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    Whilst the meanings of hashtags can be immediately obviously, such as #EndPJParalysis, some meanings are possibly less obvious.

    Yesterday, my timeline was littered by pictures of socks celebrating the #socksfordocs campaign. My immediate reaction on Twitter was this.

    But thankfully somebody sent me a private message to explain the background to the campaign.

    The background to this particular campaign is pretty amazing, and my reaction was to post a tweet with this picture this morning on my Twitter @dr_shibley.

    The history is important for me. I have found campaigns about mental health pithy and largely from professionals who’ve had no personal experience of the sheer mental torture of mental health problems (important caveat: to my knowledge). A hashtag campaign is a nice way to ‘paper over the cracks’, especially in being seen to campaign about something, such as the mental health of doctors.

    “Promoting the wellbeing of the workforce” has become a nice catchy slogan for some of the managerial class, but the reality was far from that.

    Whilst being a junior physician in distinguished London teaching hospitals more than fifteen years ago, I was developing an alcohol dependence syndrome, in which I had no insight.

    I remember one physician at a well known centre for postgraduate medical training in London, itself known for a suboptimal working culture. He told me over breakfast how I really should really book myself into the Priory, but did not offer any more details than that. He then went onto write a damning witness statement for the GMC, and later stood to be elected in the BMA Council elections.

    I remember the witness statement of another physician, personally known to the physician above as they had somehow trained together, being read out in one of my GMC hearing days. It referred to me looking ‘dishevelled’ and ‘smelling of alcohol’. This witness statement arrived at the door of the GMC two years after I left. I was offered no professional help in that NHS Trust either. Two consultants were asked to produce witness statements for the GMC from that Trust; one of them recently indeed stood to be President of the Royal College of Physicians (but thankfully lost).

    Amazingly, I was allowed to complete my 2 six-month jobs with them whey KNEW I had an active problem. Patient safety?

    The General Medical Council never asked me for my experience of being alcoholic as a junior doctor. I have done much reflection on this following the events, particularly since I have never worked in medicine ever since. But for the NHS Practitioner Health Programme, there had have been literally nobody apart from my own treating Psychiatrist on my side.

    The General Medical Council all the time claims that it never engages in guerrilla warfare to get people off their register. As it happens, coincidentally, a flurry of reports designed to induce a moral panic, but which never included reference to my mental illness, appeared, so I had to face a double stigma – a double stigma indirectly which I experienced while waiting for my 2006 GMC hearing for two years, and the stigma of my alcoholism. The cover up, including the journal of my trade union, was complete in its lack of proper discussion of the severity of my alcoholism, as that would have ruined their story. Nonetheless they continue to dribble out the odd item on careers and mental health.

    I think simple things might have helped at the time, for example if I had followed the GMC code of conduct in being disclosing to a GP about my problems. But at the time it was totally unsafe to disclose to your GP about mental illness anyway, because of the torrent of investigations which would then be launched by the GMC. While you are under investigation by the GMC, you then of course have to notify any employer.

    The intense hostility I experienced from the institutions within the medical “profession” is one which I will never forgive the profession for, and I don’t think I should ever want to work for them ever again. There’s a sense to me some of the members of it want it to be some form of Aryan race, only to represent the purest of the pure. But this is as ‘science fiction’ as the notion that registered doctors never make any mistakes.

    So, what’s this got to do with #SocksforDocs?

    It turns out the suicides of three young Doctors in New South Wales in Australia led to calls for a review of ‘mandatory reporting laws’ which can stop doctors from seeking help.  It is reported that Professor Brad Frankum, president of the Australian Medical Association (NSW), has said that he has been aware of three young doctors in training who had taken their lives, as well as two senior doctors and a young medical student.

    “They were going to save many lives and do great things, and that potential is lost,” he said.

    The timing of the two year wait for the GMC I experienced in 2004-6 is relevant. By the time of my hearing in 2006, I had already on one occasion tried to commit suicide by going on a massive binge.

    A GMC review of 28 doctors who died by suicide while under fitness-to-practise investigation between 2005 and 2013 was damning. Analysis presented elsewhere continues to look fairly at whether these suicides were preventable.

    How much morbidity and mortality has to be tolerated? A newly qualified GP voted ‘Trainee GP of the Year’ hanged himself after fearing he would be struck off by the GMC for failing an alcohol test, according to an inquest. According to a report, a young doctor, 34, had been warned by the GMC not to drink after he self-referred for ‘other issues he was having’, which resulted in restrictions on his practice, the court heard.

    32 is the year I had my hearing with the GMC. A year later, having been off the register, which I spent mostly sitting in a pub drowning my sorrows, I was admitted to the Royal Free as an emergency, having sustained a cardiac arrest and epileptic seizure. I spent 6 weeks in a coma, and became disabled.

    But thankfully I am still alive, and caring now for my mum full-time, as she has dementia. In fairness to me, I have published various medical books, as I have a keen interest in medical education.

    I think the way the medical profession, including regulation, deals with mental illness is actually corrupt to the core. The medical profession largely does not wish to admit that mental health problems exist within its workforce, as it sees mental illness as a question of blame and fault. The regulator does not believe in rehabilitation at all., but only in retribution It only is interested in the ‘red meat’ of a hostile environment to placate its Daily Mail readership. It does not believe in a learning culture, but does believe in the perks of being employed at its institution. The whole culture is totally sick; for example, the GMC has only just announced the launch of its review into why black and minority ethnic doctors are more likely to face complaints from employers than their white colleagues.

    As for me? I could never be happier. I am respected for who I am, and doing the job which matters to me – looking after my mum.  I owe the medical profession absolutely nothing, and I have successfully completed  my pre-solicitor training, my Bachelor of Law, my Master of Law (with commendation) and my Master of Business Administration.

    And much to the disgust of the complainants, I am now on the GMC medical register with a full license-to-practise currently.

    All of the complainants against me were white and middle class.

    It has been reported that

    Chief executive Charlie Massey has used a speech at the British Association of Physicians of Indian Origin (BAPIO) conference this weekend to announce the review, which will be led by two experts in leadership diversity.

    Speaking to Pulse, Mr Massey said the work would look at ‘elements of conscious and unconscious bias’ and ‘workplace cultures’.

    Euphemisms if ever I heard them.



    [NOTE: I dedicate this blogpost to @williamwyhuang.]



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    The disgraceful failure by the private sector to provide vulnerable addicts with the safest and best quality treatment available was exposed at the end of last month in a damning report issued by the Care Quality Commission (CQC).

    72% of private providers of residential-based detoxification were found to have been failing in at least one of the fundamental standards of care that everyone has a right to receive. Shamefully, providing ‘safe care and treatment’ was where the CQC found the most breaches: 63% of providers failed to meet this standard at the time of their first inspection.

    Detoxification under clinical supervision is often the first stage of a person’s addiction treatment. Often difficult and unpleasant, it is vital that they receive the best possible treatment to support their onward rehabilitation and recovery.

    And yet systemic faults were found in the way these services are provided by the private sector. Many were basic and entirely avoidable errors.

    No alcohol for me

    For example, some staff were caught giving paracetamol to people within their care more frequently than every four hours, despite the heightened risk of liver damage among heavy alcohol users. In other cases, staff failed to plan how they would manage fits during withdrawal, despite knowing that the people in their care were at risk of having seizures.

    Training in basic life support, consent, mental capacity and safeguarding were all found to be severely lacking. At times staff were found to be administering medication, including controlled drugs like methadone, without the appropriate training or being assessed as competent to do so.

    This is extremely serious. People undergoing residential-based medical detoxification from alcohol or drugs often have complex physical and mental health problems alongside their addictions. According to the Royal College of Psychiatrists, the potential dangers of erroneous detoxification include fits and hallucinations, suicide risk and risk of prescription opiate drug overdose.

    That’s why it is essential staff looking after these vulnerable patients are properly trained, follow national clinical guidelines and have appropriate 24-hour medical cover.

    So what explains this appalling failure?

    My own research in September revealed that the Tories have cut vital alcohol and drug treatment programmes by £43 million this year, forcing many people to turn to the independent sector for help. These cuts are part of wider damaging public health cuts, to the tune of £800 million by 2021.

    Specifically, 106 local authorities are reducing their drug treatment and prevention budgets this year, with a combined cut across England of £28.4 million. Similarly, 95 local authorities are reducing their alcohol treatment and prevention budgets this year by a total of £6.5 million. Equally concerning, services for children needing help with drink and drugs will be slashed by £8.3m across 70 town halls.

    Last month the Children’s Society revealed that parent’s alcohol abuse is damaging the lives of 700,000 teenagers across the UK. Frustratingly, at a time when demand for councils’ children’s services is rising, severe funding cuts from central Government are leaving more and more families to deal with these huge problems alone.

    Yet without support at an early stage as problems emerge, families can quickly reach crisis point and the risks for the children involved grow.

    The children of addicts must not be forgotten and supporting them is a personal priority of mine. Having grown up with an alcoholic father, I’m acutely aware that as a society we simply aren’t doing enough to deal with the effects of addiction.

    We know that children growing up with an alcoholic parent can often themselves go on to develop problems with alcohol or drugs or suffer mental health problems.

    That’s why during our party conference I reiterated my pledge to implement the first ever national strategy to support children of alcoholics and drug users.

    We also mustn’t ignore other forms of serious addiction. My colleague Tom Watson, Labour’s Deputy Leader, has powerfully exposed the Government’s abject failure to treat problem gamblers.

    According to the Gambling Commission the number of people with a serious habit has risen to 430,000, with a further 1.6 million at risk of developing a problem.

    And yet, shockingly, the government has no idea how many problems gamblers are being treated by the NHS or how much their addiction is costing. Like alcohol and drug addiction, we must start viewing gambling addiction as a mental health problem and not a moral failing.

    Theresa May’s mishandling of Brexit and her narrow majority in the Commons has left her with little ability or inclination to tackle these ‘burning injustices’ across society. Addiction treatment services have unquestionably suffered as a result.

    Forcing people to turn to inadequate private sector treatment is entirely unacceptable. That’s why Labour will continue the fight to ensure our health and care system, including addiction services, remains public, free at the point of use and there for all who need it.

    First published by Our NHS

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    As a child I and my whole family were badly affected by my father’s addicted habit of betting and my mother in particular had to manage at times on very little amount of money to feed, keep warm (heat) and cloth us on because of such I have a great hate for any form of betting and am supporting this that I forward to you for your consideration.

    However, betting can easily become a mental illness and whilst some may not see the true affects that this can have on families, it’s cost to the communities and the NHS has to be given greater consideration. So please do have a look at this.

    This morning the government made an announcement that could change lives. They’re talking about cracking down on betting machines that are so addictive they’ve been dubbed the “crack cocaine” of gambling.

    Packed into high streets up and down the country, these machines suck up life savings and turn people’s lives upside down. Now, the government’s at a crossroads. They could decide to drastically reduce the amount of money people can bet – or they could tinker around the edges.

    Right now the minister in charge of gambling, Tracey Crouch, wants to know what the public thinks. She’s weighing up her options, working out whether she’s got the backing to change the law so that no one can lose their life savings in a single afternoon.

    A huge petition signed by hundreds of thousands of us could be enough to show that the public’s behind her. Will you join me and sign the petition?

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    The latest sales figures show that Public Health England’s new harm reduction approach to decreasing smoking rates across the UK has not only been widely accepted, but capitalised upon this Stoptober. For the first time, vaping has featured prominently within the NHS Stoptober campaign, with the official website included in the Stoptober TV advertisement.

    Vape Club – the UK’s largest online retailer of vaping products and e-cigarettes – saw e-cigarette starter kit sales increase by 29% year on year following the launch of the 2017 campaign.
    man vaping
    Through the adoption of this harm reduction strategy, the UK has seen record high rates of smoking cessation and is fast becoming a European leader in this respect.

    This comes at a time when New York’s latest law will see vaping banned indoors in public places come into effect next month.

    Director of Vape Club Dan Marchant says that the medical acceptance in the UK has provided a watershed moment for public health:

    It’s fantastic to see the NHS finally backing vaping as a pathway to quit smoking. The industry has been backing this alternative for a long time, but with the evidence provided by Public Health England, endorsements from the likes of Cancer Research UK and the figures which are produced by Action on Smoking and Health (ASH), there can be no doubt that vaping is the most effective method to give up tobacco.

    The NHS advocating vaping as an alternative to tobacco is an enormous breakthrough and will do an outstanding amount of good for public health and tobacco control in the UK.’

    Believed to be 95% less harmful than traditional tobacco, e-cigarettes feature within the NHS’ Stoptober campaign as a way of phasing out tobacco rather than advocating – as seen in previous campaigns – the ‘cold turkey’ approach.  You can smoke Guru E-Cigs.

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    Addiction is grindingly hard on friends, family and those suffering from addiction themselves. Here are four things you can do to help those suffering from addiction to face their demons and get the help they so desperately need.



    To help those suffering from addiction, hear their call for help in the first place. Many times we would simply rather put up blinders, behaving as though this addiction isn’t even real, doesn’t exist, or isn’t our problem.

    If the person who could benefit from rehab is a close friend or family member, her or his addictive behavior is just as much your problem as hers or his. Get your friend or family member to open up to you; begin a dialogue that starts with you listening. No judgments; just get the addicted person to begin talking to you. Hear what she or he has to say.


    Have empathy for the addict’s plight. Even if the situation is completely of his or her own doing, judgments and blame have no place in the road to recovery. Open dialogue, empathy, and candor are the best ways to establish trust with your loved one seeking the shelter of rehab.

    Even if the addiction is “manageable” at point you intervene, the addict must begin the journey to recovery as soon as possible.  Perhaps the biggest key to success in rehab is early intervention.


    Be responsive. Helping someone get into rehab and being successful at it takes hard work. You need to be the point of contact for this person; if she or he is slipping, then chances are the addict does not have a very firm footing in place. But even with loved ones nearby, you may be the pivotal person to marshal them all together so that the addict who needs the help and support is sure to get it when it is needed.


    Get the addict checked into the right facility. Beachway Therapy Center is one of the best facilities in Florida. Even if you’re traveling a distance, make sure your friend or loved one is in the right place where he or she can get the right help.

    You can learn more about what their rehab center can offer here. By taking your rehab efforts into overdrive at the very end you may avoid the very real possibility of seeing the addict slide backwards. No one wants to wonder “what if” after it’s already too late.

    Do your homework. Partner with other friends who all have one goal in common; getting your friend, family member or loved one the help needed as rapidly as possible. Just because a challenge is difficult doesn’t mean it’s not worthwhile. If you need to speak with someone about getting help for a loved one, don’t delay! Time’s a fleeting mistress for us all.

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    Beyond Stressful: Why Anxiety and Addiction Are a Dangerous Combination

    Most people experience anxiety from time to time. Many individuals living in the UK, however, experience frequent, unceasing forms of anxiety. These symptoms make it more difficult for some individuals to live fulfilling, productive lives.

    According to a 2013 study published in the Journal of Psychopharmacology, more than 8 million cases of anxiety disorders were reported in the UK. Managing anxiety is possible with treatment, but this task becomes significantly more difficult when an anxiety patient is also struggling with drug or alcohol addiction.

    Anxiety and addiction are major health risks on their own, and both become considerably more dangerous when co-occurring with another disorder. Data collected by the National Health Services suggest that up to 50 per cent of people facing mental health problems also have a substance use disorder.

    Considering that anxiety is the most prevalent mental health problem in the world, it is safe to say that the combination of anxiety and addiction represents a common dual diagnosis.

    When Anxiety and Addiction Form a Pair

    Anxiety and substance use form a problematic pair for individuals trying to manage both disorders at the same time. It is not unusual for the symptoms of a substance use disorder to exacerbate the symptoms of anxiety. Likewise, those who see relief from their mental health issues via substance abuse will find that their anxiety symptoms grow more unmanageable when they are sober.

    This vicious cycle underscores just how dangerous this combination of mental health issues can be. Examples of co-occurring substance use and anxiety disorders include:

    • A post-traumatic stress disorder patient who uses alcohol to lesson psychological trauma and experiences more severe depression symptoms
    • A person with a social phobia uses prescription pills to lessen his or her inhibitions in social settings, but finds that the phobia symptoms get worse when sober
    • An obsessive-compulsive disorder patient begins using marijuana to ease his or her compulsions and develops a new obsession with the physical act of smoking

    The Need for Dual Diagnosis Treatment

    The term “dual diagnosis” refers to any time a patient is afflicted with more than one mental disorder simultaneously. These patients are particularly at risk because the symptoms of one disorder typically interfere with the treatment of the other. Patients dealing with co-occurring anxiety and substance use disorders are a prime example of this phenomenon.

    A person with a social phobia, for example, may find it difficult to participate in group therapy for his or her addiction. Similarly, a person who is going through withdrawal symptoms to overcome addiction may be more likely to experience a panic attack and feel the urge to continue using. These scenarios emphasize the need for specialized treatment that addresses the root of both disorders.

    Solving Anxiety and Addiction

    What’s the best way to treat co-occurring addiction and anxiety? Today, most experts believe that the most effective approach is to treat these conditions simultaneously. That’s why leading treatment facilities hire psychiatric professionals as well as medical doctors to join their staff. With both types of expertise available in house, these treatment centers can develop personalized recovery strategies that address the symptoms of both mental disorders.

    Considering the massive overlap of individuals with anxiety disorders and addiction, it would not be surprising if dual diagnosis treatment becomes the default treatment approach for these co-occurring disorders. In the meantime, dual diagnosis patients and their families must be diligent in finding a treatment center that can serve their needs.


    Click to access dualdiagnosis.pdf

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    In the UK, smoking is liable for a massive 80% of deaths from lung cancer, roughly 80% of deaths from bronchitis and emphysema, and around 14% of deaths from heart disease. Not to mention the fact that more than a quarter of all cancer deaths can be attributed to the habit. Despite this, current figures show that some nine million citizens still smoke, that is 19% of men and 15% of women. Troublingly, two-thirds of smokers begin before the age of 18. Yet, whilst there are countless other mediums that provide nicotine boosts at lower risk, adults are still choosing to smoke cigarettes.

    On Wednesday 31st of May the world will be celebrating No-Tobacco Day. It is an opportunity to consider all of the alternatives out there and give giving-up a chance. In recent years, there has been a boom in replacement methods, and we have never been more aware of the statistics surrounding the damage tobacco causes to our loved ones, the environment and ourselves. With more stringent tobacco laws to be affected this year, there has never been a better time to consider quitting.


    Vaping is proving to be one of the most popular and effective methods of stopping smoking, with more than half the UK’s electronic-cigarette users giving up smoking tobacco entirely. In 2012, there were 700,000 vapers in the UK; this figure has more that quadrupled so that now there are 2.9 million. Although the NHS has endorsed vaping as a much safer and healthier alternative to smoking, more than a third of smokers have still never tried it. This is because many smokers simply do not understand the reduced risks, with many expressing concerns about the safety of e-cigarette devices. A recent survey found that whilst 13% of respondents recognize that e-cigarettes are significantly less harmful that smoking, 26% believe that they are equally or more harmful than cigarettes.

    This could not be further from the truth. Recent research from Public Health England found that e-cigarettes are 95% less harmful than smoking tobacco. Moreover, cigarette smokers typically inhale over 4300 chemicals, 69 of which are carcinogens that have been proven to cause cancer. E-liquids on the other hand typically contain only four main ingredients, Propylene Glycol (a common food additive), Vegetable Glycerin (a plant-based oil), nicotine and the same flavoring used regularly in foods.

    If you are considering giving up smoking, e-cigarettes could be a great way to get you there. A 2013 survey reported that vaping has helped 9 out of 10 smokers kick their habit. 70% of those surveyed said their cravings had dramatically reduced whilst 75% relayed that it had been several weeks and even months since their last cigarette.

    tobacco or vaping?

    The Law

    In keeping with the plans to phase out smoking, the government will implement six new laws from 20th of May. Cigarettes in packs of ten will no longer be sold and rolling tobacco will only be available in 30g packs. Because of the increased carton size, the cheapest packet of cigarettes will come to £8.82. As well as this, the government will begin their plans to phase out menthol cigarettes, but this will happen at a slower rate than standard cigarettes. Expect Menthols to be unavailable from around 2020. This same period of grace will not extend to flavoured tobaccos like cherry or coconut, which will be completely prohibited from May.

    There are also plans to standardize cigarette packaging, so that all brands will have to conform to an unpleasant shade of dark green. If this wasn’t enough, at least 70% of packaging will be made up of graphic photos and warnings about the dangers of smoking. The aim is to put the brakes on individual branding and undo any remaining sales advertising campaigns. Although these measures may sound drastic, a 2015 YouGov poll found that the majority of voters support the move towards uniform packaging and cautionary pictures.

    These regulations will hit smokers on lower incomes the hardest, as their habit could become significantly more expensive. However, the idea is not to penalize the poor, but rather deter young people from taking up smoking and help current smokers kick their habit. By phasing out menthol and flavoured tobacco the government hopes to discourage the younger generations from starting to smoke, as new smokers tend to find menthol or flavoured tobacco less abrasive to inhale.

    Ultimately, the goal of these new regulations is to significantly reduce the number of smokers in the UK by making the habit harder to come by and less pleasurable.

    The Effects of Tobacco Smoke

    We are all aware that smoking is harmful, but did you know that gases produced from burning cigarettes bind to red blood cells, meaning that blood struggles to get enough oxygen to the body. A lesser-known threat of smoking is the damage that it does to blood vessels. Smokers have a high risk of contracting coronary heart disease, which means a greater chance of heart attacks, strokes and angina. Whilst most of us may find the connection between smoking and lung cancer obvious, smoking also severely increases your chances of getting cancer of the cervix, mouth and throat.

    If the negative impacts upon personal health aren’t sufficient to kick the habit, the impacts upon your loved ones will be. Children are especially vulnerable to second hand smoke as they have less developed airways. In fact, passive smoking is linked to over 165,000 new incidents of diseases in children every year. Moreover, it simply isn’t good enough to go outside or open a window. 85% of smoke is invisible and odorless, whilst smoke particles can build up on your clothes and surfaces remaining for a long time after sparking up.

    Environmentally, tobacco farming is responsible for a large proportion of deforestation and the process of manufacturing and shipping cigarettes contributes to carbon emissions. Dropped cigarette butts also make up 38% of all collected litter.

    As smoking becomes more expensive and the awareness of risks are widely publicized, there has never been a better time to quit. Especially given that, easily accessible, low risk alternatives are so readily available for an affordable price. Judging from the current trend in government policy, tobacco will soon be phased out entirely, so why not keep ahead of the curve and test out going tobacco free during World No Tobacco Day.

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    Since the introduction of the modern E-cigarette in the early 2000’s, Myths such as E-liquids contain dangerous substances, E-cigs are addictive and Second hand vaping is dangerous. E ciggarette shop Essex, Tank Puffin have created this infographic to educate you on what exactly is a myth and what is a fact when talking about vaping.

    Vaping myth

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    During the course of five or ten years, a large number of people have become addicted to various drugs. Opioids tend to be some of the most commonly abused medications. Pharmaceutical companies and researchers have worked tirelessly to find ways to help patients overcome such problems. Eventually, they determined that utilizing Buprenorphine was surprisingly effective. This specific semisynthetic opioid is available under a handful of different trade names, including Subutex, Cizdol and Suboxone. How does it work and are there are risks involved with the consumption of Suboxone? Within this comprehensive guide, you will learn all about Suboxone and the concept behind the drug.

    What It Does

    First and foremost, it would be wise to learn about the concept behind this specific medication. Suboxone relies strongly on Buprenorphine, which is actually a semisynthetic opioid. This chemical is capable of behaving like a partial agonist to the brain’s opioid receptors. When Suboxone is consumed, it actually attaches itself to your brain’s opioid receptors and stops the potential effects of other opioids. Therefore, this specific medication is often used to aid with the treatment of opioid addiction. While the medication is deemed to be very effective for this specific purpose, there are some risks involved.

    For instance, treating addiction with Suboxone has a risk of developing a physical and psychological dependence to the drug. After the patient has utilized the drug for an extended period of time, they’ll have two treatment options available to them. Patients can continue to use the drug as a maintenance dosage or they can withdraw with medical supervision.

    Precautions Before Use

    Before taking Suboxone, it is absolutely essential to speak with your doctor and tell him or her about your current medical conditions. If you have any medical problems or are allergic to naloxone or buprenorphine, it is essential to tell your doctor. He or she will take these things into consideration and determine whether or not Suboxone will be safe for you. Below, you will find a list of the potential problems, which may cause a negative reaction with Suboxone.

    • Kidney or liver disease
    • Urination problems
    • Enlarged prostate
    • Respiratory problems
    • Drug abuse in your past
    • Past head injuries, tumors or seizures

    Be sure to tell your doctor about any of these. It is also a good idea to avoid using Suboxone when pregnant. It is not currently known whether or not this drug could harm an unborn baby. However, it is likely that the child will become dependent on the drug. Therefore, it is generally best to wait until you’re clean of Suboxone, before getting pregnant.

    Things To Avoid

    Suboxone is generally very safe. However, the risks can be increased substantially when Suboxone is utilized in conjunction with other substances. This is especially true, when it comes to alcohol. In order to avoid any potential risks, it is essential to avoid consuming alcohol, while also taking Suboxone. Be sure to check your food carefully and avoid those that may have alcohol in their contents. Also, you must realize that this medication can potentially impair your reaction time and thinking. Therefore, it is generally best to avoid operating heavy machinery and driving, until the medication’s effects have dissipated. You should also remember that using Suboxone with certain drugs can be very dangerous.

    It is best to avoid drugs that can make you sleepy, as well as those that can slow your breathing. The combination could prove to be very dangerous and could result in life-threatening side effects. It is also absolutely essential to avoid altering the consistency of the medication. It should only be taken as prescribed. Do not crush the pills or break the capsules. Doing so will increase the risks substantially and could result in more devastating side effects.

    Induction Dosage

    Suboxone is administered to individuals suffering with opioid dependence. The medicine has proven to be very effective in treating this condition, as long as the patient follows the recommended dose recommendations. On the first day of treatment, the clinician will probably choose to start the patient out on an initial dose of 4-mg/1 buprenorphine/naloxone. However, some clinicians prefer the 2mg/0.5 mg dose, but this will depend on the patient’s needs and the physician’s preference. The Suboxone dosage will be titrated upwards in 2 milligrams every 2 hours, but this is only in an in-patient setting, where the patient will be supervised.

    One the second day, the physician will titrate the dose up to 16-mg/4 mg. Clinicians normally choose to administer the drug in the form of sublingual film, so the patient cannot alter the medication. According to research, patients taking Suboxone using the buccal route will receive a higher level of exposure to the naloxone, verses the sublingual route.

    Suboxone Side Effects

    Suboxone side effects will vary from one patient to another. While one patient may not exhibit any side effects, another patient may exhibit every common and rare side effect. Side effects include:

    • Intermittent cough
    • Lightheadedness
    • Overheating sensation
    • Chills or fever
    • Headache
    • Painful urination
    • Diaphoresis (excessive sweating)
    • Syncope
    • Flank (side) pain
    • Lower back pain
    • Nausea, vomiting and abdominal pain
    • Weakness and fatigue
    • Insomnia
    • Constipation

    Some patients have complained about rapid weight gain and tingling sensation in hands or feet, but it has not been scientifically determined, if these symptoms are linked to Suboxone.

    Suboxone Withdrawal Timeline And Symptoms

    Suboxone is very effective when it comes to fighting opiate addition. However, the medication must be used for long periods of time, even after the patient has long kicked opiates, he or she will usually continue to take Suboxone. While it is so effective, the prolonged use of this medication makes it extremely addictive, as well. Since this medication was designed to fight against opiate addiction it can have similar withdrawal symptoms. Some of these symptoms might include vomiting, nausea, body/muscle aches, cravings, fever/chills, headaches, sweating, insomnia, depression, anxiety, and irritability.

    The withdrawal symptoms of Suboxone will be at their worst during the first 72 hours. This is the time period when most of the physical symptoms occur. After the first week of not taking the medication, symptoms usually start to die down and users will just experience general aches and pains in the body, along with insomnia and potential mood swings. During the second week is when depression can be the biggest issue. After not taking the medication for a month, patients will be prone to relapse, because this is when the intense cravings and depression usually kick it.

    Read more articles of the psychiatrist and drug addiction specialist David Warren on

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    Whether e-cigarettes can help address health inequalities will depend on take-up in deprived communities – but cost and ‘faff’ are discouraging deprived smokers from switching, according to new research.

    The study involved community-based research in the North East of England with smokers and quitters over three years from 2012 to 2015. Research participants bought both tobacco and electronic cigarettes largely through informal outlets and personal networks – but for the very poorest, cost was a barrier to any e-cigarette use. Although £10 would buy a starter tank and e-liquid, smokers could get a week’s worth of illicit rolling tobacco for the same money. The poorest could not risk such a large outlay on something that might not work.

    Figure 1: People bought from informal outlets

    Even those who could afford better tended to buy cheap e-cigarettes (and cheap tobacco if they were still smoking) because addiction was a problem for their moral identity, as was excessive expenditure on the self. Older people were particularly likely to be put off by the association of the e-cigarette with pleasure or play, and avoided aspects of e-cigarette use which they associated with frivolity or self-indulgence: sweet flavours, expensive parts, vaping shops, culture and language.

    Users struggled with the faff factor

    Users struggled with the time, effort and expense involved in finding the ‘right’ e-cigarette and the frequency of product failure i.e. cheaper tank models splitting, leaking, or bubbling if over-tightened or dropped, and problems with batteries running out or failing to charge. Unless users were highly motivated to quit, smoking was easier and cheaper taking into account the cost of e-cigarette replacement and the availability of illicit tobacco.

    This practical problem was also a gender issue. The energy, time and money needed to switch successfully to e-cigarettes were often lacking for older women heavily invested in family care, whose personal health was relatively low in their hierarchy of concerns. Mature women in the study had a relational sense of identity in which care of the self was at the bottom of a hierarchy of concerns. For these women, their own health simply did not seem important enough, in comparison with the many tasks they did for others, for them to put in the effort needed to quit. As a result, whilst they might try an e-cigarette, they quickly became impatient with aspects in which it compared poorly with the ever-reliable, endlessly replaceable cigarette.

    Figures currently show slightly more women than men using e-cigarettes overall. Women are more likely to use disposable or first-generation ‘cigalikes’, but since second-generation devices deliver nicotine more effectively and are more satisfying to users, there is a risk that using less effective models may translate into fewer women ceasing to smoke. Gender is not discussed in the most recent UK e-cigarette evidence review; further research will be needed to establish whether there is a gender differential in the use of e-cigarettes to quit smoking successfully.

    Young men bought into vaping culture

    Smoking cessation conflicted with a local ethic of working-class hedonism which encouraged sociable smoking and drinking, particularly among younger men. This meant that to abstain or quit smoking was to risk being seen as pretentious or insufficiently masculine. However, using an e-cigarette overcame this problem, not least because an interest in gadgets and technology was a legitimate male trait. The e-cigarette was therefore a viable masculine accessory in combining hedonism with technology.

    Local masculinity was performed differently in mature adulthood, at which point smoking cessation could function as part of a narrative of family responsibility or indeed of mastery; older men positioned their e-cigarette use within this functional narrative. Normative masculinity also required that one should give up smoking if suffering serious ill-health such as cancer, stroke or heart attack; not to do so in such circumstances implied weakness or a lack of self-control. Some men with serious health problems who were unable to quit smoking remained dual users of tobacco and e-cigarettes, but deployed e-cigarettes as a badge of moral intent.

    The success of the e-cigarette in addressing health inequalities will partly depend on whether it enables users to overcome locally normative barriers to cessation. These findings suggest that it does have some potential to do this, at least in relation to men. However, the e-cigarette is constantly changing and increasingly regulated; should it become a more medicalized product, it might lose its attractiveness as a masculine accessory. On the other hand, if more reliable and effective models start to dominate the market, this will diminish the trial and error process which discourages older women users in particular.

    Whilst the findings of this study cannot be generalised to deprived areas across the UK or further afield, local meanings of smoking and cessation in relation to gender and age are crucial to e-cigarette take-up, as are place-based smoking and cessation practices more generally. Most importantly, we need to appreciate that local norms can sometimes make giving up tobacco or taking up e-cigarettes more of a risk to moral identity than carrying on smoking.

    The full article is open access and available here:
    Thirlway, Frances (2016). Everyday tactics in local moral worlds: e-cigarette practices in a working-class area of the UK. Social Science & Medicine 170: 106-113.

    About the author

    Frances Thirlway is a Research Associate at Durham University and an associate member of FUSE – the UKCRC Centre for Translational Research in Public Health. Her research interests are in health, class and culture, with a particular interest in smoking cessation (including e-cigarette use) in relation to health inequalities in the north of England and in Scotland. Follow her @fthirlway


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    There was a time in the not so distant past that all addicts were treated with the same kinds of therapies, regardless of their gender. However, in light of ongoing research, women are known to have very real needs that are specific to their gender and as a result, therapeutic intervention must be tailored to these needs. Per Wickstrom of US Addiction Services, The Best Drug Rehab and several other treatment facilities explains that biology is only one player.

    Societal and environmental triggers also need to be accounted for and in his words, “Quite frankly, those triggers are different in women than they are in men. It’s a known fact and one of the reasons why our holistic approach is so successful. We treat the whole person which means that women most often have a different slant on what is healthy for them and what can help them ease through the pains of recovery. And, make no bones about it, recovery can be painful,” he says. “But the benefits of seeing it through to recovery are beyond what words can express.”

    So Then Per – What Are the Unique Needs of Women?

    When asked to explain the unique needs of women, Per Wickstrom answered a question with a question of his own. “I ask you this. What is the one group that still is highly responsible for taking care of the home, raising children and being the caregiver in the family? Yes, although there are many more stay-at-home dads and custodial fathers in a divorce than ever before, women by far outnumber men in those positions,” he says. “This is important because these are some of the greatest needs we must address with women who come to us seeking help in recovery.” Here Per is referring to the most recent statistics that show more than 17% of custodial parents are now dads.

    Childcare Is Huge

    One of the reasons that more women don’t seek treatment is childcare. Who is going to watch the children while they are away at a recovery center? Although those very same children are often the motivator for getting clean and sober, it’s a Catch 22. You need to get clean for the kids but who will watch the kids while you’re drying out? Aftercare isn’t bad, Per notes, because women are back home with their families and interaction with their counsellor for that year of aftercare is limited to an hour or so at a time. It’s being admitted to a residential facility that is worrisome and one of the most unique needs women facing substance abuse treatment have.

    While there is no simple solution to childcare, Per says that women should seek out family members and friends who would be willing to take the kids in for a brief period of time so mom can get the help she needs. There are also some social services that might step in to provide temporary foster care and churches might be a good resource as well. This is one need unique to women that is yet to be answered satisfactorily, but it is a major concern of mothers in treatment.

    The Most Common Trigger in Women

    Research has shown that women suffer from PTSD at a much greater percentage per capita than men and it is this one disorder that often triggers substance abuse. Many women have been raped, sexually abused or treated in some way that brought about traumatic levels of stress. In seeking to treat PTSD, many doctors prescribe medications that are also addictive and in the end, these women may find some level of healing from one disorder only to end up with another – addiction.

    Addressing Those Triggers and Unique Needs

    At US Addiction Services and Per Wickstrom’s other treatment facilities, every effort is made to help women with their unique needs. Sometimes programs are tailored to the needs of a mom with little to no help in the childcare department and other times staff will help mom find a suitable solution so that she can get the care she needs. However, even women without kids find a stigma attached to substance abuse that is not attached to their male counterparts which means that the approach to treatment needs to confront societal issues as well as substance abuse issues.

    Together with their clients, US Addiction Services are always seeking new and innovative ways to afford women the recovery therapies they require while addressing their own unique needs as women. Per Wickstrom believes that knowledge is key and that once this social stigma is corrected, more facilities will be available to women. Until that time he and his staff are working overtime to help women find the solutions they need to help them on their path from addiction to recovery.

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    Drug addiction recovery has severe consequences on quality of life, utilisation of healthcare, individual productivity, and society as a whole. The approach of each country to dealing with drug addiction recovery – from sliding scale options to patient withdrawal – is unique. Both the UK and the US take substance abuse seriously, therefore data collection and variety of treatments is a significant part of their attempts to tackle substance addiction.

    As mentioned, the approach each country takes to battle substance addiction is unique. The Minnesota Model (1) – that regards an addict as a sick individual, who needs support to recover, rather than an individual who suffers from moral weakness and should be punished – was first adopted as the residential treatment model in the United States before it was implemented in the United Kingdom. The long-term objective is 100% abstinence from harmful substances.  Some people might want to know how to stop smoking pot

    In contrast, the UK adopted a different approach at the start, focusing on addiction symptoms rather than addiction causes. The coalition government then realised that this approach was failing, so the objective of making patients “drug free” became the main part of Drug Policy 2010. However, advocates of abstinence treatment for drug abuse were often accused of being misguided in the UK.

    Several drug addiction recovery centres in the US adopt methods that bring the Minnesota Model into play. For instance, 9 out of 10 centres offering treatment solutions for drug addiction in Tucson give outpatient care as well as sliding scale solutions for treatments and financial assistance (2). There are also sober living facilities and support group solutions that help in abstinence in other areas of the United States. Parents often get shocked by the rate of drug addiction among relatives and teen children, but substances are not that hard to obtain, so addiction recovery and sober living is the best way forward.

    Getting Addiction Recovery Treatment

    The UK follows a comparatively simple system. The NHS (National Health Service) handles the healthcare and each UK citizen contributes 11 percent of their income to National Insurance. Anyone who earns over $170 a week needs to pay. The benefit of this approach is that eligible individuals get drug addiction recovery treatment free of charge. Individuals can go to their nearest NHS drug addiction support service centre to seek treatment.

    Voluntary and private drug treatment organisations offer treatment options outside the NHS. Their solutions include counselling, harm minimisation solutions, and day-to-day structured programs. However, these organisations are linked to the NHS is some way. Addiction recovery solutions (NHS or outside NHS) cover all types of drugs including marijuana, cocaine, and heroine.

    In the US, before the Affordable Care Act (3), private health insurance programs often excluded addiction recovery. It was after 2008 that private insurance started offering treatments for problems like addiction and mental health disorders. Today, some treatment facilities are entirely or partially subsidised by the government, and require federal or state insurance plans for partial or full payment of medical services.

    However, federal and state insurance plans cover limited facilities, so people with private insurance are the ones who benefit from a large number of substance addiction rehab centres. Private insurance plans pay a major portion of treatment costs, so in a conventional sense, patients have to pay very little out-of-pocket expense.




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