FDA puts black box warnings on Chantix and Zyban

Reuters Health Day News reported on July 1, 2009 that the FDA has placed "black box warnings on two smoking cessation drugs: Chantix and Zyban. Here is a snippet from the article:

Two drugs prescribed to help people quit smoking, Chantix and Zyban, will now carry "black-box" warnings on the potential risks of psychiatric problems, including depression and suicidal thoughts, U.S. health officials said Wednesday.

The U.S. Food and Drug Administration said it was mandating the black-box warnings, the strictest possible, based on reports to the agency of these side effects and on a review of clinical trials and scientific literature.

"We are requiring the manufacturers of the smoking-cessation drugs Chantix and Zyban to add a new boxed warning highlighting the risk of serious mental health symptoms with use of these products," Dr. Curt Rosebraugh, director of the FDA's Office of Drug Evaluation II, said during a Wednesday teleconference.

The agency's review found that some people who used Chantix (varenicline) and Zyban (bupropion) experienced unusual changes in behavior, became depressed, or had their depression worsen and had thoughts of suicide or dying, the FDA said.

Rosebraugh said there were reports of 98 suicides and 188 suicide attempts involving Chantix, and 14 suicides and 17 attempts reported with Zyban.

You can read the whole article by clicking here.

To read the FDA News Release click here.

How does co-dependence affect children?

It is interesting how co-dependence affects children. Here is a great example from Claudia Black's great book, It Will Never Happen To Me.

"Joan can't count on her mom to be attentive about what she has to say after coming home from school. Joan's mom doesn't smile after hearing something funny which happened to Joan at school, nor is her mom very sensitive to her sadnesses. Usually, Joan's mom is preoccupied with what happened last night, or what didn't happen last night, as a result of dad's drinking."

It Will Never Happen To Me, p.35

I am seeing a teen right now in my private practice who is the "good girl" but who is suicidal, anorexic, and significantly depressed. She says that her mother is "stupid" because her mother states that she "complains too much". The teen says that dad drinks every night after work and he and mom fight. The teen says that she goes up to her bedroom and turns up her music so she doesn't have to hear the fighting.

The teen reports she went to her doctor who said she was depressed and recommended antidepressants. She says she wanted to "talk with some" so the doctor referred her to me. She says mom doesn't want to bring her because mom says it is a "waste of time."

I offer to see Mom but the teen declines saying that Mom will "yell at me if I tell you what is going on at hom. It will just make her mad."

I say, "It sounds like there is anyone you can trust?"

She nods and her eyes well up.

I am struck with how substance abuse is not only a family disease but it is transgenerational.

And so it goes..............

This is article #6 on substance abuse the Family Disease.

The Don't Trust Rule in dysfunctional alcoholic family systems

"I'm always on my guard with people. I want to trust them, but it is so much easier to just rely on myself. I'm never sure what other people want."

It Will Never Happen To Me, p.33

The Don't Talk rule in dysfunctional family systems

"Sometimes I pretend my mom is not drinking when she really is. I never even talk about it."

Melody, Age 9, It Will Never Happen To Me, p.33

Natalie Merchant and 10,000 Maniacs

Video lasts 4:04 -




Don't talk, I will listen.
Don't talk, you keep your distance
for I'd rather hear some truth tonight than entertain your lies,
so take you poison silently.
Let me be. Let me close my eyes.

Don't talk, I'll believe it.
Don't talk, listen to me instead,
I know that if you think of it, both long enough and hard
the drink you drown your troubles in is the trouble you're in now.

Talk talk talk about it, if you talk as if you care
but when your talk is over tilt that bottle in the air,
tossing back more than your share.

Don't talk, I can guess it.
Don't talk, well now your restless
and you need somewhere to put the blame for how you feel inside.
You'll look for a close and easy mark and you'll see me as fair game.

Talk talk talk about it, talk as if you care
but when your talk is over tilt that bottle in the air
tossing back more than your share.

You talk talk talk about it, you talk as if you care.
I'm marking every word and can tell this time for sure,
your talk is the finest I have heard.
So don't talk, let me go on dreaming.
How your eyes they glow so fiercely I can tell your inspired
by the name you chose for me. Now what was it? O, never mind it.

We will talk talk talk about this when your head is clear.
I'll discuss this in the morning, but until then you may talk but I won't hear.

Los Angeles Diaries, the book

Even before the scandal, I had read James Frey's A Million Pieces and knew that it was a bunch of dramatic exaggerations of what rehab is really like. Turns out, Oprah is mortified at what any reasonable person already knew, that James Frey made up most of the stuff in his memoir.

By comparison, I just finished James Brown's memoir, The Los Angeles Diaries, in which he describes his own addictions, his failed marriage, the suicides of his brother, and then sister, and his difficulty in achieving success in his field as a writer because of his alcoholism and his drug addiction.

Brown's book is more like the real thing. It is sketchy, written in a sparse and succinct style and yet very readable and engaging.

Brown grows up in a very dysfunctional family abandoned by his mother during some very formative years because she does prison time for arson after burning down an apartment house in which a person died. His mother also bankrupted the family with wild spending and poor investments and his contractor father is ruined. Jimmy started drinking and drugging when he was a kid and by the age of 14 had become an addict.

This is a dark tale told in a matter of fact way about the destruction of a family due to substance abuse. If there is any doubt that substance abuse is a terminal disease, James Brown's story will set that doubt aside.

I recommend this book.

For more information, scroll through My Favorites on the side bar, and click on Los Angeles Diaries. It will take you to the Amazon web site.

What are GCASA's core values?

I have read Jim Collins and Jerry Porras' book, Built To Last: Successful Habits Of Visionary Companies (book is listed in My Favorites in right side bar)which has inspired me and given me many ideas about how to work to make GCASA even better.

One of the things that Collins and Porras found that Visionary Companies do is stick to their core ideology while they push for continuous improvement. This idea very much resonates with our philosophy at GCASA.

An important component of a company's core ideology are its values. These values are not some saccharine pollyannish ideas that sound good but something that defines the organization at a visceral level. Different people might have different ideas about those organizational core values are but I would say they are four fold: we treat everyone, clients, staff, referral agents, general public with respect. We also recognize people's intrinsic worth and dignity no matter how low they have sunk in their lives. We believe in a person's right and responsibility to become actualized, that is, to realize his or her potential, and we believe in continuous improvement in one's own life, in one's family, in one's community, in one's place of work etc.

So the four values which resonate most deeply with me are dignity, respect, actualization and continuous improvement. These are the things that GCASA is committed to as it goes about its work. This means we are not driven by regulatory requirements, or payors, or evidence based practices. We are driven primarily by a client centered orientation which is respectful, protective of dignity, empowering of individual growth, and always trying to become better at what we do.

Let us know what you think. Leave us a comment. What do you care most deeply about as you go about your work in the substance abuse field, or as you interface with the substance abuse system.

This is article #1 in a series on Organizational Excellence.

GCASA Cares for July, 2009

During July, 2009 GCASA Cares will bring you a continuation of the series on Substance Abuse, The Family Disease. GCASA Cares will also feature a series on organizational excellence.

In addition, GCASA cares will feature GCASA staff news, GCASA events, 2 book reviews, 2 film reviews, and 4 of our staff's favorite public service announcements.

Even though it's summer time and people are on vacation, substance abuse continues to be a problem. So we hope you will visit the GCASA Cares blog often.