Drug Rehab

Marijuana Facts for Teens

2010-11-14T21:58:00.000-08:00

Q: What is marijuana? Aren't there different kinds?

A: Marijuana is a green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and flowers of the hemp plant. You may hear marijuana called by street names such as pot, herb, weed, grass, boom, Mary Jane, gangster, or chronic. There are more than 200 slang terms for marijuana.

Sinsemilla (sin-seh-me-yah; it's a Spanish word), hashish ("hash" for short), and hash oil are stronger forms of marijuana.

All forms of marijuana are mind-altering. In other words, they change how the brain works. They all contain THC (delta-9-tetrahydrocannabinol), the main active chemical in marijuana. They also contain more than 400 other chemicals. Marijuana's effects on the user depend on the strength or potency of the THC it contains. THC potency of marijuana has increased since the 1970s but has been about the same since the mid-1980s.

Q: How is marijuana used?

A: Marijuana is usually smoked as a cigarette (called a joint or a nail) or in a pipe or a bong. Recently, it has appeared in cigars called blunts.

Q: How long does marijuana stay in the user's body?

A: THC in marijuana is strongly absorbed by fatty tissues in various organs. Generally, traces (metabolites) of THC can be detected by standard urine testing methods several days after a smoking session. However, in heavy chronic users, traces can sometimes be detected for weeks after they have stopped using marijuana.

Q: How many teens smoke marijuana?

A: Contrary to popular belief most teenagers have not used marijuana and never will. Among students surveyed in a yearly national survey, only about one in five 10th graders report they are current marijuana users (that is, used marijuana within the past month). Fewer than one in four high school seniors is a current marijuana user.

Q: Why do young people use marijuana?

A: There are many reasons why some children and young teens start smoking marijuana. Most young people smoke marijuana because their friends or brothers and sisters use marijuana and pressure them to try it. Some young people use it because they see older people in the family using it.

Others may think it's cool to use marijuana because they hear songs about it and see it on TV and in movies. Some teens may feel they need marijuana and other drugs to help them escape from problems at home, at school, or with friends.

No matter how many shirts and caps you see printed with the marijuana leaf, or how many groups sing about it, remember this: You don't have to use marijuana just because you think everybody else is doing it. Most teens do not use marijuana!

Q: What happens if you smoke marijuana?

A: The effects of the drug on each person depend on the user's experience, as well as:

how strong the marijuana is (how much THC it has);
what the user expects to happen;
where (the place) the drug is used;
how it is taken; and
whether the user is drinking alcohol or using other drugs.

Some people feel nothing at all when they smoke marijuana. Others may feel relaxed or high. Sometimes marijuana makes users feel thirsty and very hungry - an effect called "the munchies."

Some users can get bad effects from marijuana. They may suffer sudden feelings of anxiety and have paranoid thoughts. This is more likely to happen when a more potent variety of marijuana is used.

Q: What are the short-term effects of marijuana use?

A: The short-term effects of marijuana include:

problems with memory and learning;
distorted perception (sights, sounds, time, touch);
trouble with thinking and problem-solving;
loss of coordination; and
increased heart rate, anxiety.

These effects are even greater when other drugs are mixed with the marijuana; and users do not always know what drugs are given to them.

Q: Can a user have a bad reaction?

A: Yes. Some users, especially someone new to the drug or in a strange setting, may suffer acute anxiety and have paranoid thoughts. This is more likely to happen with high doses of THC. These scary feelings will fade as the drug's effects wear off.

In rare cases, a user who has taken a very high dose of the drug can have severe psychotic symptoms and need emergency medical treatment.

Other kinds of bad reactions can occur when marijuana is mixed with other drugs, such as PCP or cocaine.

Q: Does marijuana affect school, sports, or other activities?

A: It can. Marijuana affects memory, judgment and perception. The drug can make you mess up in school, in sports or clubs, or with your friends. If you're high on marijuana, you are more likely to make stupid mistakes that could embarrass or even hurt you. If you use marijuana a lot, you could start to lose interest in how you look and how you're getting along at school or work.
Athletes could find their performance is off; timing, movements, and coordination are all affected by THC. Also, since marijuana use can affect thinking and judgment, users can forget to have safe sex and possibly expose themselves to HIV, the virus that causes AIDS.

Q: What are the long-term effects of marijuana use?

A: Findings so far show that regular use of marijuana or THC may play a role in some kinds of cancer and in problems with the respiratory and immune systems.

Cancer – It's hard to know for sure whether regular marijuana use causes cancer. But it is known that marijuana contains some of the same, and sometimes even more, of the cancer-causing chemicals found in tobacco smoke. Studies show that someone who smokes five joints per week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.

Lungs and Airways – People who smoke marijuana often develop the same kinds of breathing problems that cigarette smokers have: coughing and wheezing. They tend to have more chest colds than nonusers. They are also at greater risk of getting lung infections like pneumonia.

Immune System – Animal studies have found that THC can damage the cells and tissues in the body that help protect people from disease. When the immune cells are weakened, you are more likely to get sick.

Q: Does marijuana lead to the use of other drugs?

A: It could. Long-term studies of high school students and their patterns of drug use show that very few young people use other illegal drugs without first trying marijuana. For example, the risk of using cocaine is 104 times greater for those who have tried marijuana than for those who have never tried it. Using marijuana puts children and teens in contact with people who are users and sellers of other drugs. So there is more of a risk that a marijuana user will be exposed to and urged to try more drugs.

To better determine this risk, scientists are examining the possibility that long-term marijuana use may create changes in the brain that make a person more at risk of becoming addicted to other drugs, such as alcohol or cocaine. While not all young people who use marijuana go on to use other drugs, further research is needed to predict who will be at greatest risk.

Q: How can you tell if someone has been using marijuana?

A: If someone is high on marijuana, he or she might seem dizzy and have trouble walking; seem silly and giggly for no reason; have very red, bloodshot eyes; and have a hard time remembering things that just happened. When the early effects fade, over a few hours, the user can become very sleepy.

Q: How does marijuana affect driving?

A: Marijuana has serious harmful effects on the skills required to drive safely: alertness, the ability to concentrate, coordination, and the ability to react quickly. These effects can last up to 24 hours after smoking marijuana. Marijuana use can make it difficult to judge distances and react to signals and sounds on the road.

Marijuana may play a role in car accidents. In one study conducted in Memphis, TN, researchers found that, of 150 reckless drivers who were tested for drugs at the arrest scene, 33 percent tested positive for marijuana, and 12 percent tested positive for both marijuana and cocaine. Data have also shown that while smoking marijuana, people show the same lack of coordination on standard "drunk driver" tests as do people who have had too much to drink.

Q: If a woman is pregnant and smokes marijuana, will it hurt the baby?

A: Doctors advise pregnant women not to use any drugs because they could harm the growing fetus. One animal study has linked marijuana use to loss of the fetus very early in pregnancy.

Some scientific studies have found that babies born to marijuana users were shorter, weighed less, and had smaller head sizes than those born to mothers who did not use the drug. Smaller babies are more likely to develop health problems. There are also research data showing nervous system problems in children of mothers who smoked marijuana.

Researchers are not certain whether a newborn baby's health problems, if they are caused by marijuana, will continue as the child grows. Preliminary research shows that children born to mothers who used marijuana regularly during pregnancy may have trouble concentrating.

Q: What does marijuana do to the brain?

A: Some studies show that when people have smoked large amounts of marijuana for years, the drug takes its toll on mental functions. Heavy or daily use of marijuana affects the parts of the brain that control memory, attention, and learning. A working short-term memory is needed to learn and perform tasks that call for more than one or two steps.

Smoking marijuana causes some changes in the brain that are like those caused by cocaine, heroin, and alcohol. Some researchers believe that these changes may put a person more at risk of becoming addicted to other drugs, such as cocaine or heroin. Scientists are still learning about the many ways that marijuana could affect the brain.

Q: Can people become addicted to marijuana?

A: Yes. While not everyone who uses marijuana becomes addicted, when a user begins to seek out and take the drug compulsively, that person is said to be dependent or addicted to the drug. In 1995, 165,000 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they need help to stop using the drug.

According to one study, marijuana use by teenagers who have prior serious antisocial problems can quicky lead to dependence on the drug.

Some frequent, heavy users of marijuana develop a tolerance for it. "Tolerance" means that the user needs larger doses of the drug to get the same desired results that he or she used to get from smaller amounts.

Q: What if a person wants to quit using the drug?

A: Up until a few years ago, it was hard to find treatment programs specifically for marijuana users.

Now researchers are testing different ways to help marijuana users abstain from drug use. There are currently no medications for treating marijuana addiction. Treatment programs focus on counseling and group support systems. There are also a number of programs designed especially to help teenagers who are abusers. Family doctors are also a good source for information and help in dealing with adolescent marijuana problems.

Source: National Institute on Drug Abuse

Adolescent Substance Abuse

2010-11-14T21:57:00.000-08:00

Being a teenager and raising a teenager are individually, and collectively, enormous challenges. For many teens, illicit substance use and abuse become part of the landscape of their teenage years. Although most adolescents who use drugs do not progress to become drug abusers, or drug addicts in adulthood, drug use in adolescence is a very risky proposition. Even small degrees of substance abuse (for example, alcohol, marijuana, and inhalants) can have negative consequences. Typically, school and relationships, notably family relationships, are among the life areas that are most influenced by drug use and abuse.

One of the most telling signs of a teen's increasing involvement with drugs is when drug use becomes part of the teen's daily life. Preoccupation with drugs can crowd out previously important activities, and the manner in which the teen views him or her self may change in unrealistic and inaccurate directions. Friendship groups may change, sometimes dramatically, and relationships with family members can become more distant or conflictual. Further bad signs include more frequent use or use of greater amounts of a certain drug, or use of more dangerous drugs, such as cocaine, amphetamines, or heroin. Persistent patterns of drug use in adolescence are a sign that problems in that teen's environment exist and need to be addressed immediately.

What causes adolescent substance abuse?

There is no single cause of adolescent drug problems. Drug abuse develops over time; it does not start as full-blown abuse or addiction. There are different pathways or routes to the development of a teen's drug problems. Some of the factors that may place teens at risk for developing drug problems include:

insufficient parental supervision and monitoring
lack of communication and interaction between parents and kids
poorly defined and poorly communicated rules and expectations against drug use
inconsistent and excessively severe discipline
family conflict
favorable parental attitudes toward adolescent alcohol and drug use, and parental alcoholism or drug use

It is important to also pay attention to individual risk factors. These include:

high sensation seeking
impulsiveness
psychological distress
difficulty maintaining emotional stability
perceptions of extensive use by peers
perceived low harmfulness to use

How do you know when to seek help?

The earlier one seeks help for their teen's behavioral or drug problems, the better. How is a parent to know if their teen is experimenting with or moving more deeply into the drug culture? Above all, a parent must be a good and careful observer, particularly of the little details that make up a teen's life. Overall signs of dramatic change in appearance, friends, or physical health may be signs of trouble. If a parent believes his or her child may be drinking or using drugs, here are some things to watch for:

Physical evidence of drugs and drug paraphernalia
Behavior problems and poor grades in school
Emotional distancing, isolation, depression, or fatigue
Change in friendships or extreme influence by peers
Hostility, irritability, or change in level of cooperation around the house
Lying or increased evasiveness about after school or weekend whereabouts
Decrease in interest in personal appearance
Physical changes such as bloodshot eyes, runny nose, frequent sore throats, rapid weight loss
Changes in mood, eating, or sleeping patterns
Dizziness and memory problems

Howard Liddle, Ed.D.

Teen Substance Abuse and Treatment

2010-11-14T21:56:00.000-08:00

Being a teenager is often a confusing, challenging time, which can make teens vulnerable to falling into a destructive pattern of drug use. While most teens probably see their drug use as a casual way to have fun, there are negative effects that are a result of this use of alcohol or other drugs. Even if adolescent drug use does not necessarily lead to adult drug abuse, there are still risks and consequences of adolescent drug use. These negative effects usually include a drop in academic performance or interest, and strained relationships with family or friends.

Adolescent substance abuse can greatly alter behavior, and a new preoccupation with drugs can crowd out activities that were previously important. Drug use can also change friendships as teens begin to associate more with fellow drug users, who encourage and support one another's drug use. For adolescents, these changes as a result of substance abuse signal a problem in the teen's environment, and should be seen as a call to action for parents, teachers, or friends to seek help for their loved one.

Seeking Help

The sooner you can recognize that your teen is abusing alcohol or other drugs, the sooner you can seek help. Make sure to keep track of your teen, their friends, and where they are going. While your teen will probably call you a nag or become annoyed with the constant questions, it is more important to make sure that you know what is going on in your child's life, so that if a problem does arise you can take rapid action.

There are some things to look for in your adolescent's behavior that may be indications of drug use, which include changes in appearances, friends, behavior, and interests. Indications of substance abuse may include:

physical evidence of drugs or drug paraphernalia
behavior problems and a drop in academic performance
emotional distancing, depression, or fatigue
changes in mood, eating patterns, or sleeping patterns
change in friendships
increased hostility or irritability
decrease in interest in personal appearance
lying or increased evasiveness about school or weekend activities

If your teen exhibits these behaviors, they may have a problem with substance abuse, and the sooner you seek help for them, the better.

Treatment

Once teens start using drugs, they are not usually motivated to stop. For many teens, drugs are a pleasurable way to relax and fit in. For teens, drugs also don't represent a serious threat because teens typically have the mentality that they are invincible. Because of this, it is important that parents and friends are involved in encouraging adolescents to enter treatment in order to help them achieve a drug free lifestyle. Without this support, it is unlikely that teens will seek help for their drug problem.

There is a variety of treatment programs for adolescent substance abuse, and when seeking help for a loved one, it is important that the treatment program that you choose suits their individual needs.

Treatment for adolescent substance abuse usually includes:

Detoxification: Detoxification is for adolescents who need safe, medically supervised relief from withdrawal symptoms when they first enter a rehabilitation program.
Residential Rehabilitation: Residential rehabilitation is for teens who cannot stop using drugs without 24 hour supervision. Teens in residential rehab are individuals who have continued to use despite knowledge of the risks and consequences, or have continued to use despite previous attempts to stop. In a residential rehab program, these teens can learn and practice new skills that will help them in recovery. Residential programs may include individual and group therapy, 12-step programs, and relapse prevention.
Intensive Outpatient Program: Intensive outpatient programs are for teens who have committed to staying drug free, but need treatment after school to prevent use and promote recovery. These programs can also include adolescents who have already completed residential treatment, but feel that they need further support in the transition back into daily life. These programs usually rely on support from friends and family.
Aftercare/continuing care: These programs are a very important part of recovery, and help adolescents to maintain a drug free lifestyle. These programs usually include family support groups, or alumni support groups of people who have also completed a treatment program to provide support for the adolescent in recovery.

These treatment programs are designed to teach teens the skills that will help them to maintain their recovery and to sustain a drug-free lifestyle.

Drug Rehab

2010-11-14T21:53:00.001-08:00

Drug addiction is a complex illness.

It's characterized by compulsive--at times uncontrollable--drug craving, seeking, and use that persists even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence.

The path to drug addiction begins with the act of taking drugs. Over time, a person's ability to choose not to take drugs can become compromised. Drug seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and, thus, on behavior.

The compulsion to use drugs can take over the individual's life. Addiction often involves not only compulsive drug taking but also a wide range of dysfunctional behaviors that can interfere with normal functioning in the family, the workplace, and the broader community. Addiction also can place people at increased risk for a wide variety of other illnesses. These illnesses can be brought on by behaviors, such as poor living and health habits, that often accompany life as an addict, or because of toxic effects of the drugs themselves.

Because addiction has so many dimensions and disrupts so many aspects of an individual's life, treatment for this illness is never simple. Drug rehabs must help the individual stop using drugs and maintain a drug-free lifestyle, while achieving productive functioning in the family, at work, and in society. Effective drug abuse and drug rehab treatment programs typically incorporate many components, each directed to a particular aspect of the illness and its consequences.

Three decades of scientific research and clinical practice have yielded a variety of effective approaches to drug addiction treatment. Extensive data document that drug addiction treatment is as effective as are treatments for most other similarly chronic medical conditions. In spite of scientific evidence that establishes the effectiveness of drug abuse treatment, many people believe that treatment is ineffective. In part, this is because of unrealistic expectations. Many people equate addiction with simply using drugs and therefore expect that addiction should be cured quickly, and if it is not, rehab is a failure. In reality, because addiction is a chronic disorder, the ultimate goal of long-term abstinence often requires sustained and repeated treatment episodes.

Find a Drug Rehab Here

Helping Kids Navigate Their Teenage Years

2010-11-14T21:52:00.000-08:00

When Parents Need Help First

Parents can do much to help their teenage sons or daughters through a variety of difficult situations. Depression, violence, substance abuse, and bullying are all serious issues that parents and teens can work together to help resolve.

Sometimes, however, parents need to confront their own problems before they can help their teenager. Children who live in violent households, or homes where one of the caretakers uses drugs or abuses alcohol, often sustain severe emotional trauma that can last a lifetime. Even if a parent's violent behavior or substance abuse occurred when a child was small, the child may still suffer repercussions during his or her adolescent years.

Domestic violence and parental alcohol or other drug abuse adversely affect children.

Research shows that approximately 90% of children who live in homes where there is intimate partner violence see or hear the abuse. Further, children who are exposed to family violence are much more likely to become violent than are children from nonviolent families. Studies also show that if a parent uses alcohol or drugs, his or her children are more likely to drink or use drugs. Below are examples of situations where children have been affected by current, or even prior, parental behavior. If these situations sound familiar and if you need some help deciding what to do, consider seeking the advice of a local mental health professional.

Parental Alcohol or Substance Abuse

I was called to school by my daughter's principal. Apparently, when her math teacher corrected her in class, Deirdre threw a book at him and stormed out of the classroom. Deirdre's explanation was that "no one else cares, so why should I?" Today was a wake-up call. I have to admit it: My wife has a serious problem with alcohol. I'm not home much. I'm always avoiding the chaos. I know this is serious. What can I do now?

It sounds as though you recognize that your wife's alcohol abuse is affecting Deirdre. This is the first step. Parents with serious alcohol and other drug problems are often overly absorbed in their own needs and problems. They may not pre-pare meals, or be present at them. They may not carry their share of the household responsibilities. They may not properly supervise their children s homework and other aspects of their lives. Often their moods dominate the family. Their anger leaves other family members fearful and anxious. Roles may be confused and children end up taking care of the parents. Communication is often muddled.

Teens in such families feel isolated and alone, with no one to talk to. Their hurt and angry feelings may lead to depression, their own abuse of drugs, or may even erupt in violent behavior, as in your situation with your daughter. Children also sometimes seek attention and/or act out their feelings by shoplifting or committing other crimes.

So what can you do? First, children should not feel alone and abandoned, nor should they be caretakers for their parents. Deirdre needs a parent who will take responsibility and act as a parent should. Make it clear that you are assuming this responsibility and let her know that you love her. She also should know that you are aware that her mother has a problem, and that it is affecting the whole family. Take time to talk with Deirdre about what happened in school and about how she is feeling about things at home. Finally, you should encourage your wife to get help immediately.

If a family member with an alcohol or substance abuse problem is unwilling to seek help . . . Is there any way to get him or her into treatment?

This can be a challenging situation. A person with an alcohol or substance abuse problem cannot be forced to get help except under certain circumstances, such as when a violent incident results in police being called, or when it is a medical emergency. This doesn't mean, however, that you have to wait for a crisis to make an impact. Based on clinical experience, many alcohol and substance abuse treatment specialists recommend the following steps to help a person with an alcohol or substance abuse problem accept treatment:

Stop all "rescue missions"

Family members often try to protect a person with an alcohol or substance abuse problem from the consequences of his or her behavior by making excuses and by getting him or her out of difficult situations caused by the alcohol or other drug abuse. It is important to stop all such rescue attempts immediately, so that the person with the problem will fully experience the harmful effects of his or her drinking or drug use-and thereby become more motivated to stop.

Time your intervention

Plan to talk with the person shortly after an incident related to the alcohol or other drug abuse has occurred-for example, a serious family argument in which drinking or drug use played a part. Also choose a time when he or she is straight and sober, when both of you are in a calm frame of mind, and when you can speak privately.

Be specific

Tell the family member that you are concerned about his or her drinking or drug use, and want to be supportive in getting help. Back up your concern with examples of the ways in which his or her drinking or drug use has caused problems for you or your teenagers, including the most recent incident. If the family member is not responsive, let him or her know that you may have to take strong action to protect your children and yourself. Do not make any ultimatums you are not prepared to carry out.

Be ready to help

Gather information in advance about local treatment options. If the person is willing to seek help, call immediately for an appointment with a treatment program counselor. Offer to go with the family member on the first visit to a treatment program and/or Alcoholics Anonymous or Narcotics Anonymous meeting. (Consult your telephone directory for local phone numbers.)

Call on a friend

If the family member still refuses to get help, ask a friend to talk with him or her, using the steps described above. A friend who is recovering from an alcohol or other drug problem may be particularly persuasive, but any caring, nonjudgmental friend may be able to make a difference. The intervention of more than one person, more than one time, is often necessary to persuade a person with a drug problem to seek help.

Find strength in numbers

With the help of a professional therapist, some families join with other relatives and friends to confront a person with an alcohol or substance abuse problem as a group. While this approach may be effective, it should only be attempted under the guidance of a therapist who is experienced in this kind of group intervention.

Get support

Whether or not the family member with an alcohol or other drug problem seeks help, you may benefit from the encouragement and support of other people in your situation. Seeking the help of a mental health professional can provide the kind of help, insight and support that will allow for long-lasting positive change for you and, in turn, the well-being of your whole family.

The 4 Medications Used to Treat Alcoholism

2010-11-14T21:51:00.000-08:00

Can medication keep you sober? Probably not, but medication may help you stay sober, especially when medications approved for the treatment of alcoholism are combined with therapy.

While researchers have yet to find a real medication-based cure for alcoholism (and research continues in earnest), the U.S. Food and Drug Administration (FDA) has approved four medications for use in treating the disorder. These medications are all used to help people avoid relapse or decrease drinking.

The four medications approved by the FDA to treat alcoholism are:

Acamprosate
Oral naltrexone
Injectable naltrexone
Disulfiram

Why Use Medication?

Research shows that adding an approved medication for alcoholism to counseling or other forms of addiction treatment improves treatment outcomes. Alcoholism medications have been found to:

Reduce enduring symptoms of withdrawal that can prompt relapse (acamprosate)
Help minimize alcohol cravings
Help recovering alcoholics who temporarily slip back into drinking to avoid complete relapse
Prolong intervals between slips or relapses
Increase the benefits of counseling or other alcohol treatments

Medication can help an alcoholic in early recovery stay sober long enough to develop sober living and social skills that provide a continuing base for further sobriety. These medications also reduce the severity of cravings and withdrawal symptoms.

Acamprosate (Campral)

Acamprosate helps restore brain function damaged by alcoholism, and in doing so helps alcoholics maintain abstinence.

Alcohol causes intense but relatively brief withdrawal symptoms, and much longer lasting but milder symptoms of withdrawal. Although milder, these enduring withdrawal symptoms (such as difficulty sleeping, irritability and anxiety) can lead to alcohol relapse.

Acamprosate helps motivated recovering alcoholics maintain abstinence by reducing the severity of these longer lasting withdrawal symptoms. Acamprosate is thought to reduce glutamate activity, but its exact means of action remains poorly understood.

How Well Does Acamprosate Work?

Some studies show that acamprosate can double durations of abstinence. Other studies have shown less impressive outcomes. Acamprosate seems to work best for people who are motivated to stay abstinent. It must be taken three times daily, so patient compliance is very relevant.

Advantages of Acamprosate

Acamprosate is not metabolized in the liver, and so can be used by patients with liver damage or cirrhosis.
It can be used by patients taking methadone or Suboxone, and by those who require opiates for pain control (unlike naltrexone).
It causes no withdrawal symptoms and can be stopped suddenly if needed. It can also be taken safely with benzodiazepines.
It cannot be abused and it is not dangerous, even at overdose quantities.
Side effects are generally minimal, and those that occur are well tolerated.

Acamprosate becomes fully effective between five and eight days after treatment initiation.

Oral Naltrexone (ReVia)

Patients taking oral naltrexone experience reduced cravings for alcohol and, while taking the medication, drinking alcohol won’t produce as much pleasure. Since drinking doesn’t make people on naltrexone feel as good, people that slip while taking the medication tend to drink lesser amounts.

Oral naltrexone works by blocking receptor neurons in the brain’s natural opioid system. With these receptors blocked, consuming alcohol is not as pleasurable. Additionally, neurons in the mesolimbic system (the opioid system) are thought to be responsible, at least in part, for alcohol cravings. Blocking these receptors with naltrexone reduces craving intensity.

How Well Does Oral Naltrexone Work?

Oral naltrexone is effective at helping people maintain abstinence or drink less. Studies of oral naltrexone have shown that, compared to people taking a placebo, people taking the medication:

Have lower rates of relapse
If they do drink, drink less often and drink less in a sitting

Advantages of Oral Naltrexone

It works well, particularly for people who experience heavy alcohol cravings and who are motivated to maintain abstinence.
It is well tolerated, causing few side effects (the most common side effect is nausea).
It has no abuse potential and causes no withdrawal symptoms.

Disadvantages of Oral Naltrexone

It cannot be used by some people with liver problems.
It cannot be used by anyone using methadone, Suboxone or requiring opiate pain medications.
It may increase a person’s vulnerability to opiate overdose by decreasing opiate tolerance.

Most people begin oral naltrexone therapy within three to seven days after achieving alcohol abstinence. Naltrexone is FDA-approved for up to three consecutive months of treatment.

Injectable Naltrexone (Vivitrol)

Injectable naltrexone works in the same way as oral naltrexone to reduce alcohol cravings and decrease the pleasures of alcohol consumption. While oral naltrexone needs to be taken daily, intramuscularly injected naltrexone works for a continuous month. With a monthly injectable dose, everyday compliance is not an issue.

Studies that have examined the efficacy of naltrexone as a treatment for alcoholism have consistently encountered patient non-compliance as a barrier to successful treatment.

The advantages and disadvantages of injectable naltrexone treatment closely mimic those of oral naltrexone treatment. The main benefit of injectable naltrexone is increased patient compliance. Some points of concern include:

The possibility of an injection site reaction.
The duration of effectiveness means that any adverse reactions experienced will be experienced for 30 days.

Disulfiram (Antabuse)

Patients talking disulfiram cannot consume alcohol without becoming very ill. Patients taking this medication know this, and so avoid drinking alcohol while taking the medication. This helps people in recovery prolong abstinence and avoid relapse.

How Does Disulfiram Work?

Normally, alcohol is metabolized by the body into acetaldehyde and then into acetic acid. Disulfiram disrupts the final stage of this process (the metabolization of acetaldehyde into acetic acid), causing a much higher level of acetaldehyde in the body after any alcohol consumption.

High levels of acetaldehyde in the bloodstream lead to very uncomfortable reactions, such as the following:

Hyperventilation
Thirst
Nausea and vomiting
Chest pains
Dizziness
Confusion
Muscle weakness

At higher doses, the combination of disulfiram and alcohol can lead to serious reactions that can include symptoms such as:

Seizures
Heart failure
Respiratory depression
Death

Disulfiram is no longer given in doses high enough to likely cause a very severe or dangerous reaction. In the past, disulfiram was given in high dosages to patients in combination with alcohol, but that is no longer accepted medical practice.

Does Disulfiram Work?

Studies have shown that disulfiram helps to reduce drinking days amongst the actively drinking, but does not seem to work better than placebo in supporting abstinence. Patients who are supervised while taking their medication (to ensure compliance) seem to do better than those who are left unsupervised.

Disulfiram is not an appropriate medication for people with any of the following:

Mental illness
Poor impulse control
Cognitive impairments

No one should take disulfiram without a full understanding of the effects and potential consequences of the medication.

Medications Can Help Support Recovery

Medications can play a very supportive role as one of several pillars in a foundation of recovery. No medication yet available for the treatment of alcoholism works very well when offered as a standalone therapy — all must be combined with other therapies.

If you are interested in quitting drinking or reducing your consumption of alcohol, talk to your doctor about your suitability for any of the above medications. To find a doctor versed in alcoholism recovery, contact the National Resource Center at (866) 762-3712. The center is a free service providing treatment specialists 24 hours a day to answer your questions and put you in contact with appropriate healthcare professionals in your area.

Treatment for Dual Diagnosis: Substance Abuse and Mental Illness

2010-11-14T21:50:00.001-08:00

People who have both a mental or emotional disorder and a drug or alcohol addiction are said to have a dual diagnosis disorder. A dual diagnosis disorder is very common and it’s also very treatable. For the best chance of recovery, people with a dual diagnosis need integrated treatment for both substance abuse and their mental or emotional disorder at the same time.

How Common Is a Dual Diagnosis?

More than half of all people with a serious mental illness also have an alcohol or drug abuse or addiction problem, according to the Substance Abuse and Mental Health Services Administration.

More than fifty percent of drug abusers and 37 percent of alcohol abusers have a mental illness, according to the Journal of the American Medical Association.

Why Is Integrated Treatment so Important?

Each condition worsens and can prompt the other:

Alcohol and drugs can worsen psychiatric symptoms, reduce the effectiveness of psychiatric medications and reduce the likelihood of treatment compliance.

Symptomatic mental illness can prompt the use of alcohol or drugs as self medication, and can reduce the resolve or ability to stay abstinent.

For a better chance at lasting recovery, treatment must address both problems at the same time — and, ideally, should be from the same team of doctors, therapists and healthcare professionals.

Effective Dual Diagnosis Treatment

The first step in dual diagnosis treatment, if needed, is medical detoxification, which focuses primarily on the addiction. After successfully withdrawing from drugs or alcohol, the client can then participate in more integrated treatment for both addiction and mental illness.

Some components of effective dual diagnosis treatment programs include the following:

Programs that are developed exclusively for the treatment of dual diagnosis patients and that offer group therapy sessions comprised of patients undergoing similar challenges.

Programs that offer case management services, ensuring that the therapeutic services of a team of clinicians are delivered in an integrated manner and with full cooperation and communication between all involved.

Programs that bring in family members for support, education and involvement in the recovery process.

Programs that offer life-skills training, education or employment assistance programs.

Programs staffed by doctors able and willing to prescribe medications as appropriate.

Recovery From a Dual Diagnosis is Very Possible

A dual diagnosis can complicate the situation, treatment can take longer and dual diagnosis patients should seek out care specific to their needs — but dual diagnosis treatment can and does work.

Call the National Resource Center at (866) 762-3712 to learn more about treatment programs in your area that meet the needs of those with both mental illness and addiction.

Addiction Recovery: How Long Does it Take?

2010-11-14T21:50:00.000-08:00

Addiction rarely occurs overnight, and like the descent into the disease, the journey out of it can take some time.

People naturally want to know how long treatment and recovery will take. They want to know when they can expect to feel better and when they’ll stop craving that drink or that hit so badly.

Frustratingly, concrete answers to questions like these are hard to come by. Every person recovers in their own time, and every person requires something different on what is always a very individual journey.

The only part of recovery that transcends this individual experience is the reality of a lifetime of recovery. No matter who you are, once addicted, addiction recovery is for life.

The Facts of Recovery

Addiction remains an incurable disease. Although treatment can induce remission, recovery lasts a lifetime.

The National Institute on Drug Addiction (NIDA) does not recommend residential or outpatient programs that last fewer than 90 days, calling programs shorter than this “of limited effectiveness.”

NIDA recommends staying involved in addiction treatment for “significantly longer” than 90 days as the best way to encourage lasting success.

NIDA recommends that people taking methadone to help break their addiction stay on the medication for a minimum of 1 year before attempting to taper off.

Longer Is Generally Better

There are no quick fixes to overcoming an addiction, and you should be wary of those treatment methods that promise the impossible. When deciding to get treatment for your addiction, realize that recovery is a lengthy journey. For the best chance of continuing recovery, you will need to invest significant time and effort into your treatment experience.

People who enter a short- or long-term residential addiction treatment program will need to continue their involvement in aftercare outpatient programs to maximize their chances of success. That will provide them continued support and encouragement on their path of recovery.

To learn more about addiction treatment programs in your area, call the National Resource Center at (866) 762-3712. Treatment experts are available around the clock to answer your questions, without obligation, and recommend quality addiction treatment near you.

Are You Ready to Change Your Life? Understanding the Stages of Change Model?

2010-11-14T21:47:00.000-08:00

Radical life changes don’t often come out of thin air. Change begins as an idea and then a motivation and then finally, becomes an action; and this process towards change takes time.

The stages of change theory is a psychological model developed in the 1970s that is used to help patients understand how change occurs and to help treatment providers design interventions matched to each client’s needs at distinct stages.

The Stages of Change

Pre-contemplation - In this first stage, you don’t feel that you have a problem that needs changing and so aren’t thinking seriously about taking any action.

Contemplation - During this second stage, you have come to realize that you do have a problem, but you’re not quite sure yet what, if anything, you want to do about it. You may still very much enjoy your drinking or using (although it does cause some problems) and you’re not sure if you even want to stop…Something to think about.

Preparation – You have decided that change is needed and that change will come. You start thinking about how to accomplish your goal of change.

Action - You take action to make your life change. This could be by going to AA meetings or getting into treatment, for example.

Maintenance – You have achieved your goal of change and now you are trying to maintain it. This stage lasts from 6 months to 5 years in duration.

Termination or Relapse – Eventually (after 5 years) when you no longer have any desire to use and no longer require any external support to stay abstinent; you may consider your change terminated. An alternate to termination in the stages of change model is relapse. Relapse brings a person back full circle to step one again.

A person visiting a website on addiction treatment and reading an article on life change would likely be in the contemplation or preparation stage of change.

If you know you are ready for change and would like to see what treatment options are available in your area, please call the addiction treatment specialists at the National Resource Center at (866) 762-3712.

5 Techniques for Dealing with Cravings

2010-11-14T21:46:00.002-08:00

You can do your best to minimize your exposure to those things, places and people that trigger drug cravings, but you will never eliminate cravings entirely. Learning to manage and overcome drug or alcohol craving is therefore an essential skill in any journey of recovery.

Addiction treatment programs teach those in recovery skills that when practiced and used in real world situations of temptation, can prolong recovery for yet another day; day by day.

Here is a brief overview of some of the methods taught to help manage drug or alcohol cravings, as recommended by the National Institute on Drug Abuse (NIDA).

Distraction

Getting out of a situation of craving and distracting yourself with another activity is an excellent way to avoid succumbing to temptation.

Experts recommend that you make a list of activities that can distract you from a craving should the need arise (going bowling, taking the dog for a walk, doing the groceries etc.).

Many people attempt to manage cravings for a certain drug by using another drug, for example, a cocaine addict may use marijuana to help manage cocaine cravings. This is a very poor technique and too often leads to full relapse; and so having a list of better alternatives at the ready can help to minimize drug substitution behaviors.

Remembering Why You Don’t Use

During an intense craving, people fixate on a remembrance of the pleasures of drug use, forgetting temporarily the reasons why they stopped using in the first place. Reminding yourself why you chose to stop using during a period of craving can strengthen your resolve to wait it out.

Some therapists recommend that you in fact write down a list of good reasons for staying sober on an index card and keep that card on your person at all times. Then, during a tough moment of temptation, you can review your list and remember at that moment exactly why you need to stay strong.

For example

Worsening liver disease
Lose custody of my children if I use
My wife may leave me
I will lose my job if I test positive one more time

Talking Through the Craving

Talking through an episode of craving as it happens can help you to manage the severity of it. Telling someone you trust about what you are going through at the moment of a craving can empower you and reduce some of the anxiety associated with struggling against temptation alone. Talking through the craving as it happens can also help you to better understand what specifically led to the feelings of temptation.

Letting Go – Feeling the Craving

Letting yourself experience a drug or alcohol craving in a very abstract and detached kind of way can greatly diminish the experienced intensity of the event.

Therapists counsel you to envision the craving as a wave that is going to wash over you, starting low, gaining in intensity, peaking and then subsiding. Instead of fighting the craving, as you normally would, when letting go you try to experience the craving as fully as possible.

Get into a comfortable and secure place, sit back and let yourself feel the craving.

Notice:

What does it feel like?
What do my feet feel like? My knees, my stomach, my neck, etc…
How strong is the craving right now? Is it getting stronger or is it subsiding?
Can you describe the feeling of the craving in words?

In a paradoxical way, in concentrating on experiencing the craving fully you detach yourself from its influence. Many people find that this detached experiential method greatly reduces the intensity and even frequency of experienced cravings.

Reducing the Power of the Internal Voice

In most of us, feelings of craving unleash an internal voice that convinces us of the inevitability of use.

A craving might cause internal voice statements such as:

I need a drink
I can’t fight this any longer

However, once we take an objective look at craving induced inner voice statements, we can see that they are not inherently true at all; and so we can learn to counter these statements with more accurate reflections of reality.

“I need a drink” becomes, “I may want a drink, but I don’t need a drink, and all feelings of craving will pass.”

“I can’t fight this any longer” becomes, “Cravings can be unpleasant and difficult, but they are only temporary, I will feel better in a minute, as long as I don’t drink or use.”

A Cognitive Behavioral Therapy (CBT) Approach

These and other techniques for managing and overcoming cravings to use drugs or alcohol are taught as an aspect of CBT as offered for addiction recovery. Myriad clinical studies prove the efficacy of CBT as a treatment for addiction.

For Men; Chronic Heavy Drinking Lowers Testosterone Levels. What Does This Mean for You?

2010-11-14T21:46:00.001-08:00

Chronic heavy drinking is bad for you, we all know this, but if you’re a man, have you heard that heavy regular drinking might also make you less manly!?!

Alcohol does funny things to testosterone levels; none of them good. Studies have shown that when consumed in binge amounts, some men may react by showing a temporary surge in testosterone levels; a hormonal jump that may well in part explain drunken aggression. Other studies have shown, contrarily, that binge drinking causes an acute reduction in testosterone levels, for about a day or so.

In general though, heavy, lengthy and regular use of alcohol has a diminishing effect on testosterone levels. Heavy regular alcohol use robs men of normal testosterone levels, which causes a number of negative health effects.

Chronic use of opiate pain medications, such as vicodin, oxycontin or others, is also known to diminish testosterone levels.

The Consequences of Lowered Testosterone Levels Include:

Fatigue
A decrease in sex drive
Erectile dysfunction
Weight gain (fat gain, especially around the mid section)
A loss of lean muscle
Irritability
Body hair loss
A decrease in bone mass and a resultant increase in the risks of breaks and fractures
Depression
Male breasts
Shrinking testes
An increase in certain cardiovascular disease risks (men with very low testosterone levels are at a very high risk of heart attack)

Countering Alcohol Induced Testosterone Deficiencies

Lower than healthy testosterone levels can cause symptoms that are unpleasant, unattractive and downright dangerous. If alcohol causes you to lose testosterone, an obvious first step to restoring a better hormonal balance is a dramatic reduction or cessation of alcohol use.

Other methods that can increase testosterone include:

Medications
Exercise – weight lifting type exercises increase testosterone levels more than cardio exercises
Weight loss – carrying extra fat, especially a body weight that is 30% or more above ideal, can lead to hormonal imbalances
Getting a full night’s sleep
Diminishing chronic stress in your life (stress is a testosterone killer)
Good nutrition. Although weight loss is a great way to boost testosterone levels, crash diets can have the opposite effects. Stick to sensible healthy eating and exercise for weight loss.

Talk to your doctor if you worry that your testosterone levels may be low. An accurate diagnosis of the problem is always a solid first step to a good solution.

If, after a diagnosis of low testosterone levels, you find yourself still drinking alcohol at anything above a very minimal amount and infrequently, you may need to reevaluate your relationship with alcohol – after all, continuing to drink even knowing the harms that alcohol does to your body, is a hallmark sign of an alcohol problem.

Alcoholics Risk Osteoporosis

2010-11-14T21:46:00.000-08:00

What Is Osteoporosis?

Osteoporosis is a disease characterized by a reduction in bone density. Bones get smaller and weaken, putting people with the condition at a greatly elevated risk of breaks and fractures. Osteoporosis in older people is a serious health risk, often causing reductions in mobility and pain and broken bones after falls.

44 million Americans suffer from osteoporosis.
Chronic alcohol consumption increases the risks of osteoporosis.
Studies show that 25 percent of alcoholic men in their 30s, 40s and 50s show low bone density (Alcoholism Clinical and Experimental Research).

Alcohol causes a reduction in bone health and increases the risks of broken bones by decreasing coordination (alcoholics tend to fall down with greater than normal frequency).

How Does Alcohol Cause Osteoporosis?

Long-term heavy drinking damages bone health in many ways:

Heavy drinking reduces the body’s production of vitamin D, which is needed for calcium uptake.
Heavy drinking can alter hormone levels, decreasing testosterone in men and estrogen in women. A reduction in either of these hormones is associated with an increased risk of osteoporosis.
Alcoholics often have high levels of the stress hormone cortisol, which is harmful to bone health.
Alcohol increases the body’s production of parathyroid hormone, which decreases calcium levels.

What’s the Solution?

The solution to alcohol-related bone density losses is to stop consuming the substance that is causing the problem. Alcoholics who quit drinking tend to experience increased bone health, and in some cases, lost bone is even re-grown.

Other measures that can help include:

Weight-bearing exercise
Quitting smoking (smoking is also harmful to bone health)
Eating well (concentrating on getting sufficient vitamin D and calcium each day. Calcium is found in dairy products and green leafy vegetables.)

Source: The National Institute of Arthritis and Musculoskeletal and Skin Diseases

What Is Vivitrol?

2010-11-14T21:43:00.001-08:00

Vivitrol is a medication that helps alcoholics maintain abstinence during the early period of recovery. It is injected into your body once every 4 weeks and stays active in the body for this period of time.

Vivitrol contains the active ingredient naltrexone, which works by blocking natural opiate receptors in the brain. When you drink alcohol, endogenous opiates are released, and it feels good. When you drink alcohol after taking Vivitrol, the endogenous opiates that get released are blocked from having any effect, and so you don’t feel the pleasure that alcohol normally gives you.

Taking the pleasure out of drinking helps alcoholics stay motivated to quit and avoid relapse.

Does It Work?

The naltrexone in Vivitrol takes a lot of the fun out of drinking. Studies have shown that alcoholics taking Vivitrol drink fewer alcoholic beverages and less often than alcoholics not given the medication.

Studies also show that taking Vivitrol in addition to getting alcohol counseling (psychosocial therapy) works about three times better than getting counseling alone, when you compare abstinence rates at six months as a measure of success.

Vivitrol helps, but it won’t solve your problems on its own. Vivitrol can help make the early months of sobriety easier, especially when it is combined with other types of alcoholism treatment.

The Advantages of Once a Month Injections

Getting a shot once a month is a lot easier than deciding every day to continue taking a medication that takes the pleasure out of drinking. Even motivated alcoholics in recovery face temptation, and it’s a lot easier to decide to take your medicine once a month than every day.

Is Vivitrol Addictive?

Vivitrol (naltrexone) is in no way addictive. There is no withdrawal associated with sudden discontinuation of the medication.

Will It Make Me Feel Sick if I Drink?

Drinking alcohol within a month of taking Vivitrol won’t be as enjoyable, but it won’t make you feel sick.

An older medication used to treat alcoholism, Antabuse (disulfiram), worked by making alcoholics who drank while taking the medication violently ill. Antabuse is no longer commonly prescribed as anyone who wanted to start drinking could simply stop taking the Antabuse and drink without consequence, so it didn’t work all that well.

What Are the Side Effects?

Most people tolerate the medication well. Some people report feeling some nausea after the initial injection of Vivitrol, but this passes within a couple of days and isn’t normally experienced after subsequent injections.

Injection site reactions are also sometimes experienced. These can include redness, tenderness, itchiness and pain around the site of the injection.

Some other occasionally experienced side effects include:

Tiredness
Headache
Joint pain
Muscle cramps
Dizziness
Vomiting

Naltrexone, in high doses, can be harmful to the liver, and people with liver damage may not be able to take Vivitrol safely. Your doctor will likely tell you to watch out for any signs of liver problems after an injection of Vivitrol.

Will Vivitrol Counteract Pain Medications?

Naltrexone works by blocking the opiate receptors in the brain. Opiate pain medications, such as Vicodin, Oxycodone or Percocet, work by stimulating these same opiate receptors. Since naltrexone blocks these receptors, taking an opiate medication while on Vivitrol won’t result in any significant analgesia – naltrexone keeps opiate medications from working.

It is important to let your doctor know about your use of Vivitrol, especially in any trauma situation, to ensure that you receive adequate (non-opiate) pain relief when needed.

What If I’m Addicted to Opiates, Too?

Vivitrol should not be used by anyone currently dependant on opiate medications or illicit drugs such as heroin. Since naltrexone blocks the opiate receptors, an opiate-dependent person who uses Vivitrol will enter into immediate full opiate withdrawal.

You need to abstain from all opiates for 1-2 weeks prior to using Vivitrol.

6 Ways to Help a Loved One Beat Addiction

2010-11-14T21:43:00.000-08:00

It can be heart-wrenching to witness a loved one’s descent into addiction or alcoholism. Feeling powerless to create lasting change is often the hardest part as we watch a friend, parent, child or sibling risk early death to keep on getting drunk or high. It’s unbelievable, but it’s reality.

Fortunately, although you may feel powerless, you have more influence than you realize. Here are six ways that you can help get a loved one to stop abusing drugs or alcohol.

1. Get Educated

Until you get educated about the problem, you can’t hope to provide workable solutions.

The situation may seem black and white to you – “just stop using what’s killing you” – but with addiction, what seems to make the most sense isn’t necessarily what’s true or needed. Addiction creates physiological changes in the brain that make it very difficult to just “say no.”

Addiction erodes impulse control. Without treatment and relapse avoidance techniques, constant cravings are difficult to overcome.

Read all you can about the disease of addiction. It will help you to understand what your loved one is going through, why treatment is needed and what types of treatment are most likely to work – and it may increase your feelings of compassion. You are going to need the help and support of others in the family as well, so it’s important that you offer informed opinions about what can and should be done to create real and lasting change.

Go to the library and read online. You should also plan to meet with an addiction specialist to get opinions and recommendations for treatment.

2. Intervene

Myths

An addict needs to hit rock bottom before they’ll ever get help.
An addict has to decide when to get treatment.

Those two pervasive myths about addiction stop too many well-meaning and concerned family members from intervening to help their loved one get needed addiction treatment.

Addicts and alcoholics never need to hit rock bottom. Waiting for things to get worse only makes treatment harder and less likely to succeed, and many people never find their own rock bottom, until it’s too late.

Many alcoholics and addicts enter into substance abuse treatment programs initially on the urging of concerned friends or family members, at the request of employers or as mandated by the courts. Statistics show that people who do not enter into treatment as self-motivated participants are just as likely to succeed as anyone else. It does not matter how you feel walking in the door to that treatment center, it only matters how you feel walking out.

Talk to the person you love about drug rehab treatment. Sometimes you can convince them to get the help they need – sometimes they’re just waiting for someone to ask.

Often, though, it’s not that easy. Addiction hijacks the mind and treatment threatens the very existence of this addicted mind. Some of the strategies commonly employed to deflect treatment include:

Denying the problem or the extent of the problem
Lying about what they plan to do
Agreeing to get help, but not following through
Reacting with anger, deflecting the conversation away from their problem and back onto you

In many cases, an intervention is required to convince someone who is reluctant to get help into the addiction treatment they need.

A family intervention brings together everyone close to the addict or alcoholic for a loving conversation, during which the addict hears what harms their drinking or using does to them and to others.

When everyone comes together to tell personal stories of pain and to demand treatment, it is tough for the addict to continue to deny the existence of the problem and the need for treatment.

Interventions work well, but they should never be taken lightly. They are serious, difficult and emotional events that require forethought, planning and preparation. Be sure to get educated about the process before attempting your own, and consider enlisting the services of a professional interventionist to facilitate the event.

3. Participate in Treatment

Addiction affects the family, and family affects the addiction. If at all possible, family members should participate in the addiction treatment process. Family counseling and family education sessions can help reveal family dynamics that may contribute to the substance abuse and may help mend some of the wounds inevitably caused by addiction.

Getting educated as a family also prepares the group to offer the kinds of relapse prevention support that can really make a difference in those first tough months of sobriety.

4. Offer Support During and After Treatment

Addiction treatment should never end after a stay at a drug or alcohol rehab, but even with continuing aftercare, those first months of real-world temptation are a high risk period for relapse. Family support and involvement during this time can make a difference. Be there for your loved one, stay in close contact and be a good source of sober support. Boredom threatens sobriety, so arrange fun outings that avoid drinking or drug use – go for a walk in the forest!

Encourage your family member to stay active in continuing addiction treatment programs. People that participate in addiction treatment for one year or longer have a much better long-term success rate; overconfidence during the initial months is a big red flag!

If you use or drink, don’t do it anywhere near them.

5. Be Realistic

Understand that your addicted family member might slip or even relapse. Addiction is a chronic disease and relapse is an unfortunate part of it. Addiction treatment is best thought of as a medical treatment that induces symptom remission; in many cases, multiple bouts of treatment are required over a lifetime.

Working hard to get someone into treatment only to watch them relapse can be incredibly frustrating. Addiction is a frustrating disease. But it does not nullify the importance of the treatment or diminish the need for subsequent treatment. It’s just an unfortunate part of life for anyone who struggles with addiction.

6. Get Support for Yourself

You can’t help someone you love if you burn out. And ultimately, you can’t live anyone else’s life for them. It is vital that you look after yourself. Helping someone you love battle addiction isn’t a sprint, it’s a marathon, and you offer the most help if you are there for the long haul.

Many people find that support groups like Alanon or Alateen help them deal with the often painful realities of loving an addict or alcoholic. Others prefer individual counseling or other forms of support.

Bipolar and Addiction

2010-11-14T21:41:00.000-08:00

Bipolar disorder, a disease characterized by the extreme oscillation from the highs of mania to the lows of depression, affects between 1 percent and 3 percent of people. People with bipolar face an exaggerated risk of substance abuse problems, with as many as 60 percent of bipolar patients experiencing a substance abuse disorder at some point in life.

No cure exists for bipolar disorder, but the disease can be managed through medication and psychotherapy. Left untreated, the disease can be devastating, and when bipolar is combined with alcoholism or drug addiction, this devastation is compounded.

Why Is Bipolar So Strongly Associated with Addiction?

Bipolar and addiction are so intertwined that some doctors routinely test patients with bipolar for drug or alcohol abuse or addiction. But why do bipolar patients face this elevated risk of addiction?

During a manic phase, people often live a more reckless lifestyle, often fueled in part by the use of alcohol or drugs. Frequent excessive use of alcohol or drugs can lead to dependency.

Bipolar patients may self-medicate with drugs or alcohol.

Bipolar medications may cause unpleasant side effects that are diminished through the use of alcohol or drugs.

The Consequences of Alcohol or Drug Abuse for Bipolar Patients

Many bipolar patients take drugs or alcohol in an attempt to regulate, stabilize or improve their moods. Drugs and alcohol can provide temporary symptom relief, but in time, the use of drugs or alcohol worsens the symptoms of bipolar disorder. This can result in ever increasing drug or alcohol use.

Alcohol and drugs can reduce the effectiveness of bipolar medications.
The abuse of alcohol or drugs tends to reduce bipolar treatment compliance (people aren’t as likely to remember to take their meds when on a three-day bender).
Stimulant drugs, such as cocaine or methamphetamine, can induce mania and then deep depression.
The withdrawal symptoms of certain drugs, such as methamphetamine or alcohol, can worsen depression.
The abuse of drugs or alcohol can lead to a reduction in healthy social support systems. Alcoholics and drug addicts often cause strife and estrangement in the family.
The abuse of alcohol or drugs often leads to poor eating and exercise habits and a reduction in overall physical health.
Bipolar patients who abuse drugs or alcohol are at an elevated risk of suicide.
Bipolar patients who abuse alcohol or drugs spend more time hospitalized than bipolar patients that abstain.

Treatment for Bipolar and Addiction

The best treatment for a dual diagnosis of mental illness and addiction integrates various concurrent therapies to treat the person as a whole, whereas in the past, doctors preferred to deal with one problem at a time.

If the patient is actively abusing drugs or alcohol, residential detoxification and treatment may be indicated for the initial phase of treatment to ensure that any withdrawal period is navigated safely and successfully. Then continuing residential dual diagnosis treatment should be considered to allow medications (for both bipolar and addiction) and psychotherapies time to start working.

Dual diagnosis treatment elements can include:

Medication for the core mental illness
Medication to help with alcohol or drug withdrawal symptoms or cravings
Psychotherapy
Support group meetings (such as the 12 Steps)
Life skills training
Nutritional therapy
Recreational therapy
Relapse prevention planning

Effective dual diagnosis treatment must address all areas of life, from social/recreational to medical/biological, to employment/living conditions.

It is vital that treatment occur at a drug rehab facility that is equipped to handle dual diagnosis patients. In many cases, bipolar symptoms are the core underlying reason for the substance abuse. Thus, to attempt treatment for addiction at any facility that is ill-equipped to treat bipolar symptoms concurrently is to invite almost certain failure.

Bipolar complicates the treatment of addiction, and so although addiction treatment does work for dual diagnosis patients, it can take longer. As always, the earlier addiction treatment occurs, the better the probability of a successful outcome.

Will Years of Heavy Drinking Cause Brain Damage?

2010-11-14T21:40:00.001-08:00

The beer belly and a life of morning hangovers may or may not be an acceptable price for a party lifestyle – but are those nightly drinking binges worth irreversible brain damage?

Alcohol, when consumed regularly and in excess, has no health benefits and harms many of the body’s organs and systems, including the brain. Chronic heavy drinking can lead to a host of neurological problems and even severe cognitive declines.

Alcohol is toxic to the brain and a life of overindulgence can have some tragic consequences. Here is a brief overview of some of the more common forms of alcohol-related brain damage.

Alcohol-Related Brain Damage

Wernicke-Korsakoff Syndrome

Chronic thiamine (vitamin B1) deficiencies can lead to Wernicke-Korsakoff syndrome, a syndrome characterized by memory problems, a loss in cognitive functioning and in severe cases, death. Wernicke-Korsakoff Syndrome is also known colloquially as “wet brain.”

The National Institute on Alcohol Abuse and Alcoholism estimates that as many as 80 percent of alcoholics are deficient in thiamine, though only a small percentage of these people will develop Wernicke-Korsakoff. Alcoholics become deficient in thiamine through:

Insufficient nutritional intake (liquid lunches don’t have vitamin B1)
Alcohol causing limited absorption of thiamine into the body
Alcohol reducing the body’s ability to use the limited thiamine it does absorb

Insufficient thiamine levels lead to problems in brain cell metabolism, particularly in the cerebellum and in the frontal lobes. Wernicke-Korsakoff Syndrome very closely resembles Alzheimer’s disease, as people with the disorder may remember events from childhood clearly, but forget what they did or said only minutes before. Wernicke-Korsakoff impairs the brain’s ability to form new memories.

Other symptoms of the disorder include:

A dragging or staggering stride
Mental confusion
Living in a fantasy world that is perceived to be true
Paralyzed eye movements

If caught in the early stages, Wernicke-Korsakoff Syndrome can be treated through significant vitamin injections. In later stages, the condition is incurable and fatal.

Brain Shrinkage

Our brains shrink as we age but chronic heavy drinking accelerates the rate of brain shrinkage substantially. And the more you drink, the greater the shrinkage. This effect seems more pronounced in women than men. Brain volume declines are indicative of cognitive declines.

Liver Disease Related Brain Damage (Hepatic Encephalopathy)

Heavy chronic drinking is strongly associated with liver disease, including alcoholic cirrhosis. Alcoholic cirrhosis greatly compromises the liver’s ability to function, allowing certain toxins to build up in the body. Two of these toxins, manganese and ammonia, can enter the brain, causing brain cell death and a condition known as hepatic encephalopathy.

Symptoms of hepatic encephalopathy include:

Changes in personality
Mood or anxiety disorders
Sleep problems
A reduced attention span
Shaking hands
A loss of coordination

Hepatic encephalopathy can be fatal, and liver transplant can result in a significant improvement of brain function.

Alcoholic Neuropathy

Long-term heavy drinking can harm nerve tissue in the body and lead to a condition known as alcoholic neuropathy. The most common symptoms of the condition are burning or tingling sensations in the feet that can last for years.

Other symptoms include:

Nerve pain
Pins and needles
Muscle weakness
A loss of sensation (numbness)
Erectile dysfunction and incontinence
Nausea

Patients diagnosed with alcoholic neuropathy must stop drinking to prevent further nerve damage. Abstinence from alcohol usually reduces the severity of symptoms and prevents further damage, but existing nerve damage is, sadly, permanent.

Alcohol-Related Dementia

Alcohol can kill brain cells directly, or nutritional problems associated with alcoholism can do the damage. Chronic heavy drinking is associated with an increased risk for an alcohol-related form of dementia.

Heavy drinkers are less likely to consume adequate levels of essential vitamins and minerals and additionally, alcohol’s effects on the gastrointestinal system can limit the body’s ability to absorb these essential vitamins and minerals.

Alcohol-related dementias are not the same as Alzheimer’s disease, though they share some similarities. Alcohol-related dementia impacts cognitive capacities more globally, affecting far more than just memory. In addition to memory problems, symptoms of alcohol-related dementia include:

Changes in personality
Altered judgment
A reduction in social skills
A reduction in logical planning skills
A loss of coordination

If caught in the early stages, abstinence can lead to substantial symptom improvement.

Heavy Drinking Comes at a Price

Some people drink heavily for years without apparent harm; others aren’t so lucky. Lengthy alcohol abuse is associated with an increased risk of early death and for some, saddening cognitive declines.

Heavy drinkers who can reduce or eliminate their drinking greatly reduce their risks for cognitive problems later in life. Heavy drinkers who cannot reduce their drinking may want to consider seeking alcohol treatment.

Rational Emotive Behavioral Therapy (REBT)

2010-11-14T21:40:00.000-08:00

When thinking about getting addiction treatment, it’s important to understand what types of therapies are offered at different treatment centers, so that you can select a program that best meets your needs.

Here is an overview of Rational Emotive Behavioral Therapy (REBT), a form of cognitive-behavioral therapy (CBT) that is sometimes offered as a part of a comprehensive substance abuse treatment program.

Rational Emotive Behavioral Therapy is a counseling technique that is sometimes offered to help people increase life satisfaction, to reduce the symptoms of disorders such as anxiety or panic, or to avoid negative emotions that increase the odds of addiction relapse.

REBT was developed in the 1950s and was groundbreaking in its day as the counseling technique that pioneered cognitive-behavioral therapy. REBT is still widely practiced and respected today.

REBT as Drug or Alcohol Addiction Treatment

REBT strives to help people achieve greater happiness in life. It is used in addiction treatment to help people understand how they control their negative feelings. It teaches people new to recovery techniques to use in real-world situations that increase happiness and life satisfaction, and in doing so, reduces the odds of relapse.

A REBT counselor would advise that we are responsible for much of our happiness (or unhappiness) and that our beliefs influence our well-being far more than outside events do.

REBT – Changing Your Beliefs to Increase Your Happiness

While asking someone to change their beliefs may sound like some form of indoctrination, a REBT therapist asks patients to explore and change only certain negative and rigidly held beliefs that may contribute to unhappiness.

For example:

My professor gave me a “D” on my term paper.
He hates me because I disagree with him.
I give up, I’ll never pass.

Or:

My professor gave me a “D” on my term paper.
He didn’t agree with my arguments.
It’s too bad, I’ll have to work extra hard next time to keep my GPA up.

It’s all in the ABC’s! Actions produce Beliefs which produce Consequences. Importantly, it is not, in many cases, the action or adverse event that produces the emotional consequence; it is the belief you have about the action that does.

This is good, because you can’t very well stop anything bad from ever happening to you again, but you can change the way you think or believe, which changes how tough events make you feel.

In the first scenario, the person’s rigid belief (he hates me) led to despondent feelings and self-defeating behaviors.

In the second scenario, a more realistic belief led to a mild negative but healthier reaction and a plan to move on toward continuing happiness and success.

What Are Negative Beliefs?

A REBT therapist will argue that it is our negative beliefs that cause much of our unhappiness, and that if we practice, we can change these beliefs and start living happier more satisfactory lives – which for someone in recovery from substance abuse is a very important thing. It’s hard to stay sober over the long haul when you’re unhappy.

Unhealthy negative beliefs share certain elements, including:

Rigidity
Lack of acceptance for who you really are
Demand a high level of perfection from you
Prioritize what others think about you
What you think about yourself depends on what others think of you

Some examples of unhealthy beliefs include:

Those close to me must love and approve of me.
I must succeed at what I do.
Other people must behave correctly, or they must be punished.
I can’t control my happiness since the things that make me unhappy are not under my control.
If I don’t achieve my goals, things will be terrible.

In reality, we may prefer it if those close to us love and accept us, but they don’t have to, and the world won’t end if they don’t.

Other people don’t have to behave the way you think they should, and it’s not up to you to worry about punishing anyone.

You can’t control what happens to you but you can control the way you feel and respond – you can control your happiness!

Tolerance – The Path to Happiness

Accepting yourself, others and the world in general as it is, and not as it should be, is the path to greater happiness.

According to Albert Ellis, the father of REBT counseling, to live a happier life you must:

Accept yourself unconditionally – I want to succeed at work, but I don’t have to, and if I fail to do well, I can still like myself and have fun. I want to be a better husband, but I am not perfect. I will try to do better while accepting that my few negative traits do not define me as a “bad person.”

Accept others unconditionally – You accept every other person as a worthy person. You do not have to accept the self-defeating or antisocial actions of others, but no person’s few negative actions define that person completely.

Accept the world unconditionally – The world is not fair and you can’t control it. You do your best to help yourself and to help others but you acknowledge that you cannot change the world and so you must not get irrationally upset about the state of the world.

As Dr. Ellis would say, you aren’t perfect, others aren’t perfect and the world isn’t perfect – accept it, and then go out and have some fun!

Advantages of REBT

REBT therapy doesn’t require the months or years of counseling that some psychodynamic methods do; a typical course of REBT treatment ranges from 5 to 30 sessions in total.

REBT can induce lasting change and offers clients a real-world technique that can be practiced to increase life satisfaction; once learned, REBT becomes a self-help modality.

REBT does not strive to help people change their negative environmental conditions; rather, patients learn to accept imperfections in the self, others and the world, which can lead to greater happiness and personal freedom and frequently to positive environmental changes down the road.

Spotting Substance Abuse in Seniors

2010-11-14T21:39:00.000-08:00

Studies show that as many as 17 percent of American seniors may have alcohol abuse problems or alcoholism, yet this group is greatly underrepresented in addiction treatment programs.

Studies also show that when seniors do participate in addiction treatment programs, they show greater than average treatment compliance, are more likely to finish a recommended course of treatment and more likely to avoid relapse. Treatment for seniors works, but too many seniors never get the treatment they need.

Why Don’t More Seniors Get the Help They Need?

A number of factors reduce the likelihood of drug rehab participation, such as:

Family members and even doctors often misattribute certain indicators of substance abuse in seniors, such as memory loss or confusion, aches and pains, and falls as normal signs of aging.

Seniors less frequently run afoul of law enforcement, and so the courts rarely intervene.

Seniors are often out of the work force and thus, beyond the reach of employee assistance programs or concerned coworkers.

Seniors are more likely to be socially isolated. As a result, they may abuse alcohol or prescription medications without anyone’s awareness.

Family members may feel reluctant to intervene, thinking that “it’s too late” or they are “too old to change.”

Family members or even doctors may feel that seniors “deserve to enjoy themselves” in their old age.

Seniors may feel greater embarrassment than younger adults about their drug or alcohol abuse. Many seniors grew up within a social context that viewed alcohol or drug abuse as “immoral” or a “weakness of character” rather than a health condition.

A lack of mobility may deter treatment participation (seniors may need assistance in getting to and from treatment sessions).

Seniors may feel their impaired hearing or vision makes participation in drug rehab treatment impossible.

The Consequences of Continuing Alcohol or Drug Abuse by Seniors

Although some health professionals and family members may enable continuing drug or alcohol abuse through tacit support, alcohol and drug abuse by seniors can greatly reduce health, well-being and quality of life. Letting a senior “enjoy herself” in her old age is not a kindness.

Some consequences of alcohol and drug abuse by seniors include:

Physical injuries – The abuse of alcohol or prescription medications can lead to diminished coordination and an increased likelihood of injury from falls. Since bone strength is greatly reduced in older adults, falls can lead to broken bones, decreased mobility, and a reduction in overall health and well-being.

Mental health problems – Seniors who abuse prescription drugs or alcohol are at a greater risk of depression and other mental health disorders. Seniors who abuse alcohol are at an increased risk to commit suicide.

Cognitive declines – The abuse of alcohol and prescription medications can lead to memory problems, confusion and in some cases, irreversible cognitive declines. These symptoms of substance abuse are often misdiagnosed as signs of normal aging. Many cognitive declines associated with substance abuse are reversible with abstinence.

Nutritional deficiencies – The abuse of alcohol or prescription drugs is often associated with a decrease in the quality and often quantity of nutritional intake. Alcohol and certain drugs can also compromise the body’s ability to absorb or process certain vitamins and nutrients.

General health declines – The abuse of alcohol is associated with increased gastrointestinal problems, which are a common cause of hospital visits among older adults. Alcohol reduces cardiovascular and liver health and functioning, and is associated with increased risks for a host of cancers. The greater the consumption of alcohol, the greater the risk of cancer.

Sexual dysfunction – Alcohol abuse lowers testosterone levels in men, which can lead to erectile dysfunction in older men.

Seniors are more susceptible to the effects of alcohol and prescription drugs. They do not metabolize these psychoactive substances as well or as quickly as younger people, and they are more likely to mix alcohol or psychoactive medications with other medications that can result in dangerous drug interactions. What may not seem like excessive drinking in an older adult may in fact be enough to cause significant intoxication and serious health consequences.

Learning to Spot Substance Abuse in Seniors

Once in treatment, seniors tend to stay committed to their long-term recovery. Convincing a senior who is abusing drugs or alcohol to get addiction treatment can lead to increased health and cognitive functioning, a decrease in the risks of mental health disorders, and in many cases, to additional years of life.

If an older adult you know and love is drinking too much or abusing medications, you can and should intervene.

Two Kinds of Older Alcohol Abusers

There are, in broad terms, two kinds of older alcohol abusers. The first type is a lifetime heavy drinker or alcohol abuser who continues to drink heavily into older age. This type of alcohol abuser often has a medical history that includes episodes of alcohol-related medical care or addiction treatment. This type of older alcohol abuser is more likely to receive intervention in older age.

The second type of older alcohol abuser is the late-onset alcoholic. These older drinkers tend to start drinking after a major life change, such as retirement, the loss of a spouse, new care-giving roles or a loss of mobility due to health deficits. Isolation, especially after the death of a spouse, is a risk factor, as is retirement and a sudden increase in free time for drinking.

Older women who abuse alcohol are frequently late-onset alcoholics. Family members and health professionals are more likely to misinterpret signs of substance abuse in late-onset alcoholics as normal signs of aging.

Signs of Substance Abuse by Seniors

Weight loss or a sudden change in eating habits
Unexplained bruises or frequent falls and physical injuries
Walking with reduced coordination
Increased mental confusion or memory problems
Increased time spent in isolation
A reduction in personal hygiene
Depression or persistent sadness
A decrease in interest or participation in hobbies or activities that used to be enjoyed
A change in sleeping patterns
Chronic pain
A reduction in efforts made to stay in contact with family members
A change in personality
Fatigue

Investigate signs of substance abuse and if warranted, help an older adult you love get the addiction treatment he or she needs to enjoy a healthy and fulfilling life as a senior citizen.

Buprenorphine Therapy

2010-11-14T21:37:00.000-08:00

Buprenorphine, a derivative of thebaine, is an opiate that has been marketed in the United States as the Schedule V parenteral analgesic Buprenex®. In 2002, based on a re-evaluation of available evidence regarding the potential for abuse, diversion, dependence, and side effects, the DEA reclassified buprenorphine from a Schedule V to a Schedule III narcotic.

In October 2002, Reckitt Benckiser received FDA approval to market a buprenorphine monotherapy product, Subutex®, and a buprenorphine/naloxone combination product, Suboxone®, for use in opioid addiction treatment. The combination product is designed to decrease the potential for abuse by injection. Subutex® and Suboxone® are currently the only medications to have received FDA approval for this indication. In January 2003, Reckitt Benckiser began shipments of Suboxone® to pharmacies in the United States.

The approval of these formulations does not affect the treatment standards of previously approved medication-assisted treatments, such as methadone and LAAM (levo-alpha-acetyl-methadol). As indicated in Title 42 Code of Federal Regulations Part 8 (42 CFR Part 8), these therapies can only be dispensed, and only in the context of an Opioid Treatment Program. Also, neither the approval of Subutex® and Suboxone®, nor the provisions of DATA 2000, affect the use of other Schedule III, IV, or V medications, such as morphine, that are not approved for the treatment of addiction. Lastly, note that other forms of buprenorphine besides Subutex® and Suboxone®, e.g., Buprenex®, are not approved for treatment of opioid addiction.

Applied Pharmacology

Buprenorphine is an opioid partial agonist. This means that, although buprenorphine is an opioid, and thus can produce typical opioid agonist effects and side effects, such as euphoria and respiratory depression, its maximal effects are less than those of full agonists like heroin and methadone. At low doses, buprenorphine produces sufficient agonist effect to enable opioid-addicted individuals to discontinue the misuse of opioids without experiencing withdrawal symptoms. The agonist effects of buprenorphine increase linearly with increasing doses of the drug until at moderate doses they reach a plateau and no longer continue to increase with further increases in dose—the so-called “ceiling effect.” Thus, buprenorphine carries a lower risk of abuse, dependence, and side effects compared to full opioid agonists. In fact, in high doses and under certain circumstances, buprenorphine can actually block the effects of full opioid agonists and can precipitate withdrawal symptoms in an acutely opioid-intoxicated individual.

Buprenorphine has poor oral bioavailability and moderate sublingual bioavailability. Thus, formulations for opioid dependence treatment are in the form of sublingual tablets.

Buprenorphine is highly bound to plasma proteins. It is metabolized by the liver via the cytochrome P4503A4 enzyme system into norbuprenorphine and other metabolites. The half-life of buprenorphine is 24–60 hours.

Safety

Because of its ceiling effect and poor bioavailability, buprenorphine is safer in overdose than opioid full agonists. The maximal effects of buprenorphine appear to occur in the 16–32 mg dose range for sublingual tablets. Higher doses are unlikely to produce greater effects.

Respiratory depression from buprenorphine (or buprenorphine/naloxone) overdose is less likely than from other opioids. There is no evidence of organ damage with chronic use of buprenorphine, although increases in liver enzymes are sometimes seen. Likewise, there is no evidence of significant disruption of cognitive or psychomotor performance with buprenorphine maintenance dosing.

Information about the use of buprenorphine in pregnant, opioid-dependent women is limited; the few available case reports have not demonstrated any significant problems due to buprenorphine use during pregnancy. Suboxone® and Subutex® are classified by the FDA as Pregnancy Category C medications.

Side Effects

Side effects of buprenorphine are similar to those of other opioids and include nausea, vomiting, and constipation. Buprenorphine and buprenorphine/naloxone can precipitate the opioid withdrawal syndrome. Additionally, the withdrawal syndrome can be precipitated in individuals maintained on buprenorphine. Signs and symptoms of opioid withdrawal include:

Dysphoric mood
Nausea or vomiting
Muscle aches/cramps
Lacrimation
Rhinorrhea
Pupillary dilation
Sweating
Piloerection
Diarrhea
Yawning
Mild fever
Insomnia
Craving
Distress/irritability

Abuse Potential

Because of its opioid agonist effects, buprenorphine is abusable, particularly by individuals who are not physically dependent on opioids. Naloxone is added to buprenorphine to decrease the likelihood of diversion and abuse of the combination product. Sublingual buprenorphine has moderate bioavailability, while sublingual naloxone has poor bioavailability. Thus, when the buprenorphine/naloxone tablet is taken in sublingual form, the buprenorphine opioid agonist effect predominates, and the naloxone does not precipitate opioid withdrawal in the opioid-dependent user.

Naloxone via the parenteral route, however, has good bioavailability. If the sublingual buprenorphine/naloxone tablets are crushed and injected by an opioid-dependent individual, the naloxone effect predominates and can acutely precipitate the opioid withdrawal syndrome.

Under certain circumstances buprenorphine by itself can also precipitate withdrawal in opioid-dependent individuals. This is more likely to occur with higher levels of physical dependence, with short time intervals (e.g., less than 2 hours) between a dose of opioid agonist (e.g., methadone) and a dose of buprenorphine, and with higher doses of buprenorphine.

Evidence of Effectiveness

Studies have shown that buprenorphine is more effective than placebo and is equally as effective as moderate doses of methadone and LAAM in opioid maintenance therapy. Buprenorphine is unlikely to be as effective as more optimal-dose methadone, and therefore may not be the treatment of choice for patients with higher levels of physical dependence.

Few studies have been reported on the efficacy of buprenorphine for completely withdrawing patients from opioids. In general, the results of studies of medically assisted withdrawal using opioids (e.g., methadone) have shown poor outcomes. Buprenorphine, however, is known to cause a milder withdrawal syndrome compared to methadone and for this reason may be the better choice if opioid withdrawal therapy is elected.

Non-pharmacological Therapies

Effective treatment of drug addiction requires comprehensive attention to all of an individual’s medical and psychosocial co-morbidities. Pharmacological therapy alone rarely achieves long-term success. Thus Suboxone® and Subutex® treatment should be combined with concurrent behavioral therapies and with the provision of needed social services.

The choice of treatment setting in which to provide non-pharmacological therapies should be determined based on the intensity of intervention required for a patient. The continuum of treatment setting intensities ranges from episodic office-based therapy to intensive inpatient therapy.

Ideal candidates for opioid addiction treatment with buprenorphine are individuals who have been objectively diagnosed with opioid addiction, are willing to follow safety precautions for treatment, can be expected to comply with the treatment, have no contraindications to buprenorphine therapy, and who agree to buprenorphine treatment after a review of treatment options. There are three phases of buprenorphine maintenance therapy: induction, stabilization, and maintenance.

The induction phase is the medically monitored startup of buprenorphine therapy. Buprenorphine for induction therapy is administered when an opioid-dependent individual has abstained from using opioids for 12–24 hours and is in the early stages of opioid withdrawal. If the patient is not in the early stages of withdrawal, i.e., if he or she has other opioids in the bloodstream, then the buprenorphine dose could precipitate acute withdrawal.

Induction is typically initiated as observed therapy in the physician’s office and may be carried out using either Suboxone® or Subutex®, dependent upon the physician’s judgment. As noted above, Buprenex®, the parenteral analgesic form of buprenorphine, is not FDA-approved for use in opioid addiction treatment.

The stabilization phase has begun when the patients have discontinued or greatly reduced the use of their drug of abuse, no longer has cravings, and is experiencing few or no side effects. The buprenorphine dose may need to be adjusted during the stabilization phase. Because of the long half-life of buprenorphine it is sometimes possible to switch patients to alternate-day dosing once stabilization has been achieved.

The maintenance phase is reached when the patient is doing well on a steady dose of buprenorphine (or buprenorphine/naloxone). The length of time of the maintenance phase is individualized for each patient and may be indefinite. The alternative to going into (or continuing) a maintenance phase, once stabilization has been achieved, is medically supervised withdrawal. This takes the place of what was formerly called “detoxification.”

Be especially scrutinizing as you determine the drug rehab program that meets your specific needs. This site has listings of drug rehab programs and treatment centers, alcohol rehabilitation programs, teen rehabs, sober houses, drug detox and alcohol detox centers.

Please call (866) 762-3712 to find the right drug rehabilitation center for you or your loved one.

What are the short-term effects of cocaine use?

2010-11-14T21:36:00.001-08:00

Short-term effects of cocaine

Increased energy
Decreased appetite
Mental alertness
Increased heart rate and blood pressure
Constricted blood vessels
Increased temperature
Dilated pupils

Cocaine's effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect.

The duration of cocaine's immediate euphoric effects depends upon the route of administration. The faster the absorption, the more intense the high. Also, the faster the absorption, the shorter the duration of action. The high from snorting is relatively slow in onset, and may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes.

The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

What are the long-term
effects of cocaine use?

Long-term effects of cocaine

Addiction
Irritability and mood disturbances
Restlessness
Paranoia
Auditory hallucinations

Cocaine is a powerfully addictive drug. Once having tried cocaine, an individual may have difficulty predicting or controlling the extent to which he or she will continue to use the drug. Cocaine's stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the brain's reward system, and is either directly or indirectly involved in the addictive properties of every major drug of abuse.

An appreciable tolerance to cocaine's high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitization) to cocaine's anesthetic and convulsant effects, without incre?g the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

What are the medical complications of cocaine abuse?

Medical consequences of cocaine abuse

Cardiovascular effects

disturbances in heart rhythm
heart attacks

Respiratory effects

chest pain
respiratory failure

Neurological effects

strokes
seizures and headaches

Gastrointestinal complications

abdominal pain
nausea

There are enormous medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions and coma.

Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. And, persons who inject cocaine have puncture marks and "tracks," most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug, or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.

Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone. While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.

Are cocaine abusers at risk
for contracting HIV/AIDS
and hepatitis B and C?

Yes. Cocaine abusers, especially those who inject, are at increased risk for contracting such infectious diseases as human immunodeficiency virus (HIV/AIDS) and hepatitis. In fact, use and abuse of illicit drugs, including crack cocaine, have become the leading risk factors for new cases of HIV. Drug abuse-related spread of HIV can result from direct transmission of the virus through the sharing of contaminated needles and paraphernalia between injecting drug users. It can also result from indirect transmission, such as an HIV-infected mother transmitting the virus perinatally to her child. This is particularly alarming, given that more than 60 percent of new AIDS cases are women. Research has also shown that drug use can interfere with judgement about risk-taking behavior, and can potentially lead to reduced precautions about having sex, the sharing of needles and injection paraphernalia, and the trading of sex for drugs, by both men and women.

Additionally, hepatitis C is spreading rapidly among injection drug users; current estimates indicate infection rates of 65 to 90 percent in this population. At present, there is no vaccine for the hepatitis C virus, and the only treatment is expensive, often unsuccessful, and may have serious side effects.

What is the effect of
maternal cocaine use?

The full extent of the effects of prenatal drug exposure on a child is not completely known, but many scientific studies have documented that babies born to mothers who abuse cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are often shorter in length.

Estimating the full extent of the consequences of maternal drug abuse is difficult, and determining the specific hazard of a particular drug to the unborn child is even more problematic, given that, typically, more than one substance is abused. Such factors as the amount and number of all drugs abused; inadequate prenatal care; abuse and neglect of the children, due to the mother's lifestyle; socio-economic status; poor maternal nutrition; other health problems; and exposure to sexually transmitted diseases, are just some examples of the difficulty in determining the direct impact of perinatal cocaine use, for example, on maternal and fetal outcome.

Many may recall that "crack babies," or babies born to mothers who used cocaine while pregnant, were written off by many a decade ago as a lost generation. They were predicted to suffer from severe, irreversible damage, including reduced intelligence and social skills. It was later found that this was a gross exaggeration. Most crack-exposed babies appear to recover quite well. However, the fact that most of these children appear normal should not be over-interpreted as a positive sign. Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, but significant, deficits later, especially with behaviors that are crucial to success in the classroom, such as blocking out distractions and concentrating for long periods of time.

What treatments are effective
for cocaine abusers?

There has been an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be poly-drug users, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of problems. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient's drug abuse.

Pharmacological Approaches

There are no medications currently available to treat cocaine addiction specifically. Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine treatment medications. Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. For example, one of the most promising anti-cocaine drug medications to date, selegeline, is being taken into multi-site phase III clinical trials in 1999. These trials will evaluate two innovative routes of selegeline administration: a transdermal patch and a time-released pill, to determine which is most beneficial. Disulfiram, a medication that has been used to treat alcoholism, has also been shown, in clinical studies, to be effective in reducing cocaine abuse. Because of mood changes experienced during the early stages of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

Behavioral Interventions

Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction, for which there is, as yet, no viable medication. However, integration of both types of treatments is ultimately the most effective approach for treating addiction. It is important to match the best treatment regimen to the needs of the patient. This may include adding to or removing from an individual's treatment regimen a number of different components or elements. For example, if an individual is prone to relapses, a relapse component should be added to the program. A behavioral therapy component that is showing positive results in many cocaine-addicted populations, is contingency management. Contingency management uses a voucher-based system to give positive rewards for staying in treatment and remaining cocaine free. Based on drug-free urine tests, the patients earn points, which can be exchanged for items that encourage healthy living, such as joining a gym, or going to a movie and dinner. Cognitive-behavioral therapy is another approach. Cognitive-behavioral coping skills treatment, for example, is a short-term, focused approach to helping cocaine-addicted individuals become abstinent from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. The same learning processes can be employed to help individuals reduce drug use. This approach attempts to help patients to recognize, avoid, and cope; i.e., recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, such as pharmacotherapy.

Therapeutic communities, or residential programs with planned lengths of stay of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. Therapeutic communities are often comprehensive, in that they focus on the resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Therapeutic communities typically are used to treat patients with more severe problems, such as co-occurring mental health problems and criminal involvement.

New Campaign Seeks to Educate the Public on Drunk Driving Facts

2010-11-14T21:36:00.000-08:00

A new survey estimates that as many as three-fourths of American adults think they know enough about how drinking affects their blood alcohol levels, while in fact, most don't even know the legal limits in their own state. The Century Council, a group backed by major distillers, is campaigning to better educate the public about those limits and how much you have to drink to exceed them.

The group is an interactive program designed to educate users on blood-alcohol concentrations based on their weight and gender and the number and types of drinks they consume. It also factors in elapsed time, how quickly someone is drinking and how much food the individual has eaten.
"Our research indicates about 20 percent of Americans will drink a little more than usual at the holiday time, so as a result I think that it creates an additional incentive for distillers, as responsible companies, to go out and educate those people who may be enjoying the holiday celebrations more than they're used to," Century Council president Ralph Blackman said.

The council cites federal statistics showing that 1,708 people died in alcohol-related crashes last year between Thanksgiving and New Year’s Day.

Blackman said people often don't realize just how fast their blood alcohol concentration goes up, and how long it takes before it returns to normal. The program, the council hopes, will help drinkers face the facts and, very importantly, it hopes to help save lives this holiday season. As Blackman explains, "What we say is, ‘Well, you've just gotten the information you need to make a responsible decision and the responsible decision is not drinking up to the legal limit. The responsible decision is deciding when you've drunk enough and you are not impaired and therefore not a danger behind the wheel."

Important Findings:

The Century Council's November survey data were collected by telephone interviews of 1001 adults, 18 years or older, in the contiguous United States. Another sample polled 364 adults living in eight states.

**77%said they had enough information about drinking and driving and how drinking affects their blood alcohol level

**72% didn't know the blood alcohol limit in their state

**The average respondent thought .33% was the limit in his or her state, which is actually four times the national standard of .08%

**17% know that 12 ounces of beer, 5 ounces of wine and drinks with 1.5 ounces of distilled spirits all have the same impact on a person’s blood alcohol levels

Source: National Instutite on Alcoholism and Alcohol Abuse

Understanding Drug Abuse and Addiction

2010-11-14T21:35:00.000-08:00

Many people view drug abuse and addiction as strictly a social problem. Parents, teens, older adults, and other members of the community tend to characterize people who take drugs as morally weak or as having criminal tendencies. They believe that drug abusers and addicts should be able to stop taking drugs if they are willing to change their behavior.

These myths have not only stereotyped those with drug-related problems, but also their families, their communities, and the health care professionals who work with them. Drug abuse and addiction comprise a public health problem that affects many people and has wide-ranging social consequences. It is NIDA's goal to help the public replace its myths and long-held mistaken beliefs about drug abuse and addiction with scientific evidence that addiction is a chronic, relapsing, and treatable disease.

Addiction does begin with drug abuse when an individual makes a conscious choice to use drugs, but addiction is not just "a lot of drug use." Recent scientific research provides overwhelming evidence that not only do drugs interfere with normal brain functioning creating powerful feelings of pleasure, but they also have long-term effects on brain metabolism and activity. At some point, changes occur in the brain that can turn drug abuse into addiction, a chronic, relapsing illness. Those addicted to drugs suffer from a compulsive drug craving and usage and cannot quit by themselves. Treatment is necessary to end this compulsive behavior.

A variety of approaches are used in treatment programs to help patients deal with these cravings and possibly avoid drug relapse. NIDA research shows that addiction is clearly treatable. Through treatment that is tailored to individual needs, patients can learn to control their condition and live relatively normal lives.

Treatment can have a profound effect not only on drug abusers, but on society as a whole by significantly improving social and psychological functioning, decreasing related criminality and violence, and reducing the spread of AIDS. It can also dramatically reduce the costs to society of drug abuse.

Understanding drug abuse also helps in understanding how to prevent use in the first place. Results from NIDA-funded prevention research have shown that comprehensive prevention programs that involve the family, schools, communities, and the media are effective in reducing drug abuse. It is necessary to keep sending the message that it is better to not start at all than to enter rehabilitation if addiction occurs.

A tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data. Overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" - the gap between the public perception of drug abuse and addiction and the scientific facts.

Please call (866) 762-3712 to find the right drug rehabilitation center for you or your loved one.

Millions of Americans in Denial About Their Own Drug Abuse

2010-11-14T21:31:00.000-08:00

Millions of Americans in Denial About Their Own Drug Abuse

Results of the 2001 National Household Survey on Drug Abuse reveal that, while millions of Americans habitually smoke pot, drink alcohol, snort cocaine and swallow prescription drugs, too many drug users who meet the criteria for needing treatment do not recognize that they have a problem. The figure of those "in denial" is estimated at more than 4.6 million--a significantly higher number of individuals in need of professional help than had previously been thought.

According to the results of the survey, of the 5.0 million people who needed but did not receive treatment in 2001, an estimated 377,000 reported that they felt they needed treatment for their drug problem. This includes an estimated 101,000 who reported that they made an effort but were unable to get treatment and 276,000 who reported making no effort to get treatment.

"We have a large and growing denial gap when it comes to drug abuse and dependency in this country," said John Walters, Director of National Drug Control Policy. "We have a responsibility--as family members, employers, physicians, educators, religious leaders, neighbors, colleagues, and friends--to reach out to help these people. We must find ways to lead them back to drug free lives. And the earlier we reach them, the greater will be our likelihood of success."

70,000 Participated in the Nationwide Survey

70,000 people, aged 12 and older, participated in the nationwide survey and were asked questions concerning run-ins with the law, drunken driving, difficulties at school or work, as well as details of their drug use. Many users who said they'd encountered trouble in most areas still believed they were in control of their habit.

Overall, the Household Survey found that 15.9 million Americans age 12 and older used an illicit drug in the month immediately prior to the survey interview. This represents an estimated 7.1 percent of the population in 2001, compared to an estimated 6.3 percent the previous year.

The survey’s results reveal that 10.8 percent of youths age 12 to 17 were current drug users in 2001 compared with 9.7 percent in 2000. (On a positive note, youth cigarette use in 2001 was slightly below the rate for 2000, continuing a downward trend since 1999.)

Among young adults age 18 to 25, current drug use increased between 2000 and 2001 from 15.9 percent to 18.8 percent. There were no statistically significant changes in the rates of drug use among adults age 26 and older.

Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator Charles G. Curie emphasized that, "Behind these numbers are real children and adults impacted by drug use. We must refuse to give up on people who have handed over their aspirations and their futures to drug use. People need to know help is available, treatment is effective and recovery is possible." Curie added that the prevalence of drug use and abuse is partly due to a drop in the amount of people who see certain substances, such as marijuana, as harmful.

Marijuana

An estimated 2.4 million Americans used marijuana for the first time in 2000. Because of the way trends in the new use of substances are estimated, estimates of first- time use are always a year behind estimates of current use. The annual number of new marijuana users has varied considerably since 1965 when there were an estimated 0.6 million new users. The number of new marijuana users reached a peak in 1976 and 1977 at around 3.2 million. Between 1990 and 1996, the estimated number of new users increased from 1.4 million to 2.5 million and has remained at this level.

The measure of perceived risk in the use of marijuana among youth provides an important predictor of drug use, particularly among youths. As perceived risk of using marijuana decreases, rates of marijuana use tend to increase. Perceived great risk of smoking marijuana once or twice a week decreased from 56.4 percent in 2000 to 53.3 percent in 2001. Among youths age 12 to 17, the percentage reporting great risk in marijuana use declined from 56.0 to 53.5 percent.

Ecstasy

The number of persons who had ever tried Ecstasy (MDMA) increased from 6.5 million in 2000 to 8.1 million in 2001. There were 786,000 current users in 2001. In 2000, an estimated 1.9 million persons used Ecstasy (MDMA) for the first time compared with 0.7 million in 1998. This change represents a tripling in incidence in just 2 years.

Oxycontin ®

The number of persons reporting use of Oxycontin ® for non-medical purposes at least once in their lifetime increased from 221,000 in 1999 to 399,000 in 2000 to 957,000 in 2001. The annual number of new users of pain relievers non medically has also been increasing since the mid-1980s when there were roughly 400,000 initiates. In 2000, there were an estimated 2.0 million.

Alcohol

About 10.1 million persons age 12 to 20 years reported current use of alcohol in 2001. This number represents 28.5 percent of this age group for whom alcohol is an illicit substance. Of this number, nearly 6.8 million, or 19.0 percent, were binge drinkers and 2.1 million, or 6.0 percent, were heavy drinkers. In 2001, more than 1 in 10 Americans, or 25.1 million persons, reported driving under the influence of alcohol at least once in the 12 months prior to the interview. The rate of driving under the influence of alcohol increased from 10.0 to 11.1 percent between 2000 and 2001. Among young adults age 18 to 25 years, 22.8 percent, drove under the influence of alcohol.

Tobacco

An estimated 66.5 million Americans 12 years or older reported current use of a tobacco product in 2001. This number represents 29.5 percent of the population. Youth cigarette use in 2001 was slightly below the rate for 2000, continuing a downward trend since 1999.

Rates of youth cigarette use were 14.9 percent in 1999, 13.4 percent in 2000, and 13.0 percent in 2001. The annual number of new daily smokers age 12 to 17 decreased from 1.1 million in 1997 to 747,000 in 2000. This translates into a reduction from 3,000 to 2,000 in the number of new youth smokers per day.

Measuring the Most Serious Problems

The Household Survey includes a series of questions designed to measure more serious problems resulting from use of substances. Overall, an estimated 16.6 million persons age 12 or older were classified with dependence on or abuse of either alcohol or illicit drugs in 2001 (7.3 percent of the population). Of these, 2.4 million were classified with dependence or abuse of both alcohol and illicit drugs, 3.2 million were dependent or abused illicit drugs but not alcohol, and 11.0 million were dependent on or abused alcohol but not illicit drugs. The number of persons with substance dependence or abuse increased from 14.5 million (6.5 percent of the population) in 2000 to 16.6 million (7.3 percent) in 2001.

Between 2000 and 2001, there was a significant increase in the estimated number of persons age 12 or older needing treatment for an illicit drug problem. This number increased from 4.7 million in 2000 to 6.1 million in 2001. During the same period, there was also an increase from 0.8 million to 1.1 million in the number of persons receiving treatment for this problem at a specialty facility. However, the overall number of persons needing but not receiving treatment increased from 3.9 million to 5.0 million.

New Focus on Mental Health Needs

For the first time, the Household Survey included questions that measure serious mental disorders. Both youths and adults were asked questions about mental health treatment in the past 12 months.

The survey found a strong relationship between substance abuse and mental problems. Among adults with serious mental illness in 2001, 20.3 percent were dependent on or abused alcohol or illicit drugs; the rate among adults without serious mental illness was 6.3 percent. An estimated 3.0 million adults had both serious mental illness and substance abuse or dependence problems during the year.

In 2001, there were an estimated 14.8 million adults age 18 or older with serious mental illness. This represents 7.3 percent of all adults. Of this group with serious mental illness, 6.9 million received mental health treatment in the 12 months prior to the interview.

In 2001, an estimated 4.3 million youths age 12 to 17 received treatment or counseling for emotional or behavioral problems in the 12 months prior to the interview. This represents 18.4 percent of this population and is significantly higher than the 14.6 estimate for 2000. The reason cited most often by youths for the latest mental health treatment session was "felt depressed" (44.9 percent of youths receiving treatment), followed by “breaking rules or acting out" (22.4 percent), and "thought about or tried suicide" (16.6 percent).

Please call (866) 762-3712 to find the right drug rehabilitation center for you or your loved one.

Source: U.S. Dept. of Health and Human Services

The Relationships Between Alcohol and Other Drug Use and Psychiatric Symptoms and Disorders

2010-11-14T21:29:00.001-08:00

Establishing an accurate diagnosis for patients in addiction and mental health settings is an important and multifaceted aspect of the treatment process. Clinicians must discriminate between acute primary psychiatric disorders and psychiatric symptoms caused by Alcohol and Other Drugs (AODs). To do so, clinicians must obtain a thorough history of AOD use and psychiatric symptoms and disorders.

There are several possible relationships between AOD use and psychiatric symptoms and disorders. AODs may induce, worsen, or diminish psychiatric symptoms, complicating the diagnostic process.

The primary relationships between AOD use and psychiatric symptoms or disorders are described in the following classification model (Landry et al., 1991a; Lehman et al., 1989; Meyer, 1986). All of these possible relationships must be considered during the screening and assessment process.

AOD use can cause psychiatric symptoms and mimic psychiatric disorders. Acute and chronic AOD use can cause symptoms associated with almost any psychiatric disorder. The type, duration, and severity of these symptoms are usually related to the type, dose, and chronicity of the AOD use.
Acute and chronic AOD use can prompt the development, provoke the reemergence, or worsen the severity of psychiatric disorders.
AOD use can mask psychiatric symptoms and disorders. Individuals may use AODs to purposely dampen unwanted psychiatric symptoms and to ameliorate the unwanted side effects of medications. AOD use may inadvertently hide or change the character of psychiatric symptoms and disorders.
AOD withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes. Cessation of AOD use following the development of tolerance and physical dependence causes an abstinence phenomenon with clusters of psychiatric symptoms that can also resemble psychiatric disorders.
Psychiatric and AOD disorders can coexist. One disorder may prompt the emergence of the other, or the two disorders may exist independently. Determining whether the disorders are related may be difficult, and may not be of great significance, when a patient has long-standing, combined disorders. Consider a 32-year-old patient with bipolar disorder whose first symptoms of alcohol abuse and mania started at age 18, who continues to experience alcoholism in addition to manic and depressive episodes. At this point, the patient has two well-developed independent disorders that both require treatment.
Psychiatric behaviors can mimic behaviors associated with AOD problems. Dysfunctional and maladaptive behaviors that are consistent with AOD abuse and addiction may have other causes, such as psychiatric, emotional, or social problems. Multidisciplinary assessment tools, drug testing, and information from family members are critical to confirm AOD disorders.

The symptoms of a coexisting psychiatric disorder may be misinterpreted as poor or incomplete "recovery" from AOD addiction. Psychiatric disorders may interfere with patients' ability and motivation to participate in addiction treatment, as well as their compliance with treatment guidelines.

For example, patients with anxiety and phobias may fear and resist attending Alcoholics Anonymous or group meetings. Depressed people may be too unmotivated and lethargic to participate in treatment. Patients with psychotic or manic symptoms may exhibit bizarre behavior and poor interpersonal relations during treatment, especially during group-oriented activities. Such behaviors may be misinterpreted as signs of treatment resistance or symptoms of addiction relapse.

AOD Use and Psychiatric Symptoms

AOD use can cause psychiatric symptoms and mimic psychiatric syndromes.
AOD use can initiate or exacerbate a psychiatric disorder.
AOD use can mask psychiatric symptoms and syndromes.
AOD withdrawal can cause psychiatric symptoms and mimic psychiatric syndromes.
Psychiatric and AOD use disorders can independently coexist.
Psychiatric behaviors can mimic AOD use problems.

The Terminology of Dual Disorders

The term dual diagnosis is a common, broad term that indicates the simultaneous presence of two independent medical disorders. Recently, within the fields of mental health, psychiatry, and addiction medicine, the term has been popularly used to describe the coexistence of a mental health disorder and AOD problems. The equivalent phrase dual disorders also denotes the coexistence of two independent (but invariably interactive) disorders, and is the preferred term used in this Treatment Improvement Protocol (TIP).

The acronym MICA, which represents the phrase mentally ill chemical abusers, is occasionally used to designate people who have an AOD disorder and a markedly severe and persistent mental disorder such as schizophrenia or bipolar disorder. A preferred definition is mentally ill chemically affected people, since the word affected better describes their condition and is not pejorative. Other acronyms are also used: MISA (mentally ill substance abusers), CAMI (chemical abuse and mental illness), and SAMI (substance abuse and mental illness).

Common examples of dual disorders include the combinations of major depression with cocaine addiction, alcohol addiction with panic disorder, alcoholism and polydrug addiction with schizophrenia, and borderline personality disorder with episodic polydrug abuse. Although the focus of this volume is on dual disorders, some patients have more than two disorders, such as cocaine addiction, personality disorder, and AIDS. The principles that apply to dual disorders generally apply also to multiple disorders.

The combinations of AOD problems and psychiatric disorders vary along important dimensions, such as severity, chronicity, disability, and degree of impairment in functioning. For example, the two disorders may each be severe or mild, or one may be more severe than the other. Indeed, the severity of both disorders may change over time. Levels of disability and impairment in functioning may also vary.

Thus, there is no single combination of dual disorders; in fact, there is great variability among them. However, patients with similar combinations of dual disorders are often encountered in certain treatment settings. For instance, some methadone treatment programs treat a high percentage of opiate-addicted patients with personality disorders. Patients with schizophrenia and alcohol addiction are frequently encountered in psychiatric units, mental health centers, and programs that provide treatment to homeless patients.

Patients with mental disorders have an increased risk for AOD disorders, and patients with AOD disorders have an increased risk for mental disorders. For example, about one-third of patients who have a psychiatric disorder also experience AOD abuse at some point (Regier et al., 1990), which is about twice the rate among people without psychiatric disorders. Also, more than half of the people who use or abuse AODs have experienced psychiatric symptoms significant enough to fulfill diagnostic criteria for a psychiatric disorder (Regier et al., 1990; Ross et al., 1988), although many of these symptoms may be AOD related and might not represent an independent condition.

Compared with patients who have a mental health disorder or an AOD use problem alone, patients with dual disorders often experience more severe and chronic medical, social, and emotional problems. Because they have two disorders, they are vulnerable to both AOD relapse and a worsening of the psychiatric disorder. Further, addiction relapse often leads to psychiatric decompensation, and worsening of psychiatric problems often leads to addiction relapse. Thus, relapse prevention must be specially designed for patients with dual disorders. Compared with patients who have a single disorder, patients with dual disorders often require longer treatment, have more crises, and progress more gradually in treatment.

Psychiatric disorders most prevalent among dually diagnosed patients include mood disorders, anxiety disorders, personality disorders, and psychotic disorders. Each of these clusters of disorders and symptoms is dealt with in more detail in separate chapters.

AOD Abuse, Addiction, Dependence, Misuse

The characteristic feature of AOD abuse is the presence of dysfunction related to the person's AOD use. The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), produced by the American Psychiatric Association and updated periodically, is used throughout the medical and mental health fields for diagnosing psychiatric and AOD use disorders. It provides clinicians with a common language for communicating about these disorders and for making clinical decisions based on current knowledge. For each diagnosis, the manual lists symptom criteria, a minimum number of which must be met before a definitive diagnosis can be given to a patient.

Criteria for AOD abuse hinge on the individual's continued use of a drug despite his or her knowledge of "persistent or recurrent social, occupational, psychologic, or physical problems caused or exacerbated by the use of the [drug]" (American Psychiatric Association, 1987). Alternately, there can be "recurrent use in situations in which use is physically hazardous." The DSM-IV draft continues this emphasis (American Psychiatric Association, 1993).

Thus, AOD abuse is defined as the use of a psychoactive drug to such an extent that its effects seriously interfere with health or occupational and social functioning. AOD abuse may or may not involve physiologic dependence or tolerance. Importantly, evidence of physiologic dependence and tolerance is not sufficient for diagnosis of AOD abuse. For example, use of AODs in weekend binge patterns may not involve physiologic dependence, although it has adverse effects on a person's life.

AOD Abuse

Significant impairment or distress resulting from use

Failure to fulfill roles at work, home, or school

Persistent use in physically hazardous situations

Recurrent legal problems related to use

Continued use despite interpersonal problems

Therefore, screening questions should relate to life problems that result from AOD use, taking into consideration that patients may not have the insight to perceive that their life problems are caused by AOD abuse.

The phrase AOD addiction (called "psychoactive substance dependence" in the DSM-III-R and "substance dependence" in the DSM-IV draft) is an often progressive process that typically includes the following aspects: 1) compulsion to acquire and use AODs and preoccupation with their acquisition and use, 2) loss of control over AOD use or AOD-induced behavior, 3) continued AOD use despite adverse consequences, 4) a tendency toward relapse following periods of abstinence, and 5) tolerance and/or withdrawal symptoms.

AOD Addiction or Dependence

Pathologic, often progressive and chronic process
Compulsion and preoccupation with obtaining a drug or drugs
Loss of control over use or AOD-induced behavior
Continued use despite adverse consequences
Tendency for relapse after period of abstinence
Increased tolerance and characteristic withdrawal (but not necessary or sufficient for diagnosis)

The DSM-III-R describes nine diagnostic criteria, of which three or more must be present for a month or more to establish a diagnosis of dependence. Screening questions can be based on these criteria. The DSM-IV draft committee deleted DSM-III-R criterion 4 and the requirement of symptoms being present for at least 1 month. The DSM-IV draft emphasizes the symptoms of tolerance and withdrawal, which the draft committee placed at the top of the list of criteria.

In the DSM-III-R, criteria 1 and 2 deal with loss of control; criterion 3 addresses time involvement; criteria 4 and 5 relate to social dysfunction; criterion 6 relates to continued use despite adverse consequences;and criteria 7, 8, and 9 relate to the development of tolerance and withdrawal. It is important to note that tolerance, physiologic dependence, and withdrawal are neither necessary nor sufficient for the establishment of a diagnosis of AOD addiction.

The term AOD dependence can be confusing because it has multiple meanings. The DSM-III-R uses the phrase "psychoactive substance dependence" to describe the process of addiction, while many pharmacologists use the term "dependence" exclusively for describing the biologic aspects of physical tolerance and/or withdrawal. The American Society of Addiction Medicine describes drug dependence as having two possible components: 1) psychologic dependence and 2) physical dependence.

Psychologic dependence centers on the user's need of a drug to reach a level of functioning or feeling of well-being. Because this term is particularly subjective and almost impossible to quantify, it is of limited usefulness in making a diagnosis.

Physical dependence refers to the issues of physiologic dependence, establishment of tolerance, and evidence of an abstinence syndrome or withdrawal upon cessation of AOD use. In this case, AOD type, volume, and chronicity are the important variables: Given a certain substance, the higher the dose and longer the period of consumption, the more likely is the development of tolerance, dependence, and subsequent withdrawal symptoms. Physical dependence and tolerance are best understood as two of many possible consequences (which may or may not include addiction and abuse) of chronic exposure to psychoactive substances.

Among patients with a psychiatric problem, any AOD use -- whether abuse or not -- can have adverse consequences. This is especially true for patients with severe psychiatric disorders and patients who are taking prescribed medications for psychiatric disorders. For patients with psychiatric disorders, the infrequent consumption of alcohol can lead to serious problems such as adverse medication interactions, decreased medication compliance, and AOD abuse. Screening questions can relate to evidence of any use of AODs, as well as frequency, dose, and duration.

Medication misuse describes the use of prescription medications outside of medical supervision or in a manner inconsistent with medical advice. While medication misuse is not an abuse problem per se, it is a high-risk behavior that: 1) may or may not involve AOD abuse, 2) may or may not lead to AOD abuse, 3) may represent medication noncompliance and promote the reemergence of psychiatric symptoms, and 4) may cause toxic effects and psychiatric symptoms if it involves overdose.

Thus, some patients may consume medications at higher or lower doses than recommended or in combination with AODs. Also, certain patients may respond to prescribed psychoactive medications by developing compulsive use and loss of control over their use.

Source: The U.S. Department of Health and Human Services

A Family History of Alcoholism

2010-11-14T21:29:00.000-08:00

If you are among the millions of people in this country who have a parent, grandparent, or other close relative with alcoholism, you may have wondered what your family's history of alcoholism means for you. Are problems with alcohol a part of your future? Is your risk for becoming an alcoholic greater than for people who do not have a family history of alcoholism? If so, what can you do to lower your risk?

Many scientific studies, including research conducted among twins and children of alcoholics, have shown that genetic factors influence alcoholism. These findings show that children of alcoholics are about four times more likely than the general population to develop alcohol problems. Children of alcoholics also have a higher risk for many other behavioral and emotional problems. But alcoholism is not determined only by the genes you inherit from your parents. In fact, more than one–half of all children of alcoholics do not become alcoholic. Research shows that many factors influence your risk of developing alcoholism. Some factors raise the risk while others lower it.

Genes are not the only things children inherit from their parents. How parents act and how they treat each other and their children has an influence on children growing up in the family. These aspects of family life also affect the risk for alcoholism. Researchers believe a person's risk increases if he or she is in a family with the following difficulties:

an alcoholic parent is depressed or has other psychological problems;
both parents abuse alcohol and other drugs;
the parents' alcohol abuse is severe; and
conflicts lead to aggression and violence in the family.

The good news is that many children of alcoholics from even the most troubled families do not develop drinking problems. Just as a family history of alcoholism does not guarantee that you will become an alcoholic, neither does growing up in a very troubled household with alcoholic parents. Just because alcoholism tends to run in families does not mean that a child of an alcoholic parent will automatically become an alcoholic too. The risk is higher but it does not have to happen.

If you are worried that your family's history of alcohol problems or your troubled family life puts you at risk for becoming alcoholic, here is some common–sense advice to help you:

Avoid underage drinking—First, underage drinking is illegal. Second, research shows that the risk for alcoholism is higher among people who begin to drink at an early age, perhaps as a result of both environmental and genetic factors.

Drink moderately as an adult—Even if they do not have a family history of alcoholism, adults who choose to drink alcohol should do so in moderation—no more than one drink a day for most women, and no more than two drinks a day for most men, according to guidelines from the U.S. Department of Agriculture and the U.S. Department of Health and Human Services. Some people should not drink at all, including women who are pregnant or who are trying to become pregnant, recovering alcoholics, people who plan to drive or engage in other activities that require attention or skill, people taking certain medications, and people with certain medical conditions.

People with a family history of alcoholism, who have a higher risk for becoming dependent on alcohol, should approach moderate drinking carefully. Maintaining moderate drinking habits may be harder for them than for people without a family history of drinking problems. Once a person moves from moderate to heavier drinking, the risks of social problems (for example, drinking and driving, violence, and trauma) and medical problems (for example, liver disease, brain damage, and cancer) increase greatly.

Talk to a health care professional—Discuss your concerns with a doctor, nurse, nurse practitioner, or other health care provider. They can recommend groups or organizations that could help you avoid alcohol problems. If you are an adult who already has begun to drink, a health care professional can assess your drinking habits to see if you need to cut back on your drinking and advise you about how to do that.

Drug Rehab

Marijuana Facts for Teens

Adolescent Substance Abuse

What causes adolescent substance abuse?

How do you know when to seek help?

Teen Substance Abuse and Treatment

Seeking Help

Treatment

Drug Rehab

Drug addiction is a complex illness.

Helping Kids Navigate Their Teenage Years

When Parents Need Help First

Domestic violence and parental alcohol or other drug abuse adversely affect children.

Parental Alcohol or Substance Abuse

Stop all "rescue missions"

Time your intervention

Be specific

Be ready to help

Call on a friend

Find strength in numbers

Get support

The 4 Medications Used to Treat Alcoholism

Treatment for Dual Diagnosis: Substance Abuse and Mental Illness

Addiction Recovery: How Long Does it Take?

Are You Ready to Change Your Life? Understanding the Stages of Change Model?

5 Techniques for Dealing with Cravings

For Men; Chronic Heavy Drinking Lowers Testosterone Levels. What Does This Mean for You?

Alcoholics Risk Osteoporosis

What Is Vivitrol?

6 Ways to Help a Loved One Beat Addiction

Bipolar and Addiction

Will Years of Heavy Drinking Cause Brain Damage?

Rational Emotive Behavioral Therapy (REBT)

Spotting Substance Abuse in Seniors

Buprenorphine Therapy

Applied Pharmacology

Safety

Abuse Potential

Evidence of Effectiveness

Non-pharmacological Therapies

What are the short-term effects of cocaine use?

Short-term effects of cocaine

What are the long-term effects of cocaine use?

What are the medical complications of cocaine abuse?

Medical consequences of cocaine abuse

Are cocaine abusers at risk for contracting HIV/AIDS and hepatitis B and C?

What is the effect of maternal cocaine use?

What treatments are effective for cocaine abusers?

New Campaign Seeks to Educate the Public on Drunk Driving Facts

Important Findings:

Understanding Drug Abuse and Addiction

Millions of Americans in Denial About Their Own Drug Abuse

Millions of Americans in Denial About Their Own Drug Abuse

70,000 Participated in the Nationwide Survey

Marijuana

Ecstasy

Oxycontin ®

Alcohol

Tobacco

Measuring the Most Serious Problems

New Focus on Mental Health Needs

The Relationships Between Alcohol and Other Drug Use and Psychiatric Symptoms and Disorders

AOD Use and Psychiatric Symptoms

The Terminology of Dual Disorders

AOD Abuse, Addiction, Dependence, Misuse

AOD Abuse

AOD Addiction or Dependence

A Family History of Alcoholism

What are the long-term
effects of cocaine use?

Are cocaine abusers at risk
for contracting HIV/AIDS
and hepatitis B and C?

What is the effect of
maternal cocaine use?

What treatments are effective
for cocaine abusers?