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GAM BIT’S HEALTH & WELLNESS > SEPTEM BER 2011 >VOLUME 37 > NUM BER 9
G A M B I T ’ S H E A LT H + W E L L N E S S
DEFINING
ADDICTION NEW RESEARCH SHOWS ADDICTION IS LARGELY A GENETIC DISEASE. A HOMEGROWN BOXINGINSPIRED WORKOUT
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INTEGRATIVE
MEDICINE
9
A RECIPE FOR MOSTARDA, AN ITALIAN CONDIMENT
10
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HealtH & Wellness > bestofneworleans.com > september 06 > 2011
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C
ntents s e p t e m b e r 2011
Fighting Addiction?
5
The roots of addiction lie in our DNA.
7
A boxing-inspired boot camp.
9
Integrative medicine combines many healing modalities.
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A sweet-and-spicy mostarda recipe.
HealtH Feature
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expert adviCe
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Wellspring Health news in brief.
The Science of Addiction
addiction is a brain disease, not a choice, says the american society of addiction medicine. by missy Wilkinson
D
behaviors such as food or gambling or sex. (It is) the same disease state. Addiction is not a choice.” The new definition reveals addiction to be a primary disease, much like diabetes or cardiovascular disease. It can be a root cause behind other behavioral, social and psychological problems like depression, cognitive distortions, social isolation and anxiety. According to ASAM’s definition, “genetic factors account for about half the likelihood that an individual will develop addiction” — meaning if one of your parents is or was an addict, you are genetically predisposed to developing addiction. Since addiction has physical, neurobiological causes, one would expect the brains of addicts to function differently than the brains of non-addicts. This is exactly what happens, says Dr. Howard Wetsman, medical director at Townsend, a network of local outpatient addiction treatment centers. Many (not all) addicts have a morphology (or mutation) in the genes associated with the production, release, reuptake and metabolizing of dopamine, a neurotransmitter associated with pleasure and reward. Wetsman refers to the intricate factors governing normal dopamine levels as “dopamine tone.” “Generally, people who have a low dopamine tone are not able to make great attachments and feel rewards from normally rewarding activities, and that is when the drug or behavior comes along,” he says. “ Our society likes to think that drugs cause addiction. It’s actually the other way around for most people with addiction. The addiction causes the drug use,” he writes in his book, QAA: Questions and Answers on Addiction.
The new definition reveals addiction to be a primary disease, much like diabetes or cardiovascular disease.
a largely genetic, chronic, potentially The genetic factor is so pervasive terminal brain disease, addiction requires that Wetsman has instituted genetic lifetime treatment. testing as part of Townsend’s intake procedure. “The test identifies two dozen genetic mutations in the brain that relate to symptoms of addiction,” says John Antonucci, an intake coordinator at Townsend who is recovering from addiction. “This information helps fine-tune medical interventions, and it is amazing when you take a patient and their family members, and they realize it really is a biological brain disease. I like to equate it to seeing the X-ray when you have a broken arm. And I have seen family members break down and cry when they realize all this time, their kids weren’t doing this to spite them. They were doing it because they were sick.” Though Antonucci says nine out of 10 of Townsend’s patients report addiction in their family trees, there are some addicts without a family history or genetic indication of the disease (but because addiction can express itself through many different compulsions, from overeating to compulsive spending, it can sometimes be hard to trace, Wetsman says). New Orleans native, Xavier University alumnus, father of five and recovering addict Darryl Rouson, now a Florida state representative, had no known family history of addiction. “My mother was known to cut her beer with 7-Up, and my dad drank three or four times a year,” says Rouson, who began drinking and using cocaine in the ’80s. “I wasn’t drinking for the social nature, I wanted the effect, and I wanted it quickly, and for a long time. For me, it started out filling what I thought were voids in my life, low self-esteem: I never thought I was cute enough, strong enough, athletic enough or smart enough, and I was always doing things to compensate for these lacks.” Rouson says he has been through eight treatment programs and is well-versed in the genetic component of addiction, but he has never been tested for the morphologies. Though genetic testing can provide clarity to a diagnosis of addiction, and a basis for what medications will best normalize individuals’ brain chemistry, neither testing nor medications are necessary for recovery. “There are millions of people who have gotten sober by going to 12-step meetings (like Alcoholics Anonymous or Narcotics Anonymous). For some people, that works,” says Jo Cohen, clinical director page 6
HealtH & Wellness > bestofneworleans.com > sePtember 06 > 2011
escribed in the Alcoholics Anonymous Big Book as “cunning, baffling, powerful,” addiction often seems as inscrutable as the human mind itself. Its reach is widespread: Else Pedersen, executive director of Bridge House, estimates 10 to 15 percent of the population has an addiction. “We all either have this or have some strong primary connection to it,” she says. “This is everywhere, and it needs to be dealt with like the medical issue it is. We need to give it the same attention we give other diseases that are progressive, pervasive and potentially lethal.” Last month, The American Society of Addiction Medicine (ASAM) made a big step toward widespread recognition of addiction as a medical issue rather than a behavioral issue or moral failing. It released a new definition which states addiction is a chronic, underlying, largely genetic brain disease. “The disease is about brains, not drugs,” former president of ASAM Dr. Michael Miller said in a press release. “It’s about underlying neurology, not outward actions.” Miller oversaw a fouryear effort by more than 80 addiction experts and neuroscience researchers which yielded the new definition. Dr. Ken Roy, medical director of Addiction Recovery Resources Incorporated in Metairie, calls it a game-changer. “This is a definition based on a consensus of expert opinion and scientific literature that changes the understanding of addiction from a choice or a self-treatment to a condition of brain structures that basically compels behavior outside the ability to choose,” he says. “It’s also pivotal in the sense that it equates a compulsion to use chemicals with compulsions to have other kinds of
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“Our medical approach to addiction dovetails very nicely into 12-step recovery, because there is a scientific basis behind how it works.”
HealtH & Wellness > bestofneworleans.com > september 06 > 2011
- John Antonucci, intake coordinator at Townsend
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of Bridge House and Grace House in New Orleans. “We support the science, but like everything else in treatment, it’s an individualized approach.” Although people do not choose to become addicts, they do have choices over how they manage the disease. Addiction requires ongoing treatment, which varies from person to person — some may benefit from ongoing use of medications like Suboxone, some may require longterm inpatient treatment, others may stay sober simply by attending 12-step meetings. Antonucci stresses that a strong routine of recovery-related activities like meetings or volunteering helps people maintain sobriety, as does access to help from addiction doctors. “This is a chronic disease like diabetes or hypertension,” he says. “If you are diabetic, you get exercise and take insulin, but there are times you need to check up with your endocrinologist.” Rouson manages his addiction by attending 12-step meetings, sponsoring other recovering addicts, reading Alcoholics Anonymous literature, and giving back to the community by sharing his story at prisons and recovery centers. He will speak at Xavier Wednesday, Sept. 14, to celebrate National Recovery Month. “One of the critical reasons why I got clean was I was given a choice,” he says. “(My wife) Ruby was dead and I had taken her $80,000 life insurance policy and spent $60,000 on cocaine. I was in a courtroom with my wife’s family and they were trying to convince the judge to take my four-year-old son. The judge said I could either choose Daniel or drugs, but after today, I would not have both. I chose my son.” Antonucci and Rouson both say their community outreach work, which is a tenant of Alcoholics Anonymous (the 12th step states, “Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs”), is essential to their ongoing sobriety. And though there may seem to be a disconnect between the scientific, biologically based addiction definition and the DR. HOWARD WETSMAN, MEDICAL DIRECTOR AT spiritually based 12-step TOWNSEND, HAS INSTITUTED GENETIC TESTING AS PART OF programs, ASAM’s THE RECOVERY CENTER’S INTAKE PROCEDURE. research scientically sup-
SUPPORT GROUPS AND 12-STEP MEETINGS HELP ports the activities recovering addicts MILLIONS OF PEOPLE STAY SOBER. undertake in 12-step recovery programs as ways to maintain sobriety. “Our medical approach to addiction dovetails very nicely into 12-step recovery, because there is a scientific basis behind how it works,” Antonucci says. “Part of my recovery is, I serve food to homeless people every Saturday night, and afterwards, I feel great. Why do I feel great? My hedonic tone has gone up. Doing something really healthy for the community has changed my brain chemistry.” Wetsman agrees that engaging in charitable activities can normalize dopamine levels. “You get dopamine lowering from being isolated and feeling less-than,” he says. “You can’t feel isolated and less than when you help somebody else — dopamine receptors actually physically gain in number. The receptors are much more plastic than we think.” Pedersen, Antonucci and medical professionals across the board hope the new definition of addiction will serve to remove much of the shame and stigma surrounding the disease, which in turn will facilitate recovery for the millions who suffer from addiction. “When people have a strong understanding about the disease, that’s when the miracles happen, and treatment can be extremely successful,” Antonucci says. “Don’t be afraid to get better. This can work for you, too. Give yourself a chance.”
RESOURCES Alcoholics Anonymous: 838-3399 (24-hour helpline); www.aa-neworleans.org Addiction Recovery Resources: 4836 Wabash St., Metairie, 780-2766; www. arrno. health.officelive.com Bridge House: 4150 Earhart Blvd., 522-4474; www.bridgehouse.org Grace House: 1401 Delachaise St., 899-2423; www.gracehouseneworleans.org River Oaks Hospital: 1525 River Oaks Road W., 734-1740; www.riveroakshospital.com Townsend: 888-504-1714 (24-hour patient line), 3600 Prytania St., Suite 72, 8975144; 4330 Loveland St., Metairie, Suite A, 454- 5172; 19411 Helenberg Road, Suite 101, Covington, 985-893-2522; www.townsendla.com.
e x e r ci s e fo r li f e
living on the edge Created by a loCal boxing instruCtor, the edge system gets partiCipants in fighting form. by russ lane
A
created at the Impact Center in Flagstaff, Ariz., where he used heavy bags for training purposes. “It was this gumbo of 20 years in boxing and the exposure to all the different elements I learned in fitness and strength and health,” he says. The boxing tradition is most evident in The Edge’s emphasis on dynamic exercise: explosive movements and coordination. In traditional weight lifting, Hudson explains, you lift a weight, stop, and put the weight down. The energy and movement stops prematurely. By contrast, Hudson emphasizes throws and jumps. “When you throw, you keep the movement focusing outward,” he says. “You don’t stop the movement prematurely.” A lanky boxer demonstrates the principle, throwing a bag across the room and using hip motion for power and balance — the same movement behind a straight right punch. The Edge’s homegrown status allows Hudson and workout instructors to constantly refine the program, and the nature of the workout allows participants to isolate muscles and increase coordination in ways traditional cardio or weight lifting can’t, Hudson says. Participants of varying skill levels all received results, whether they were trying to lose weight, wanted supplement training for sports or a structured program to build discipline. “I tell people that if you’re doing other activities, if you’re doing ... other fitness sports, this should improve it,” Hudson says. “In other words, it’s a systemic improvement, it’s not sportsspecific. The way it impacts you is to make you more effective.” page 8
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t St. Charles Avenue Athletic Club (1600 St. Charles Ave., 523-2582; www.scaac-nola.com), a stocky yet peppy Russian instructor urges 12 men and women to run in place while executing 30 triceps extensions. They use weighted bags for resistance, and the contents shift with each movement. There’s a domino effect of thuds as participants hurl the bags to the floor after finishing their repetitions. “Trust me, I’m feeling it too,” says instructor Konstantin Smorodnikov. Welcome to The Edge System. The four-week program combines cardio, strength, mobility and endurance training into a workout where weighted bags serve as the only special equipment. But as its name suggests, intensity (or an “edge”) is integral to the program. Jazzercise this ain’t. “It’s a boxer’s workout without hitting or being hit,” says Daniel Hudson, who created the program. “You’re using all the techniques and skills, but presenting them … in such a way they’re accessible to those who aren’t professional athletes or professional boxers.” A former boxing instructor and 2001 Golden Gloves Champion, Hudson says his program took its cues from New Orleans’ rich boxing tradition, which dates back to the late 1800s, when Louisiana became the first state to legalize prizefighting. Hudson was introduced to boxing in Monroe, La. and worked out with Kenny Weldon, one of the sport’s top trainers. Hudson also completed some of Evander Holyfield’s training program. When teaching group exercise as a side project, Hudson thought back to the boxing program he
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E X E R CI S E FO R LI F E
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TIPS AND TRICKS TO MAXIMIZE THE EDGE EXPERIENCE Bring a large water bottle. Running to grab extra water takes too much time and interrupts the workout flow. No 16-ounce bottle will do. Use weights strategically. The weighted bags come in an assortment of weights. Keep a variety of weighted bags close at hand for different exercises. Stick with a lighter bag to better isolate hard-to-train muscles and perfect the movements. When in doubt, ask. If you’re concerned about getting injured or confused by the complex movements, speak with the instructor following the session. Rookies, move up. Stay close to the instructor if you’re just learning the movements and routines. You’ll learn faster and the instructor will be able to help more. A tip if you’re struggling: Most movements have variations for those concerned about injury or physical limitations. But don’t use them as a crutch. When in doubt, focus on your breath, not the pain, and you’ll be astounded by what you accomplish.
HEALTH & WELLNESS > BESTOFNEWORLEANS.COM > SEPTEMBER 06 > 2011
IN THE EDGE SYSTEM, WEIGHTED BAGS ARE THE ONLY EQUIPMENT PARTICIPANTS USE.
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from the professionals of east j e f f e r s o n g e n e r a l h o s p i ta l
holistic health by KatiE KiddEr crosbiE
i
doctor with East Jefferson General Hospital, recently completed a fellowship in integrative medicine at the Arizona Center for Integrative Medicine at the University of Arizona. “Human beings are naturally able to heal themselves, and our role is to foster that,” Magonet says.“People see that a cut heals on their hand, but they don’t necessarily think they can heal their depression. I think a lot of it is harnessing natural healing. That’s a big part of the philosophy.” Integrative medicine physicians do not see Eastern and Western medical practices as mutually exclusive. Treatment plans may run the gamut of medical procedures (including prescriptions and surgery) combined with holistic therapies like massage, acupuncture, supplements, counseling, meditation, nutrition and exercise. The goal is to work with the patient to find the best possible treatment within the realm of what that patient wants. Magonet explains hypothetically what a patient suffering from depression might expect during a visit to his office: “I would ask all the standard questions related to their symptoms such as what is their past history, are they taking drugs and alcohol, what are the current stressors in their life,
etc. Then I would push it a bit more: What’s your diet like? Are you taking any supplements? What’s your social support like? “We strive to find solutions that can accomplish our clinical goals while also fitting in with the wishes of our patients. That might include supplements that have been used to treat depression, exercise to alter mood, getting them involved socially, or focusing on sleep, which can have a huge impact on mood.” Integrative medicine skeptics in the medical community argue that integrative medicine waters down the evidence-based practice of Western medicine with largely unproven treatments and therapies, attributing positive results from these practices to the placebo effect. “Critics … say it is belief-based rather than reality-based or that there is a large impact from the placebo effect, but I would say all medicine is influenced by the placebo effect,” Magonet says. “There is acceptance if you look at a variety of medical centers that now have centers for integrated medicine like Harvard, Duke and the University of California at San Francisco.” An increasing number of scientific studies point to benefits of holistic treatments.
Acupuncture appears to lessen symptoms of nausea in cancer patients receiving chemotherapy. The National Cancer Institute reports, “Of all the investigated effects of acupuncture on cancer-related or chemotherapy-related symptoms and disorders, the positive effect of acupuncture on chemotherapy-induced nausea and vomiting ... is the most convincing, as demonstrated by the consistency of the results of a variety of clinical study types …” Perhaps the most revolutionary aspect of integrative medicine is the way physicianpatient relationships are viewed. Because the goal is to treat the person as a whole instead of responding only to symptoms, physicians spend considerable time talking to their patients, hearing what they want for themselves and their health and learning what motivates them. “I see more patients who want to take control of their health and their life,” Magonet says. “It is our job to acknowledge the desire on the part of the patient to be proactive in their health, rather than have the physician as a paternal kind of figure. It’s a collaboration.”
HealtH & Wellness > bestofneworleans.com > sePtember 06 > 2011
f you hear of integrative medicine in passing, it may trigger thoughts of acupuncture, herbal supplements and chiropractors. While it’s true that the blending of Eastern and Western medicine is part of what defines the approach, integrative medicine (like the patients it treats) is more than just a sum of its parts. Integrative medicine’s driving philosophy is to treat the whole person by considering of all facets of his or her lifestyle. In addition to a patient’s symptoms, integrative physicians take into account personal history, stressors, eating habits, social interactions and sleep patterns. Originally met with skepticism within the medical community, the field is rapidly gaining support across the country. As defined by The Consortium of Academic Health Centers for Integrative Medicine, integrative medicine “reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and healing.” Gordon Magonet, a family medicine
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Mostarda with the Most a sweet, spicy mix of mustard and candied fruit, this italian condiment brings intense flavor with minimal calories. By ruSS lane
w
ith their ability to tack on excess calories, saturated fat and salt, sauces often are considered a health taboo. Yet if prepared wisely, they can provide variety and panache to lean proteins and vegetables. Mostarda, a little-known Italian condiment, pairs brilliantly with pork and turkey. As a makeahead dish or for entertaining, it provides a little heat, a little sweetness and a lot of creativity to standard healthy fare. A tangy cross of a jam, a pickled fruit and a chutney, mostarda is prepared by candying pitted fruits and pairing the mixture with ground mustard seed-infused oil. “In some places, (the fruit-mustard combination) is probably a big jump because most (people) are used to yellow mustard,” says chef Chris DeBarr of The Green Goddess. “It’s basically a chutney by any other name, but it has the presence of mustard seed and mustard oil.” This healthful take on mostarda is a twist on a variant from the Veneto, Italy region, where mostardas are more jam-like than candied. We keep the two essential ingredients — mustard seed and fruit — and replace sugar and oil with small amounts of high-flavor ingredients: Citrus, honey and red wine lend sweetness; low-sodium chicken broth and balsamic vinegar provide richness; and rosemary and cinnamon bring the intensity. Prepared mustard (Dijon or Creole) is a quick alternative to mustard oil. By lengthening the cooking time, flavors reduce and intensify, increasing sweetness, tang and bite without adding salt or sugar. The end result is worth the time, creating a dining experience that belies its low caloric impact. Given the intensity of its flavors, the mostarda is best served in limited portions, like a sipping whiskey. DeBarr notes that most mostardas use pitted fruits. Cherries are our favorite option, but mashed figs and blueberries provide a late-summer alternative.
what Sour Cherry MoStarda
&
how
Recipe by Russ Lane Makes about 1 1/2 cups 2 taBleSpoonS Chopped red onion 1 Clove garliC, Chopped 1/2 teaSpoon MuStard SeedS, toaSted and CruShed 1/2 Cup Creole or dijon MuStard, divided 1 Cup Sour CherrieS, pitted 1/2 Cup dried CranBerrieS ZeSt and juiCe of one orange 1/4 Cup red wine 2 taBleSpoonS BalSaMiC vinegar or apple Cider vinegar 1 Cup water, or flavored Beef or ChiCken StoCk 1/2 ounCe freSh roSeMary, Chopped 1/8 teaSpoon CinnaMon 1 taBleSpoon olive oil for Sauteing 1 taBleSpoon honey, or Brown riCe Syrup, or agave neCtar (optional)
On high heat, saute onions, garlic and mustard seeds until softened. Add dried fruit, orange zest, orange juice, red wine, vinegar and water/stock, scraping the pan’s bottom to dislodge particles. Add mustard, reduce heat to medium and stir occasionally to prevent burning. After about 20 minutes of cooking, add fresh rosemary. Continue cooking until the mixture reaches a jam-like consistency (about 10 more minutes), then set it aside to cool. Adjust the flavors with no more than 1 tablespoon of honey for sweetness or mustard for bite. Serve chilled or at room temperature with pork, lean meats or bitter greens. Per serving: calories 46, calories from fat 12g, fat 1g, saturated fat 0g, sodium 132mg, total carbohydrates 6g, dietary fiber 1g, sugars 3g, vitamin C 18 percent daily value, potassium 79 mg.
E
W LL spring
h E a Lt h n E Ws b r i E f s
brEastoration fund
Saturday, Sept. 10, the House of Blues will raise funds for breast cancer survivors when the Louisiana Breast Cancer Task Force holds its annual “Pink Ribbon Fling” gala to benefit The Cancer Association of Greater New Orleans’ (CAGNO) Breastoration Fund. The fund was created by cancer survivors to help women who are considering breast reconstruction following a mastectomy and to provide educational resources to those at risk for, or diagnosed with, breast cancer. The gala begins with a patron party from 7 p.m. to 8 p.m., and will feature Rockin’ Dopsie and the Zydeco Twisters. Additional activities include a reception buffet, open bar, silent auction and raffles. Tickets for the patron party are $125, and tickets for the main event are $75. They may be purchased online at www.cagno.org or by calling 293-2618. — Lora Ghawaly
ovarian and brEast CanCEr faCts
ContEst WinnEr Curbs hiv stigma
New Orleans native La’Nette Buras is among the 10 first-place winners of the 2011 REYATAZ “Fight HIV Your Way” contest. The contest, which received more than 1,300 entries, invited people affected by HIV to submit an essay or photo documenting the way they fought the disease. The contest was created to raise community awareness of and lessen the social stigma surrounding HIV. Buras’ story, along with the other winners’ entries, has been sent to the Alvin Ailey American Dance Theater as inspiration for a new work, which premieres on World AIDS Day, Dec. 1. — Ghawaly
advanCEs in shouLdEr rEpLaCEmEnt surgEry
Dr. Brett Cascio, a surgeon at Lake Charles Memorial Hospital, is one of the first physicians in the nation to perform the Total Shoulder resurfacing procedure. The procedure, which resurfaces damaged joint bone and tissue and uses 3-D mapping technology to identify appropriate implant sizes, is a less-invasive alternative to shoulder replacement surgery. Approximately 5,000 shoulder arthroplasties (joint repair surgeries) are performed annually. — Missy Wilkinson
hEart impLant study
The Louisiana Heart Center completed one of its first implants of the AngelMed Guardian cardiac monitor and alert system,
Dr. Brett CasCio reCently performeD one of the nation’s first total shoulDer resurfaCing proCeDures at lake Charles memorial hospital.
T KS A N E A GR S! TH 4 AR R E FO Y
GET A
which helps patients get to the emergency room more quickly during a heart attack’s early stages by tracking major changes in the heart’s electrical signals and notifying patients they should seek medical attention. The monitor is part of an ALERTS Pivotal study, which investigates the safety and effectiveness of the new system. The Louisiana Heart Center is one of the first medical facilities to use the AngelMed Guardian system. Patients interested in participating in the ALERTS study should contact Brandy Ocman at the Louisiana Heart Center by calling (985)871-4155, ext. 304. — Ghawaly
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From 5:30 p.m. to 7:30 p.m. Tuesday, Sept. 13, The Center for Restorative Breast Surgery (1717 St. Charles Ave., 899-2800; www.breastcenter.com) hosts a talk with gynecologic oncologist Dr. Patricia Braly
about the genetic factors that link ovarian and breast cancers. Braly, who has treated women’s cancer for more than 30 years, will discuss BRCA1 and BRCA2 genes and their ties to cancer. The free program is part of the Center’s monthly EnCourage support group meetings. Reservations are required. — Ghawaly
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