Binge eating disorder Essay Example for Free

Binge eating disorder Essay Binge eating disorder (BED) is characterized by recurrent episodes of binge eating not accompanied by inappropriate compensatory behaviors. Although it is not yet officially recognized, it was included in the current Diagnostic and Statistical Manual of Mental Disorders (DSM) as a disorder to be studied, with research criteria included. It is also slated to be included in the next DSM as one of the officially recognized eating disorders. There have been several treatment modalities employed in its treatment: pharmacotherapy, psychotherapy, and a combination of the two. Being a â€Å"young† disorder, BED still needs future research to show which modality treats it best in the long run. Approaches to Treatment of Binge Eating Disorder What Is BED? How Is It Different From Bulimia Nervosa? Binge eating disorder (BED) is characterized by recurrent episodes of binge eating not accompanied by inappropriate compensatory behaviors (Sadock Sadock, 2003). Although binge eating, by itself, is more commonly associated with bulimia nervosa, binge eating disorder is recognized as a separate entity. Unlike BED, bulimia nervosa involves excessive concern with body shape and weight, and bulimics often have a â€Å"self-perception of being too fat, with an intrusive dread of fatness† (World Health Organization [WHO], 1993). Moreover, the absence of compensatory behaviors further distinguishes BED from the non-purging type of bulimia nervosa, which is defined by the Diagnostic and Statistical Manual of Mental Disorders, or DSM-IV, as when the individual â€Å"has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas† (American Psychiatric Association [APA], 2000). Diagnosis of Binge Eating Disorder Although binge eating disorder still has to gain official recognition, the Text Revision of DSM-IV (APA, 2000) lays down the following â€Å"research criteria† for diagnosing the disorder: A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following: (1) eating, in a discrete period of time (e. g. , within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances (2) the sense of lack of control over eating during the episode (e. g. , a feeling that one cannot stop eating or control what or how much one is eating) B. Binge-eating episodes are associated with three (or more) of the following: (1) eating much more rapidly than normal (2) eating until feeling uncomfortably full (3) eating large amounts of food when not feeling physically hungry (4) eating alone because of being embarrassed by how much one is eating (5) feeling disgusted with oneself, depressed, or very guilty after overeating C. Marked distress regarding binge eating is present. D. The binge eating occurs, on average, at least 2 days a week for 6 months. E. The binge eating is not associated with the regular use of inappropriate compensatory behaviors (e. g. , purging, fasting, excessive exercise, etc. ) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. Several issues have been raised regarding the criteria mentioned above. For example, one question raised by some experts in the field is that there is no definite way to assess just how much food constitutes â€Å"an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances. † Fulfilling these criteria would at best be a subjective process. While the DSM-IV criteria for BED is usually applied to adults, Marcus and Kalarchian (2003) have proposed a separate set of provisional research criteria for diagnosing BED in children. These are: A. Recurrent episodes of being eating. An episode of binge eating is characterized by both of the following: (1) food seeking in absence of hunger (e. g. after a full meal) (2) a sense of lack of control over eating (e. g. , endorse that ‘‘When I start to eat, I just can’t stop’’) B. Binge episodes are associated with one or more of the following: (1) food seeking in response to negative affect (e. g. , sadness, boredom, restlessness) (2) food seeking as a reward (3) sneaking or hiding food C. Symptoms persist over a period of 3 months. D. Eating is not associated with the regular use of inappropriate compensatory behaviors (e. g. , purging, fasting, excessive exercise) and does not occur exclusively during the course of anorexia nervosa or bulimia nervosa. Some of the questionnaires used to diagnose binge eating disorder are: the Binge Eating Scale (BES), the Three Factor Eating Questionnaire, the Body Shape Questionnaire, the Structured Clinical Interview for the Diagnosis of DSM Disorders (SCID), and the Eating Disorders Examination (EDE). The Treatment of Binge Eating Disorder Overview In the management of BED, the primary goal is to achieve abstinence from binge eating (Bulik, Brownley Shapiro, 2007). However, studies have shown that BED has comorbid conditions that require as much attention, such as depression, generalized anxiety disorder, panic attacks and even attempts at suicide (Grucza, Przybeck Cloninger, 2007). Furthermore, since patients diagnosed with BED do not usually engage in inappropriate compensatory behaviors, they are usually obese as well, a condition that sometimes causes more concern in professionals caring for BED patients because of its health implications. Because of the different aspects of this disorder, different treatment modalities are being used, with some experts favoring one and others favoring another. Pharmacotherapy Medications used to treat binge eating disorder include appetite suppressants, anticonvulsants, selective serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants. These have been studied in double-blind placebo-controlled trials, and the results, though modest, have been promising (Appolinario McElroy, 2004). Appetite suppressants. According to Appolinario, Bacaltchuk, Sichieri, Claudino, Godoy-Matos, Morgan, Zanella Coutinho (2003), fenfluramine hydrochloride was the first antiobesity agent shown to be effective in treating binge eating disorder. However, this drug has been withdrawn from the market because of intolerable side effects. Currently, the anti-obesity agent that seems to be the most studied in the treatment of BED is sibutramine. Sibutramine is a drug that inhibits the reuptake of serotonin, norepinephrine, and, to some extent, dopamine. A study by Appolinario et al. (2003) showed that patients taking sibutramine, as opposed to those given a placebo pill, experienced a significant reduction in the number of days with binge episodes. Whereas those in the placebo group actually gained some weight, the patients given sibutramine lost an average of 7. 4 kg. The study participants were asked to fill out the Binge Eating Scale and the Beck Depression Inventory before and after their treatment program, and the sibutramine group had significantly lower scores after treatment. The study cites dry mouth and constipation as the adverse reactions commonly encountered by those taking sibutramine. The authors concluded that sibutramine is effective and well tolerated for treating obese BED patients. Another study supporting the use of sibutramine in BED was published in the American Journal of Psychiatry in January 2008. Wilfley, Crow, Hudson, Mitchell, Berkowitz, Blakesley, Walsh, and the Sibutramine Binge Eating Disorder Research Group (2008) found that patients taking sibutramine (15 mg daily for 24 weeks) were able to significantly reduce the following measures: weekly binge frequency, weight (mean of 4. 3 kg), frequency of binge days, body mass index, and eating pathology, such as cognitive restraint, disinhibition and hunger. Moreover, these patients also experienced global improvement and had a greater percentage of abstinence from binge eating (58. 7%, compared with the 42. 8% of the placebo group). Anticonvulsants. In the February 2003 edition of the American Journal of Psychiatry, McElroy, Arnold, Shapira, Keck, Rosenthal, Karim, Kamin Hudson (2003) reported that 30 patients with binge eating disorder randomly assigned to receive a flexible dose (25 to 600 mg per day) of the anticonvulsant drug topiramate had a significantly greater rate of reduction in binge frequency, binge day frequency, weight (mean loss of 5. 9 kg), and body mass index. They also had lower scores on the Yale-Brown Obsessive Compulsive Scale, which was modified for binge eating, and on the Clinical Global Impression severity scale. However, six patients receiving topiramate were unable to continue participating in the study because of adverse events, mostly headaches and paresthesias. The researchers concluded that topiramate was useful for the short-term treatment of BED. The journal Biological Psychiatry also published a study by McElroy, Hudson, Capece, Beyers, Fisher, Rosenthal, and the Topiramate Binge Eating Disorder Research Group (2007), which showed that 195 patients taking topiramate were able to reduce binge eating days per week, binge episodes per week, weight (mean loss of 4. 5 kg), and body mass index compared with those assigned to take placebo. Thirty percent of those taking topiramate left the study, mostly due to adverse effects such as paresthesia, upper respiratory tract infection, somnolence and nausea. However, thirty percent of those taking the placebo pill also were not able to continue with the program. Despite the adverse events reported, the authors concluded that topiramate is well tolerated and was efficacious in treating BED and its features, particularly obesity. Another antiepileptic drug that was evaluated for efficacy in the treatment of binge eating disorder is zonisamide. McElroy, Kotwal, Guerdjikova, Welge, Nelson, Lake, D’Alessio, Keck Hudson (2006) reported in the Journal of Clinical Psychiatry that thirty patients given zonisamide (100 to 600 mg per day for 16 weeks) had a reduction in the frequency of their binge eating episodes, body weight, body mass index, and scores on the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating and the Clinical Global Impressions Severity Scale. Eight of the patients receiving zonisamide discontinued treatment because of accidental injury with bone fracture, psychological complaints and cognitive complaints. In conclusion, the researchers noted that zonisamide was efficacious in treatment of BED with obesity but that it was not well tolerated. Selective serotonin reuptake inhibitors (SSRIs) and norepinephrine reuptake inhibitors. Several selective serotonin reuptake inhibitors have been shown to have beneficial effects in the management of binge eating disorder. Among the earliest SSRI’s shown to be useful in BED treatment was fluvoxamine. Hudson, McElroy, Raymond, Crow, Keck, Carter, Mitchell, Strakowski, Pope, Coleman Jonas (1998) reported that forty-two patients who received a flexible dose of fluvoxamine (50 to 300 mg) for 9 weeks had a significantly greater decrease in the frequency of binges and in body mass index. Furthermore, these patients given fluvoxamine achieved a greater reduction in Clinical Global Impression severity score and a greater rate of increase in Clinical Global Impression improvement scores. However, fluvoxamine did not have a significant effect on the participants’ Hamilton depression scale scores, and the proportion of patients who dropped out of the study because of adverse effects came from the fluvoxamine group. Furthermore, another study done 5 years later on a different, smaller set of patients showed that there was a reduction in binge frequency, eating concern, shape concern and weight concern in both the group receiving fluvoxamine and the group receiving placebo (Pearlstein, Spurell, Hohlstein, Gurney, Read, Fuchs Keller, 2003). The authors say this is just an example of the â€Å"inconsistent results of antidepressant studies in binge eating disorder† (Pearlstein et al. , 2003). Another SSRI shows greater promise. McElroy, Hudson, Malhotra, Welge, Nelson Keck (2003) conducted a 6-week, double-blind, flexible-dose (20 to 60 mg per day) study on the efficacy of citalopram in reducing the frequency of binge eating episodes. They reported that the 19 patients receiving citalopram, compared with those receiving placebo, had a significantly greater rate of reduction in the frequency of binge eating episodes, frequency of binge days, weight, body mass index and severity of illness. In addition, citalopram was said to be well tolerated by the participants of the study. A head-to-head comparison of two SSRI’s – sertraline and fluoxetine – was conducted by Leombruni, Piero, Lavagnino, Brustolin, Campisi Fassino (2008) and published in the journal Progress in Neuro-psychopharmacology and Biological Psychiatry. Twenty-two participants were given 100 to 200 mg of sertraline daily, while twenty were given 40 to 80 mg of fluoxetine per day. After 8 weeks, participants from both groups had significant weight loss and their scores in the Binge Eating Scale improved. There was no significant difference found between the two drugs, and the researchers concluded that both SSRI’s are effective options in treating patients with BED. A drug that inhibits both serotonin and norepinephrine reuptake was studied by Noma, Uwatoko, Yamamoto Hayashi (2008). Although the trial did not focus exclusively on individuals with binge eating disorder but consisted of 25 binge eaters, some of whom were diagnosed with anorexia or bulimia nervosa. These patients received the drug milnacipran for 8 weeks and were found to have improved scores in relation to their drive for binge eating and regret for the same. Milnacipran was noted to be more effective in patients without purging. Venlafaxine, another medication that inhibits the reuptake of both serotonin and norepinephrine, was mentioned by Appolinario et al. (2003) as effective in BED therapy. McElroy, Guerdjikova, Kotwal, Welge, Nelson, Lake, Keck Hudson (2007) examined the effects of atomoxetine, a norepinephrine reuptake inhibitor, on BED. Twenty patients who received the drug had a significant decrease in binge-eating episode frequency, binge day frequency, weight, and body mass index. Their scores on the Clinical Global Impressions Severity of Illness scale, the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating obsession subscale, and the Three Factor Eating Questionnaire hunger subscale improved as well. However, three of the patients receiving atomoxetine asked to discontinue their treatment because of increased depressive symptoms, constipation or nervousness. Tricyclic antidepressants. Bulik, Brownley Shapiro (2007), in a review of the diagnosis and management of binge eating disorder, also mentions imipramine as one of the drugs that were shown in trials to be effective in the treatment of BED. Imipramine is a tricyclic antidepressant that is used mainly for the treatment of depression and enuresis. A drug from the same family, desipramine, was also mentioned as having beneficial effects in BED. There have indeed been many drugs explored by research for the treatment of binge eating disorder. However, while a lot of studies show that they do have a beneficial effect on patients with BED, particularly with regards to a reduction in binge frequency and weight, the results are somewhat modest. In addition, there have been no long-term studies tracking the efficacy of these drugs as yet. And then, of course, there is the concern that many of those individuals taking these drugs might give them up due to the adverse effects they cause. More importantly, the drugs do not address the underlying cause of binge eating, the psychopathology in individuals that lead them to take in large amounts of food despite the knowledge that doing so could harm them physically and socially. Thus, while many experts in the field would agree that medications help to curb the comorbidities of BED, they still encourage the use of psychotherapy. Psychotherapy Cognitive behavioral therapy. The behavioral therapeutic approach to binge eating disorder that is probably the most tested is cognitive behavioral therapy, or CBT (Bulik, Brownley Shapiro, 2007). As the name implies, the theory behind this practice is the cognitive behavioral model of binge eating, which â€Å"postulates that binge eating develops in response to restrictive food intake and occurs in the context of ongoing dietary restraint and the experience of negative emotions† (Levine Marcus, 2003). In short, inaccurate thoughts and beliefs – for example, those about body shape and weight – lead to inappropriate eating behavior. CBT helps patients identify these binge-triggering thoughts and modify them so as to accomplish binge abstinence. According to Bulik, Brownley Shapiro (2007), cognitive behavioral therapy has been reported by several studies to be effective in reducing â€Å"binge frequency, related psychological aspects of binge eating (restraint, disinhibition, and hunger), depressed mood, and ratings of illness severity in individuals with BED. † Levine Marcus (2003) note that, while cognitive behavioral therapy has been traditionally used in the management of individuals with bulimia nervosa, the technique has been modified to accommodate the differences between bulimia nervosa and binge eating disorder. For example, unlike people with bulimia nervosa, those with binge eating disorder tend to be obese, so CBT can directly target cognitions about having a large body size. They explain, â€Å"Overweight individuals with BED may be helped to accept their body size and to restructure maladaptive thoughts about the amount of weight loss they are likely to achieve. That is, although modest weight loss may relate to improvements in binge eating, for most BED patients this decrease may not correspond with their desired weight loss. It is therefore important that cognitions about acceptable body sizes be targeted during treatment. † Interpersonal psychotherapy. Another type of therapy that has found success in patients with bulimia nervosa and has since been also applied to people with binge eating disorder is interpersonal psychotherapy, or IPT. While CBT focuses on the thoughts that trigger eating binges, interpersonal psychotherapy operates on the theory that binge eating stems from the internal milieu created by specific social and interpersonal problems. Thus, it â€Å"focuses on identifying and addressing specific, problematic interpersonal patterns, in an effort to ameliorate dysfunctional eating behaviors† (Levine Marcus, 2003). As with CBT, IPT is focused, structured and time-limited. However, it does not address the patient’s beliefs about eating, weight and shape and, unlike CBT, does not directly target eating behaviors. In the Archives of General Psychiatry, Wilfley, Welch, Stein, Spurrell, Cohen, Saelens, Dounchis, Frank, Wiseman Matt (2002) report on a comparative study that they conducted between CBT and IPT. Both were done in a group setting, and the participants in each group went through 20 weekly sessions of therapy. Results showed that â€Å"binge-eating recovery rates† were similar for both CBT and IPT immediately after treatment. They further conducted follow-up on each participant and noted that, while, there was a slight increase in binge eating when the treatment ended, the frequency of such binges remained significantly lower than the frequency prior to initiation of either CBT or IPT. In addition, the researchers reported significant reductions in psychiatric symptoms, and these were maintained through follow-up. They noted that, while dietary restraint decreased more quickly in patients who underwent CBT, a similar level of dietary restraint was accomplished by those who underwent IPT by the time of follow-up. The participants’ weight decreased only slightly, but significantly, and the authors then concluded that group IPT is a reasonable alternative to group CBT for dealing with overweight BED patients. Dialectical behavior therapy. Another type of therapy used for the treatment of BED is dialectical behavior therapy, or DBT. This is described by Levine Marcus (2003) as â€Å"a comprehensive treatment program based on cognitive and behavioral principles and complemented by the use of acceptance-based strategies derived primarily from Zen Buddhism. † Patients undergo a weekly individual outpatient therapy and, at the same time, a weekly group skills therapy that has the goal of increasing behavioral skills that can help them deal with binge eating. According to Bulik, Brownley Shapiro (2007), dialectical behavior therapy â€Å"fosters the development of skills in the domains of mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. † Although it is still considered an â€Å"alternative† form of behavior therapy, there have been studies showing that DBT has led to a greater reduction in binge days, binge episodes, and concerns with weight, shape and eating. Other behavioral therapies. Aside from cognitive behavior therapy, interpersonal psychotherapy and dialectical behavior therapy, Bulik, Brownley Shapiro (2007) mention self-help, exercise and virtual reality therapy as treatment modalities that have been tried in patients with BED. Self-help interventions are delivered in various formats, and may be done with or without structure, and with out without the aid of a facilitator or a therapist. It has been shown by some studies to result in greater reductions in the mean number of binge days and in the clinical severity of BED. Abstinence and cessation rates were also reported to be improved with self-help, but weight loss was not significantly achieved. Medications and Psychotherapy: Combined and Compared Several studies have explored the option of combining pharmacotherapy with psychotherapy. Bulik, Brownley Shapiro (2007) discuss the results of these studies. For example, a trial compared fluoxetine alone with CBT alone and fluoxetine plus CBT. The authors of that trial reported that CBT plus fluoxetine, and CBT alone, were more effective than fluoxetine alone in reducing the frequency of binges, concerns with eating and body shape, disinhibition and depression. Another comparison discussed in the same paper compared desipramine alone, weight loss therapy, and CBT. Bulik, Brownley Shapiro (2007) relate: â€Å"Binge eating was significantly reduced after 12 weeks in both groups receiving CBT; however, this effect did not persist at 36 weeks of treatment. Average weight loss was greatest in the weight loss therapy group in the early stages of treatment, but over time (i. e. , at 3-month follow-up) the group receiving desipramine lost the most weight. Desipramine showed no clear advantage in reducing symptoms of depression. † Claudino, de Oliveira, Appolinario, Cordas, Duchesne, Sichieri Bacaltchuk (2007) compared topiramate alone with CBT plus topiramate and concluded that â€Å"topiramate added to CBT improved the efficacy of the later, increasing binge remission and weight loss in the short run. Topiramate was well tolerated, as shown by few adverse events during treatment. † Finally, Molinari, Baruffi, Croci, Marchi Petroni (2005) conducted a comparison of CBT alone, fluoxetine alone, and CBT plus fluoxetine. Results showed that â€Å"the two groups which underwent psychotherapy resulted in a better outcome in terms of number of bingeing episodes, maintenance of weight loss reduction from baseline and psychological well being than the group treated with pharmacological therapy alone. † The authors concluded that the results of their study highlight the importance of a multidisciplinary approach to binge eating disorder. However, as with pharmacotherapy alone and with psychotherapy alone, the long-term efficacy of a combined drugs-and-talk approach to binge eating disorder still has to be proven by future studies. Practical Advice To Tell Patients Empowering patients to take control of their disorder is also important. Smith, Barston, Segal Segal (2008) offer the following tips that concerned eating disorder professionals can give their patients: †¢ Eat breakfast. Skipping breakfast often leads to overeating later in the day, so start your day right with a healthy meal. Eating breakfast also jump starts your metabolism in the morning. Studies show that people who eat breakfast are thinner than those who don’t. †¢ Avoid temptation. You’re much more likely to overeat if you have junk food, desserts, and unhealthy snacks in the house. Remove the temptation by clearing your fridge and cupboards of your favorite binge foods. †¢ Stop dieting. The deprivation and hunger of strict dieting can trigger food cravings and the urge to overeat. Instead of dieting, focus on eating in moderation. Find nutritious foods that you enjoy and avoid labeling foods as â€Å"good† or â€Å"bad. † †¢ Exercise. Not only will exercise help you lost weight in a healthy way, but it also lifts depression, improves overall health, and reduces stress. The natural mood-boosting effects of exercise can help put a stop to emotional eating. †¢ Destress. Learn how to cope with stress in healthy ways that don’t involve food. Conclusion Binge eating disorder is still relatively â€Å"young. † With its anticipated inclusion in the next edition of the DSM, a lot of studies have turned their attention to this eating disorder that has only been recognized as an entity separate from the other eating disorder in the last decade. Hopefully, these studies, and the ones still to be conducted, will provide a sound basis for how best to approach binge eating disorder. More importantly, only future research can tell which treatment modalities really work best in the long term. In the meantime, patients with binge eating disorder need help in the here and now. References American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text rev. ) Washington, DC: American Psychiatric Association Sadock, B. J. , Sadock, V. A. (2003). Synopsis of Psychiatry: Behavioral Sciences / Clinical Psychiatry (9th ed. ). Philadelphia, PA: Lippincott Williams Wilkins. World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization. Marcus, M. D. Kalarchian, M. A. (2003). Binge eating in children and adolescents. Int J Eat Disord, 34(Suppl), S47–S57. Retrieved from PubMed database. Bulik, C. M. , Brownley, K. A. , Shapiro, J. R. (2007). Diagnosis and management of binge eating disorder. World Psychiatry, 6(3), 142-148. Grucza, R. A. , Przybeck, T. R. Cloninger, C. R. (2007). Prevalence and correlates of binge eating disorder in a community sample. Comprehensive Psychiatry, 48(2), 124-131. Appolinario, J. C. McElroy, S. L. (2004). Pharmacological approaches in the treatment of binge eating disorder. Current Drug Targets, 5(3), 301-307. Appolinario, J. C. , Bacaltchuk, J. , Sichieri, R. , Claudino, A. M. , Godoy-Matos, A. , Morgan, C. , Zanella, M. T. Coutinho, W. (2003). A randomized, double-blind, placebo-controlled study of sibutramine in the treatment of binge-eating disorder. Archives of General Psychiatry, 60, 1109-1116. Wilfley, D. E. , Crow, S. J. , Hudson, J. I. , Mitchell, J. E. , Berkowitz, R. I. , Blakesley, V. , Walsh, B. T. , the Sibutramine Binge Eating Disorder Research Group. (2008). Efficacy of sibutramine for the treatment of binge eating disorder: a randomized multicenter placebo- controlled double-blind study. American Journal of Psychiatry, 165(1), 51-58. McElroy, S. L. , Arnold, L. M. , Shapira, N. A. , Keck, P. E. Jr. , Rosenthal, N. R. , Karim, M. R. , Kamin, M. Hudson, J. I. (2003). Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial. American Journal of Psychiatry, 160(2), 255-261. McElroy, S. L. , Hudson, J. I. , Capece, J. A. , Beyers, K. , Fisher, A. C. , Rosenthal, N. R. the Topiramate Binge Eating Disorder Research Group. (2007). Topiramate for the treatment of binge eating disorder associated with obesity: a placebo-controlled study. Biological Psychiatry, 61(9), 1039-1048. McElroy, S. L. , Kotwal, R. , Guerdjikova, A. I. , Welge, J. A. , Nelson, E. B. , Lake, K. A. , D’Alessio, D. A. , Keck, P. E. , Hudson, J. I. (2006). Zonisamide in the treatment of binge eating disorder with obesity: a randomized controlled trial. Journal of Clinical Psychiatry, 67(12), 1897-1906. Hudson, J. I. , McElroy, S. L. , Raymond, N. C. , Crow, S. , Keck, P. E. Jr. , Carter, W. P. , Mitchell, J. E. , Strakowski, S. M. , Pope, H. G. Jr. , Coleman, B. S. Jonas, J. M. (1998). Fluvoxamine in the treatment of binge-eating disorder: a multicenter placebo-controlled, double-blind trial. American Journal of Psychiatry, 155(12), 1756-1762. Pearlstein, T. , Spurell, E. , Hohlstein, L. A. , Gurney, V. , Read, J. , Fuchs, C. Keller, M. B. (2003). A double-blind, placebo-controlled trial of fluvoxamine in binge eating disorder: a high placebo response. Archives of Women’s Mental Health, 6(2), 147-151. McElroy, S. L. , Hudson, J. I. , Malhotra, S. , Welge, J. A. , Nelson, E. B. Keck, P. E. Jr. (2003). Citalopram in the treatment of binge-eating disorder: a placebo-controlled trial. Journal of Clinical Psychiatry, 64(7), 807-813. Leombruni, P. , Piero, A. , Lavagnino, L. , Brustolin, A. , Campisi, S. Fassino, S. (2008). A randomized, double-blind trial comparing sertraline and fluoxetine 6-month treatment in obese patients with binge eating disorder. Progress in Neuro-psychopharmacology and Biological Psychiatry, 32(6), 1599-1605. Noma, S. , Uwatoko, T. , Yamamoto, H. Hayashi, T. (2008). Effects of milnacipran on binge eating – a pilot study. Neuropsychiatric Disease and Treatment (4)1, 295-300. McElroy, S. L. , Guerdjikova, A. , Kotwal, R. , Welge, J. A. , Nelson, E. B. , Lake, K. A. , Keck, P. E. Jr. Hudson, J. I. (2007). Atomoxetine in the treatment of binge-eating disorder: a randomized placebo-controlled trial. Journal of Clinical Psychiatry, 68(3), 390-398. Levine, M. D. Marcus, M. D. (2003). Psychosocial treatment of binge eating disorder: An update. Eating Disorders Review, 14(4). Retrieved from http://www. gurze. net/site12_5_00/newsletter16. htm. Wilfley, D. E. , Welch, R. R. , Stein, R. I. , Spurrell, E. B. , Cohen, L. R. , Saelens, B. E. , Dounchis, J. Z. , Frank, M. A. , Wiseman, C. V. Matt, G. E. (2002). A randomized comparison of group cognitive-behavioral therapy and group interpersonal psychotherapy for the treatment of overweight individuals with binge-eating disorder. Archives of General Psychiatry, 59, 713-721. Claudino, A. M. , de Oliveira, I. R. , Appolinario, J. C. , Cordas, T. A. , Duchesne, M. , Sichieri, R. Bacaltchuk, J. (2007). Double-blind, randomized, placebo-controlled trial of topiramate plus cgnitive-behavior therapy in binge-eating disorder. Journal of Clinical Psychiatry, 68(9), 1324-1332. Molinari, E. , Bariffu, M. , Croci, M. , Marchi, S. Petroni, M. L (2005). Bingea eating disorder in obesity: comparison of different therapeutic strategies. Eating and Weight Disorders, 10(3), 154-161. Smith, M. , Barston, S. , Segal, R. Segal, J. (2008). Binge eating disorder: Symptoms, causes, treatment, and help. Retrieved from http://www. helpguide. org/mental/binge_eating_disorder. htm.

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Peachtree Healthcare Essay

Peachtree Healthcare has been faced with a dilemma. There has been a major IT infrastructure problem within the company for some time now. Since technology has taken over in the healthcare field, it is imperative that Peachtree Healthcare get the technology needed so that they can be trusted and well known within the healthcare industry. Mission The mission of Peachtree Healthcare is to ensure quality, consistency, and continuity of care across the entire network – and to deliver care with the highest levels of efficiency and economy while maintaining respect for patients and staff. Objectives The hospital needs to decide on what long / short term IT infrastructure system strategies and roadmaps are needed to increase efficiency. The new system should allow sharing of patient records, ensure quality, consistency, and continuity of care across entire network of hospitals and physicians. Key Issues The IT infrastructure is not reliable; therefore, uses are unable to perform their day to day functions including clinical duties. This is impacting quality and safety of patient care. Recommendations Adopt service oriented architecture (SOA) which will enable selective standardization. CURRENT SITUATION (10) Peachtree Healthcare has major IT infrastructure problems and is struggling to find the right fix. Growth through acquisitions has led to the inheritance of many incompatible legacy systems. Current IT resources are focused on maintaining inefficient processes in order to keep the hospital running. The maintenance costs of the current IT system are so high that further innovation has become a luxury. In addition there have been recent meltdowns of clinical information systems. IT infrastructure is not reliable; therefore users are unable to perform their day to day functions, including clinical duties. This is impacting quality and safety of patient care. Furthermore there is pressure from the hospital’s board to standardize hospital procedures and practices without fully assessing the need for it. Max Berndt (CEO), Candace Markovich (CIO) and Tom Drane (CFO) are struggling to analyze the current situation subjectively in order to properly manage the pressure to follow competitors. CRITERIA (5) The hospital needs to decide on what long / short term IT infrastructure system strategies and roadmaps are needed to increase efficiency. The new system should allow sharing of patient records, ensure quality, consistency, and continuity of care across entire network of hospitals and physicians. The system should also ensure â€Å"selective† standardization of certain medical procedures across the network but allow sufficient flexibility to individual hospitals and professionals in other areas. Other criteria include: †¢ Time to value – when will the new system realize value for each business unit †¢ Flexibility – easy to modify, upgrade and customization capabilities †¢ Staff buy-in – ability to convince all staff to give this project a try ALTERNATIVES & RECOMMENDATIONS (15) Alternative 1: Monolithic System (Modular Enterprise System) A monolithic system is single set of systems and applications that will provide consistency across Peachtree’s facilities but may not give doctors enough flexibility. Other pros and cons include: Alternative 2: Service-Oriented Architecture (SOA) System A servicer-oriented architecture system is modular design that will allow Peachtree to standardize incrementally and selectively but poses certain risks as a newer technology. Recommendation: My recommendation is to crease a strategy of selective standardization using a SOA system. This means assessing and deciding on a SOA architecture standard. Reviewing individual business functions and deciding on an ideal standard for that functional unit then migrating others to it. This will allow Peachtree to standardize incrementally, which Max has wanted most in an IT infrastructure. RISK MANAGEMENT PLAN (15) Since SOA is a new technology, there are serious risks and consequences involved with this approach. The SOA technology is not mature yet and has not been tested in the long term. As a result there is a lot of unpredictability. To mitigate these risks Peachtree should gradually replace its old system with the SOA System. They should proceed with SOA in stages by piloting smaller projects to quickly provide value to business units. By gradually installing the SOA, Peachtree and its doctors would learn about how the systems worked and they could then master it in a sense as the infrastructure moved further. By gradually installing the infrastructure, Peachtree would not only minimize risk but also create flexibility and control. With the gradual learning process on the new SOA system, Peachtree and its physicians would allow IT to shift priorities along the way. Peachtree should also create case studies to get other business units and vendors support throughout roll-out process. They should also consider hiring external change management consultants to ensure minimum user disruption and smooth transition into the new system.

Should I Drink This Beer Essay - 1650 Words

Should I drink this beer? Should I Get A Job? Am I too fat? These are some typical questions that adolescents face during their middle school and high school years. Peer pressure can change the answer to those three simple question in both a negative or positive way. Peer pressure is when a group of your peers is trying to influence you to do something in either a good or bad way. Peer pressure can be shown in many different types of situations such as when drugs and alcohol come into an adolescent s life, worrying about their body image, and teenage sex, as well as dealing with bullying, and depression. Peer pressure shows up the most when adolescents come in contact with drugs and alcohol while they are with friends. Kathiann Kowalski from the book Teens at Risk says that â€Å"Teenagers are particularly vulnerable to peer influences† (Egendorf, L. K., Hurley, J. A., P. 43). Some obvious ways to tell if an adolescent is being peer pressured is how they act around a certain group of people and doing things that they wouldn’t normally do. â€Å"In a NIDA-funded study, teens driving with their friends in the car were more likely to take risks—like speeding through yellow lights—if they knew that two or more of their friends were watching† (Why Does Peer Pressure Influence Teens To Try Drugs?). Many teens have an impulse when they are with friends to try and act out to impress their friends. Drugs and alcohol have also always been a major concern to parents with adolescents onlyShow MoreRelatedCrafted Beer vs Mass Produced Beer1546 Words   |  7 P agesbetter, mass produced or crafted beer? According to (http://www.brewersassociation.org/pages/business-tools/craft-brewing-statistics/craft-brewer-defined) a craft brewer is â€Å"small, independent and traditional†. They have to produce less than six million barrels to be considered a craft brewery. Also from a financial point there is a difference to a mass producing beer brewery, an alcoholic industry can only have a maximum of 25% of the brewery. If they own more than this they are considered mass producingRead MoreBook Review1706 Words   |  7 Pagesthe audience reading the book about the six vital drinks that helped make up history. He explains this by showing how the drink influenced major events around the globe. He begins with beer which the oldest from the six drinks and ends with the youngest drink Coca-Cola. Standage explains how beer was important in the adoption in agriculture and the beginnings of civilizations. Farming became adapted by people in order to maintain a supply of beer. Farming surpluses allowed people of society toRead MoreEssay about Business Model and Strategic Plan Part 11551 Words   |  7 Pagesand Strategic Plan Part I BUS/475 April 28, 2015 Business Model and Strategic Plan Part I Anheuser-Busch InBev is the name of the leading global brewer. The company has a â€Å"portfolio of more than 200 beer brands, including three global flagship beers: Budweiser, Stella Artois and Beck’s† (â€Å"Anheuser-Busch†, 2015). Budweiser is an American style lager and was introduced in 1876 by Adolphus Busch. Adolphus Busch wanted to create the United States first national beer brand. Budweiser becameRead MoreSpss Softdrink Questionnaire1500 Words   |  6 Pagesstronger data management skills. Second, as Faculty Advisor for the UCA Marketing Club, and a member of the Central Arkansas Professional Chapter of the American Marketing Association, I am hearing from the marketing professionals is that marketing majors need better data management skills. Given the preceding, I decided to develop computer-based exercises using SPSS, with the objective of increasing student proficiency in data analysis and data management. The SPSS Exercises which correlate withRead MoreDrugs And Alcohol / Tobacco1687 Words   |  7 PagesDrugs and Alcohol/Tobacco: Beer Beer, a very well-known and consumed beverage, used to be very different from what it is today. Many drink it without knowing its intricate history, ingredients, benefits, disadvantages, and statistics. Throughout history, beer has traveled the world in distinct times and places. Its physical appearance has changed drastically as well as its name. The word â€Å"beer† initiated from the word, â€Å"bibere† which is the Latin verb that means â€Å"to drink†. People began concedingRead MoreA History of the World in 6 Glasses Study Questions Essay1485 Words   |  6 Pagesin setting up this book is that many drinks have built and brought together human history in to what we know about it. 2. The fluids that are mentioned in the book are vital because each one played a role in many areas of history and they are a crucial part of creating a certain period of history. â€Å"Beer in Mesopotamia and Egypt† 1. The discovery of beer is linked to the growth of the first civilizations because in both cultures of Mesopotamia and Egypt, beer was the main drink. It was consumedRead MoreHow Haacht Brewery Is An Independent And Family Owned Company Based Out Of Belgium1593 Words   |  7 Pagesdifferent types of specialty beers and produce soda and mineral water. One of their largest selling drinks and main brand, Primus, is produced from all natural ingredients. Primus is a pilsner, which is a distinct and unique type of beer. In October 2008, Lew LaraTBWA Sao Paulo, an agency in Brazil, released a print advertisement for Primus titled â€Å"Ocean†. The advertisement featured a group of young adults on a piece of wood floating in the ocean drinking Primus beer. It also engages in maintainingRead MoreThe Gastro Bar / Pub1294 Words   |  6 Pagesis â€Å"to rejuvenate the culture in beer drinking.† It was opened on the 14th of July 2014 and since then has become very successf ul and popular. The idea was to create the atmosphere of the classic English pub. Denis Belenko, a popular interior designer, designed the pub to resemble Harry Potter’s beer house. His company creates a unique customized design for each place. â€Å"We make the place feel like home to the customer and that’s when he will stay for another beer† – explains Belenko as to why allRead MoreDo Super Bowl Beer Commercials Influence Youth Drinking?1460 Words   |  6 PagesStudies Do Super Bowl beer commercials influence youth drinking? APA ABSTRACT There are studies that show that our youth are influenced by what they watch on television. Companies spend millions of dollars creating ads that will entice a person to buy their product. Unfortunately, this form of adverstising does not stop with reaching adults. These ads are seen by millions of teenagers, and the influence is based on how attractive or fun the ads seem to be. Advertising beer commercials, especiallyRead More A Night with Alberta Essay1109 Words   |  5 Pagesdormitory is a small jazz club. The large tinted front windows at street level and the subdued lighting might make a visitor think of an abandoned storefront. However, this small place is where magic can happen. The Cookery is a portal between the present and the past. Entering the club, the host finds my new wife and me a seat. This is both polite and practical for the fresh snow renders the newest patrons blind at first. Once seated at the postage stamped sized tables, the eyes begin to adjust

Philosophy of Food - An Authentic Approach to Eating

A good philosophical question can arise from anywhere. Did you ever think, for example, that sitting down to dinner or strolling through the supermarket might serve as a good introduction to philosophical thinking? That is the foremost philosopher of food’s credo. What’s Philosophical About Food? Philosophy of food finds its basis on the idea that food is a mirror. You may have heard the saying ‘we are what we eat.’ Well, there is more to say regarding this relation. Eating mirrors the making of a self, that is, the array of decisions and circumstances that bring us to eat the way we do. In them, we can see reflected a detailed and comprehensive image of ourselves. Philosophy of food reflects on the ethical, political, social, artistic, identity-defining aspects of food. It spurs from the challenge to more actively pondering our diets and eating habits so as to understand who we are in a deeper, more authentic way. Food as a Relation Food is a relation. Something is food only with respect to some organism, in a set of circumstances. These, first of all, are bound to vary from moment to moment. For instance, coffee and pastry are a fine breakfast or afternoon snack; yet, to most of us they are unpalatable for dinner. Secondly, circumstances are bound to involve principles that are, at least in appearance, contradictory. Say, you refrain from eating soda at home, but at the bowling alley, you enjoy one. At the supermarket, you buy only non-organic meat, but on vacation, you crave for a McBurger with fries. As such, any given ‘food relation is first and foremost the mirror of an eater: depending on the circumstances, it represents the eater’s needs, habits, convictions, deliberations, and compromises. Food Ethics Probably the most obvious philosophical aspects of our diet are the ethical convictions that shape it. Would you eat a cat? A rabbit? Why or why not? It’s likely that the reasons you give for your stance are rooted in ethical principles, such as: â€Å"I love too much cats to eat them!† or even â€Å"How could you do such a thing!† Or, consider vegetarianism: a large number of those who conform to this diet do so to prevent unjustified violence being done to animals other than human. In Animal Liberation, Peter Singer labeled â€Å"speciesism† the attitude of those who draw unjustified distinctions between Homo sapiens and other animal species (like racism sets an unjustified distinction between one race and all others). Clearly, some of those rules are mingled with religious principles: justice and heaven can come together on the table at, as they do on other occasions. Food as Art? Can food be art? Can a cook ever aspire to be an artist on a par with Michelangelo, Leonardo, and Van Gogh? This question has spurred heated debates over the past years. Some argued that food is (at best) a minor art. For three main reasons. First, because foods are short-lived in comparison to, e.g., chunks of marble. Second, food is intrinsically linked to a practical purpose – nourishment. Third, food depends on its material constitution in a way in which music, painting, or even sculpture are not. A song such as â€Å"Yesterday† has been released on vinyl, cassette, CD, and as a mp3; food cannot be alike transferred. The best cooks would hence be very good artisans; they can be paired with fancy hairdressers or skilled gardeners. On the other hand, some think that this perspective is unfair. Cooks have recently started featuring in art shows and this seems to concretely disprove the previous remarks. Probably the most famous case in point is Ferran Adrià  , the Cat alan chef who revolutionized the world of cooking over the past three decades. Food Experts Americans keep in high esteem the role of food experts; French and Italians notoriously do not. Probably, it’s because of different ways to regard the practice of evaluation of a food. Is that French onion soup authentic? The review says the wine is elegant: is that the case? Food or wine tasting is arguably an entertaining activity, and it’s a conversation starter. Yet, is there a truth when it comes to judgments about food? This is one of the hardest philosophical questions. In his famous essay â€Å"Of the Standard of Taste†, David Hume shows how one can be inclined to answer both â€Å"Yes† and â€Å"No† to that question. On the one hand, my tasting experience is not yours, so it is totally subjective; on the other, provided an adequate level of expertise, there is nothing odd with imagining to challenge a reviewer’s opinion about a wine or a restaurant. Food Science Most foods we buy at the supermarket carry on their labels â€Å"nutritional facts†. We use them in order to guide ourselves in our diet, to stay healthy. But, what do those numbers have to do really with the stuff we have in front of us and with our stomachs? What â€Å"facts† do they help us establishing really? Can nutritionism be regarded as a natural science on a par with – say – cell biology? For historians and philosophers of science, food is a fertile terrain of research because it raises basic questions regarding the validity of laws of nature (do we really know any law regarding metabolism?) and the structure of scientific research (who finances the studies on the nutritional facts you find on the labels?) Food Politics Food is also at the center of a number of funding questions for political philosophy. Here are some. One. The challenges that food consumption poses to the environment. For example, did you know that factory farming is responsible for a higher rate of pollution than airfare travel? Two. Food trades raise issues of fairness and equity in the global market. Exotic goods such as coffee, tea, and chocolate are chief examples: through the history of their commerce, we can reconstruct the complex relationships between continents, States, and people over the past three-four centuries. Three. Food production, distribution, and retail is an opportunity to talk about the condition of workers across the earth. Food and Self-Understanding In the end, as the average person enters at least a few ‘food relations’ per day, a refusal to ponder eating habits in a meaningful manner can be likened to a lack of self-understanding or lack authenticity. Since self-understanding and authenticity are among the chief aims of philosophical inquiry, then food becomes a true key to philosophical insight. The gist of the philosophy of food is hence the quest for an authentic diet, a quest that can be readily furthered by analyzing other aspects of ‘food relations’.

My Father The Major Has A Big Announcement For The Town

My father the major has a big announcement for the town. â€Å"People all over the city are getting a virus called plague or the black death† he said. As the major went on â€Å" the capitol will be here soon to take away our contestants for this year s hunger games.† â€Å"If they don’t make it in time we will have to evacuate the city and who ever is left behind we must leave behind† the major said. Everyone started to gasp and panic. I thought to myself, but what about gale and my sister Prim he can t leave his family and neither can I he still has his mother and I have my father.My mother died from pneumonia. His father left them to escape the capitol one day and they caught him running through the woods where Gale and I hunt. That day the capitol found him,ever since then Gale had to take care of his family on his own. As I walked down the road to Gale s house I stopped by the bakery to see that nice man with the witch if a wife. â€Å"Hello is the bakery open right now? I wanted to know if I could talk to the man of the bakery.† He never told me his name and he never talked a lot. I think it’s because I talk too much. People always say at school that all I do is blabber my mouth about anything I can. I think my father told me stop right here but I don’t remember because of the announcement. I waited awhile...still no one came out. Then I heard a big CRASH. So I grabbed the pan that the water was leaking in from the roof and started walking into the back. My father always told me toShow MoreRelatedMachismo in Chronicle of a Death Foretold by Gabriel Garcia Marquez1029 Words   |  5 Pagesmachismo expected of Latino men is exemplified by Santiago Nasar. Machismo men as stereotypically thought of as strong, rich, loud, and as womanizers. They are often associated with violence. Nasar would be a prime example of this because in his closet he has a â€Å"Mannlicher Schoenauer, 30-.06 rifle, a .300 Holland Holland Magnum rifle, a .22 Hornet with a double-powered telescopic sight, and a Winchester repeater.† (Marquez 5). This is ironic because even with a multitude of weapons Nasar ends up dead.Read More Alcoholics Anonymous Field Visit Report Essay2158 Words   |  9 Pagesand maintain their own sobriety. This idea of alcoholics helping each other spread slowly throughout until 1939. At this point, a group of a hundred sober members wrote and published the book Alcoholics Anonymous, which they refer to now as the â€Å"Big Book.† In 1941, A.A. become widely known because of an article printed in a national magazine that was widely read, The Saturday Evening Post. (Kinney Leaton, page 268). In A.A. there are no dues or fees, the only requirement is a desire toRead MoreEssay on Comparing Arnold Schwarzenegger and Adolf Hitler4575 Words   |  19 PagesComparing Arnold Schwarzenegger and Adolf Hitler To ‘learn’ history means to seek and find the forces which are the causes leading to those effects which we subsequently perceive as historical events.† – Adolf Hitler Growing up poor in a small town in Austria he had dreams of becoming famous; some would even say this dream soon became an obsession. This fascination soon engulfed his life, viewing his goals as a catalyst for a better life. After a brief stint in the army he pursued this dreamRead MoreRetailing and Big Bazaar12258 Words   |  50 Pages A Project Report on CUSTOMER PREFERENCES IN CHOOSING BIG BAZAAR, RTC ‘X’ ROADS. 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In 2004, R K Global launched its retail broking business on pan India level with a vision to capitalise the much untapped potential of strong retail segment. Ever since then, it has multiplied its retail client base manifold, by offering a highly competitive brokerage of 0.05% on delivery and 0.02% on intraday transactions. This was highly appreciated and lapped up immediately by retail investors all over India and in a showRead MoreComparision Between Vietnam and Uk Wedding4240 Words   |  17 Pagesto Mr Tran Huy Phuong, of Hanoi University of Foreign Studies for his valuable instruction, corection, comment and assitance during the development of my report. I would like to give a big thank to the English Department for giving me an opportunity and encouragement to complete my research. Finally I also would like to convey my thanks to all of my friends for their help. Content Introduction. Part 1: Similarities in wedding customs of Vietnam and England 1. Introduce the situation. 2. 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Copyright  © 2012, Richard Ivey School of Business Foundation Version: 2012-12-16 â€Å"Mamas Papas has a simple philosophy: to be a trusted, reassuring resource for parents.† www.mamasnpapas.co.za Driving home from the South African Broadcasting Association (SABC) in Auckland Park, Johannesburg, Nawaal Motlekar, managing director of Kwenta Media andRead MoreAdvertising Term Paper with Case Study6753 Words   |  28 Pagesexample, my product is advertising Reebok and is concentrating on people who play American Football. The advertisement is using the testimonial* method to advertise Reebok. The purpose for advertising is to commercialize a product or anything else to a certain audience or to any audiences. Another purpose for advertising is to persuade people to buy the product so that youll get more money. A third purpose is to make the company a bigger name by getting more buyers. For example, the purpose of my advertisement

Charles Koller Cocaine Essay Example For Students

Charles Koller Cocaine Essay Cocaine is one of the worst drugs on the streets today. It has destroyedmillions of lives and will hurt many more in the years to come. The Partnershipfor a Drug-Free America is a group that is concerned. They created a web site(located at http://www.drugfreeamerica.org.cocaine.html) that gives straightinformation on cocaine and every other known illicit drug. This information isinvaluable to parents. With an enemy like cocaine people need all theinformation that they can get. The web site explains every thing about Cocaine. Cocaine is distributed in two main forms. Powder cocaine is a white crystallinesubstance. It is usually snorted through the nose, or in can be mixed with waterand injected. This causes high that lasts for about 15 to 30 minutes. Crackcocaine is cocaine hydrochloride. Cooking cocaine with baking soda producescrack. The high from crack lasts about 5 to 10 minutes. Some people use itoccasionally and others use it many times a day. No matter how much it isextremely addictive. The high produced by cocaine is a surge in energy, anextreme feeling of pleasure. If used heavily it can cause its victim to sufferfrom paranoia, aggression, insomnia, and depression associated withdrawal. Onceit is out of the users brain the user may experience depression, irritability,and fatigue. One of the main reasons people use cocaine is achieve an alteredstate of perception (the process of selecting, organizing, and interpretingsensory information, enabling us to recognize meaningful objects and events Text1 25). When the brain is under the influence of cocaine it will perceiveinformation from the environment differently. The main people use cocaine try toget a feeling of euphoria, this is when the mind perceives everything aspositive. The feeling of euphoria only takes place while cocaine is in theusers brain once it leaves the brain; the mind perceives almost everything asnegative. Another issue with the altered state of perception produced by cocaineis people hurting themselves or others while under the influence of cocaine. Aperson driving under the influence of cocaine has the extreme possibility ofbeing overconfident (the tendency to be more confident than correct tooverestimate the accuracy of ones beliefs and judgments text page 274). Anoverconfident driver not under the influence of cocaine can be a great danger. That danger is multiplied by ten when that person is on cocaine. One of the mainproblems with getting a user off cocaine is withdrawal (the discomfort anddistress that follow discontinuing the use of an addictive drug text page 191). The symptoms of withdrawal associated with cocaine are paranoia, aggression,insomnia, and depression. These symptoms are one of the main reasons that it ishard for people to stop using cocaine. Another problem associated with cocainewithdrawal is that after a while of heavy cocaine use the user can only achievehappiness while under the influence of cocaine. To counteract the problems posedby cocaine withdrawal there are support groups to teach people how to live theirlives without cocaine. Despite the odds everyday people beat their cocaineaddiction. The psychological perspective that is very important to the purposeof this article is the social-cultural (investigates the connection betweensociety and behavior text page 5) perspective. The goal of the web site is togive parents the information needed to protect their kids from drug abuse. Thisperspective studies what influences people have to start using drugs in thefirst place. Psychologists from this field are involved marketing an ti-druginformation to people especially the youth. One thing that research in thisfield is information on who uses the drug and why. The Federal Drug EnforcementAdministration (DEA) has commissioned many studies on why youths begin to usecocaine. The have found what people have known for years. Teenagers tend to beoverconfident and they will try it, and before they know it they are hooked. .u1f613ffde439cc6e32c43186bde01b34 , .u1f613ffde439cc6e32c43186bde01b34 .postImageUrl , .u1f613ffde439cc6e32c43186bde01b34 .centered-text-area { min-height: 80px; position: relative; } .u1f613ffde439cc6e32c43186bde01b34 , .u1f613ffde439cc6e32c43186bde01b34:hover , .u1f613ffde439cc6e32c43186bde01b34:visited , .u1f613ffde439cc6e32c43186bde01b34:active { border:0!important; } .u1f613ffde439cc6e32c43186bde01b34 .clearfix:after { content: ""; display: table; clear: both; } .u1f613ffde439cc6e32c43186bde01b34 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u1f613ffde439cc6e32c43186bde01b34:active , .u1f613ffde439cc6e32c43186bde01b34:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u1f613ffde439cc6e32c43186bde01b34 .centered-text-area { width: 100%; position: relative ; } .u1f613ffde439cc6e32c43186bde01b34 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u1f613ffde439cc6e32c43186bde01b34 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u1f613ffde439cc6e32c43186bde01b34 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u1f613ffde439cc6e32c43186bde01b34:hover .ctaButton { background-color: #34495E!important; } .u1f613ffde439cc6e32c43186bde01b34 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u1f613ffde439cc6e32c43186bde01b34 .u1f613ffde439cc6e32c43186bde01b34-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u1f613ffde439cc6e32c43186bde01b34:after { content: ""; display: block; clear: both; } READ: Italian Tourism EssayThis information has helped spawn the just say no anti-drugcampaign. Another important perspective to this article is the biological (Howthe body and the brain create emotions, memories, and sensory experiences textpage 5) perspective. Psychologist from this perspective study how cocaineeffects the brain. Their research is very important, since they might find adrug that will alleviate the withdrawal symptoms of cocaine. If a drug like thiswas found it would be a great help to people who are addicted to cocaine. Whatcocaine does to the brain is terrible. It kills brain cells like beach killsgerms. After a long period