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Does a longer stay help?

September 19th, 2018

How long should someone stay in Rehab?

I’m sure this is a million dollar question and of course depends on so many things, how many problems we have, how bad they are and so on, but still, some people come in for a very brief respite and others stay longer so it’s interesting to know if there is any evidence for different benefits for different lengths of stay.

People come to clinics with many different problems, depression, addiction, alcoholism, eating disorders and so on. Unfortunately we rarely only have just one problem and so treatment needs to be tailored to helping on all these fronts at the same time.

Equally, there are many different treatments, Psychiatry, medicine, psychology, psychotherapy and so on. Understanding exactly which one works best for each individual and in what combination, is a very complicated process and makes research quite tricky. To do any research then, we need to find one common measurable factor and see how it is affected by the combined treatments.

I this study I looked at how depressed people were when they arrive and how this changed through treatment. The Becks Depression Index was created by the co-founder of CBT, Dr Aaron Beck. Thankfully it’s a fairly brief questionnaire but it has the benefit that it has been used in so many different clinical situations that there is very good evidence for its ability to accurately measure depression.

The BDI scores different ranges for depression you can see here:

1-10____________________These ups and downs are considered normal
11-16___________________ Mild mood disturbance
17-20___________________Borderline clinical depression
21-30___________________Moderate depression
31-40___________________Severe depression
over 40__________________Extreme depression

I decided to look at the scores of all the patients in the last year who came in with a score greater than 31, indicating Severe Depression. I then wanted to compare the average score on admission with the average score before leaving depending on how long they stayed. I know this is a small sample group since the research was conducted in a small clinic and I only took the data from the last year, so I may be able to do further analysis and build up greater numbers but it was still an interesting first analysis.

What we found was that for those who only stayed one week, the average score on admission was 37, so close to extreme depression, and the score on discharge, after that one week, was 26, so in the middle of the range of moderate depression. Not a bad shift in just one week!

In the group who stayed two weeks, the scores were quite similar to those who stayed just one week, the admission score was a bit higher, this group were scoring an average of 41 which is categorized as Extreme Depression but after just two weeks the scores came down two categories to 25, described as Moderate Depression.

It is really interesting to note what happened in the next two groups. For the clients who stayed for 3 weeks, the average admitting score was 40, so still very close to the Extreme Depression category, but the score after three weeks of treatment came down to just 13, described as ‘mild’ mood disturbance. Equally, the group who stayed four weeks also had a very high average score on admission of 38 and were just 14 on discharge, four weeks later.

So what can we conclude from this? Again, as I said at the beginning, we have to be careful to draw too many conclusions from such a small sample of patients but it does seem as though, although a one week and two weeks stay is beneficial, it looks as though three and four week stays are where you will see much more significant shifts.

Myth busted, a small amount of alcohol isn’t good for you

September 3rd, 2018

Drinking any amount of alcohol is harmful

Alcohol is the leading attributable cause of death amongst the adult population ( between the ages of 15-49 ) and yet the message people have heard from doctors and the media has been that drinking a small amount of red wine may be good for your health. This was never true but it led to a lot of vulnerable people being given a validation for their drinking by the medical profession. This week, the medical research journal “The Lancet” has finally exposed this myth and made clear it’s advice that drinking anything at all is harmful.

There is nothing wrong with doing harmful things of course. Riding horses is harmful, and yet, people make an educated decision that riding their horse is fun and it is what they choose to do. You could say the same about riding a motorbike or many other activities that people do to enjoy themselves. They are prepared to take the risks that they know go along with it.

The same might be said for alcohol. People drink and enjoy it and can do so knowing the risks involved. So what is the big fuss with this new report in the Lancet?

Well, there is a massive difference when half of the alcohol is consumed by people with a mental health problem which gives them a pathological dependence on alcohol. In this case, every bit of information needs to be as clear as possible.

If you do a quick Google for ‘red wine is good for your heart’ you will find a long list of articles that have come out over the years where people tried to make the case that drinking ‘one glass a day of red wine’ was good for your health, specifically, it was supposed to be good for your heart. Unfortunately, these studies were flawed because they compared moderate drinkers against abstainers without taking into account the health reasons that may have led people to abstain. When you take this factor out, there were never any health benefits to drinking even just one glass of wine per day ( https://www.jsad.com/doi/10.15288/jsad.2016.77.185 ) Every drink did some damage.

So, no health benefits, but on the other hand, among the population from 15-49, alcohol was the leading attributable risk factor in deaths! So there is a massive risk that needs to be communicated about heavy alcohol consumption even though, for some strange reason, it seems to be hard to have that message communicated clearly.

Of course, the average person who drinks just one glass of wine per day probably doesn’t care if they take it or leave it and probably doesn’t care about the minimal impact it might have on their health, positive or negative. Unfortunately, the group who paid most attention to the ‘supposed’ health benefits of alcohol were the group I mentioned earlier who were drinking substantially more than one glass of wine per day and who are experiencing devastating consequences from drinking on all fronts, not least health. Having information which was misleading had the terrible effect of reinforcing denial about the need to stop drinking.

Finally, the truth is made clear. Any drinking is harmful and excessive drinking is excessively harmful.
( https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext ) These are the facts. If you choose to drink moderately and accept those risks then that is great and absolutely your right, but please help us communicate more clearly with the 10% who are hurting themselves and others terribly.

TMS Depression Treatment

March 27th, 2018

Transcranial Magnetic Stimulation is an exciting treatment for depression using magnets to stimulate the dorsolateral prefrontal cortex at the front of the brain which is associated with mood.

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BBC Radio 4 report on bad practice in rehabs

March 19th, 2018

BBC World at One news programme has reported on poor and unsafe practice in the private rehab sector.
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World Sleep Day

March 16th, 2018

Today is world sleep day and poor sleep is one of the most common difficulties people face when recovering from mental health problems.
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PROMIS’s Philippe Cavaroz gives a talk at iCAAD addiction conference in Paris

March 13th, 2018

Philippe Cavaroz presented on behalf of the PROMIS French team at the prestigious iCAAD conference in Paris today. There were speakers representing all aspects of care for people with addiction problems.
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Lets be more careful with the language we use to describe addiction problems

March 1st, 2018

In this last couple of years, I have seen Dr John Kelly speak a few times and I am always impressed with what he has to say. I want to share a few ideas he has brought up and to begin with, I’d like to share his ideas about the language we use to describe addiction problems, both as lay people and professionals.

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Antidepressant effectiveness rated

February 26th, 2018


This week a research study was published in the medical journal “The Lancet” which aimed to evaluate the effectiveness of many different antidepressants. This wasn’t new research per say, but a huge study of lots of published and unpublished papers.
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10 of the best: Products to aid sleep

January 29th, 2018

Sleep was the antithesis to my addiction. The concept of an assigned task to be completed in a specific time frame – simply unrealistic. The closest I came to restfulness was a mild neurological siesta, usually at the most inopportune moment.
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10 of the best: Free-from beauty products

January 22nd, 2018

Once we’ve done the hard bit and banished the nasties from our bodies, we can start to be more conscious of what products we’re using on our skin – from the value of their properties to the repercussions of their manufacture. Here’s our pick of the 10 best free-from products, what they do and why we love them.

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