Tag Archives: behavioral health

A Pediatrician’s View On Alcohol and Marijuana

As my children, and my friends’ children, are getting older, a question that comes up again and again from friends is this: Which would I rather my children use — alcohol or marijuana?

The immediate answer, of course, is “neither.” But no parent accepts that. It’s assumed, and not incorrectly, that the vast majority of adolescents will try one or the other, especially when they go to college. So they press me further.

The easy answer is to demonize marijuana. It’s illegal, after all. Moreover, its potential downsides are well known. Scans show that marijuana use is associated with potential changes in the brain. It’s associated with increases in the risk of psychosis. It may be associated with changes in lung function or long-term cancer risk, even though a growing body of evidence says that seems unlikely. It can harm memory, it’s associated with lower academic achievement, and its use is linked to less success later in life.

But these are all associations, not known causal pathways. It may be, for instance, that people predisposed to psychosis are more likely to use pot. We don’t know. Moreover, all of these potential dangers seem scary only when viewed in isolation. Put them next to alcohol, and everything looks different.

Because marijuana is illegal, the first thing I think about before answering is crime. In many states, being caught with marijuana is much worse than being caught with alcohol while underage. But ignoring the relationship between alcohol and crime is a big mistake. The National Council on Alcoholism and Drug Dependence reports that alcohol use is a factor in 40 percent of all violent crimes in the United States, including 37 percent of rapes and 27 percent of aggravated assaults.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary

Loopholes in Insurance Barring Mental Health Patients

A flood of patients who have become newly insured under the Affordable Care Act are visiting doctor’s offices and hospitals, causing some health workers to worry about how they can provide care to everyone in need. One group, however, isn’t lining up for care: People with mental health issues or substance use disorders.

Though Obamacare extends coverage to this group – collectively referred to as behavioral health – various loopholes in the health care law at this time have kept people from requesting mental health care. Some states haven’t expanded Medicaid, the government health insurance program for poor or disabled Americans, leaving about 5 million in a coverage gap, the majority of whom, experts believe, need mental health care. In other cases, patients aren’t even aware of the benefits they can get with their new health insurance.

The Congressional Budget Office projected that 13 million uninsured Americans would have access to health coverage by 2014, whether through Medicaid, online exchanges or the private market. But so far the demand for mental health services hasn’t budged, even though provisions in the health law make it more affordable.

More patients seeking mental health care will come within the next few years, experts project, and the question then will be whether there will be enough providers available. Paul Gionfriddo, CEO of Mental Health America, predicts a ” bump in the road where access gets a little more constrained,” though he is optimistic that the details of the law will work the way they are supposed to in time.

“We haven’t been hearing about access issues from our members,” says Stuart Gordon, director of policy and health care reform at the National Association of State Mental Health Program Directors.

That isn’t for lack of need. Mental health is one of the most common health care issues, affecting as many as 1 in 4 adults each year.

The federal Substance Abuse and Mental Health Services Administration found in a 2013 report that 9.6 million adults reported having a serious mental illness, such as major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder.

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Jeffrey R. Ungvary President

Jeffrey R. Ungvary