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Behavioral Health: The Link to Individual and Organizational Wellness

Mark S. Gold, MD Distinguished Professor & Chairman Department of PsychiatryUniversity of FloridaMarch 26 & 31, 2009

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Agenda

• Discuss how mental health and substance abuse issues can negatively affect the workplace

• Learn about the importance of exercise in mood maintenance, recovery, and resilience

• Gain strategies to promote understanding of mental health issues, drug addictions, interventions and treatment

• Enhance your company’s ability to support employees with regard to behavioral health issues and improve the bottom line

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U.S. has dropped from 11th to 42nd place, over 20 years, in the world ratings for life expectancy

Why? Expensive health insurance, rising infant mortality rates and an ever-increasing rate of obesity

Alcohol/drug related accidents cause most of premature deaths

More than 25% of babies are born after exposure to tobacco, alcohol, and drugs

The decline reflects the disparity in wealth: The life expectancy of African Americans is 73.3 compared with 77.9 for

whites.

For African-American males, it is even shorter: 69.8.

Nearly 1/3 of U.S. adults are obese

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U.S. Life Expectancy Ranking Drops

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• Tobacco• Lack of exercise, obesity• Alcohol• E.T.S.• Drugs, alcohol, accidents and suicide

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50% of Deaths in U.S.

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Actual Cause No. (%) in 1990 No. (%) in 2000

Tobacco 400,000 (19) 435,000 (18.1)

Poor diet / inactivity 300,000 (14) 400,000 (16.6)

Alcohol consumption 100,000 (5) 85,000 (3.5)

Microbial agents 90,000 (4) 75,000 (3.1)

Toxic agents 60,000 (3) 55,000 (2.3)

Motor vehicle 25,000 (1) 43,000 (1.8)

Firearms 35,000 (2) 29,000 (1.2)

Sexual behavior 30,000 (1) 20,000 (0.8)

Illicit drug use 20,000 (1) 17,000 (0.7)

Total 1,060,000 (50) 1,159,000 (48.2)

Mokdad et al., JAMA 2004

Causes of Death in the U.S.

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• Air• Exposed skin• Hands• Head-hair

Source of Secondhand Exposure

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Nov. 4, 2002

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The swimmer, who won a record eight gold medals at the Beijing Games, did not dispute the authenticity of the picture: “I engaged in behavior which was regrettable and demonstrated bad judgment,” Phelps said.

Michael Phelps

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AVERAGE POTENCY OF TESTED CANNABIS SAMPLES

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9.00%

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SEIZURES

DOMESTIC ERADICATION

ALL SAMPLES

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NEJM 357(12): 1222; 2007

Proportional Contribution to Premature Death

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Cocaine Positivity by Zip Code, 2006

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Cocaine Deaths in the State of Florida

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Effects of Drug Abuse

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• Drugs produce sense of well-being and euphoria

• Drugs of abuse change the brains set point for reward and pleasure

• Drug withdrawal produces depression and anhedonia

Anhedonia and Abstinence

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Annual Numbers of New Non-medical Users of Pain Relievers: USA, 1965-2002

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• Tobacco– 12 million deaths over past 40 years– 30% of cancer & heart disease deaths– linked to other substance abuse, mental

illness in teens• Alcohol

– linked to liver disease, cancers, unintentional accidents / mortality, suicide, co-occurring mental health disorders

• Illicit drugs– 16,000 deaths annually– risk of teen depression, conduct problems

and death from homicide, suicide, accidents, illness

Health Consequences

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Total Cost of Addiction to Society, 2007: $647.6 Billion

Tobacco$201.4 billion

Alcohol$236.5 billion

Illicit Drugs $209.7 billion

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Substance Costs to NIH Prevalence Society Spending

AOD $446B 1.5B 22 millionCancer $219B 5.5B 10 millionTobacco $201B 0.5B 25 millionDiabetes $154B 1.0B 16 millionDepression $100B 0.4B 19 million

HIV $ 40B 3.0B 0.44 million

Comparative Costs, Spending, & Prevalence

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Drug-Related Visits Alcohol-Related Visits

0%

2%

4%

6%

8%

10%

0.6%

5.0%

2.7%

5.5%

3.7%

7.0%

1995

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2000 2005 1995 2000 2005

Adapted by CESAR from Cherpitel, C.J. and Ye, Y. “Trends in Alcohol- and Drug-Related ED and Primary Care Visits: Data from Three U.S. National Surveys (1995-2005),” The American Journal of Drug and Alcohol Abuse 34(5):576-583, 2008.

U.S. Drug-Related Emergency Department Visits by Adults Increased Significantly Since 1995

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Drug Abuse Is a “Treatable Drug Abuse Is a “Treatable Disease”Disease”

NIH/NIDA

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MDs are out of the loop (Penn Addiction Referral Sources)

Source of Addiction Referrals 1990 2004

Criminal justice 38% 59%Employers/EAP 10% 6%Welfare/CPS 8% 16%Hospitals/physicians 4% 3%

Huge Public Health Problem

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“Bridget Jones’s Diary”

Depression and Smoking

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• Genetics• Access to

fattening foods:– increase in

fast-food restaurants

– high-calorie corn syrup consumption

• Result? The population of obese U.S. adults has grown 50% since the 1970s

What’s Making Us So Fat?

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… thatMarilyn Monroe was 5’5” tallandweighed a healthy 135 pounds

Did You Know …

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… that most fashion models are thinner than 98% of American women

Did You Know …

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employees $285,000 a year, 30% of which is from missed employees $285,000 a year, 30% of which is from missed workdaysworkdays

• Men who carry around extra fat cost their employers $170 more in medical expenses

• Overweight women ring up $495 more in doctor bills

The Fattening of America … Employers Are Concerned

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Percentage of Adult Obesity

• Mississippi is No. 1 in obesity: 31.7%• Change over last year: up 1.1 points

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DietDiet Physical ActivityPhysical Activity

Lifestyle Lifestyle ModificationModification

PharmacotherapyPharmacotherapy

SurgerySurgery

Obesity Treatment Pyramid

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Steinbrook, R. N Engl J Med 2004;350:1075-1079

Estimated Number of Bariatric Operations Performed in the United States, 1992-2003

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Self-medication hypothesis

• Some patients report food is comforting in times of stress

• When offered a more palatable diet, most animal species eat more and become obese.

Depressed and Stressed

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~5%~5%Weight LossWeight Loss

5%-10%5%-10%Weight LossWeight Loss

HbA1cHbA1c

Blood PressureBlood Pressure

Total CholesterolTotal Cholesterol

HDL CholesterolHDL Cholesterol

TriglyceridesTriglycerides

1. Wing RR et al. Arch Intern Med. 1987;147:1749-1753.

2. Mertens IL, Van Gaal LF. Obes Res. 2000;8:270-278.

3. Blackburn G. Obes Res. 1995;3 (Suppl 2):211S-216S.

4. Ditschunheit HH et al. Eur J Clin Nutr. 2002;56:264-270.

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Impact of Weight Loss on Risk Factors

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• Not smoking• Taking exercise• Moderate alcohol intake• Eating five servings of fruit and

vegetables a day

Source: Khaw KT, Wareham N, Bingham S, Welch A, Luben R, et al. (2008) Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk Prospective Population study. PLoS Med 5(1): e12.

Four Health Behaviors Can Add 14 Extra Years of Life

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5% - 10% weight loss =  • improved symptoms of arthritis• improved mobility and physical endurance • improved blood pressure• improved cholesterol• 20%+ reduction in total mortality • 30%+ reduction in diabetes-related deaths • 40%+ reduction in obesity-related cancer deaths

Impact of Weight Loss on Health

Source: National Heart, Lung, Blood Institute

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Complex Multi-Factorial

EnvironmentDrive Time

City PlanningSociety Mores

Ethnicity Income

Education

Genetics

Lifestyle

Taste Preference

Processed Foods

Cultural

Physical ActivityMetabolic

Food

Psychologicaland

Behavioral

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• Some 70 million Americans suffer from a chronic sleep disorder or intermittent sleep problem

• Women have the problems more often than men

• Sleep difficulties increase with age

Sleeplessness Is Up, as the Economy Is Down

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Sleeplessness Is Up, as the Economy Is Down (cont.)

Other findings in the poll:• 46 percent said their sleep needs aren't being met• 35 percent sleep less than six hours a night• Consequences of sleep deficit:

– 41 percent have driven while sleepy– Almost 1/3 said that lack of sleep affected their

work– 1/3 said lack of sleep caused emotional

problems, such as anxiety and depression• Sleep disorders reported:

– 89 percent reported insomnia– 33 percent reported restless leg syndrome– 14 percent reported sleep apnea

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Like butter and sugar, obesity has a cost per pound The annual per-pound cost of being overweight is $19.39. For 25-year-olds, it averages $10.25 for every overweight

pound. By age 64, it increases to $26.32. (On average, overweight people are 29 pounds overweight;

the obese are 82 pounds overweight.) Added annual health care costs:

For someone age 25: $209 for the overweight $960 for the obese

By age 64: $610 for the overweight $2,300 for the obese

Costs in Dollars

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Elements of Successful (MD )Treatment—Apply to All Chronic Disease Management

• Active involvement of coach or manager• Contingency management• Frequent random drug testing• A.A. and abstinence orientation• Active management of relapse and intensified

treatment in response• Long-term, 5-year plus, continuing care approach• Include diet• Include exercise• Include stress-/self-management • Focus on lifelong recovery

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Resources

• Dr. Goldhttp://www.psychiatry.ufl.edu/faculty/gold-mainshort.shtml