- Sedative, hypnotic, or anxiolytic use disorder is the continued use of these
substances despite clinically significant distress or impairment.
- It typically includes a strong desire to take these substances, difficulties in
controlling their use, persisting in their use despite harmful consequences, a
higher priority given to the use of these substances than to other activities
and obligations, increased
tolerance, and a physical withdrawal state.
Prediction
Episodic or continuous for years
Problems
Occupational-Economic Problems:
- Significant academic or occupational impairment (e.g., increased errors,
school/work absenteeism, decreased productivity, theft of drugs)
Disinhibited (Disinhibition):
- Intoxicated behavior, impaired driving
- Impulsivity, dangerous risk taking, irresponsibility
- Law-breaking, violence
- Marital (or child) discord/abuse/neglect
Cognitive Impairment (Impaired Intellect):
- Marked denial; lack of insight
- Impaired concentration, memory, learning
Emotional Distress (Negative Emotion):
- Depressed mood, generalized anxiety, suicidal behavior
Medical:
- Intoxication causes relaxation, sleepiness, and mild euphoria (getting high)
- Denial of addiction; accidental or deliberate overdoses; withdrawal seizures;
automobile accidents; accidental injuries
 Back
to top
Click Here For Free Diagnosis
Limitations of Self-Diagnosis
Self-diagnosis of this disorder is often inaccurate. Accurate diagnosis of this disorder
requires assessment by a qualified practitioner trained in psychiatric diagnosis and
evidence-based treatment.
However, if no such professional is available, our free computerized diagnosis is usually
accurate when completed by an informant who knows the patient well. Computerized
diagnosis is less accurate when done by patients (because they often lack insight).
Example Of Our Computer Generated Diagnostic Assessment
Sedative, Hypnotic, or Anxiolytic Use Disorder 304.10
This diagnosis is based on the following findings:
- Abused sedative/anxiolytic in the past 5 years (still present)
- Greater use of sedative/anxiolytic than intended (still present)
- There is a persistent desire or unsuccessful efforts to cut down or control
sedative/anxiolytic use (still present)
- A great deal of time is spent in obtaining sedative/anxiolytic, using
sedative/anxiolytic, or recovering from its effects (still present)
- Craving, or a strong desire or urge to use sedative/anxiolytic (still present)
- Recurrent sedative/anxiolytic use resulting in a failure to fulfill major role
obligations at work, school or home (still present)
- Continued sedative/anxiolytic use despite having persistent social problems
that this substance made worse (still present)
- Important social, occupational, or recreational activities are given up or
reduced because of sedative/anxiolytic use (still present)
- Recurrent sedative/anxiolytic use in situations in which it is physically
hazardous (still present)
- Continued using sedative/anxiolytic despite knowing it caused significant
problems (still present)
- Developed tolerance to the sedative/anxiolytic (still present)
- Developed withdrawal symptoms to the sedative/anxiolytic (still present)
Treatment Goals:
- Goal: stop sedative/anxiolytic use because using more than
intended.
- Goal: stop sedative/anxiolytic use because it is getting out of
control.
- Goal: stop sedative/anxiolytic use in order to prevent wasting so
much time using this substance, or recovering from its use.
- Goal: stop sedative/anxiolytic use in order to decrease craving for
this substance.
- Goal: stop sedative/anxiolytic use so that she can better fulfill
major role obligations at work, school or home.
- Goal: stop sedative/anxiolytic use in order to improve the
sedative/anxiolytic-related social problems.
- Goal: stop sedative/anxiolytic use in order to increase time spent
on important social, occupational, or recreational activities.
- Goal: stop sedative/anxiolytic use in hazardous situations in order
to prevent injury.
- Goal: stop sedative/anxiolytic use in order to prevent further
worsening of current sedative/anxiolytic-related physical or emotional
problems.
- Goal: stop sedative/anxiolytic use because tolerance to this
substance is developing.
- Goal: stop sedative/anxiolytic use because sedative/anxiolytic
withdrawal symptoms are developing.
Back
to top
Dependence Syndrome Due To Use Of Sedatives Or Hypnotics F13 - ICD10
Description, World Health Organization
Repeated use of sedatives or hypnotics that typically includes a strong desire to take
the drug, difficulties in controlling its use, persisting in its use despite harmful
consequences, a higher priority given to drug use than to other activities and
obligations,
increased
tolerance,
and a physical withdrawal state.
Sedative, Hypnotic, or Anxiolytic Use Disorder
- Diagnostic Criteria, American Psychiatric Association
An individual diagnosed with sedative, hypnotic, or anxiolytic use disorder needs to
meet all of the following criteria:
- A problematic pattern of sedative, hypnotic, or anxiolytic use leading to
clinically significant impairment or distress, as manifested by at least two of
the following, occurring within a 12-month period:
- Sedatives, hypnotics, or anxiolytics are often taken in larger amounts or
over a longer period than was intended.
- There is a persistent desire or unsuccessful efforts to cut down or control
sedative, hypnotic, or anxiolytic use.
- A great deal of time is spent in activities necessary to obtain the
sedative, hypnotic, or anxiolytic, use the sedative, hypnotic, or
anxiolytic, or recover from its effects.
- Craving, or a strong desire or urge to use the sedative, hypnotic, or
anxiolytic.
- Recurrent sedative, hypnotic, or anxiolytic use resulting in a failure to
fulfill major role obligations at work, school, or home.
- Continued sedative, hypnotic, or anxiolytic use despite having persistent or
recurrent social or interpersonal problems caused or exacerbated by the
effects of sedatives, hypnotics, or anxiolytics (e.g. arguments with a
spouse about consequences of
intoxication;
physical
fights).
- Important social, occupational, or recreational activities are given up or
reduced because of sedative, hypnotic, or anxiolytic use.
- Recurrent sedative, hypnotic, or anxiolytic use in situations in which it is
physically hazardous.
- Sedative, hypnotic, or anxiolytic use is continued despite knowledge of
having a persistent or recurrent physical or psychological problem that is
likely to have been caused or exacerbated by the sedative, hypnotic, or
anxiolytic.
- Tolerance, as defined by either of the following:
- A need for markedly increased amounts of the sedative, hypnotic, or
anxiolytic to achieve intoxication or desired effect.
- A markedly diminished effect with continued use of the same amount of
the sedative, hypnotic, or anxiolytic.
- Withdrawal, as manifested by either of the following:
- The characteristic withdrawal syndrome for sedatives, hypnotics, or
anxiolytics:
- Cessation of (or reduction in) sedative, hypnotic, or anxiolytic use
that has been prolonged.
- Two (or more) of the following, developing within several hours to a
few days after the cessation of (or reduction in) sedative,
hypnotic, or anxiolytic use:
- Autonomic hyperactivity (e.g., sweating or pulse rate greater
than 100 bpm).
- Hand tremor.
- Insomnia.
- Nausea or vomiting.
- Transient visual, tactile, or auditory hallucinations or
illusions.
- Psychomotor agitation.
- Anxiety.
- Grand mal seizures.
- These withdrawal signs or symptoms cause clinically significant
distress or impairment in social, occupational or other important
areas of functioning.
- These withdrawal signs or symptoms are not attributable to another
medical condition and are not better explained by another mental
disorder, including intoxication or withdrawal from another
substance.
- Specify if:
- With perceptual disturbances: This specifier may be noted
when hallucinations with intact reality testing or auditory,
visual, or tactile illusions occur in the absence of a delirium.
- Sedatives, hypnotics, or anxiolytics (or a closely related substance,
such as alcohol) are taken to relieve or avoid withdrawal symptoms.
Note: This criterion is not considered to be met for individuals
taking sedatives, hypnotics, or anxiolytics under medical supervision.
- Specify if:
- In early remission: After full criteria for sedative, hypnotic,
or anxiolytic use disorder were previously met, none of the criteria for
sedative, hypnotic, or anxiolytic use disorder have been met for at
least 3 months but for less than 12 months
(with
the exception that the criterion, "Craving, or a strong desire or urge
to use sedative, hypnotic, or anxiolytic," may be met).
- In sustained remission: After full criteria for sedative,
hypnotic, or anxiolytic use disorder were previously met, none of the
criteria for sedative, hypnotic, or anxiolytic use disorder have been
met at any time during a period of 12 months or
longer
(with the exception that the criterion, "Craving, or a strong desire or
urge to use sedative, hypnotic, or anxiolytic," may be met).
- Specify if:
- In a controlled environment: This additional specifier is used if
the individual is in an environment where access to sedatives,
hypnotics, or anxiolytics is restricted.
Back
to top
Diagnostic Features
This class of substances include all prescription sleeping medications and almost all
prescription antianxiety medications. Nonbenzodiazepine antianxiety agents (e.g.,
buspirone, gepirone) are not included because they are not associated with significant
abuse.
Sedative, Hypnotic, or Anxiolytic Use Disorder is a condition characterized by the
harmful consequences of repeated use of sedative-like drugs, a pattern of compulsive use
of sedative-like drugs, and (sometimes) physiological dependence on sedative-like drugs
(i.e.,
tolerance
and/or withdrawal). This disorder is only diagnosed when the use of sedative-like drugs
becomes persistent and causes significant academic, occupational, social or medical
impairment.
Sedative, Hypnotic, or Anxiolytic Intoxication causes significant psychological and
social impairment (e.g., inappropriate sexual or aggressive behavior, mood lability,
impaired judgment, impaired social or occupational functioning). This intoxication
causes one or more
of
the following: slurred speech, incoordination, unsteady gait, nystagmus, impairment of
attention/memory, stupor/coma.
Sedative, Hypnotic, or Anxiolytic Withdrawal causes two or more of the following:
autonomic hyperactivity (e.g., sweating or pulse rate greater than 100 bpm), hand
tremor, insomnia, nausea/vomiting, transient visual/tactile/auditory hallucinations or
illusions,
psychomotor
agitation, anxiety, grand mal seizures. This withdrawal causes significant distress or
disability. This withdrawal may cause a life threatening delirium.
Complications
In Sedative, Hypnotic, or Anxiolytic Use Disorder drug tolerance usually develops, and
at higher doses there may be a sudden onset of respiratory depression and hypotension,
which may result in death. Severe intoxication may be associated with brief but severe
depression
that
can lead to suicide attempts and completed suicide. Arguments, fights, interference with
work or school performance are all common complications. High doses of sedative-like
drugs, when mixed with alcohol, can be lethal. Intravenous use of these drugs may lead
to
hepatitis
and HIV. Intoxication can result in accidental injuries and car accidents.
Comorbidity
Individuals with Sedative, Hypnotic, or Anxiolytic Use Disorder often have other
Substance Use Disorders (e.g., alcohol, tobacco, and illicit drugs). This disorder
commonly co-occurs with Antisocial Personality Disorder, Major Depressive Disorder,
Bipolar Disorder, and
Anxiety Disorders.
Associated Laboratory Findings
Almost all sedative-like drugs can be detected on standard toxicology drug urine or
blood tests. Blood toxicology tests can quantify the amounts of these drugs in the body.
Urine screens can remain positive for up to 1 week after the use of these drugs.
Prevalence
The 12-month prevalence in the American population, aged 12-17 years is 0.3%, and 0.2%
among adults age 18 are older. Prevalence decreases with age and is greatest among 18-
to 29-year-olds (0.5%) and is lowest among those aged 65 and older. The male:female
ratio in
adolescence is 1:2, but in adults is 1:1.
Course
Sedative, Hypnotic, or Anxiolytic Use Disorder usually starts in the teens or 20s when
intermittent use becomes daily use. "Doctor-shopping" often occurs to seek out multiple
physicians to obtain sufficient drug supplies. Tolerance can reach high levels, and
withdrawal
(including seizures and withdrawal delirium) may occur. Impairment of memory,
problem-solving, and motor coordination increases with age. In older adults, chronic
intoxication can resemble a progressive dementia.
Familial Pattern
Genetics may play a significant role in the occurrence of this disorder. Many
individuals with Sedative, Hypnotic, or Anxiolytic Use Disorder have genetic behavioral
disinhibition (a highly heritable tendency towards impulsivity, novelty-seeking,
dangerous risk-taking
and rule-breaking).
Inappropriate Prescribing of Benzodiazepines
Our Other
Prescription Drug Problem
In America, from 1996 to 2013, the number of adults who filled a benzodiazepine
prescription (for drugs like alprazolam, clonazepam, diazepam, and lorazepam) rose
from 8.1 million to 13.5 million, an increase of 67%. During roughly the same time
(1999-2015), deaths from benzodiazepine overdose increased from 1135 to 8791. Three
quarters of deaths involving benzodiazepines also involve an opioid.
Of
particular concern is benzodiazepine use among the elderly, who are especially
vulnerable to adverse effects, including an increased risk for falls, fractures,
motor vehicle accidents, impaired cognition, and dementia.
Highly potent new
forms of benzodiazepines are increasingly penetrating the illicit market.
Manufactured in clandestine laboratories in the United States and elsewhere, these
drugs are indistinguishable from prescription benzodiazepines and are potentially as
deadly as the synthetic opioid analogue fentanyl. Clonazolam, an analogue of
clonazepam that is akin to a combination of alprazolam and clonazepam, is so potent
that it needs to be dosed at the microgram level using a high-precision scale to
prevent accidental overdose. It can be bought on the Internet as a “research
chemical” and shipped virtually anywhere.
Benzodiazepines have proven utility
when they are used intermittently and for less than 1 month at a time. But when they
are used daily and for extended periods, the benefits of benzodiazepines diminish
and the risks associated with their use increase. Many prescribers don’t realize
that benzodiazepines can be addictive and when taken daily can worsen anxiety,
contribute to persistent insomnia, and cause death. Other risks associated with
benzodiazepines include cognitive decline, accidental injuries and falls, and
increased rates of hospital admission and emergency department visits. Fortunately,
there are safer treatment alternatives for anxiety and insomnia, including selective
serotonin-reuptake inhibitors and behavioral interventions. Just as with opioids,
some patients benefit from long-term use of benzodiazepines. But even in low-risk
patients, it is best to avoid daily dosing to mitigate the development of tolerance,
dependence, and withdrawal.
Physicians should check their state’s
prescription drug monitoring program (PDMP) before prescribing benzodiazepines, as
is often required with opioids. Such databases allow the physician to check for
dangerous drug combinations (such as combinations of opioids and benzodiazepines)
and to determine whether the patient is “doctor shopping.”
Efforts should
also be made to shut down illegal online pharmacies and other drug-trafficking
networks where people obtain illicit benzodiazepines, particularly superpotent
analogues.
Effective Therapies
The effectiveness of treatment for this disorder is unknown because there are no
randomized controlled trials.
It is possible to stop abusing sedatives. To do this you must: (1) totally divorce
yourself from drug-using or drug-supplying people, (2) not use alcohol or any other
illegal drugs, (3) keep socially active and help others, (4) talk to other people who
have successfully
stayed off drugs, (5) devote yourself to important activities that give meaning and
purpose to life (e.g., family, friends, sports, work, helping others, church etc.).
Therapists know that these 5 steps work, but our therapies are often ineffective in
motivating patients to complete these essential steps to recovery.
Top 20 Most Harmful Drugs In Britain In 2008
Professor David Nutt published in the Lancet the following rating of Britain's most
dangerous drugs. They are listed in descending order from the most harmful.
1. Heroin
Class A drug. Originally used as a painkiller and derived from the opium poppy.
There were 897 deaths recorded from heroin and morphine use in 2008 in England
and Wales, according to the Office of National Statistics (ONS). There were
around 13,000 seizures,
amounting
to 1.6m tonnes of heroin.
2. Cocaine
Class A. Stimulant produced from the South American coca leaf. Accounted for 235
deaths -- a sharp rise on the previous year's fatalities. Nearly 25,000 seizures
were made, amounting to 2.9 tonnes of the drug.
3. Barbiturates
Class B. Synthetic sedatives used for anaesthetic purposes. Blamed for 13
deaths.
4. Street methadone
Class A. A synthetic opioid, commonly used as a substitute for treating heroin
patients. Accounted for 378 deaths and there were more than 1,000 seizures of
the drug.
5. Alcohol
Subject to increasing concern from the medical profession about its damage to
health. According to the ONS, there were 8,724 alcohol deaths in the UK in 2007.
Other sources claim the true figure is far higher.
6. Ketamine
Class C. A hallucinogenic dance drug for clubbers. There were 23
ketamine-related deaths in the UK between 1993 and 2006. Last year there were
1,266 seizures.
7. Benzodiazepines
Class C. A hypnotic relaxant used to treat anxiety and insomnia. Includes drugs
such as diazepam, temazepam and nitrazepam. Caused 230 deaths and 1.8m doses
were confiscated in more than 4,000 seizure operations.
8. Amphetamine
Class B. A psychostimulant that combats fatigue and suppresses hunger.
Associated with 99 deaths, although this tally includes some ecstasy deaths.
Nearly 8,000 seizures, adding up to almost three tonnes of confiscated
amphetamines.
9. Tobacco
A stimulant that is highly addictive due to its nicotine content. More than
100,000 people a year die from smoking and tobacco-related diseases, including
cancer, respiratory diseases and heart disease.
10. Buprenorphine
An opiate used for pain control, and sometimes as a substitute to wean addicts
off heroin. Said to have caused 43 deaths in the UK between 1980 and 2002.
11. Cannabis
Class B. A psychoactive drug recently appearing in stronger forms such as
"skunk". [Since this video was made; there is now conclusive proof that cannabis
causes a 6.7 fold increase in the risk of developing schizophrenia.] Caused 19
deaths and there were 186,000
seizures, netting 65 tonnes of the drug and 640,000 cannabis plants.
12. Solvents
Fumes inhaled to produce a sense of intoxication. Usually abused by teenagers.
Derived from commonly available products such as glue and aerosol sprays. Causes
around 50 deaths a year.
13. 4-MTA
Class A. Originally designed for laboratory research. Releases serotonin in the
body. Only four deaths reported in the UK between 1997 and 2004.
14. LSD
Class A. Hallucinogenic drug originally synthesised by a German chemist in 1938.
Very few deaths recorded.
15. Methylphenidate
Class B drug. Brand name of Ritalin. A psychostimulant sometimes used in the
treatment of attention deficit disorders.
16. Anabolic steroids
Class C. Used to develop muscles, notably in competitive sports. Also alleged to
induce aggression. Have been blamed for causing deaths among bodybuilders. More
than 800 seizures.
17. GHB
Class C drug. A clear liquid dance drug said to induce euphoria, also described
as a date rape drug. Can trigger comas and suppress breathing. Caused 20 deaths
and 47 seizures were recorded.
18. Ecstasy
Class A. Psychoactive dance drug. Caused 44 deaths, with around 5,000 seizures
made.
19. Alykl nitrites
Known as "poppers". Inhaled for their role as a muscle relaxant and supposed
sexual stimulant. Reduce blood pressure, which can cause fainting and in some
cases death.
20. Khat
A psychoactive plant, the leaves of which are chewed in east Africa and Yemen.
Also known as qat. Produces mild psychological dependence. Its derivatives,
cathinone and cathine, are Class C drugs in the UK.
Ineffective therapies
Some individuals buy sedative-like drugs illegally over the internet, and argue that any
resulting sedative addiction should be treated "like any other medical disorder". They
forget that there is no treatment for Sedative, Hypnotic, or Anxiolytic Use Disorder
that has
been proven effective.
Legalizing Illicit Drugs
Some people argue that illicit drugs should be legalized to decrease the crime
associated with these drugs. Historically, tobacco and alcohol were once illegal drugs.
Tobacco smoking is now the leading cause of death in America, and alcoholism is the
third leading cause
of
death. Thus legalizing illicit drugs does not make them any less medically and socially
harmful. In fact the opposite is true; legalizing illicit drugs increases their use and
the harm they cause. The Government of Finland is passing legislation that will
gradually ban
all
tobacco use by 2040.
Back
to top
Dr.
Flisser: Sedative Abuse
Dr. Gardere:
Addiction
- Sedative Use Disorder - Google
- Sedative
Intoxication - DSM-IV Diagnostic Criteria, American Psychiatric Association
- Sedative Intoxication
Delirium - DSM-IV Diagnostic Criteria, American Psychiatric Association
- Sedative-Induced
Anxiety Disorder - DSM-IV Diagnostic Criteria, American Psychiatric
Association
- Sedative-Induced Mood
Disorder - DSM-IV Diagnostic Criteria, American Psychiatric Association
- Sedative-Induced
Persisting Amnestic Disorder - DSM-IV Diagnostic Criteria, American
Psychiatric Association
- Sedative-Induced
Persisting Dementia - DSM-IV Diagnostic Criteria, American Psychiatric
Association
- Sedative-Induced
Psychotic Disorder - DSM-IV Diagnostic Criteria, American Psychiatric
Association
- Sedative-Induced
Sexual Dysfunction - DSM-IV Diagnostic Criteria, American Psychiatric
Association
- Sedative-Induced
Sleep Disorder - DSM-IV Diagnostic Criteria, American Psychiatric
Association
- Sedative
Withdrawal - DSM-IV Diagnostic Criteria, American Psychiatric Association
- Sedative Withdrawal
Delirium - DSM-IV Diagnostic Criteria, American Psychiatric Association
- Excellent Animation
- 5 Myths
About Addiction - CBC
Stories
Stages of Learned Behavior
Our survival involves learning what to avoid (i.e., fear) and what to approach (i.e.,
crave). Both fear and craving are essential for our survival, but both can spiral out of
control.
For example, an individual can develop a phobia about snakes in which the fear becomes
excessive. This phobia can develop into an obsession in which the individual spends much of
the time thinking about snakes, and how to avoid them.
This obsession can develop into a compulsion in which the individual spends much of the time
doing superstitious, compulsive, ritual behaviors aimed at avoiding snakes.
Likewise, an individual can develop an excessive craving for alcohol which causes
significant distress or disability.
This excessive craving for alcohol can develop into an obsession in which the individual
spends much of the time thinking about alcohol, and how to get it.
This obsession can develop into a compulsion in which the individual spends much of the time
compulsively drinking, and feeling powerless to resist this craving.
| 4 STAGES OF FEAR |
4 STAGES OF CRAVING |
Normal Fear:
Is in proportion to the actual danger, and doesn't cause significant
distress or disability.
|
Normal Craving:
Doesn't cause significant distress or disability.
|
Excessive Fear (Phobia):
Is out of proportion to the actual danger posed, and causes significant
distress or disability.
|
Excessive Craving:
Is not socially acceptable, and causes significant distress or disability
(e.g., "I'm using [alcohol] too much").
|
Obsessional Fear:
Persistent, unwanted or obsessional thoughts about the fear develop, which
cause significant distress or disability.
|
Obsessional Craving:
Persistent, unwanted or obsessional thoughts about the craving develop,
which cause significant distress or disability (e.g., "I spend much of my
time thinking about [alcohol], and how to get it").
|
Compulsive Fear:
Compulsive behaviors develop (aimed at reducing the anxiety associated with
the obsession), which the individual finds very hard to resist doing.
|
Compulsive Craving:
Compulsive behaviors develop (aimed at satisfying the craving), which the
individual finds very hard to resist doing (e.g., "I can't stop myself from
using [alcohol]").
|
Back
to top
World Health Organization Drug Use Disorder Treatment
Guidelines
Treatment Guidelines
Treatment
Crime
Back
to top
Overcoming Drug Addiction
Self-Help Groups for Drug Addiction
Monitoring Your Progress
NOTE: When each of the following presentations finish; you must exit
by manually closing its window in order to return to this webpage.
The Healthy Social Behavior Scale lists social behaviors that research has
found to be associated with healthy social relationships. You can keep score (totaling its
4-point scale answers) on a separate piece of paper to monitor your progress.
The Mental Health Scale lists behaviors and symptoms that research has found
to be associated with mental health (or disorder). You can keep score (totaling its 4-point
scale answers) on a separate piece of paper to monitor your progress.
The Life Satisfaction Scale lists the survey questions often used to measure
overall satisfaction with life. You can keep score (totaling its 4-point scale answers) on a
separate piece of paper to monitor your progress.
Life
Satisfaction Scale (5-Minute Video)
The "Big 6" Dimensions of Mental Health
Research has shown that there are 5 major dimensions (the "Big 5 Factors" or
Five-Factor
Model) of personality disorders and other mental
disorders.
This website uses these 5 major dimensions of human behavior (i.e., Agreeableness,
Conscientiousness, Openness/Intellect, Extraversion/Sociability, and Emotional
Stability) to describe all mental disorders. This website adds one more dimension,
"Physical Health", to create the "Big 6" dimensions of mental health.
The behaviors of the "Five Factor Model of Personality" represent five adaptive functions
that are vital to human survival. For example, when one individual approaches another, the
individual must: (1) decide whether the other individual is friend or foe [
"Agreeableness"
], (2) decide if this represents safety or danger [
"Emotional Stability"
], (3) decide whether to approach or avoid the other individual [
"Extraversion/Sociability"
], (4) decide whether to proceed in a cautious or impulsive manner [
"Conscientiousness"
], and (5) learn from this experience [
"Openness/Intellect"
].
Desiderata
(5-Minute Video)
The following "Morning Meditation" allows you to plan your day using these "Big 6"
dimensions of mental health.
The following "Evening Meditation" allows you to review your progress on these "Big 6"
dimensions of mental health.
Back
to top
"In physical science a first essential step in the direction of learning any
subject is to find principles of numerical reckoning and practicable methods for
measuring some quality connected with it. I often say that
when you can measure what you are speaking about and express it in
numbers you know something about it; but when you cannot measure it,
when you cannot express it in numbers, your knowledge is of a meagre and
unsatisfactory kind: it may be the beginning of knowledge,
but you have scarcely, in your thoughts, advanced to the stage of science,
whatever the matter may be."
Lord Kelvin (1824 – 1907)
- The best
summary on bad research is given by Laura Arnold in this TEDx lecture.
If you read nothing else about research, you owe it to
yourself to watch this short video - it is excellent!
- Economist in grim battle against deceptive scholarship
- List of Predatory
Journals and Publishers
- The power
of asking "what if?"
- The active placebo effect: 2300 years ago, the Greek Stoic philosophers
taught that it is not the objective event, but our subjective
judgment about the event, that determines our behavior. The active placebo
effect bears witness to this ancient wisdom.
- Criteria For High Quality Research Studies
It is
troubling that a recent study found that two-thirds of important psychological research studies couldn't
be replicated. High quality research must meet the following
criteria:
-
Randomized Controlled Trial:
Ask: Was the trial randomized? Was the randomization
procedure described and was it appropriate?
The best research design is to have research subjects randomly assigned
to an experimental or control group. It is essential that confounding
factors be controlled for by having a control group or comparator condition
(no intervention, placebo, care as usual etc.).
-
Representative Sample:
Ask: Do the research subjects represent a normal
cross-section of the population being studied?
Many psychological research studies using university students are
flawed because their subjects are not representative of the normal
population since they are all W.E.I.R.D. (White, Educated, Intelligent,
Rich, and living in a Democracy).
-
Single Blind Trial:
Ask: Was the treatment allocation concealed?
It is essential that the research subjects are kept "blind" as to
whether they are in the experimental or control group (in order to control
for any placebo effects).
-
Double Blind Trial (Better Than Single Blind Trial):
Ask: Were blind outcome assessments conducted?
In a double blind study, neither the research subjects nor the outcome
assessors know if the research subject is in the experimental or control
group. This controls for both the placebo effect and assessor bias.
-
Baseline Comparability:
Ask: Were groups similar at baseline on prognostic
indicators?
The experimental and control groups must be shown to be comparable at
the beginning of the study.
-
Confounding Factors:
Ask: Were there factors, that weren't controlled for,
that could have seriously distorted the study's results?
For example, research studies on the effectiveness of mindfulness cognitive therapy in
preventing depressive relapse forgot to control for whether the research
subjects were also simultaneously receiving antidepressant medication or
other psychological treatments for depression.
-
Intervention Integrity:
Ask: Was the research study protocal strictly
followed?
The research subjects must be shown to be compliant (e.g., taking their
pills, attending therapy) and the therapists must be shown to be reliably
delivering the intervention (e.g., staying on the research protocol).
-
Statistical analysis:
Ask: Was a statistical power calculation described?
The study should discuss its statistical power analysis; that is
whether the study size is large enough to statistically detect a difference
between the experimental and control group (should it occur) and usually
this requires at least 50 research subjects in the study.
Ask: Are the results both statistically
significant and clinically significant?
Many medical research findings are statistically significant
(with a p-value <0.05), but they are not clinically significant
because the difference between the experimental and control groups is
too small to be clinically relevant.
For example, the effect of a
new drug may be found to be 2% better than placebo. Statistically (if
the sample size was large enough) this 2% difference could be
statistically significant (with a p-value <0.05). However,
clinicians would say that this 2% difference is not
clinically significant (i.e., that it was too small to really
make any difference).
Statistically, the best way to test for
clinical significance is to test for effect size (i.e., the
size of the difference between two groups rather than confounding
this with statistical probability).
When the outcome of
interest is a dichotomous variable, the commonly used measures of
effect size include the odds ratio (OR), the relative risk (RR), and
the risk difference (RD).
When the outcome is a continuous
variable, then the effect size is commonly represented as either the
mean difference (MD) or the standardised mean difference (SMD)
.
The MD is the difference in the means of the treatment
group and the control group, while the SMD is the MD divided by the
standard deviation (SD), derived from either or both of the groups.
Depending on how this SD is calculated, the SMD has several versions
such, as Cohen's d, Glass's Δ, and Hedges' g.
Clinical Significance: With Standard Mean Difference, the
general rule of thumb is that a score of 0 to 0.25 indicates
small to no effect, 0.25-0.50 a mild benefit, 0.5-1 a moderate
to large benefit, and above 1.0 a huge benefit. It is a
convention that a SMD of
0.5
or larger is a standard threshold for clinically
meaningful benefit.
The statistical summary
should report what percentage of the total variance of the dependent
variable (e.g., outcome) can be explained by the independent
variable (e.g., intervention).
In clinical studies, the study
should report the number needed to treat for an additional
beneficial outcome (NNTB), and the number needed to treat for
an additional harmful outcome (NNTH).
Number Needed To Benefit (NNTB): This is defined as the
number of patients that need to be treated for one of them to
benefit compared with a control in a clinical trial. (It is
defined as the inverse of the absolute risk reduction.)
Note: Statistically, the NNTB depends on which control group is used for
comparison - e.g., active treatment vs. placebo
treatment, or active treatment vs. no
treatment.
Number Needed To Harm (NNTH): This is
defined as the number of patients that need to be treated for
one of them to be harmed compared with a control in a clinical
trial. (It is defined as the inverse of the absolute increase in
risk of harm.)
Tomlinson found “an NNTB of 5 or less was probably associated
with a meaningful health benefit,” while “an NNTB of 15
or more was quite certain to be associated with at most a small
net health benefit.”
Ask: Does the researcher accept full
responsibility for the study's statistical analysis?
The researcher should not just hand over the study's raw
data to a corporation (that may have $1,000 million invested in the
study) to do the statistical analysis.
-
Completeness of follow-up data:
Ask: Was the number of withdrawals or dropouts in each
group mentioned, and were reasons given for these withdrawals or
dropouts?
Less than 20% of the research subjects should drop out of the study.
The intervention effect should persist over an adequate length of time.
-
Handling of missing data:
Ask: Was the statistical analysis conducted on the
intention-to-treat sample?
There must be use of intention-to-treat analysis (as opposed to a
completers-only analysis). In this way, all of the research subjects that
started the study are included in the final statistical analysis. A
completers-only analysis would disregard those research subjects that
dropped out.
-
Replication of Findings:
Ask: Can other researchers replicate this study's
results?
The research study's methodology should be clearly described so that
the study can be easily replicated. The researcher's raw data should be
available to other researchers to review (in order to detect errors or
fraud).
-
Fraud:
Ask: Is there a suspicion of fraud?
In a research study, examine the independent and dependent variables
that are always measured as a positive whole number (e.g., a variable
measured on a 5-point Likert-type scale ranging from "1 = definitely
false to 5 = definitely true" etc.). For each of these
variables, look at their sample size (
n
), mean (
M
) and standard deviation (
SD
) before they undergo statistical analysis. There is a high suspicion of
fraud in a study's statistics:
- If the M is mathematically impossible (online
calculator): This is one of the easiest ways to
mathematically detect fraud. The mean (
M
) is defined as "the sum (
Sum
) of the values of each observation divided by the total number
(
n
) of observations". So:
M
=
Sum
/
n
. Thus: (
Sum
) = (
M
) multiplied by (
n
). We know that, if a variable is always measured as a positive
whole number, the sum of these observations always has to be a whole
number. For these variables to test for fraud: calculate (
M
) multiplied by (
n
). This calculates the
Sum
which MUST be a positive whole number. If the calculated
Sum
isn't a positive whole number; the reported mean (
M
) is mathematically impossible - thus the researcher either
cooked the data or made a mistake. A recent study of 260 research papers
published in highly reputable psychological journals found that
1 in 2 of these research papers reported at
least one impossible value
, and 1 in 5 of these research papers reported multiple
impossible values. When the authors of the 21 worst offending
research papers were asked for their raw data (so that its
reliability could be checked) - 57% angrily refused. Yet such
release of raw data to other researchers is required by most
scientific journals. (Here is an example of a research paper filled with mathematically
impossible means.)
- If the SD is mathematically impossible (online
calculator): When researchers fraudulently "cook" their
data, they may accidently give their data a mean and standard
deviation that is mathematically impossible.
- If the
SD/M is very small
(i.e., the variable's standard deviation is very small compared
to the mean suggesting data smoothing).
- If the
SD's are almost identical
(i.e., the variables have different means but almost identical
standard deviations).
- If the 4th digit of the values of the variables aren't uniformly
distributed - since each should occur 10% of the time (Benford's Law).
- If the researcher is
legally prevented from publishing negative
findings
about a drug or therapy because that would violate the
"nondisclosure of trade secrets" clause in the research contract
(i.e., it is a "trade secret" that the drug or therapy is
ineffective - hence this can not be "disclosed"). Approximately half of all registered clinical
trials fail to publish their results.
- If the
researcher refuses to release his raw data to
fellow researchers
(so that they can check its validity). In order to be published
in most scientific journals, a researcher must promise to share his
raw data with fellow researchers. Thus a researcher's refusal to do
so is almost a sure indicator of fraud.
- If the
research study's data contradicts the study's
own conclusions
- surprisingly, this often occurs.
- Calling Bullshit
In The Age of Big Data - "Bullshit is language, statistical figures,
data graphics, and other forms of presentation intended to persuade by
impressing and overwhelming a reader or listener, with a blatant disregard for
truth and logical coherence." Reading the syllabus of this university course
should be required reading for every student of mental health. This syllabus is
absolutely fantastic!
- Statistical Methods in Psychology Journals: Guidelines and
Explanations - American Psychologist 1999
- Not All Scientific Studies Are Created Equal - video
- The
efficacy of psychological, educational, and behavioral treatment
- Estimating the reproducibility of psychological science
- Psychologists grapple with validity of research
- Industry sponsorship and research outcome (Review) -
Cochrane Library
- 'We've been deceived': Many clinical trial results are
never published - (text and video)
- Junk
science misleading doctors and researchers
- Junk science under spotlight after controversial firm buys
Canadian journals
- Medicine with a side of mysticism: Top hospitals promote
unproven therapies - Are some doctors becoming modern witchdoctors?
- When Evidence Says No, But Doctors Say Yes
- Cochrane Reviews (the best evidence-based, standardized
reviews available)
Research Topics
Back
to top
|
