Category ask the doctor

The “B” in LGBT: Bisexual People and Behavioral Health

By: Amy Andre, MBA, MA, member of SAMHSA’s Sexual and Gender Minority Interest Group

From September 21-27, we celebrate Bisexuality Awareness Week.  In honor of this upcoming event, I’d like to talk about the “B” in the LGBT (lesbian, gay, bisexual, transgender) community.  Did you know that, of all those who identify as gay, lesbian, or bisexual, half identify as bisexual? That means the “B” the largest segment of the LGBT community.

Bisexual people are people who are attracted to more than one gender (although not necessarily at the same time, to the same extent, or in the same way). Like gay and lesbian people, many bisexual people experience discrimination on the basis of sexual orientation, and this discrimination can have an impact on health.  According to data from the National Health Information Survey and others, bisexual people face discrimination and higher rates of mental and/or substance use disorders compared to people who are not bisexual.

For years, researchers at medical schools and public health institutions have shown that, compared to their heterosexual peers, gay and lesbian people have higher levels of depression and suicidality, as well as smoking, alcohol and substance misuse, and that these are, in part, linked to homophobia and its effect on behavioral health.  More recent research shows that the same is true for bisexual people, and to an even larger extent.  In addition, the literature shows that bisexual people, compared to their gay and lesbian peers, are less likely to be out of the closet, which might have implications for behavioral health.  One goal of Bisexuality Awareness Week is to call attention to the health disparities faced by this community, and another goal is to highlight the importance of targeted, culturally competent programs to reduce those disparities.

The Administration has taken important steps towards meeting the unique needs of the bisexual community.  Last year the White House’s Office of Public Engagement convened a panel of bisexual community leaders and bisexual health experts to participate in a roundtable discussion on the topic.  And this year, SAMHSA will be hosting a “brown bag” training event for staff to learn about behavioral health in the bisexual community.  SAMHSA has also recommended that sexual orientation (including bisexuality) survey items be added to the National Survey on Drug Use and Health, beginning in 2015.

People who identify as bisexual face challenges, but getting the behavioral health care they need doesn’t have to be one of them.  By educating  health care providers about including culturally competent support services to the bisexual community, SAMHSA is working to fulfill its mission is to reduce the impact of substance abuse and mental illness on America’s communities.

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Scottish readers: Undecided about the referendum? Please read Scottish Independence, Power And Propaganda.

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#ShareWellness During National Wellness Week 2014

By: Pamela S. Hyde, J.D., SAMHSA Administrator

Living wellness means balancing the physical, emotional, social, intellectual, spiritual, financial, occupational, and environmental dimensions of your life. Practicing wellness is essential to behavioral health. People with mental and/or substance use disorders die earlier than the general population, making wellness especially important for those with a behavioral health condition.

But how do we incorporate wellness into our everyday lives? Getting involved in National Wellness Week 2014 is a great place to start! This week long celebration aims to help Americans recognize the value of living wellness and inspires us to improve our healthy behaviors. Join me and others across the country in using social media to share wellness tips and ideas. Include the hashtag #ShareWellness when you post a message, photo, or video of yourself showing your favorite wellness activity. You can also gather ideas for new wellness activities by following the #ShareWellness conversation throughout the week.

SAMHSA Administrator Hyde #ShareWellness, Always be grateful.

In addition to participating in the #ShareWellness conversation on social media, you can use the interactive wellness map to see what’s happening in your community. If you’re interested in hosting a National Wellness Week activity, the Wellness Community Activation Kit has information and resources that can help you get started in organizing and planning your event.

I know practicing wellness is important to my overall health and well-being. I like to take a moment each day to practice being grateful which is shown to improve well-being. I look forward to seeing how you #ShareWellness this week!


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Join the Recovery Month Movement

By: Michael Duffy, RN, BSN, SAMHSA Region VI Regional Administrator

Throughout the month of September, communities across the country have come together to observe the 25th annual National Recovery Month (Recovery Month). Community events are the cornerstone of Recovery Month and provide a setting celebrate the successes of people who are in recovery. As individuals and communities across the country unite to speak up about behavioral health conditions and the reality of recovery, I invite you to join the movement and participate in Recovery and Health: Echoing Through the CommunityExternal Web Site Policy, a nationwide webcast.

On Monday, September 15, 2014 at 12:00 p.m. EST, a panel of national experts and experienced practitioners in recovery and health will kick-off an interactive discussion about integrating recovery into state and community systems. During this discussion, participants can send live questions to the panelists via email or on Twitter (@samhsagovExternal Web Site Policy). At the end of the panel discussion, echo site participants are invited to lead their own discussion using the information from the webcast to brainstorm and create an action plan to integrate recovery into their community.

Get involved and join the voices for recovery!

Register your Echo Site now! Register as an individual now!

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Short video increases HIV testing in emergency department patients who initially declined

Science Spotlight

A NIDA-funded study shows that one-third of emergency department patients who initially declined to be tested for HIV changed their minds after watching a 16-minute video. This video described the importance of testing as well as demonstrated how an HIV test can be conducted without drawing blood (i.e., orally) and provide results in approximately 20 minutes.

Because emergency departments often serve populations that have little or no other access to care, HIV testing at these sites can be critical in promoting earlier diagnosis to guide patients to treatment and to reduce continued transmission.

For a copy of the study abstract, published online July 27, go to:

For more information, contact the NIDA press office at or 301-443-6245.

NIDA Press Office

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world's research on the health aspects of drug abuse and addiction. The Institute carries out a large variety of programs to inform policy and improve practice. Fact sheets on the health effects of drugs of abuse and information on NIDA research and other activities can be found on the NIDA home page at To order publications in English or Spanish, call NIDA's new DrugPubs research dissemination center at 1-877-NIDA-NIH or 240-645-0228 (TDD) or fax or email requests to 240-645-0227 or Online ordering is available at NIDA's media guide can be found at, and its new easy-to-read website can be found at

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

NIH. . .Turning Discovery Into Health®

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National Drug Facts Week 2015 to begin January 26

NDFW logo

National Drug Facts Week, which brings together teens and scientific experts to shatter persistent myths about drug use and addiction, will be held Jan. 26 through Feb. 1, 2015.  Ideas for community-based events, as well as success stories from previous years, are highlighted on the National Drug Facts Week Web portal. Last year, more than 1,000 events were held with teens throughout all states, and several internationally. The fifth National Drug Facts Week is sponsored by the National Institute on Drug Abuse, which is part of the National Institutes of Health.

“National Drug Facts Week has been growing every year, from 92 events at its inception almost five years ago,” said NIDA Director Dr. Nora D. Volkow. “This tells us how much teens - who are bombarded daily with misinformation about drugs - want science-based facts about drug use.”

National Drug Facts Week was launched in 2010 to counteract the myths that teens often hear from the Internet, TV, movies, music, or friends. One popular myth is that marijuana is harmless, although science tells us that marijuana use by teens may negatively affect brain development and impair school and athletic performance. Teen use of marijuana is up compared to five years ago, perhaps because fewer teens consider marijuana to be a harmful drug.

To help shatter the myths surrounding marijuana and other addictive substances, National Drug Facts Week encourages events that allow teens to ask questions of addiction scientists or health experts about drug use and addiction. Events can be sponsored by a variety of organizations, including schools, community groups, sports clubs, and hospitals. Topics for discussion can include not only what science tells us about marijuana, but also about prescription drug abuse, and the use of tobacco and alcohol.

NIDA provides an online toolkit that advises teens and their adult advisors how to create an event, publicize it, find an expert, and obtain scientific information on drugs. This year, NIDA has merged its National Drug Facts Week website with its popular NIDA for Teens site, This will enable easier browsing between event planning tools and NIDA’s drug information fact sheets, which are designed with teen-friendly language and graphics. Event holders who register online will receive free booklets with science-based facts about drugs, including one of NIDA’s most in-demand teen publications,  Drugs: Shatter the Myths. Also this year, NIDA offers three interactive tools that can be projected on large screens at events or used with mobile devices:

National Drug Facts Week is again supported by many federal agencies, including the White House Office of National Drug Control Policy (ONDCP); the National Institute on Alcohol Abuse and Alcoholism at NIH; the Office of Safe and Healthy Students in the U.S. Department of Education; the Substance Abuse and Mental Health Services Administration in the Department of Health and Human Services; the Drug Enforcement Administration (DEA) in the U.S. Department of Justice; and the U.S. Department of Housing and Urban Development.  (HUD).  Each agency will post National Drug Facts Week information on its website and encourage the development of special events linking experts to teens.

“President Obama’s vision is for all of America’s children to grow up in healthy and safe communities,” said ONDCP Acting Director Michael Botticelli. “This administration’s drug policy is based on neuroscience, and we are committed to informing young people and health care professionals about the negative consequences drug and alcohol use can have on their futures.”

The Office of Safe and Healthy Students will help promote National Drug Facts Week and encourage schools to participate. “National Drug Facts Week allows NIDA staff to connect directly with youth and to share facts on drug use in a direct, evidence-based, and non-judgmental fashion,” said David Esquith, director of the Office of Safe and Healthy Students. “Once again, our office is pleased to help promote this week’s activities and to encourage schools to participate.”

DEA will again share in efforts to encourage community-based events. “National Drug Facts Week provides a unique opportunity to discuss drug abuse, relevant science, and the dangers of addiction.  DEA is proud to encourage community-based events that engage teens in a dialogue about drugs,” said DEA Administrator Michele M. Leonhart. “Having an honest and open discussion about the dangers of drug abuse is a significant first step in drug prevention.  We are pleased to support NIDA’s efforts to help youth make informed choices.”

HUD, which reaches approximately 1.5 million families globally, is participating by encouraging executive and field office public housing directors to hold National Drug Facts Week events and by promoting the week-long observance through Facebook.

Also during National Drug Facts Week, NIDA scientists will hold their annual Web chat with teens around the country. Drug Facts Chat Day will be held Jan. 30 from 8 a.m. to 6 p.m. Eastern time. Further details on the popular annual chat, including registration information and transcripts from previous years, can be found at

Organizations with questions about National Drug Facts Week can e-mail NIDA at Event organizers can register events starting today at

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NIDA Director Dr. Nora Volkow to speak at TEDMED 2014

Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, will be a featured speaker at the TEDMED 2014 conference being held this month in Washington, DC. A world-renowned neuroscientist and leading expert on addiction as a brain disease, Dr. Volkow will address the obesity epidemic and the parallels between compulsive overeating and drug addiction.

Dr. Volkow is one of 80 speakers selected to speak at TEDMED, the annual multi-disciplinary gathering where leaders from all sectors of society come together to explore the promise of technology and potential of human achievement in health and medicine.

WHAT: TEDMED 2014 Annual Conference
“Unlocking Imagination in Service of Health and Medicine”

WHEN: September 11, 2014 8:30 a.m. - 10:10 a.m. ET (Dr. Volkow presentation)
(The entire event runs from Wednesday, September 10 – Friday, September 12)
Dr. Volkow will appear in Session 4: “Stealing Smart,” where speakers will share inspiring stories and ideas about how to adapt solutions from other industries and fields to solve the most intractable problems in health and medicine. More information on Dr. Volkow’s appearance can be found at

WHERE: John F. Kennedy Center for the Performing Arts
Washington, D.C. 
For information about TEDMED Live, which broadcasts the entire program from the TEDMED stage, visit

WHO: Nora D. Volkow, M.D
Director, National Institute on Drug Abuse
Volkow Bio

If you are interested in a pre-interview with Dr. Volkow about her participation in TEDMED and/or her research, please contact the NIDA press office at or 301-443-6245.

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Recently we were asked to explain more about ceilings and help understanding this statement:

“Buprenorphine acts similar to opioid agonists in lower doses, with the same addictive potential as oxycodone or heroin. In higher doses—doses above 8 mg or 8000 micrograms per day—the ‘ceiling effect’ eliminates interest and cravings for the drug.”

QUESTION“I’m not sure I followed this. Can you explain more? What would you think about someone who is taking 1-2mg of Suboxone twice a day without a prescription, and says they want to stay on that dose once they find a prescriber? Are they better off on 8mg or more per day, or would it be ok for a prescriber to keep them at the lower dose? Is the answer the same if they hope to taper off the medication completely within a year (they don’t feel able to do this on their own right now, but hope to be able to when some life circumstances change). Thanks!”

This gets a bit complicated at best. A couple background issues; buprenorphine has a ‘ceiling’ to its effect, meaning that beyond a certain dose, increases in dose do not cause greater opioid effect. That is the mechanism for how buprenorphine blocks cravings.  

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Drug Relapse A Simple Explanation

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Weathering Crises in Recovery

Many addicts in recovery will experience situations that trigger them, especially those who have past trauma. When they experience fear during an accident or a crisis situation, such as the hurricane and flooding on the East Coast, it triggers the same response mechanism that was activated in the previous trauma. This may also trigger a subsequent desire to relapse into old addictive behaviors. Becoming aware of triggers is an important way of guarding against this possibility.

As recovery deepens and surface memories are replaced by those that have been buried more deeply in the subconscious, addicts will be faced with emotions that may surprise them and catch them off guard. It is key to the working relationship with their sponsor, counselor or therapist at this stage of their recovery to reassure them that this does not mean that they need to relapse. They are being given an opportunity to work through these emotions in ways that they did not previously do. Given the support and understanding that is helpful for their sense of safety, addicts can begin to express feelings they may not have been aware of in their earlier recovery. The process is long-term and they will continue to uncover emotional “baggage” that has been stored away for many years in some cases.

Crises situations will often bring these emotions home to roost. It is part of recovery that is sometimes frightening and surprising for those who believe they have fully recovered from their addiction and processed all of the necessary emotional attachments. Although they may have touched on some of their feelings about situations and people in their past, they may need to work a bit deeper at this juncture.

Weathering a current crisis situation is difficult when the addict does not expect to feel the depth of emotions that show up. They need to know that they will sometimes feel things that are not necessarily related to the situation they may find themselves in. Old wounds will appear because they may be responding to a feeling that is similar to one from another time in their life. If they are prepared to have strong emotional responses to situations that feel like another situation from their past, they can be prepared to walk through the feelings and process them without relapsing into an old behavior or even their addiction.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

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Hobbies in Recovery

Most people have hobbies. Some hobbies can become addictions. It is certain that addicts in early recovery can see how their previous behaviors became lost as their addiction became more and more the driving force of their lives. Or perhaps their hobbies became additional addictions that they could not stop being compulsive and obsessive about. Learning balance in recovery is a constant challenge, as it is for most people. Balancing work with play, balancing money for bills and fun, balancing home with social life, balancing everything can be a challenge and will remain one when life intervenes and things get out of balance again.

Sometimes an illness will unbalance a life that was going along well. Other times it will be the good things that come into life that can create an imbalance, such as a new relationship, a new job, a move (up or down), a marriage, a child, stepchildren, loss of a loved one or family member, addition of a loved one or family member, so many things can challenge our balancing act.

Many new to recovery are sure that their lives will become boring and dull without substance or process abuse, the reason for their recovery to begin with. In many ways, this could be true. However, most find that they are so busy with recovery that they don’t have time to miss the old behaviors, and that what they are doing in recovery is so much more rewarding that they can’t remember why they participated in their addiction to begin with. This is all to the good.

As with any life, however, it is important for the balance to swing back to fun. Not everyone will agree on what fun is. For some it will be the social gatherings of their recovery groups. For others, it will be learning to write, to paint, to play a musical instrument, to collect butterflies, to dance, to act on stage or screen, the possibilities are endless. Hobbies and interests round us out as human beings, opening doors to new careers and creating opportunities for new relationships with others whose interests are similar to our own. Finding these interests can be a challenge that is enjoyable to overcome. There are psychological tests available to indicate interests for career development and education, surveys to guide people toward the appropriate avenues for exploration, and unlimited numbers of books on every subject possible. Computers and technology now make all of this information readily available to everyone.

Many addicts will experiment with different ideas for hobbies before they settle on the ones they will begin to enjoy. Their interests will wax and wane over time and new hobbies will replace the first ones. As they grow and change and life goes on, they will find things that sing to their hearts for a time and then morph into new interests and hobbies, or they will meet others who introduce them to new places and things to do. The world is a vast and rich environment, full of unimaginable opportunities for growth and enjoyment. Recovery can open the doors to all of this for those who are looking for their hearts’ desires.

Kelly McClanahan has an MSW in clinical social work, with a specialization in substance abuse treatment. Having worked in this field for over 20 years, she is currently working on her certification as an addictions’ counselor.

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