on, your craving goes away. It's a little bit like traveling to a country where there isn't any alcohol. Craving goes away.
Groups also help a lot, where your craving might go up sitting in an AA meeting or in a group therapy moment, but it passes. And then you leave and you're much better.
GUPTA: I understand that Antabuse, you get quite ill if you drink alcohol while you're taking that.
MILLMAN: You tend not to drink on the Antabuse. And that tends -- if you take it in the morning, that means you're mostly not going to be craving it, because you know you can't drink.
GUPTA: Sure. OK, let's keep going. Another question now. This one from Marge in Georgia. "Can one be cured of one addiction only to develop another? How can someone with an addictive personality truly be cured of addictions?"
MILLMAN: I don't really believe that there is an addictive personality. I believe there's a lot of psychological determinants of addiction. So depression, anxiety, or possibly a genetic predisposition. But there's not one addictive personality.
The truth is, though, that some people do lick one addiction and then start playing with another dependency producing drug, and get dependent on that.
So when someone has been addicted, they have to be very, very careful.
Many of us know about addiction because we smoked cigarettes. And we were able to keep it to that and then stop smoking, but often addictions can transfer.
GUPTA: All right. We're having a great discussion. Dr. Robert Millman is our guest, an addiction specialist. Stay with us. We're talking about compulsive eating and gambling. Both those things after the break.
(BEGIN VIDEO CLIP)
UNIDENTIFIED FEMALE: You have to eat to survive. So what do you do if you're addicted to food? Find out after the break.
Plus, could this pill be all it takes to stop a gambling habit? Our expert weighs in.
First, this week's medical headlines in "The Pulse".
(END VIDEO CLIP)
JUDY FORTIN, CNN CORRESPONDENT (voice-over): Returning to daylight saving time won't help the millions of American teens who already don't get enough shut eye. Only 20 percent of adolescents get the recommended nine hours on school nights, according to the National Sleep Foundation.
Lack of sleep can affect the ability to focus and respond quickly. It also increases risk of obesity, diabetes, and heart disease.
It's considered major abdominal surgery with a risk of serious side effects like blood clots or infection. But a record number of women are giving birth by Cesarean Section. Three out of ten U.S. moms get C-sections, some out of convenience, others out of necessity. Experts say women should know the risks before going into the operating room.
Judy Fortin, CNN.
GUPTA: Welcome back to HOUSE CALL. We're talking about breaking free of addiction. Now government figures show nearly two-thirds of adults are overweight in this country. And some experts say many of them are actually fighting an addiction.
Again, Christy Feig.
CHRISTY FEIG, CNN CORRESPONDENT (voice-over): When Cindy Hines eats, it's not always because she's hungry.
CINDY HINES, FOOD ADDICT: I will wander my house. And I call it foraging. I'll go open up my refrigerator, hoping the food fairies come and added whatever that right food is that will make me feel whole.
FEIG: And experts say that's how addiction differs from just eating too much. Food addiction is an effort to feel an emotional need.
ANNE KATHERINE, AUTHOR: It's not due to a lack of social ability on their part. It's due to an actual brain chemical that causes them in a part of the brain that causes them to value food over contact with people.
FEIG: That can include hiding food, eating large portions, or going to events for the food and not the people, says Anne Katherine, an expert on the brain chemistry of food addiction.
KATHERINE: When they take sugar or carbs, they have an elevated serotonin response inside their bodies. And that gives them a feeling of relief and comforting.
FEIG: To stay in control, patients must avoid trigger foods. For Cindy, that means steering clear of any refined sugar.
HINES: How many times have I been with a friend who said, oh, just one piece of pie won't hurt. What they don't realize is it's my cocaine. It's my drug.
FEIG: That's why group support is so essential. Katherine says it's about reprogramming the brain to find comfort in people, not food. And that takes friends, who will help you succeed.
I'm Christy Feig reporting from Washington.
GUPTA: All right, thanks, Christy. Some experts have even called junk food a gateway drug, leading to more addictive behaviors. That's interesting.
Talking with us about all forms of addiction is Dr. Robert Millman. He's director of alcohol and substance abuse services at the Psychiatric Clinic of New York Presbyterian Hospital Weil Cornell Medical Center.
Doctor, this interesting stuff. Let's jump right back into an inbox. The question from Sophia in Washington. "What are the most effective treatments for compulsive eating and food addiction," doctor?
MILLMAN: I do think that the term addiction gets overused. And food is a particularly difficult one, because as we know, you can stay away from heroin, and you can stay away from alcohol, or cocaine, but you can't stay away from food.
You can admit that you're powerless over heroin, but you can't be powerless over food because we all have to eat.
But there are good treatments. And I think as was mentioned, group process helps a lot, having support, being able to rely on other people is very useful.
Also, therapy helps a lot, because there are psychological factors in overeating, not just biologic. So that cognitive behavioral therapy, the kind of treatment that's practical that gives you homework, that teaches you how to change your behavior can be very useful as well.
Sometimes medication to treat the underlying psychological disorder, or the coexisting psychological disorder can be helpful. But you can also be addicted to not eating. So you can eat too much, but anorexia in some ways is that same kind of profound dependence.
GUPTA: You know, doctor, another addiction that some people consider a behavioral problem is gambling. We talked a little bit about that, but a study has come out showing the drug Nalmefene, currently used for alcoholism, may block that high. Compulsive gamblers experience a sort of high. And they block that. Some are calling it a magic pill. Is it?
MILLMAN: There are no magic pills. Everyone's always looking for that silver bullet that cures behavioral, psychological and biological problems.
There are drugs that get close, like Buprenorphine or Methadone in heroin dependents, but it doesn't take care of everything.
So that's a narcotic antagonist like Naltrexone. And the idea is to block the high from gambling. I think it might be useful in some people, but far from persuaded that it's going to be a magic bullet.
But gambling, compulsive gambling is profoundly disabling. And certainly, it should be seen as a potential addiction.
GUPTA: We are talking with addiction specialist Dr. Robert Millman. More on battling addiction, ahead. Plus, we're going to check in with our fit nation tour.
(BEGIN VIDEO CLIP)
UNIDENTIFIED MALE: Yes. My dad and I are pretty competitive, whether it's skiing...
(END VIDEO CLIP)
UNIDENTIFIED FEMALE: Meet the Robbins, a father son team who compete to lose. We'll explain after break.
GUPTA: We're back with HOUSE CALL. I'm traveling around the country with the CNN team, educating and motivating people to take action against obesity. Well, this week, we stopped in Iowa, where they've already taking getting active to a whole new level.
GUPTA (voice-over): This is Iowa's homegrown version of those other games, the annual Iowa Games.
UNIDENTIFIED MALE: We have 50 sports, everything from I say A to W, archery to wrestling. But we have equestrian, we have soccer, we have basketball, baseball, track and field.
GUPTA: But there's one thing different about these games. They're not about winning.
UNIDENTIFIED MALE: Nice job, nice job.
GUPTA: The Iowa Games are about losing.
UNIDENTIFIED FEMALE: I've lost 156 pounds.
GUPTA: The Games began 20 years ago as a venue for fun and competition, but a growing obesity epidemic caused a sea change. The game's sponsor shifted the emphasis to getting active.
JIM HALLIHAN, DIRECTOR, IOWA GAMES: We've got to provide an environment where people have fun doing it. And they don't realize it, but they're moving around a lot and being very active.
GUPTA: During the past four decades, obesity levels in Iowa have been steadily rising. According to the Iowa Health Department, 61 percent of adults in Iowa are either overweight or obese. Only 12 states have a higher percentage of overweight adults.
Concern about obesity in this state spawned another program in 2003, sponsored by the same group that puts on the games. Lighten up, Iowa. It stresses teamwork. People sign up for a five-month health program, where they and their teammates get ideas about how to be more active and eat healthier. The idea has caught on.
HALLIHAN: Two years ago, we had 8500 people. Last year, we had 19,300 who lost 93,000 pounds and logged 4.6 million miles of activity.
GUPTA: Back at the Games, a father and son team have been carving up the slope at Iowa's Winter Games for the past several years.
TROY ROBBINS, IOWA GAMES COMPETITOR: Yes. My dad and I are pretty competitive, whether it's skiing or losing weight. And so, we both kind of jumped on the boat and started losing weight together. And each week, we out do each other.
GUPTA: The competition has paid off.
GARY ROBBINS, IOWA GAMES COMPETITOR: We lost a couple hundred pounds total. And it's just something - it's a time for Troy and I to bond together. And we just have a great time doing it.
GUPTA: At this year's Games, more than 20,000 participated. And that translates to potentially thousands of pounds of weight loss.
GUPTA: All right, Iowa, keep up the good work. And stay with us, as well. More HOUSE CALL after the break.
GUPTA: For more information about overcoming addiction, go to samhsa.gov. That's the Substance Abuse and Mental Health Administration, where you can find self tests and guides to finding treatment. And also call them at 1-800-662-HELP.
Dr. Robert Millman's been our guest today. Good discussion, doctor. Do you have a final thought for our viewers?
MILLMAN: Perhaps that addictive behaviors are a major public health problem in this country and represent the number one cause of premature, preventable death. It's serious.
GUPTA: It does sound serious. I'm glad we talked about it. Unfortunately, we are out of time for today. Dr. Millman, thank you so much for spending some time with us.
MILLMAN: Thank you.
GUPTA: And tune in next weekend, everybody, when we're going to be talking about complimentary medicine from acupuncture, to chiropractic care. Could it help you? E-mail your questions to HOUSECALL@CNN.com. And tune in for some expert advice.
Thanks for watching. I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.
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