Author Archives: Susan

APA Finds Political Stress Significant

The American Psychological Association (APA) conducted its annual “Stress in America” survey to examine how Americans feel and how much stress they are experiencing and why.

Of those surveyed, 63% said that the future of the nation is a significant source of stress, 62% indicated that money stresses are significant, and 61% said that work was a significant source of stress, according to the news release.

APA has conducted the annual survey for more than a decade, and money and work
have consistently topped the list of stressors. In 2017, however, after adding a question with a list of additional stressors, the survey revealed a common new source of significant stress: the future of our nation. While the public’s overall stress level remains the same, on average,
compared to last year, Americans are more likely to report symptoms of stress, which include anxiety, anger and fatigue, said the announcement.

The survey was conducted by Harris Poll on behalf of APA.

The full report is available at

The APA Help Center also includes: 10 tips for dealing with the stress of uncertainty and Managing conversations when you disagree politically.

Data was weighted to reflect proportions in the population. The online survey included 2,047 women, 1,376 men with political affiliations of 1,454 Democrats, 698 Republicans, and 672

Race of the respondents was 1,088 White, 810 Hispanic, 808 Black, 506 Asian and 206 Native American adults.

About a third (1,122) fell at or below 200 percent of the federal poverty level and 2,087 were above.

Parents made up 1,182 and those without children were 2,258.

Data was collected online. Because the sample is based on those who were invited and agreed to participate in the Harris Poll online research panel, no estimates of theoretical sampling error can be determined.


Gov Edwards Meets with President Trump to Address Opioid Crisis

Gov. John Bel Edwards and Dr. Rebekah Gee, secretary of LDH, attended a listening session at
the White House with President Trump on October 26 to discuss the growing opioid crisis. Also participating were Governors Bill Walker from Alaska, Chris Christie from New Jersey, Matt Bevin from Kentucky and others.

According to the press release, Gov. Edwards also met privately with Acting Drug Czar Richard
Baum to discuss drug and addiction trends in Louisiana, Gov. Edwards’ priorities related to
drug use, and opportunities to collaborate with the White House in the future.

Edwards praised a decision by Trump to declare the opioid crisis a national public health emergency. President Trump indicated that he intended to file a lawsuit against opioid
manufacturers for their role in escalating the national crisis. In September, Gov. Edwards and
the Louisiana Department of Health (LDH) filed a similar lawsuit.

“I appreciate President Trump’s commitment to this issue,” said Gov. Edwards. “This problem has escalated in Louisiana at a rapid pace, and we are taking action to combat the opioid crisis. The president’s declaration will put more tools at our disposal, and will allow us to help more Louisianans who’ve fallen victim to opioid abuse. This is going to take time, and my  administration and I are committed to working with the Trump Administration to provide assistance to as many people as we can.”

According to the White House, declaring a public health emergency will mobilize additional federal resources, including:

• Allowing for expanded access to telemedicine services, including services involving remote
prescribing of medicine commonly used for substance abuse or mental health treatment,

• Helping overcome bureaucratic delays and inefficiencies in the hiring process, by allowing the Department of Health and Human Services to more quickly make temporary appointments of specialists with the tools and talent needed to respond effectively to our Nation’s ongoing public health emergency,

• Allowing the Department of Labor to issue dislocated worker grants to help workers who have been displaced from the workforce because of the opioid crisis, subject to available funding, and

• Allowing for shifting of resources within HIV/AIDS programs to help people eligible for those
programs receive substance abuse treatment, which is important given the connection
between HIV transmission and substance abuse.


Gov. Edwards Makes Several Board Appointments in Oct

Gov. Edwards announced in October that he reappointed Kathryn A. Steele, Ph.D., of
Metairie, to the Louisiana Licensed Professional Counselors Board of Examiners. Steele is a
licensed professional counselor, licensed marriage and family therapist, and professor of counseling at New Orleans Baptist Theological Seminary. Dr. Steele was nominated by the
Louisiana Association for Marriage and Family Therapy and will serve as a licensed
marriage and family therapist on the board.

The Louisiana Licensed Professional Counselors Board of Examiners is responsible for the regulation of Provisional Licensed Professional Counselors or PLPCs (formerly Counselor
Interns), Provisional Licensed Marriage and Family Therapists or PLMFTs (formerly MFT Interns), Licensed Professional Counselors or LPCs, and Licensed Marriage and Family Therapists or LMFTs.

The Governor also reappointed Paul M. Schoen, of Covington, to the Addictive Disorder Regulatory Authority. Schoen is a licensed addiction counselor and certified compulsive gambling counselor in private practice. Additionally, he is a veteran of the United States Navy
Reserve. He was nominated by the Louisiana Association of Substance Abuse Counselors and Trainers, Inc., and will serve as a member with significant experience and knowledge in the area of compulsive gambling.

Gov. Edwards also appointed Kerri L. Cunningham, of Lafayette, to the Addictive Disorder Regulatory Authority. Cunningham is a licensed clinical social worker, licensed addiction counselor, and the Clinical Director of Victory Addiction Recovery Center.

As required by statute, she was nominated by the Louisiana Association of Substance Abuse Counselors and Trainers, Inc.

The Addictive Disorders Regulatory Authority licenses and regulates addictive disorder counselors and prevention professionals in the State of Louisiana.

Also in October Gov. Edwards appointed Antoinette Q. Bankston, of Baton Rouge, to the Human Trafficking Prevention Commission Advisory Board. Bankston is a licensed clinical social worker and the Executive Director of the Baton Rouge Children’s Advocacy Center. As required by statute, she was nominated by the Louisiana Chapter of the National Association of Social Workers.

The Human Trafficking Prevention Commission Advisory Board provides information and
recommendations from the perspective of advocacy groups, service providers, and trafficking victims to the Human Trafficking Prevention Commission.

Bambi D. Polotzola, of Opelousas, was reappointed to the Louisiana Developmental Disabilities Council. Polotzola is the Director of the Governor’s Office of Disability Affairs and will serve as its representative on the council.

The Louisiana Developmental Disability Council’s mission is to lead and promote advocacy, capacity building, and systemic change to improve the quality of life for individuals with
developmental disabilities and their families.


Blade Runner 2049

Blade Runner 2049
by Alvin G. Burstein

Unusual for a sequel, newly released Blade Runner 2049 is a darker and more complex film  than its predecessor, set thirty years earlier. Both used a dystopian setting to explore issues of exploitation and empathy as elements of the human condition. The first film was a striking description of the contrast between a degenerate capitalistic system and the human capacity for love and of love as an anodyne for the bitterness of mortality. The new film, set thirty years later, extends that exploration in a profound way.

In the first film, we learn about bioengineered replicants manufactured by the Tyrell Corporation to support the human elite. Replicants look human, but have a limited life span and are identifiable by their lack of emotional responses. Blade Runners, cops in a post-modern, degenerate Los Angeles, are charged with “retiring” those replicants who resent their limited lifespan and resist their exploitation. Deckard, a human Blade Runner is charged with retiring Rachael, an experimental replicant who has had artificial memories implanted to “provide an emotional cushion.” She believes she is human and weeps when she finds that her human memories were artificially implanted. Despite her limited life expectancy, she and Deckard fall in love and, after harrowing adventures, flee into hiding.

In the sequel, a young Blade Runner, KD6-37, himself a replicant, broods over whether his childhood memories are implanted or genuine. In the course of a “retirement” mission,
he stumbles on evidence that Rachael had died, but not before giving birth, with a possible implication that he might be her and Deckard’s child. Without revealing that last implication, he reports the discovery to his chief.

He is ordered to destroy any evidence of his discovery because of the potential for precipitating racial war inherent in replicants being able to reproduce themselves rather than being manufactured. The Blade Runner embarks on a personal mission to find Deckard and resolve the uncertainty of whether his memories are genuine or not.

The search and its complications are dramatic and suspenseful. In the course of the search he finds Deckard living hidden in a virtual museum of nostalgic memorabilia in the ruins of old LA where—meaningfully— we hear records of Sinatra and Presley singing songs about love.

With Deckard, he joins a revolt against the corporate interests producing replicants. He saves Deckard’s life and reunites Deckard with his child, a daughter. In the course of his efforts
the young Blade Runner is mortally wounded. And suffers another, more tragic wound. He learns that his childhood memories had been implanted.

Reuniting Deckard and Rachael’s daughter is not motivated by family ties. It is not grounded in familial love, with its sexual implications and complications. It is altruistic, an unrequited
caring for the other. This Blade Runner dies alone, abandoned, shorn of his memories, of a family tie to Deckard, to Rachael, to anyone.

Altruism, selfless behavior, perplexed and fascinated Anna Freud. Her favorite play was said to be Rostand’s Cyrano de Bergerac, which she saw as epitomizing altruistic love. Cyrano conceals his love for Roxanne to shield her from being disillusioned about her husband. Cyrano dies taking pride in having made that choice.

Classic Greek tragedies depicted admirable individuals suffering as a result of a fateful error. Blade Runner 2049 suffers in a profoundly different way. His tragic loss, his sacrifice, is not the result of an error, but comes from giving up an illusion. It is, like Cyrano’s sacrifice, a form of self-assertion. But with a deeply painful cost.


Psychology Laboratory Directors Discuss Research at “Science Café”

Psychological scientists from laboratories around the state shared their work at the first “Science Café,” hosted by the Louisiana Psychological Association this week in New
Orleans. Researchers from the University of New Orleans, Pennington Biomedical and the
University of Louisiana Lafayette discussed current advancements with psychologists
attending the association’s Fall Workshop.

Dr. Elliot Beaton, Assistant Professor in the Department of Psychology at the University
of New Orleans and the director of the Stress, Cognition, and Affective Neuroscience Laboratory, discussed how stress affects brain development and function in children and adolescents at ultra-high risk for later development of serious mental illness.

The goal of Dr. Beaton’s work is to help explain diagnosis, prevention, and mitigation by
understanding early prodromal indicators. He uses functional and structural magnetic
resonance imaging with network connectivity analyses. Dr. Beaton combines this with
behavioral, psychophysiological, hormonal, and immunological stress measures. He was joined by researchers Ashley Sanders, MS, and David Stephenson, MS.

Dr. Christopher Harshaw, Assistant Professor, directs the Mechanisms Underlying Sociality Laboratory at U. of New Orleans. His focus is on understanding the role played by somatic factors in cognition and behavior. Autism Spectrum Disorders frequently exist with a
variety of somatic complaints and issues, including gastrointestinal problems, allergic and immune disorders, as well as thermoregulatory and/or metabolic dysfunction. Dr. Harshaw discussed whether and to what extent such somatic correlates are simply “noise” versus causally related to clinically important facets of dysfunction.

Dr. Robert Newton, Jr., is Associate Professor and director of the Physical Activity & Ethnic Minority Health Lab at Pennington Biomedical. Dr. Newton discussed the effect of
physical activity on African American’s health through the Aerobic Plus Resistance
Training to Increase Insulin Sensitivity in African American Men study. One major goal of
the study is to determine the physiological effects of exercise training in this hard-to-reach
population. African-Americans suffer disproportionately from various health conditions, and
decreased physical activity and increased inactivity levels have been shown to be independent
risk factors for the development of chronic diseases including cardiovascular disease,
diabetes, and obesity. AfricanAmericans spend less time in activity and more time in inactivity than is recommended.

Dr. Valanne MacGyvers is Assistant Professor at the University of Louisiana at Lafayette, where she has taught for 23 years. In her lab Dr. MacGyvers focuses on issues of mindset in achieving excellence, examining the role of mindset in the prediction of academic excellence and in the understanding of psychological problems in adolescents, including depression, anxiety and eating disorders. She discussed current research which examines academic achievement in college and graduate school, measurement development, the role of music in preparing impoverished preschoolers for Kindergarten, understanding the development of empathy, and people’s attitudes about breast feeding in public.

Dr. T. Scott Smith is Assistant  Professor and director of the Louisiana Applied and Developmental Psychological Sciences Laboratory, a laboratory primarily focused on applied
research, or how information may be used to understand the world better or even make adjustments towards our overall  understanding of cognition. One major area of focus is cell phone distraction and how cell phone distraction affects the learning process, not only in the
classroom, but also how applicable distractions may affect driving behaviors and eyewitness

Dr. Smith also discussed his work on the effects of video game play on aggressive behaviors for children, adolescents, and adults, and how young children process information, specifically reconstruction memory, and how these processes affect their ability to be (in)effective witnesses.

Dr. Charles Taylor, Assistant Professor of mechanical engineering, is founder of the Cajun Artificial Heart Laboratory, a biomedical research lab with high-end computing and
visualization systems as well as a mock circulatory loop for the purpose of testing artificial heart valves. Dr. Taylor is a bioengineering professor and his lab delivers research capabilities
to the artificial internal organ community in the form of robust in vitro systems, with accompanying computational tools, to accelerate medical device development. Dr. Taylor
discussed the theories and principles of artificial organ creation and his on-going projects.

Dr. Taylor and Dr. Scott Smith, from the U. of Louisiana Lafayette Psychology Department, are
collaborating to develop the SMART test or Sensory Motor and Reaction Time Test for persons with blindness and visual impairment.


More Mental Health, Less Incarceration – Prison Reforms Launched

In an announcement this week, Gov. Edwards said that key parts of the “Justice Reinvestment Initiative,” a package of reform measures passed by the 2017 Legislature, will begin to be implemented. Certain inmates in Louisiana who are currently serving a sentence for non-violent, non-sex offenses, as defined by Louisiana law, will be released an average 60-90 days early. This is an effort to reduce the state’s incarceration rate, the highest in the nation, a pledge the Governor made in taking office.

“Louisiana’s label as having the highest incarceration rate in the nation may be part of our past, but it will not be a part of our future,” said Gov. Edwards.

The package of 10 pieces of legislation is designed to steer less serious offenders away from prison, strengthen alternatives to imprisonment, reduce prison terms for those who can be safely supervised in the community, and remove barriers to successful reentry.

“For more than a year, stakeholders from every walk of life in Louisiana publicly met to
thoroughly review our criminal justice system. Following a model set forth by other Southern,
conservative states, their goal was to make Louisiana a safer place for our children while
being smarter on crime than we have been in the past…” he said.

“Along the way, we will, undoubtedly, find areas where we can improve these changes,” the
Governor said, including “alternatives to incarceration.”

The effort is estimated to save approximately $262 million, with more than $180 million of
those savings being reinvested in programs that reduce the recidivism rate and empower offenders to leave a life of crime.

Louisiana is the latest state to enact such reforms; many others have experienced simultaneous drops in their crime and imprisonment rates. For example, the Texas incarceration rate is down 16% and crime down 30%. In North Caroline incarceration is down 16% and crime down 16%.

The House and Senate votes for S.B. 139 (the bill that includes changes to parole and good time) passed by 26- 11 in the Senate, 75-30 in the House, and then 20-13 in the Senate

This past June, Dr. Raman Singh, Director, Medical and Behavioral Health, Louisiana Department of Public Safety & Corrections, told psychologists at the Louisiana Psychological Association, that the leverage for dramatic changes in the state’s incarceration rate was to institute behavioral health reforms in the Louisiana criminal justice system.

Singh, a medical doctor and cardiologist by training, said, “Louisiana’s incarceration rate
contributes to over-representation of the mentally ill in the criminal justice system.”

Dr. Susan Tucker, clinical psychologist and the Assistant Warden at the Bossier Parish
Medium Security Facility, and President-Elect of LPA, introduced Dr. Singh and explained the
significance of comprehensive psychological programs in the corrections and justice system.
Tucker developed the Steve Hoyle Intensive Substance Abuse Program nationally recognized for excellence.

In 2016 the Louisiana Legislature commended Tucker and her team in a House Concurrent Resolution pointing to multi-million dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed by Tucker.

Singh explained to the audience of psychologists and professors that the reasons for over-incarceration in Louisiana are well-established. Based on a 2016 Louisiana Legislative Auditor’s review Singh said the top reasons were mandatory sentences and habitual offender laws, high rates of local incarceration without treatment programs, and “not addressing issues driving criminal behavior such as substance and mental illness.”

“Incarceration of mentally ill exacerbates symptoms of mental illness. Rarely does incarceration of the mentally ill lead to an improvement in their mental status,” said Singh.

In a related story, in October Attorney General Jeff Landry wrote that taxpayers should be concerned about this “dangerous legislation.” He said that some of those released will
qualify for welfare and that the savings, targeted toward programs to help prisoners with addiction, mental health, and job skills, “…has apparently now morphed…” into more grants rather than taxpayer savings.

Governor Edwards replied that Landry should “Learn the Facts, Stop the Fear Mongering,” in a press release this week.



Louisiana Department of Health Files Suit Against Opioid Manufacturers

On September, the Louisiana Department of Health announced a law suit filed against several leading opioid manufacturers for their role in escalating the opioid crisis in Louisiana. The lawsuit, filed in the 19th Judicial District Court in East Baton Rouge Parish, alleges that the drug
companies engaged in fraudulent marketing regarding the risks and benefits of prescription opioids, which helped fuel Louisiana’s opioid epidemic.

“These drug companies led prescribers to believe that opioids were not addictive and even suggested that treating physicians prescribe greater dosage units to those who had already
become addicted to opioids,” said Gov. John Bel Edwards. “As evident by the hundreds of Louisiana families that have lost loved ones due to this crisis, nothing could be further from the truth. We intend to hold these  pharmaceutical companies responsible for the lasting damage they have caused upon our people and the millions of dollars their wrongful claims have cost our state.”

The Louisiana Department of Health is seeking damages for the amounts it has already paid for excessive opioid prescriptions and treatment costs as a result of those prescriptions.
Louisiana joins dozens of other cities, counties and states that have filed similar lawsuits in response to the alarming number of cases of opioid addition and opioid-related deaths
throughout the country. Lawsuits were also filed last week by local sheriff’s offices in Avoyelles, Lafayette, Jefferson Davis and Rapides Parishes.

“By all means necessary, we are fighting the opioid epidemic in Louisiana. All indicators of this problem – opioid prescriptions, overdoses and deaths – are up. Recognizing that a key
contributor to opioid addiction is prescription medications, where 110 prescriptions for opioids are written for every 100 Louisiana residents, we are addressing a fundamental cause of this
problem,” said Dr. Rebekah Gee, secretary of the Louisiana Department of Health.


Dr. Rizutto Leads Rebuilding Project

Dr. Tracey Rizzuto and colleagues are helping those in the hardest hit storm affected areas to rebuild the local business communities, through a group composed of leadership and members of the Society for Industrial-Organizational Psychology and the Society of Consulting
Psychology, two Divisions of the American Psychological Association.

The effort began recently as the Harvey Organizational Psychology Effort or HOPE, Dr. Rizzuto told the Times. However, the project quickly evolved into an effort between the two Divisions of APA, to be called the Catastrophe Aid and Rebuilding Effort, or CARE.

The group “… is now positioned to respond to a broader range of disaster events,” said Rizzuto, Associate Director, School of Leadership and Human Resource Development, at the LSU College of Human Science & Education.

The interdivisional APA taskforce is working to provide pro bono business recovery services to those in the stormaffected areas, explained Rizzuto. The growing taskforce has over 30
volunteers at present and is working to link with regional leaders in the hardest-hit areas, she said.

The original group, HOPE, started working to connect to local Industrial-Organizational psychologists in the Texas and Louisiana area, to local government administrations, and to
identify businesses in need of services, she explained.

“We’re reaching out to our professional base to inquire about needs for assistance,” such as  housing/food donations, replacing books, assist with academic lectures if possible,” said

The current project is modeled after Rizzuto’s work on the Katrina Aid and Relief Effort,” called KARE, Rizzuto said. In the wake of Hurricane Katrina, the leadership of the Society of
Industrial-Organization (SIOP) called on its membership to deliver needed resources to people and businesses affected by the storm. “The Katrina Aid and Relief Effort (KARE) became SIOP’s
first outreach taskforce designed to deliver pro bono business consulting services with the goal of aiding disaster recovery,” explained Rizzuto.

Along those same lines, the current effort will likely help with a host of services including emotional management, hiring/selection tools, training programs, recruitment, etc.

According to a report in Industrial-Organizational Psychology, KARE provided assistance in managing stress and adversity, change, motivation, and healing from the disaster. Also some of
those served voiced interest in hiring, leadership, training, team management and general business issues.

KARE received commendations from the Louisiana State Senate, the American Society of Association Executives, and the Center for Association Leadership for the work.

Dr. Rizzuto and her team are welcoming voluteers. CARE group volunteers will be placed in complementary teams composed of individuals with a wide range of experience and expertise. Dr. Rizzuto explained that volunteers will work alongside colleagues. “You will not be alone,” she said. The group meets every Wednesday on Zoom.

For those interested in volunteering, the site for the Castastrophe Aid and Rebuilding Effort (CARE) site is:


Dr. Leonhard Meets with Medicaid Task Force to Support Innovations

Dr. Christoph Leonhard, PhD, ABPP, Professor in the clinical PsyD program of The Chicago  School of Professional Psychology at Xavier University of Louisiana, met recently with the Medicaid Integrated Assessment Task Force, a group created by Representative Barbara Norton and others, with the goal to “make a thorough study and evaluation of Louisiana’s current statewide system of healthcare delivery for Medicaid enrollees with serious mental illness.”

Dr. Leonhard is a member of the Louisiana Psychological Association’s task group to study innovations in healthcare, a committee chaired by Dr. Lacey Seymour. Leonhard is also the Chair of the Health Psychology Interest Area for the Psychological Association.

Representative Norton’s 2017 House Concurrent Resolution No.55 created the Medicaid Task Force, and had noted, “…the mental health and well-being of the residents of Louisiana is a vital issue that affects not only quality of life, but also the health of communities, families, and economic stability.”

According to the Department of Health and the Resolution, the purpose of the Medicaid Integrated Assessment Task Force is to study and evaluate Louisiana’s current statewide system of healthcare delivery for Medicaid enrollees, and especially with concern for those with
serious mental illness.

The task force members should strive to “render objective, fiscally feasible recommendations to the legislature for the implementation of policies that could be adopted by the state for the delivery of integrated primary and behavioral health services for Medicaid enrollees,” according
to the agency officials.

Data from the Substance Abuse and Mental Health Services Administration indicates that people with mental illness are more likely to have chronic health conditions, such as high blood pressure, asthma, diabetes, heart disease, and stroke, than those without mental illness, and those individuals are more likely to use costly hospitalization and emergency room treatment.

Individuals with primary health conditions such as asthma and diabetes report higher rates of substance use disorders and serious psychological distress.

According to the Centers for Medicare & Medicaid Services (CMS):
1) Fifty percent of Medicaid enrollees have a mental health diagnosis;

2) People diagnosed with mental illness and common chronic health conditions have healthcare costs that are 75% higher than those without a mental health diagnosis;

3) for individuals with a co-occurring mental illness or substance use disorder and common chronic condition, the cost is two to three times higher than what an average Medicaid enrollee pays for healthcare;

4) and costs of treating those with diabetes is as much as four times higher when a cooccurring
condition such as depression or alcohol addiction is untreated.

The members of the Task Force will be asked to give ideas for innovations that can address these and other issues, and work with the existing programs where feasible.

Dr. Lacey Seymour will be working with a group of psychologists, including Dr. Leonhard, to develop responses for the Medicaid team, according to several sources.

Dr. Chris Leonhard is a health psychologist and originally earned his degree from University of Nevada and completed his internship and postdoc at Harvard Medical School (McLean and Mass General Hospitals). He is Board Certified in Behavioral Psychology and currently is
conducting research in Behavioral Medicine and physical activity promotion


Inside the Opioid Crisis

by J. Nelson

In an example of flawed decisions in the medical/pharma industrial complex, over-prescribing has catapulted overdose deaths to the top, compared to peak years for auto fatalities, HIV or gun deaths.

“We now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths,” writes the Center for Disease Control (CDC).

The National Institute on Drug Abuse says opioid overdoses account for 60% of those deaths.
Researchers from the University of Virginia say these statistics are underreported by 24% for opioids and 22% for heroin overdose deaths, and with particularly large errors in certain states, one being Louisiana.

Overdoses are trending up, not down, by almost 20% for last year. STAT News predicts that
opioids could kill nearly 500,000 people in the next decade.

At the peak of the prescribing frenzy, 2013, doctors wrote nearly 250,000,000  opioid prescriptions––enough for every adult in the United States of have his or her own bottle of pills, reports the CDC.

Despite the flood of legal opioids into the society, the CDC reported no change in pain that would meaningfully drive the prescribing: “…there had not been an overall change in the amount of pain that Americans reported.”

Last year, 20 years after the opioid marketing blitz and prescribing ramp-up began, the
CDC found that there was no long-term benefit for opioids compared to no opiods. However, they did find ample evidence for harm, a fact that the FDA had failed to discover when they approved drugs like OxyContin in the 90s.

Not surprisingly, at least for psychologists, the CDC did find that psychological and physical treatments for pain were beneficial (“CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016,”). This despite the fact that these non-medical approaches are rarely integrated into treatment programs.

Echoing the overprescribing of antidepressants, citizens hoping for genuine healthcare appear to have once again become the unwitting lab rats of a commercial, profit–driven industry, where they and many providers are lulled into quick fixes that ignore long-term consequences and the psychology of the whole person.

Depth of the Problem

Opioids are derived from the same type of compound as heroin, and morphine-like effects for pain relief. The effects also include feelings of relaxation and euphoria. One recreational user described it as “Bliss.” Another as, “Physical––warmth, relaxation. Mental––Joy, boost in self-confidence, loss of anxiety…”.

Schedule I and II drugs have been determined to have a high risk for physical and psychological addiction. Schedule I are illegal and Schedule II are considered to have medical value and so legal by prescription. Heroin is a Schedule I opioid. Drugs like oxycodone, hydrocodone, and methadone are Schedule II opioids.

With continued use, tolerance and dependence result. Increased dosages are needed for the same results. Researchers say that dependency can occur after as few as seven days. Overdose risks go up.

In the 1990s drug manufacturers launched new opioid formulations, assumed to be safe. They expanded markets to non-cancer pain and moderate or temporary pain. Building on a new theme that all pain should be eliminated the opioid market quadrupled from 1999 to 2010, according to the General Accounting Office (GAO).

Physicians for Responsible Opioid Prescribing (PROP) found that the supposed safety of the new formulations in the 1990s was based, not on research, but primarily on a letter to the editor in a medical journal. The sound-bite idea began to circulate in the medical communities and was uncritically accepted as fact, notes PROP researchers.

The risk of addiction is serious. Among new heroin users, approximately 75% report having abused prescription opioids before turning to heroin, notes the CDC. The National Institute on Drug Abuse places the figure at 80%. PROP researchers reported that people get hooked by a prescription and then turn to street heroin.

Heroin use has been increasing among men and women, in all income levels. Those historically low in rates of heroin use––women, the privately insured, and those with higher incomes are seeing the greatest increases, says CDC. While addictions were up overall, those mainly affected were whites, especially those with less education.

In 2015 two Princeton researchers, Anne Case and Angus Deaton, presented findings to the  National Academy of Sciences that drug and alcohol poisonings, suicide, and chronic liver diseases and cirrhosis, had increased so dramatically that all-cause mortality was up for US
middle-class whites, while declining for Blacks, Hispanics and for those in other countries.

“Over the 15-year period, midlife all-cause mortality fell by more than 200 per 100,000 for black non-Hispanics, and by more than 60 per 100,000 for Hispanics. By contrast, white non-Hispanic mortality rose by 34 per 100,000.”

“This is a disturbing trend,” said Dr. William Schmitz, Jr., Past-President of the American
Suicidology Association The addiction chips away at the person’s hope and adds to the
burdensomeness they experience,” he said. “There is overlap between the accidental overdose and the intentional. The person may think, ‘I’m taking this and if I die, I die and if not, I’ll be here tomorrow.’ What this really speaks to is the increasing need for collaboration in mental and physical health,” he said.

The Problem in Louisiana

Louisiana is in the middle of the crisis, with some of the highest opioid prescribing rates and an escalating death rate from overdose.

In a Louisiana House Health and Welfare Committee hearing this past April, Representative  Helena Moreno told members that there are “… more opioids prescribed in Louisiana than are people in this state.”

In 2007, Louisiana prescribers gave out 110.1 opioid prescriptions per 100 persons, based on numbers from the CDC. Only five others were higher: West Virginia (135.1), Kentucky (130.8), Tennessee (128.8), Alabama (120.3), and Oklahoma at (114.4).

Little change has occurred in recent years. In 2012 the map of southern rural states was the
same, with Louisiana a 112.4 rate, with a slight drop to 108.9 in 2015. The rate again dropped
slightly last year, down to 100.4.

The Louisiana Commission on Preventing Opioid Abuse, looking at internal figures from the state’s Prescription Monitoring Program (PMP), says that the number is even higher. “Over the last six years, since the PMP began monitoring narcotic prescribing behavior, Louisiana has
averaged 122 prescriptions per 100 persons. This rate is 39% percent higher than the national
average (87.44).”

Addictions have rocketed up along with prescriptions. Ed Carlson, CEO Odyssey House
Louisiana, testified at a Senate hearing that, “All of the drug and alcohol treatment programs
throughout the state were overwhelmed with the amount of the people who were seeking
and needing treatment. We currently have waiting lists for all of our programs,” he said.

Louisiana has also experienced a significant increase in overdose deaths, with a 12.4%
increase for 2014 to 2015, according to the CDC.

Another characteristic of the opioid crisis is the inconsistency in prescribers, not accounted
for by the illness level of those being treated.

Prescribing varies widely across the nation from county to county. In 2015, six times more
opioids per resident were dispensed in the highestprescribing counties than in the
lowest-prescribing counties, notes the CDC. Characteristics such as rural versus urban,
income level, and other demographics, explain only about a third of the differences
found in prescribing rates across the country.

In Louisiana, highest parishes include Evangeline (192.1), St. Landry (145.5) Rapides (144),
Richland (139.3), Washington (136), and Tangipahoa (129.5).

Examples from ProPublica, using Medicare Part D information, shows that Hydrocodone Acetaminophen was the first ranked drug prescribed in Louisiana with 812,468 claims.

Highest prescribers were physicians in Pain Medicine and Physical Rehabilitation. The top
prescriber wrote 14,223 prescriptions for opioids. Of his 866 patients, 91% filled at least
one prescription for an opioid. The review by ProPublica rated his patients as less sick than

Another prescriber in Alexandria reported 1,333 patients receiving prescriptions from Medicare Part D and 98% of these filled at least one prescription for an opioid.

True Believers: A Bad Idea Gains Momentum

According to a 2003 report by the GAO, several national pain organizations issued new
guidelines in the mid-1990s, based on their belief that pain was undertreated in non-cancer
pain patients.

In 1995, the American Pain Society, led by Dr. Russell Portenoy, a New York pain doctor, recommended that pain should be treated in a special category. In an investigative
report by the Wall Street Journal (“A Pain-Drug Champion Has Second Thoughts”), said
Portenoy urged the tracking of pain as a “Fifth Vital Sign.”

The idea of a 5th vital sign was adopted by the Joint Commission on Accreditation of Healthcare Organizations, the Veterans Administration, and the Federation of State Medical Boards who provided reassurance to doctors who wanted to more freely prescribe opioids. The Federation drew up recommendations with the help of individuals linked to drug manufacturers, including Purdue Pharma (OxyContin), according to WSJ. The federation received nearly $2 million from opioid makers.

Around the same time, OxyContin was approved by the FDA, but lists no research on the drug.

An explanation by the FDA states: “At the time of approval, FDA believed the controlled-release formulation of OxyContin would result in less abuse potential, since the drug would be absorbed slowly and there would not be an immediate “rush” or high that would promote abuse. In part, FDA based its judgment on the prior marketing history of a similar product, MS
Contin, a controlled-release formulation of morphine approved by FDA and used in the medical community since 1987 without significant reports of abuse and misuse.”

In a Los Angeles Times investigation, based on sealed court documents, the physician who led the agency’s review of the drug, declined to speak with the press. The Times noted that shortly after OxyContin’s approval, the physician left the FDA and in two years was working for Purdue Pharma.

As enthusiasm grew the then Agency for Health Care Policy and Research, part of the national Department of Health, offered reassurance to prescribers about their “exaggerated concerns.”

The GAO noted that providers and hospitals were further required to ensure that patients received pain treatment. The Joint Commission implemented its pain standards for hospital
accreditation in 2001, a guide sponsored by Purdue Pharma.

Reassurances of safety appeared to be based on limited scientific research, a letter to the editor to JAMA, according to PROP and others, and perhaps a small study of 38 individuals.

How could such a gap in scientific decisions occur?

“Most doctors and virtually all patients are unschooled in how meaningfully to compare the
risks of foregoing versus undergoing treatment, and the patient’s frantic desire to ‘do
something now’ often trumps the doctor’s ancient commitment to ‘first, do no harm,’” wrote law professor John Monahan in a special report on statistical illiteracy in medicine, published by the Association for Psychological Science.

Dr. Jason Harman, a decision science expert at LSU, notes, “Doctors have very complex jobs. I know from some of my work on learning in complex systems that accurate and timely feedback is essential for optimal performance in a complex task.”

Some outcomes however have delayed or obscured feedback. In terms of opioids, the
immediate feedback a doctor receives is generally positive––pain is reduced––while
feedback about negative consequences is delayed if it is received at all. This basic
structure of feedback in the environment makes it very understandable to me how
doctors, who have the best intentions, could fall into such an ultimately harmful practice

Marketing Blitz on Doctors’ Psyches

In 1997 Purdue Pharma created a marketing effort that overshadowed anything previously and catapulted sales of OxyContin.

“Purdue directed its sales representatives to focus on the physicians in their sales territories who were high opioid prescribers,” said the GAO. “This group included cancer and pain specialists, primary care physicians, and physicians who were high prescribers of Purdue’s older product, MS Contin. One of Purdue’s goals was to identify primary care physicians who would expand the company’s OxyContin prescribing base. Sales representatives were also directed to call on oncology nurses, consultant pharmacists, hospices, hospitals, and nursing homes.”

By 2003 primary care physicians had grown to constitute nearly half of all OxyContin prescribers, based on data from IMS Health, an information service providing pharmaceutical market research. The GAO report stated that the DEA expressed concern that this resulted in OxyContin’s being promoted to physicians who were not adequately trained in pain

Purdue doubled the total OxyContin sales force by 2000 to nearly 700 and reached up to
94,000 physicians. Bonuses topped at $240,000, on a salary of $55,000.

Purdue expanded its physician speaker bureau, conducted speaker-training conferences,
sponsored pain-related educational programs, and issued OxyContin starter coupons for
patients’ initial prescriptions.

They also sponsored pain-related Web sites, advertising OxyContin in medical journals, and
distributed OxyContin marketing items to health care professionals–fishing hats, stuffed plush toys, coffee mugs with heat-activated messages, music compact discs, luggage tags, and pens containing a pullout conversion chart.

Purdue conducted over 40 national pain management and speaker training conferences,
usually in resort locations, to recruit and train health care practitioners for its national speaker bureau. Over five years, more than 5,000 physicians, pharmacists, and nurses, whose travel, lodging, and meal costs were paid by the company, were engaged. By 2002, Purdue’s speaker bureau list included nearly 2,500 physicians and over 20,000 pain-related educational programs.

“For the first time in marketing any of its products, Purdue used a patient starter coupon program for OxyContin to provide patients with a free limited-time prescription,” and by 2001 34,000 coupons had been redeemed nationally.

Purdue’s market share increased fourfold for cancer pain and tenfold for non-cancer pain by 2002.

Outdated Medical Model of Pain

“It is now widely accepted that pain is a biopsychosocial phenomenon,” clinical health
psychologist and Past-President of the Southern Pain society, Dr. Geralyn Datz, told the Times.

“For many years the biomedical model of treatment has prevailed as a way to treat pain patients,” Datz said. “This model is based on some very early research about acute pain and basically states that there is a one-to-one correspondence between the extent of injury and the amount of pain experienced. Therefore, large injuries lead to large pains and small injuries lead to small pains,” she said.

Datz explained that this model also assumes that surgery and medications can fix pain. “While
this is sometimes true, this model fails to appreciate what we now know about the central nervous system,” she said.

“We know that chronic pain is a complex and dynamic process, and it involves a person’s
thoughts, beliefs, experiences and these all can influence pain for better or worse. In addition, conditions such as depression and anxiety can arise from the presence of pain, and these also can worsen pain through interactions of the brain with the body.”

“In order to really address chronic pain, we must address the persons reactions to it and teach ways to overcome it, including retraining the brain away from the unpleasant pain signals. This is a psychological process involving education and training and coaching,” Datz said.

“We know that cognitive behavioral treatments create quantifiable changes in the brain, and
that these are distinct to this type of treatment. So these effects are lasting and result in long
term success.”

Dr. Datz says that the “best results are achieved through collaborative care,” but too often, insurance companies make it difficult for patients to have this type of help.

Treating with inappropriate drug therapy, is costly,” said Dr. John Caccavale, author of Medical Psychology Practice and Policy Perspectives. The cost for adverse drug reactions in 2001 was $72 billion to $172 billion while the cost for the drugs was $132 billion. “Actually, it’s now worse,” Caccavale said. “The incidence of hospitalizations from adverse events has risen substantially because of the growing use of medications in all categories.”

Failed Health System

The opioid crisis suggests one more area of poor outcomes for the U.S. healthcare system.
Bloomberg has reported that of 55 countries in a measure of life expectancy and high medical
care spending, the U.S. ranks 50th, dubbing the U.S. the “least-efficient” health- care system in the world. In a comparison of age–adjusted deaths from all causes, the World Health Organization ranks the United States last in similar countries.

Medical care is the largest industry in the U.S., accounting for almost $3 trillion in sales in 2015, according to the National Health Expenditure Data from CMS. At the same time, life expectancy in the U.S. is only 78.9 years, falling behind all other nations except for those such as Jordan, Colombia, and Russia, said Bloomberg.

Likewise, Louisiana ranks 50th of all the states, according to the Louisiana Department of Health and the 2015 Report from America’s Health Rankings.

“Health is a misnomer, because most activity involves illness,” say authors of “The Anatomy of Health Care in the United States” in a 2013, JAMA article. “Prevention requires tools that are often unfamiliar because educational, behavioral, and social interventions, not usually considered to be part of medicine, may be most effective for many diseases,” the authors write.

The system is politically closed to innovation. Three hundred “Advisors and Experts,” primarily from the American Medical Association’s House of Delegates, representing 109 medical specialties, lobby an “Editorial Panel,” composed of representatives from medical societies,
insurance companies and the government, decide on what is paid for, by way of codes.

The “Current Procedural Terminology” or CPT codes, and how much is paid for each service, is decided behind closed doors of the Relative Value Scale Update Committee,” or “RUC,” by those who stand to profit the most.

The system includes the FDA. Dr. Irving Kirsch, Associate Director of the Program for Placebo Studies at Harvard Medical School, has laid out the damning evidence that drug companies and the FDA skew research to approve drugs that have little actual value. The FDA receives 40 percent of its funding from the pharmaceutical companies, Kirsch said.

Add to this the political force of the top spenders for lobbying in Washington: Blue Cross/Blue Shield (3rd), American Hospital Association (4th) the American Medical Association (5th), and the Pharmaceutical Industry (6th).

This closed system is not surprising. In 2002 the 10 drug companies in the Fortune 500 made $35.9 billion in profits, more than all the other 490 companies profits combined.

Legislators in Louisiana are trying. In 2017 there were numerous bills and resolutions put forth to stem the tide of prescribing.

Senators Mizell and White asked for medical societies and hospitals to eliminate pain as the 5th vital sign, in Resolution 21. House Bill 192 led by Representative Moreno and 43 others, put some restrictions on prescribing opioids, became law as Act 82.

Act 88 by Representive Leger and others established the Drug Policy Board’s Advisory Council on Heroin and Opioid Prevention and Education, and Act 76 led by Senator Mills encourages prescribers to use the Prescripton Monitoring Program, where currently only about one third use the system.

The enforcement of these measures will depend on the professional boards. The Department of Health has filed a suit against drug companies.

It will be seen if this can help in the opioid prescribing crisis or the “underlying epidemic” suggested by Case and Deaton that may have contributed what author Christopher Caldwell calls, “American Carnage.”


Stress Comes of Age

by Susan Andrews, PhD

For generations traditional medicine has refused to consider “stress” and
other emotional problems as having a direct effect on our body and health.
The doctor might nod sagely and say things like, “it’s all in your head or that
is just your imagination.” Slowly, persistently, the evidence built up showing
many direct effects of stress on the body. Then, the stress was shown to be
transmitted across generations – from a parent to the child, not just
environmentally, but also physically – in the developing brain of the neonate.

But, today, it appears as if stress as a topic of real consideration has come
of age. Cardiologists and internists are now overheard as saying, “next visit
we will talk about stress.” It is like the physicians have decided that stress
and its many “physical friends and relations” really should belong to
medicine, as much as if not more than it does to psychologists. This may
afford psychologists an opportunity to build working relationships with
medical practices. Medical professionals may be able to talk about stress in
physical and medical terms but stress is still best treated without medication
and before it causes illness.

Not only can physicians now be heard talking about stress to their patients,
but also more and more continuing education programs are focusing on the
topic. Most recently, the serious connection between stress and
inflammation is being taught around the world. This is hugely important as
unresolved inflammatory responses are fingered as the root cause of many
chronic illnesses and dis-eases, such as diabetes, metabolic syndrome,
age-related changes and neurodegeneration, heart disease, cancer, MS,
ulcerative colitis, Crohn’s Disease, and Rheumatoid arthritis.

You can appreciate how close the relationship between chronic stress and
chronic inflammation is when you look at the potential causes of just one
chronic inflammatory illness, such as chronic inflammation in the digestive
tract. The #1 cause is often listed as Emotional Stress in the form of panic
attacks, rapid pulse, with night sweats. This constellation of symptoms is a
sign of a cortisol-prompted inflammation. When cortisol remains high in the
blood (immune system and adrenals on overdrive), it results in dilated blood
vessels that force blood to your organs in preparation of an attack. The #2
cause is Physical Stress.

Another indicator that Stress has come of age is the number of related hits
Google gives you for a search on “stress.” Any guess between 115,000,000
and 150,000,000 is acceptable. Actually, today the result was 131,000,000.
The results range from causes and triggers of stress to Symptoms of
Anxiety and Stress to things stress is associated with to ways to manage

It is the ways to manage stress that we do best as psychologists. The bulk
of the 131 million websites that came up are focused on ways to reduce,
manage, get rid of, or lower stress. Many of these websites are very
superficial and even misleading. Or, they are aimed at selling their product.
Stress can almost never be properly managed by simply reading an article
or book or looking at a website. It takes time, determination and good
coaching or therapy for a person to begin to drop bad habits, learn how to
live a more healthy life, and then finally put what they learned into real
action. The techniques to reduce stress only work if you use them.


It: Chapter One

by Alvin G. Burstein, PhD

Well, Steven King, abetted by director Andy Muschietti and a
stable of screenwriters, has done it again. His 1986
publication, It, has appeared on screen, and has audiences
lined up waiting to experience horror. The plot is slick. A
group of school kids, each of whom is weighed down by a
social disqualification, struggles with rejection and bullying in
and out of school. The group coalesces, aptly calling
themselves “The Losers.” Their leader stutters badly,
another is an overweight nerd, there is a sexually abused girl
seen as promiscuous, a hypochondriac, a loudmouth, a
Jewish kid being coerced into rabbinic studies, and a black.
As a group and individually, they are the target of vicious
bullying by school mates.

Then worse erupts. The younger brother of one of The
Losers is lured into a sewer by an evil creature who calls
himself Pennywise the Dancing Clown. The film takes us into
The Losers’ battle against victimhood at the hands of real life
bullies and the surreal, cannibalistic, shape shifting It.

Rather than rehearsing the twists, turns and outcome of the
tale, I will remark that the movie’s title is a promise that if you
enjoyed chapter one, you will be titillated by the prospect of
more to come. Beyond that, the film epitomizes the horror flic
genre, and raises the question of what attracts viewers to this
film and its counterparts. Where does horror or terror fit in
the panoply of emotion? Why would one pursue an
opportunity to experience that feeling? How is it that a clown
might be an apt focus for that feeling?

That the experience of fear and terror, independent of an
objective threat, is universal is attested by the phenomenon of
night terrors and nightmares in children and by their beliefs in
boogiemen and toilet monsters. King tips his hat to that latter
by It’s residence in the sewer system and It’s eruption out of
drain pipes. Inadvertently or deliberately, King also gestures
toward Freudian theory in Pennywise and the eponymous
account of his doings by naming Pennywise “It.” Of Freud’s
three mental agencies, Ego, Superego and Id, the last is the
arena of hidden and stormy passions—and Freud knew well,
and so might King, that “Id” is Latin for “It.”

From a psychoanalytic point of view, maternal empathic
soothing and protection in the earliest months of life transmutes
into a sense of safety and self-assurance in dealing with the
world. The obverse of that mothering, early ruptures of that
bastion, is a catastrophic experience. Otto Rank, one of the
early psychoanalysts, posited that the universal and traumatic
experience of ejection from the womb lays down an
inescapable fearful template that is part of the human condition.
Thus each of us, it can be argued, have somewhere within us,
in the darkness of the Id, that template of terror. From a cultural
point of view, the story of the eviction from Eden in Abrahamic
societies can be understood as a literary endorsement of
Rank’s insight.

But why clowns? There was an explosion of concerns about
evil-doing clowns in 2014 and again two years later. The
concerns were amplified by social media and were of
questionable authenticity. But they parallel the persistent
rumors of poison and razor blades in Halloween treats. Clowns
are intended to give us something to laugh about. But there is
also something eerie and artificial about them. Something
might be hidden under that mask of grease paint, that carmined

Life and living involve dire risks on which we do not like to
dwell, lest they trigger an eruption of a well of terror that swirls,
deep and hidden in our minds. Horror films provide an
opportunity to play with those fears, to entertain them—briefly
and under our control.