Words from Dr. Bracco

Collaboration and Common Sense

Virtually all of us in the course of our lives evolve or develop a world view. Our world view may be seen as a set of core beliefs that create a framework for us to understand the environment we find ourselves in. Our world view is shaped by our families, teachers and experiences. While individualism and competition appear to be prevailing values in American society I have learned to view my world from another vantage point.

One of the individuals that shaped my thinking was Alfred Adler, a contemporary of Sigmund Freud. Adler’s basic tenet was that humans experience a deep sense of inferiority given that they are exposed to a world filled with natural and man-made forces that are overwhelming. Consider what we must experience at the moment of birth. If we are to thrive we must overcome the challenges in this world that threaten our survival. Adler believed that the solution lay in “common sense.”

Common sense in Adler’s view consists of people coming together to share their talents and ideas in search of answers. Collaboration is common sense and common sense is collaboration.
A social model that supports Adler’s view involves having individuals solve a problem by themselves such as, ranking a list of items that they may need for survival on a deserted island, then they are to come up with the list as a group. Invariably the group solution proves to be synergistic, that is, it proves to be better than any one of the individual solutions. As the saying goes “The whole proves to be greater than the sum of its parts.”

In seeking to fulfill Seven Counties’ mission of building healthy communities; common sense, and consequently collaboration are necessities. While there are many ways to organize the community in which we live I use a model in which our community is composed of twelve systems ; 1) Health, 2) Social Welfare, 3) Government, 4) Criminal Justice, 5) Business & Industry, 6) Faith, 7) Education, 8) Housing, 9) Transportation, 10) Media, 11) Recreation and 12) General Public. Each of these systems affects the health of a community. To achieve its mission Seven Counties must work collaboratively with and across all of these systems.

In order to build a healthy community Seven Counties must create linkages with each of these systems. If we stand alone we will realize our inferiority and we will fail. We can only achieve our mission by collaborating and using our common sense.

Are Suicide Rates Higher at Christmas?

Contrary to popular belief, suicide rates decline during the holiday season. A study was done on 188,000 recorded suicides in the U.S. and they found on average there were 102 fewer suicides during the holiday season. There was a noted dip in suicide rates leading up to, and following the Christmas holiday. One group of researchers found on average there were about 34 suicides per million people. They also found Holiday rates were lower with Christmas and New Year’s Eve at 30/million, and Thanksgiving at a surprisingly low 26/million. The New Years day rate was very high at 41/million people. This group of researchers believes the large number is due to the end of a holiday season when people get depressed at the thought of returning to work and everyday life.

The researchers have some reasons why suicide rates decline during the holidays.

~ Gathering of friends and relatives gives off a secure vibe and creates a comfortable atmosphere.

~Christmas celebrations evoke positive memories.

~There is an increase in awareness of resources available during this period.

Many assumptions are made about suicide and the holidays, but the holidays have a more relevant connection with depression. Loneliness, depression, feelings of loss, financial burdens, family conflicts, and alcohol abuse has shown to increase during the holidays. Some of these stresses can be dealt with before they hit with several simple steps. Planning ahead by identifying your feelings about Christmas is a good place to start. Second of all, being realistic about what can be afforded to give is a good guideline to your shopping adventures. Lastly, choosing to celebrate with the people who make you feel positive and hopeful as well as letting go of expectations about the holidays and just having fun. These are wonderful ways of dealing with the stresses of the holiday season.

"Are Suicide Rates Higher at Christmas?." Centre for Suicide Prevention. Centre for Suicide Prevention, 16 Dec. 1995. Web. 20 Nov. 2009. . Ballas, Chris. "Depression - Suicide Rates and the Holidays." Healthcentral.com - Trusted, Reliable and Up To Date Health Information. My Depression Connection, 7 Jan. 2009. Web. 20 Nov. 2009. http://www.healthcentral.com/depression/c/49/54818/suicide-holidays.
Snopes. "snopes.com: Christmas Suicides." snopes.com: Urban Legends Reference Pages. Snopes.com, 30 July 2007. Web. 20 Nov. 2009. .

People with Schizophrenia and Smoking

People with Schizophrenia have a three to four times higher rate of smoking than the general population. In a British study on 100 people with Schizophrenia, they found 92% of the men and 82% of the women were smokers, and they commonly smoke high-tar, unfiltered cigarettes. This type of cigarette is used by only 1% of the total smoking population. “People with mental illnesses have 30% more heart disease and 30% more respiratory disorders” says Ann Crocker about her research. Not only do an estimated 80% of the people with this disorder smoke, but those that are depressed and with anxiety disorders also smoke in great numbers. This can be compared to the 25% of the total adult population.


So, why do these people smoke more than the average adult? Initially people with this disorder smoke for the same reasons other people smoke; social pressure, peer influence, it’s “cool.” These reasons do come into play with smoking and Schizophrenia, but there may be a more compelling reason behind their smoking addiction. Nicotine causes an increase in synaptic dopamine so they may smoke to make up for the lack of dopamine production. This dopamine production causes stimulation to different areas of the brain responsible for mood, cognition, and appetite. By smoking they are improving the production of dopamine therefore improving their mood, sharpening cognition, and decreasing appetite.


“There is substantial evidence that nicotine could be used by patients as a self-medication to improve deficits in attention, cognition, and information processing, and to reduce side effects of antipsychotic drugs,” the German researchers concluded. In addition to these things “sensory gating” is also impacted by smoking. Receptors for nicotine are involved in sensory gating, and several studies have shown sensory gating is markedly improved after smoking, therefore lowering auditory hallucinations common in schizophrenia.

Norman L Keltner, & Joan S Grant. (2006). Smoke, Smoke, Smoke That Cigarette. Perspectives in Psychiatric Care, 42(4), 256-61. Retrieved November 17, 2009, from Health Module. (Document ID: 1182665371).
"Why Do Schizophrenics Smoke Cigarettes? Brain Blogger." Brain Blogger Topics from Multidimensional Biopsychosocial Perspectives. N.p., n.d. Web. 17 Nov. 2009.

"The world becomes our safety net."

ann-e
(click ann-e for a video)

"ann-e," the new application for the Apple iPhone, was created to connect people in recovery with a support network of peers in the 12-step community. "If it encourages one addict to come out of isolation into recovery, then the application has been a success" states ann-e. This anonymous network of people in recovery was developed to give addicts a network of people with similar problems and with people that are willing to help no matter the time. They developed this application with the simple concept- "Together we can do what we could never do alone." With this network of people it won't be long before the "world becomes our safety net."

This application is a peer-to-peer networking application that allows members of any 12 step program to ask each other for help and support. There are three main ways of communicating with this application:

• Anonymous peer-to-peer instant messaging between those seeking and offering help.
• Conference bridges where members are able to have a voice call anonymously.
• Facilitates face-to-face meetings between trusted peers by disclosing proximity and location.

ann-e allows users to register their affiliated 12-step program and their anonymous name for identification in the application. Also, it allows those offering help to log in and help members seeking help by chatting or setting themselves as "on call" during a set period. This application is also a safe way to exchange contact information of members that have met face-to-face. If you are a member seeking help it shows the location of your "helper" therefore it is easier to know if it is possible to set up a face-to-face meeting.

The top ten 12-step programs on the application are:

1. Alcoholics Anonymous
2. Narcotics Anonymous
3. Al-Anon
4. Overeaters Anonymous
5. Gamblers Anonymous
6. Cocaine Anonymous
7. Sex Addicts Anonymous
8. Recovering Food Addicts
9. Food Addicts Anonymous
10. Alateen

This is only a short list of the programs that are offered, there are these and so many more available for users. The main use/purpose of the ann-e application is as a tool for prevention to stay in contact with other recovering addicts to help find direction. A sign on in the morning is a good way to check in with other users and to make sure the day's path is heading toward recovery.

Step Twelve: "Having had a spiritual awakening as the result of these steps, we tried to carry this message to other addicts, and to practice these principles in all our affairs."

"Technical Attributes of iPhone App ann-e." Welcome to ann-e iPhone Application. N.p., n.d. Web. 12 Nov. 2009. .

"Of Mice and Mania"

There is a study being done to find the relationship of dopamine production to people with bipolar disorder in a manic episode. It is being conducted by manipulating a gene called the Clock gene in mice which is located in their brain and is associated with dopamine production. The purpose for altering this gene in mice is to find out which genes affect the neurochemical processes in humans related to dopamine.

Mice with the altered Clock gene seemed to respond more to the electric impulses sent to the pleasure pathways of their brain than the unaltered mice. These genetically altered mice kept coming back to the stimulus frequently, and the unaltered mice were not going back as often. When the Clock mice were given a dose of cocaine they were going back to the stimulus like the unaltered mice were, so their usage of the stimulus was reduced by the dose they were given.

Also, when mice were given a choice between water or sugar solution, this is something that mice find rewarding, the genetically altered mice chose the sugar solution more often than the normal unaltered mice. Genetically altered mice mimic symptoms of people in a manic bipolar state; hypersensitivity to rewards and euphoria, hyperactivity and nervous behavior, reduced anxiety and risk taking, mood stabilizing drug addiction.

Eitghty to ninety percent of people with bipolar disorder have a relative with a mood disorder. Clinicians have noted both depression and manic episodes increase substance abuse. This means these people tend to abuse stimulant drugs during manic phase and alcohol during depressive period. The lifetime rate of substance abuse for people with bipolar disorder is 38% where the rate is 10% for people without psychiatric illness. When bipolar patients abuse stimulating drugs their risks for hospitalization and suicide increase.

The genetically altered mice have different neurobiology than normal mice. Neurons in the starting point for brain dopamine pathways, including the reward circuit, fire more frequently and strongly resulting in greater dopamine release. Extra dopamine in the reward pathway is a critical factor in addiction and may influence vulnerability to both drug abuse and manic symptoms. This research is being done to find if the release of extra dopamine is also true in people with bipolar disorder in a manic episode. The findings may also provide clues to new treatments for people with bipolar disorder and drug abuse.

Whitten, Lori. "Manic Mice Show Heightened Sensitivity to Rewards." NIDA Notes Nov. 2009: 9-10. Print.

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Domestic Violence

Domestic violence is defined as using force or threats to hurt and control family members. This violence can come in various forms and can harm children, partners, even the elderly:

1. Physical-shoving, shaking, kicking, punching, using a weapon



2. Emotional-threats, insults, demands, criticism, harassment.



3. Sexual-assault, rape, or attempted rape.



4. Neglect-failing to provide proper food, schooling, and medical care.
   

There is a circle progression of domestic violence; it starts out with tension building in the home. Secondly the abuser attacks when they are set off by something/someone. The next progression is that there is a period of remorse by the abuser where they buy gifts and do things to “fix” the damage they have done. And lastly they repeat once something/someone sets them off again.

Surprisingly in over half of all cases of domestic violence alcohol and drug usage has been used as an excuse. Alcohol and drugs ALWAYS increase the risk of domestic violence. People are more likely to act violently if they are under the influence of alcohol or drugs.

So, why do people stay in abusive relationships we wonder?Fear of revenge by abuser.
-A sense of duty to keep the family together no matter what.
-A fear of losing children due to dangerous circumstances or surroundings.
-Children often don’t report abuse because they don’t want to “tell” on their parents OR they feel like they will get in trouble if they say anything.

This type of violence has several serious affects on the family involved in these individuals. Domestic violence results in the following:

-Emotional pain-family members may feel ashamed and guilty, worthless, depressed, and maybe even anxious.
-Physical injuries-bruises, head injuries, broken bones, and cuts or burns.
-Death-as violence continues it usually gets worse sometimes resulting in death from attacker.
-Other problems-job loss, school problems, unpaid bills, legal problems.

Domestic violence affects millions of families each year, these families are of all ethnicities, income level, and religion. Domestic Violence is a very serious crime and shouldn’t be taken lightly. This violence is never the fault of the victim, always is 100% the abusers fault.

Thoughts From Dr. Bracco

Not-for-profits As Investments

Too often, not-for-profit organizations are viewed as bottomless pits of expenses. They have us reaching in our pockets in order to do good or out of guilt. We do not seem to appreciate them as having a positive economic impact on our community. From an economic perspective we seem to place greater value on the for-profit sector. But, did you know that in our seven county region there are 5,201 not-for-profits who cumulatively have an income exceeding 10 Billion Dollars and assets of over 11 Billion Dollars? These organizations, aside from their humanitarian missions, have a significant impact on their local economies. They provide tens of thousands of jobs that contribute to both taxes and consumerism that spurs growth in our local communities.

Seven Counties Services has multiple major footprints in our community. We are the largest non-hospital not-for-profit and the 26th largest employer in our region. The programs that we provide have assisted many in our community, who would otherwise be disenfranchised, to engage in productive activities that add further value to their lives. Our First Steps Program saves $7 in special education expenses for every $1 that is expended. Where else can you get a 700% return on your investment? Jail diversion services enable us to redirect $1 million dollars a year to other purposes. Project Link allowed the redirection of $23.1 million dollars by insuring that 77 babies were born drug free to mothers who had been addicted to cocaine or alcohol. Family Preservation services kept 451 children at home with their families rather than requiring foster care that would have cost $3.7 million. In virtually every program operated by Seven Counties such results are actualized.

Given the economic challenges we face in our Commonwealth, perhaps an altered perception of not-for-profits is in order. Stimulus dollars have been targeted to “shovel ready” projects which conjure up images of bricks and mortar. We tend to invest in buildings rather than in people. When these buildings are institutions such as jails, psychiatric hospitals, nursing homes, we have taken a short term investment and turned them into a long term expenses. Serving people in these environments rather than through community based services and support for families is not sustainable, nor does it promote recovery and the opportunity for us to realize our potential.