Omega 3, Nutritional Supplements, Heart Study, Healthy Diet

I read recently that a heart study conducted in Germany at the University of Heidelberg showed that in patients who have had a heart attack the use of omega 3 fatty acids (found in fish oils )did not make a difference in reducing further negative cardiovascular events. The study involved 3,800 people half of whom took a purified form of prescription omega 3 fatty acids and half of whom took placebo. They were followed for one year. Omega 3 fatty acids have been touted as reducing risk of heart disease but there had not been previously published work in a controlled study using a placebo which is the standard in assessing any drug's efficacy. What the study did not show however is whether or not use of omega 3 fatty acids reduce risk of heart disease in patients who have not had heart attacks nor if a longer follow-up period than one year might show positive results.

It made me think of nutritional supplements in general and how various recommendations have come and gone as placebo controlled trials show no added benefit to a good healthy diet. We have had L-tyrptophan for depression, mega dose vitamin C for a wide variety of problems, sAme for depression, vitamin E, and now mega doses of vitamin D and omega 3 fatty acids. Each was found no more effective than a normal well balanced and healthy diet and each supplement has been associated with some potential harm. What is not clear is whether supplements are the same thing as getting the substance naturally through diet. There may turn out to be some benefit in taking omega 3 fatty acid supplements but my recommendation will continue to follow the American Heart Association recommendations to eat fish twice per week.

Here at Cottonwood we do place an emphasis on experiencing the benefits of a healthy diet and education on how to eat well for a healthy lifestyle.

Thought for the day

"I have often been amazed at how every person loves himself more than he loves others yet places less value on his own judgment of himself than on the judgment of others concerning him".

Marcus Aurelius

Men, Mentoring, Leadership, Role Modeling

I talked yesterday about the difficulty in finding ways to educate young people in an effective manner to reduce risk of drug use and addictions and indicated that the first line of defense are parents who are not addicted to alcohol,tobacco,or drugs as well as a peer group that is antidrug. In addition it has been found that tobacco use generally precedes other drug use and that delaying the onset of smoking behavior can reduce overall drug use. We still don't know yet though how to best educate teens and young adults that will actually reduce drug use. There is another factor for young men, however,and that is the role of fathering, mentoring and role models.

Men tend to follow leaders and other men more than ideas and ideals. The role of fathering is critical for development of emotional health and well being and many families are left without a father as role model or leader to assist in helping the young man channel normal masculine energy. There is tremendous physical and sexual energy that if unchannelled can lead to problems. In someone with a sense of powerlessness it leads to attempts to control others, particularly women. If a young man has a lot of anger it can lead to abusive and antisocial behavior, and fears and anxieties become depression and addictions fairly easily.

So in order to reduce teen and young adult drug and alcohol abuse it is not enough for us to say that the schools need to be doing something but the responsibility lies with us to see in what ways we are leading, mentoring, or fathering a young man in our lives.

Thought for the day

"What is man that though are mindful of him?"

The Psalmist

Heroin, Opioids, Overdose, Death

I heard some sad news yesterday. A young man at my daughter's high school recently died of a drug overdose. This was the third overdose death this school year. The deaths were presumed accidental and the drugs in each case were opioids, the class of medication that I have talked about here as being an increasing problem in teens and young adults. One of the favored opioids in our area is not a prescription pill but heroin. Heroin is easy to obtain here in Tucson and now can be used not just intravenously but smoked as "black tar". Many young people who would never consider putting a needle in their arm now have access to one of the most powerful and dangerous(except for nicotine) drugs. They smoke it feeling "safe" and don't realize that like intravenous use it can result in overdose and death.

My immediate reaction is that they should be teaching about drugs in the schools! But I realize that has been done before nationwide with the D.A.R.E. program. The D.A.R.E. program was found to be totally ineffective and had no positive benefit in reducing teen drug use. It was a waste of time and money. So it is not just education but the type of education that is important. Finding that is not easy. We do know that teens accept things more from their peer group than from adults in general but also that we as adults do have influence. A peer group that is against drug use and parents who are not addicted to drugs, alcohol, or tobacco are the best first line of defense. But other than that we don't yet know the best ways for teens to communicate and educate their peers.

There is one thing that I want to talk further about, though, and that is a significant factor in influencing young men's behavior. Young men may be motivated by ideals and ideas but when it actually comes down to behavior, men follow other men not ideas and concepts. I will talk more about this in the next several days.

Thought for the day

Men follow men.

A Surprise Gift

I had something interesting happen to me yesterday. I had recently had a birthday and my daughter returned home from a church youth group with a present that one of her friends got for me. This was quite a surprise as I am not particularly close to this young man. I have had a number of interactions with him but do not feel thsat I have done anything special that would warrant him getting a gift for me. It is true that a lot of people for various reasons have been unkind to him and I have always tried to be especially nice to him because of this. But I was taken aback by this gift.

What it made me think about again is how we never really know how are interactions affect the people we are with. Something that might seem ordinary to me can have a significant meaning for the other person that I can never realy be aware of. I have had this happen to me. I think about one particular time in which I was quite down and someone who wouldn't be expected to me gave me a hug. While a simple gesture to the other person it was very powerful to me and helped me keep going through a very difficult time. I am sure that this person had no idea of what that gesture meant to me.

I am somewhat awed and humbled by this phenomenon and it reminds me that little ineractions whether positive or negative can have a profound impact.

Thought for the day

Whatever we do in this life has deep meaning of which we are usually very little aware of.

Environment, Green, Sustainabilty

Yesterday I mentioned that I like the word sustainability better than green to denote efforts to maintain a healthy envoronment in which we live.. Green to me carries a connotation that it probably doesn't to other people. To me it stands for the mindset that some people have that there is something inherently wrong with development and a blaming attitude towards people. Again this is just my personal connotation. I like the word sustainabilty better.

Sometimes it seems to me that there is very little that I can do that will make a difference. I can do some things. We recycle. We drive modest fuel efficient cars. We are putting in a solar water heater. We don't heat our pool. We try not to keep lights on. But I feel at times that it doesn't really matter, that as an individual household we are limited. Fortunately there are people wiser than me who don't take a fatalistic attitude. We have such people at Cottonwood. We have a Sustainability Team of staff members that continues to look at all that we do at Cottonwood. This group has changed the way we do some things here and keeps meeeting regularly to help us reduce negative enivironmrntal impact. I am glad we have this optimistic team which encourages a much healthier attitude about our ability to make a significant difference.

So to our Sustainabiltiy Team, Thanks!

Thought for the day

Together we can make a difference.

Environment, Green, Sustainability

Yesterday while walking our dog Buddy I was trying to pay special attention to the area in which we were walking to really "see" the area and environment. What initialy struck me was how much concrete there is in our area. We live near a major intersection and though I don't go in that direction I was thinking about the fact that we live in a somewhat impoverished natural environment. No walks in the country, the desert for Buddy and me. But then very quickly I thought about all the things that go along with the concrete environment.

I live literally 5 minutes away from some of the best medical care in the world if I should become ill. I live less than 5 minutes from a grocery store which has more food that I could eat in a year. I am nearby a bookstore and a library that gives me access to the best minds of the past and present. I have instant access to anything I want to know more about via the internet. All of this goes along with an environment that is full of cars, concrete, and use of energy.

We can't go back in time nor do I think we want to. Development and growth is inevitable. John Denver used to sing in his song Rocky Mountain High "more people more scars upon the land". That was easy for him to say. He already had his place in Aspen! I don't like the word green to describe environmental concerns. I know it doesn't mean this but the connotation to me is that somehow people ourselves and development are wrong in themselves. I prefer the word sustainabilty as it implies a more realistic attitude.

More on this tomorrow. In the meantime I plan to continue to enjoy my walks with Buddy.

Thought for the day

May God give us the wisdom to partner together in new ways.

Addiction, Recovery, Cottonwood, Nursing

I have talked before about the great staff we have at Cottonwood. Today I want to introduce you to one of our wonderful nurses, Brian Law, RN

When asked to write about yourself, it always proves to be a difficult task. You don't want others to get the wrong impression of you and, as I've always found, it is a royal pain just figuring out what to begin with. (So lets keep it simple and start at the beginning... Mostly due to the fact I can't think of anything more witty to start with!)

I was born 28 years ago in a sunny little town feared by many (mostly due to it's 120 degree weather) known as Yuma, Arizona. I am a July baby, and as many native Arizonan women know, being pregnant in a town whose weather is known for the immediate evaporation of any form of fluid isn't an easy task, but somehow mom did it. I spent most of my childhood doing three basic things: 1) Getting into trouble with my “gifted” friends, 2) Playing a major role in my baby brother's upbringing (in his first 3 years of life he consistently and stubbornly referred to me as “not the momma”), 3) Reading lots and lots of comic books. The heroes that existed in comic books had a huge influence on me. I never really took to their unique sense of fashion, but their dedication to helping others in need was something I seem to really take to heart. The combination of that, and my experience with the upbringing of my baby brother Branden really made it so I wanted to dedicate myself to a career that enabled me to help others.

Knowing that I wanted a career that enabled me to help others was easy. Finding a career that enabled me to help others turned out to be very hard. First and foremost, capes aren't cheap and honestly makes anyone below 6 feet tall look fat and stumpy. All kidding aside though, I spent years at the University of Arizona searching for my fated career. In high school, I was good at everything and tested very well. In college, I really didn't excel because I felt lost and not knowing what my ultimate career goals just compounded that feeling. It took a near death experience to help me find what I wanted to do with my life. In the end, all it took was my Mazda truck flipping 5 times and over a quarter of a mile on the I-10 heading east towards Tucson to place me on the right path. I still don't have any memory about what occurred the 5 hours after the accident but what I do remember clearly is how the nurses at the hospital helped me out. It was seeing those nurses in action that inspired me to join this profession and what fuels me still in this career path. Today, I aim at excelling in this profession and the idea of helping more and more people drives my passion in and for this career and what led to me work at Cottonwood for nearly 3 years now.

American Society of Addiction Medicine, Certification Exam

I have some good news to share. Recently I, along with two other colleagues here learned that we passed an exam we took back in December. The exam was for The American Society of Addiction Medicine (ASAM) certification. Two of us were certified and one was re certified.

The American Society od Addiction Medicine is the largest group of physician addiction specialists in the country and consists not only of psychiatrists but Internal Medicine physicians, Family Practice physicians and Anesthesiologists who are interested in advancing the field of addiction medicine. Certification does not imply clinical competence but means that the person has the education and knowledge base required to be an addiction specialist. The exam was very hard and I really had my doubts as to whether I would pass or not as this was not a psychiatric exam but a medical exam and covered areas that I don't necessarily deal with on a day to day basis. I was very pleased to know that I had passed as this exam required a great deal of study and preparation. If I had to retake the test at a later date I am not too sure that I could have gone through that study process again!

So, I am happy to share good news.

Thought for the day

"Do nothing from selfishness or conceit but with humility of mind regard one another as more important than yourselves".

Depression, Heart Disease, Nurse's Study, Risk Factor

Two recent reports from studies on depression remind us once again of the mind-body connection. It has been known for quite some time that depression is common in those patients who have suffered a heart attack or stroke and that those who have depression tend to have a worse survival outcome. The American Heart Association recommends that everyone with heart disease be regularly screened for depression. It also has been shown that those with diabetes have an increased risk of depression but also that depression is an independent risk factor for the development of diabetes. Now the same link has been shown with depression and heart disease. Depression is an independent risk factor for the development of heart disease similar to high cholesterol and hypertension.

The American Journal of Cardiology reported findings from The Nurse's Study which involved 63,000 women who were followed from 1992-2004. None of the women(mostly white) had heart disease but 8% had depression. Those with depression were found to have twice the risk of dying from sudden cardiac death than those without and to a lesser degree other forms of heart disease. Sudden cardiac death usually results from an abnormal heart rhythm. An additional interesting finding was that the use of antidepressants was linked to the increase in sudden cardiac death although the newer antidepressant medications have not been associated with heart rhythm abnormalities. It is thought that the use of antidepressants is more common in those with severe depression and that might account for the findings but further research needs to be done.

A recent paper presented at the American Psychosomatic Society showed a similar depression- heart disease link. The Washington University of St. Louis along with the Veteran's Administration studied twins from 1992-2005. Twin studies are often used to help determine the degree of genetic influence in a disease. They found that in those with a genetic risk of both heart disease and depression those who had depression at the onset of the study developed heart disease while those at genetic risk who did not have depression did not develop heart disease.

Both these studies show once again the potential devastating effects of depression and support the idea that there needs to be adequate insurance benefits for evaluation and treatment of depression which will reduce overall disease burden as well as decrease total health care costs.

Thought for the day

The mind and body are inseparable.

Sisters, Friendship

Just a personal update today. I am very happy as my older daughter Amy flew in from Illinois last night and she will spend the rest of the week with us. They are having comprehensive exams for her graduate program at Northern Illinois University but she has passed all her exams earlier and has the week off.

One of the fun things about her being home is to see her and her sister Meg together. Meg is 6 years younger than Amy but they are the best of friends. They spend a great deal of time texting each other when apart(although we don't have an unlimited texting plan which we remind Meg of!). I really have not understand the texting thing. If I try to text I am way too slow. I don't understand though why if you have a phone you don't just call. Isn't that what a phone is for? The only thing I can understand texting for is when you are busy and doing something else and shouln't be using the phone anyway (like in class). But that is just me.

Amy had never met Pounce the cat before so it was fun to introduce them. Pounce is very friendly and seems to take to anyone. Amy always goes with me on our dog Buddy's walks and we get a chance to discuss and argue about life and philosophy. The trouble is though that she is much smarter than I am. I am just happy to be around her for a little while.

Thought for the day

"In everything give thanks for this is God's will for you".

St. Paul

Addiction, Recovery, Therapeutic Recreation

As I have said before one of the nice things about working at Cottonwood is being associated with the great people we have here on staff. I want to introduce you today to Richard Patterson, MS, CTRS, our Therapeutic Recreation Specialist.

Hello. My name is Richard Patterson. Everyone calls me Butch, a nickname that was given to me by the nurse in the hospital where I was born. I was the biggest baby in the nursery.

I have worked at Cottonwood for some 14 years. I am a recreation therapist by training and the Coordinator of Recreation Therapy Services. People often tell me I have the BEST job at Cottonwood as there is kickboxing, Rocks and Ropes, outings, Challenge Course and "Funstitute". People see the results but not the preparation that goes into making these activities not only fun but therapeutic.

What part of the job do I enjoy the most? It is being present when someone recognizes they can have fun without the aid of mood altering chemicals or feeling guilty for being happy. It is looking at the face of someone who has just completed the 45 minute kickboxing workout (butt boxers included) without any rest stops. It's hearing the joy in an individual's voice when they complete their first rockclimbing wall.

What is my favorite activity? Whatever I am doing at the time. If I had to put it down I guess it would be Rocks and Ropes because it gives patients so many opportunities to gain insight into their own behavior and problem solving.

Favorite Saying

"Man does not cease to play because he grows old; man grows old because he ceases to play".

Full-Time Position Available Adult and Extended Care Units Counselor Cottonwood de Tucson

Full-Time Position Available Adult and Extended Care Units Counselor Cottonwood de Tucson

Cottonwood de Tucson is a highly acclaimed treatment facility specializing in effective inpatient dual diagnosis, chemical dependency and behavioral health programs. We currently have a full-time position available working with our Adult population at both our inpatient treatment and extended care facilities.

The desired candidate must have an AZ license in good standing with the AZ Board of Behavioral Health and a minimum of two years experience working with adults in chemical dependency and/or behavioral health group therapy. Previous work with trauma and eating disorders is highly preferred.

Along with the opportunity to contribute to the well being of others in an atmosphere of caring and support, we offer a competitive salary and benefits package.

For consideration, send your resume along with salary requirements to:

Human Resources Director
Cottonwood de Tucson, Inc.
4110 W. Sweetwater Drive
Tucson, AZ 85745
Fax: (520) 743-2133
E-Mail: bcox at cottonwoodrecovery dot com

Addiction,Opioids, Prescription Drug Abuse, Risks

We see a lot of different problems at Cottonwood. One thing in common though is that the problems of addiction have caused destruction in the lives of our patients and their families. One recent situation is particularly sad to me because it seems like such an unnecessary waste of life. The details may be changed but the story is true.

A young woman entered treatment here recently for addiction to prescription pain pills. The event that prompted her admission was that she had been at a party with her twin sister where both of them were using a variety of prescription medication including pain pills and sedatives. Both of them fell asleep but her sister never woke up. Their mother blamed the patient for her sister's death and she came into treatment not only with a serious addiction but with extreme guilt and remorse as well. It is a terrible tragedy.

Prescription drug abuse is very common, particularly among those 18-35. In 2007 4.6% of these young adults had an addiction to prescription pain pills or sedatives. The most commonly used drugs are the opioid pain pills Oxycontin, Oxycodone, Lortabs, Vicodin and Methadone and the sedatives Xanax, Klonopin, and Valium. Abuse of these drugs now are (second only to tobacco and alcohol) the most commonly abused drugs for teens and young adults surpassing marijuana use. One reason is the increasing availability of the medication. Most are stolen from family members or diverted from friends and they are easy to purchase (though expensive) on the street. Another reason for increasing use is that many people consider these medications to be "safe" and are unaware of the high risk of addiction as well as the risk of death if taken in sometimes even moderate overdoses. The use of the sedatives increases the effect of the opioids and raise a greater possibility of creating a very negative outcome.

Prescription drug abuse is likely to continue to increase and I hope we can get the message out that they are not "safe" drugs.

Thought for the day

"In peace I will both lie down and sleep, for you alone O' Lord make me to dwell in safety

The Psalmist

FDA, Warnings, Medication, Side Effects

I learned something new today which has gotten me to thinking about an old problem - that of medication risks and side effects.

I learned that many of the medication patches (transdermal delivery systems) that are now used commonly can cause skin burns if one is wearing them during an MRI scan. There are now 60 different medication patches that are used for a variety of conditions from nicotine cessation, to hormonal replacement to pain control and many others. Apparently about 1/4 of these patches contain traces of aluminum or other metals in their backing which can overheat and cause burns in the MRI scanner. I did not know this. The FDA is considering placing a warning label on every patch so patients will know to remove them during the scan.

This got me to thinking about FDA warnings and medication side effects in general and how it is becoming increasingly more difficult for doctors and patients to weigh the risks of taking a medication or undergoing a treatment.There are so many more medications now than in the past that it is hard for anyone person to keep up to date. In addition to side effects and risks there are many drug-drug interactions which can be harmful. On top of this there is now direct to consumer advertising from the pharmaceutical companies urging patients to discuss certain medications with their doctor to see if they are right for them. When I look at The Physician's Desk Reference (PDR) which is the detailed prescribing information on all medications it sometimes appears that any medication can cause any side effect! How to tell the the most common and potentially the most dangerous is not easy for us as patients. For example what does a person make of advertisements for antidepressants that tell of possible increase in suicidal risk or asthma medications which can cause respiratory problems and death. What about arthritis medication that says it can cause serious life threatening infections?

Medication data bases are the best way to screen for drug-drug interactions but are not helpful in making decisions about whether or not to take the medication in the first place. These decisions are based upon the relative risks vs the potential benefits in any one individual. What we all need to remember is that no medication is safe. There is no treatment without risk. I believe that the only good way to handle these dilemmas is a good doctor-patient relationship in which there is full freedom and opportunity to discuss these issues. We as physicians must take the time needed to have these kind of talks.

Thought for the day

"O love, you ever burn and are never extinguished".

St Augustine

Addiction,Recovery, Therapeutic Fitness, Wellness

I would like from time to time introduce you to my colleagues and co-workers. We have the best staff that I have ever been involved with and I am proud and honored to work these very caring people. Today I would like to introduce our Therapeutic Fitness Consultant Deb Tobias.

Hi! I am Deb Tobias.

Growing up in the trees of Upstate New York with five brothers, one sister and eventually a single, hard working mother, left me with many hours and days of exploration, solitude, acceptance and patience. What my teachers labeled as day dreaming was actually me observing those around me. How they reacted, how they thought and how they moved. I spent many hours observing how the human spirit affected ourselves and those around us. I spent many years and still do, observing what kind of impact negativity, unhappiness and imbalances have on ourselves and those we love so dearly. Shortly after attending Business school and working for Corporate America, I realized that I hadn’t navigated my own life very well in finding my life purpose and happiness. I perused my dream of helping people discover how strong they truly are both mind and body.

Everyday at Cottonwood I come back to my “roots”. I see people struggle with diversity, addiction and searching for a purpose and a reason. We are all one big family on earth and we must help each other and our environment. We cannot do this without love, tolerance, forgiveness, acceptance and self awareness. I have been very blessed by God in my life with two beautiful daughters and my other children, my dogs, Lucky and Zoey. I have also been blessed with a wonderful job at Cottonwood de Tucson where I get to share, explore and help navigate individuals toward a beautiful life of balance. Personal Training is not just about working a muscle. The connection between mind and body is so significant that you cannot move one without the other. This is true in the Gym and it is true in life. I am so very happy and blessed to share in helping individual’s everyday find the connection and truly start down the path of finding their higher power and life’s purpose. Everyday is a gift and every step is a step towards health, peace and joy.

Arizona, Addiction Psychiatry, Co-Occuring, Cottonwood, Treatment

One thing that is special about Cottonwood that few people are aware of is the availability that our psychiatrists have to work with patients, There are many substance abuse treatment centers that treat co-occurring psychiatric disorders but I believe we have the greatest psychiatrist to patient ratio in the world. We have 3 full time psychiatrists on staff, in house, for a center with less than 60 patient beds. My patient load is 20-24 , hardly ever above that. That is astounding! I don't believe there is a treatment center anywhere in the world that comes close. If you are one or know of one I would be happy to have you let me know.

Our situation is such that the psychiatrist, the most highly trained person on staff is not relegated to doing psychiatric evaluations and medication management. I am available for a wide variety of roles. With my on site presence I am constantly interacting with the therapists both formally and informally. The therapist and I are able to sit down with the patient several times during their stay to formulate and review the treatment plan together as well as come up with behavioral objectives and assignments. I am able to meet with every family of every patient during family program week alongside the patient's individual therapist and twice in the week if need be. We can treat patients who are very ill as I have the luxury of seeing a patient as often as needed even three to four times per day if necessary to help stabilize a patient. I can work with all my depressed and anxious patients providing cognitive behavioral therapy sessions twice per week. Our therapists are able to confer with me as often as needed. And we have three psychiatrists doing this! This luxury of psychiatric availability is otherwise unheard of.

Addiction psychiatry availability is one of many factors that convince me that Cottonwood is the place to come for those suffering from substance abuse and co-occurring psychiatric disorders.

Thought for the day

"I have not brought misery upon my fellows. I have not made the beginning of every day laborious in the sight of him who worked for me".

Ancient Egyptian-Confessions of the Righteous Soul

Prostate Cancer, Finasteride, PSA, Part 3

In my last two posts I have talked about how the recommendation by the American Urological Association (AUA) and the American Society of Clinical Oncology that men who get regular prostate cancer screening with the blood test for prostate-specific-antigen (PSA) consider taking the medication finasteride poses a dilemma for men as neither organization has made the recommendation that men get this screening in the first place. Screening with the PSA has not yet conclusively shown to reduce overall mortality rates.

The PSA is not a perfect test. There are a number of false positives which will lead to some unneccesary biopsies and false negatives as well. There is a lot of research trying to come up with a better more specific test but for now it is the best we have. All major cancer organizations recommend that men over 50 talk with their doctors about whether or not to check the PSA but give no further guidelines than that. So what is a man to do?


I am a member of Zero, which is a coalition of prostate cancer education and research advocacy groups which believes that one death from prostate cancer is one death too many. Zero currently focuses it's efforts on attempting to increase research funding, make sure that PSA tests are covered by insurance companies as well as Medicaid programs, and encouraging more widespread prostate cancer screening. I am concerned that Zero may get sidetracked by the finasteride issue. No pharmaceutical except finasteride has ever been recommended for prevention in such a large group of people (which is essentially most middle aged men) and I think this receommendation is premature. We only have one study (albeit a large one) showing it's preventative effects. We don't know though about possible risks and untoward effects associated of so widespread use of finasteride and I believe that more studies need to be done and that current efforts be focused on research for better screening tools, treatments, and education about the need for PSA screening.

In the meantime I think the issue is best summed up by Howard Sandler MD, chair of radiation oncology at Cedars-Sinai Medical Center in Los Angeles. He was the moderator of the press briefing on the finasteride study and was asked directly by a reporter whether or not he will take the drug. His answer - "I haven't made up my mind yet".

Thought for the day

The existence of love is one certainty in life.