Treat, Don’t Blame Addicts

Why We Should Treat, Not Blame Addicts Struggling to Get ‘Clean’

Journalist David Sheff’s son Nic began using marijuana and alcohol at the age of 12, then heroine and crystal meth. Sheff was baffled; his son transformed from an intelligent student and athlete into an addict living on the streets. At first he thought Nic was just being a wild teenager who needed some tough love. But after struggling to find Nic treatment — and keep him alive — Sheff realized that his son was dealing with a serious disease, more similar than different from diabetes, hypertension or even cancer.

With his personal experience and more than 10 years of research, Sheff concluded that addiction is a health crisis with a price tag of US$600 billion in combined medical, economic, criminal and social costs every year.

In a follow-up to his memoir “Beautiful Boy,” David Sheff has written a new book, “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy,” in order to outline a slew of reasons why society and addiction treatments have largely failed to help the 20 million Americans with addictions.

Sheff asserts that the reason that addiction treatments overwhelmingly fail is because of how we view addiction. And he says correcting common misconceptions about the disease can be the first step towards improving the social support and medical treatment systems for those struggling with their addictions.

Below are the top myths about addiction, according to David Sheff.  

---

Myth No. 1: Good kids don’t use drugs, bad kids do. 

Myth No. 2: It’s impossible to prevent drug use. Kids who are going to use are going to use.

Myth No. 3: People who get addicted are weak and without morals.

Myth No. 4: Addicts must hit bottom before they can be treated.

Myth No. 5: You don’t treat drug problems with drugs.

Myth No. 6: The only way for addicts to stop using is by going to AA meetings.

Myth No. 7: Marijuana is not addictive. No one’s ever died from marijuana. It’s not a gateway drug. Marijuana shouldn’t be legalized.

Myth No. 8: America’s drug problem is unsolvable.

• We’ve failed at solving America’s drug problem not because it’s impossible to do so, but we’ve been focusing on the wrong things. The main problem is that we’ve treated drug use as a criminal problem and drug users as morally bankrupt.
• There are several developments that make me optimistic that we can lower drug use, treat addicts and potentially solve many of the problems in America caused by addiction:
• There’s a growing understanding and acceptance that addiction is a disease and must be treated like we treat other diseases.
• There are advances in treatment that will dramatically improve the likelihood that addicts will get well. There are also new prevention strategies, early assessment, and brief intervention strategies that work.
• There is progress toward making sure that people who need treatment will be able to find programs that use evidence-based treatment.
• There is a new organization founded called Brian’s Wish To End Addiction

The top myths about addiction above were adapted from content from David Sheff’s new book, “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy. The views are his own.

Full story at; http://www.pbs.org/newshour/rundown/2013/04/addiction-mythbusters-understand-what-triggers-addiction-and-how-to-manage-the-disease.html

Drug Addiction Treatment

Principles of Drug Addiction and Alcoholism Treatment: A Research-Based Guide (Third Edition)

Principles of Effective Treatment

1. Addiction is a complex but treatable disease that affects brain function and behavior.  Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.

2. No single treatment is appropriate for everyone.  Treatment varies depending on the type of drug and the characteristics of the patients. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

3. Treatment needs to be readily available.  Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.

4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.  To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.

5. Remaining in treatment for an adequate period of time is critical.  The appropriate duration for an individual depends on the type and degree of the patient’s problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.

6. Behavioral therapies—including individual, family, or group counseling—are the most commonly used forms of drug abuse treatment.   Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem-solving skills, and facilitating better interpersonal relationships. Also, participation in group therapy and other peer support programs during and following treatment can help maintain abstinence.

7. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.  For example, methadone, buprenorphine, and naltrexone (including a new long-acting formulation) are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Acamprosate, disulfiram, and naltrexone are medications approved for treating alcohol dependence. For persons addicted to nicotine, a nicotine replacement product (available as patches, gum, lozenges, or nasal spray) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.

8. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.  A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.

9. Many drug-addicted individuals also have other mental disorders.  Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.

10. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse.  Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and can, for some, pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.

11. Treatment does not need to be voluntary to be effective.  Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.

12. Drug use during treatment must be monitored continuously, as lapses during treatment do occur.  Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.

13. Treatment programs should test patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling, linking patients to treatment if necessary.   Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Substance abuse treatment facilities should provide onsite, rapid HIV testing rather than referrals to offsite testing—research shows that doing so increases the likelihood that patients will be tested and receive their test results. Treatment providers should also inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug-abusing populations, and help link them to HIV treatment if they test positive.

More at; http://www.drugabuse.gov/publications/principles-drug-addiction-treatment

Marijuana sent 11,000 to Emergency

Synthetic Marijuana Sent 11,000 People to Emergency Rooms in 2010

More than 11,000 people ended up in emergency rooms after using synthetic marijuana in 2010, according to a new government report. Most were teenagers and young adults, USA Today reports.

Synthetic marijuana, commonly known as K2 or Spice, is a mixture of herbs, spices or shredded plant material that is typically sprayed with a synthetic compound chemically similar to THC, the psychoactive ingredient in marijuana. K2 is typically sold in small, silvery plastic bags of dried leaves and marketed as incense that can be smoked. It is said to resemble potpourri.

Short term effects include loss of control, lack of pain response, increased agitation, pale skin, seizures, vomiting, profuse sweating, uncontrolled spastic body movements, elevated blood pressure, heart rate and palpitations. In addition to physical signs of use, users may experience severe paranoia, delusions, hallucinations and increased agitation.

The new report, from the federal government’s Drug Abuse Warning Network, is the first to analyze the impact of synthetic marijuana, the newspaper notes. The report found 12-to-17-year-olds accounted for one-third of the emergency room visits, while young adults ages 18 to 24 accounted for an additional 35 percent.

Among patients ages 12 to 29, the report found 59 percent of those who paid visits to the emergency room for synthetic marijuana use had no evidence of other substances.

In 2010, ordinary marijuana sent 461,028 people to the emergency room.

In July, President Obama signed legislation that bans synthetic drugs. The law bans harmful chemicals in synthetic drugs such as those used to make synthetic marijuana and bath salts.

From Join Together online

Parents and children both affected by substance misuse

Children and teenagers recognised too as perpetrators

A new report has identified parents as sufferers of abuse and violence from substance misusing children. The report by Adfam and Against Violence and Abuse (AVA) explores and documents Child to Parent Violence (CPV) and consulted with 88 parents seeking support from services.

• Between a rock and a hard place – Project report (pdf)
• Between a rock and a hard place – Executive summary (pdf)

Key findings from the research found:

• Children as young as 11 and as old as 40 are physically, emotionally and/or mentally abusing their parents
• There is a significant correlation between substance misuse and perpetrating domestic violence
• 88% of victims of abuse were female and 12% were male
• That abuses range from lower grade emotional manipulation to at the extreme end deaths.
• Metropolitan Police Service records show that in 2009, 6 out of 7 non-partner/ex partner victims were mothers or fathers killed by sons – with substance misuse or mental health problems considered a key factor

The report makes recommendation including calls for better understanding of CPV, how to respond to requests for help and referral mechanisms are needed for front-line workers (such as police, social workers and GPs. It argues family support services are a cost effective resource, providing essential support to parents at a fraction of the cost that other health and social care services.

Children’s Commissioner re-iterates calls for protection of children

A new report from the Children’s Commissioner urges the Government to give as much attention to alcohol abuse among parents as to other drug misuse, and to train the relevant authorities to spot the signs of problem drinking in families earlier. See BBC report.

The Children’s Commissioner exists to promote the best interests of children and young people in England. It’s report suggest more than a fifth of all children in the UK, approximately 2.5 million, are living with a hazardous drinker (risky) drinker. The research also suggests 26,000 babies in England are living with a parent who is a dependent drinker, which is equivalent to 31,000 across the UK.

• Silent Voices – A briefing on the key themes and findings from the report
• Silent Voices – Supporting children and young people affected by parental alcohol misuse (Full report)

Synthetic Drugs Outlawed

Obama Signs Legislation Banning Synthetic Drugs

President Obama on Monday signed legislation that bans synthetic drugs. The law also expedites the Food and Drug Administration’s (FDA) approval of new drugs and medical devices.

The law bans harmful chemicals in synthetic drugs such as those used to make synthetic marijuana and “bath salts,” according to the Star Tribune. While more than 30 states have banned various compounds in synthetic drugs, new ones are continually being created, the newspaper notes.

“In Minnesota and across the country, we are seeing more and more tragedies where synthetic drugs are taking lives and tearing apart families,” Senator Amy Klobuchar of Minnesota said in a statement. “Today’s action means that this critical legislation to give law enforcement the tools they need to crack down on synthetic drugs is finally the law of the land.” Senator Klobuchar co-sponsored bills banning synthetic drugs, which were included in an amendment to the FDA’s Safety and Innovation Act.

Synthetic drugs are readily available online. The law outlaws sales of synthetic drugs by both retail stores and online retailers.

In December, the National Institute on Drug Abuse released new information indicating that one in nine high school seniors had used “Spice” or “K2” over the past year, making synthetic marijuana the second most frequently used illicit drug, after marijuana, among high school seniors. Poison control centers operating across the nation have also reported sharp increases in the number of calls relating to synthetic drugs.

By Join Together Staff

Teens Use Diverted Medical Marijuana

74 Percent of Teens in CO Substance Abuse Treatment Programs Used Diverted Medical Marijuana

Three-quarters of teenage patients in substance abuse treatment programs in Denver, Colorado said they used someone else’s medical marijuana, according to a new study.

The study revealed that 121 of 164 teenage patients (73.8 percent) have ever used medical marijuana prescribed to someone else.  Patients reported using diverted medical marijuana from one to 1,000 times, with a median of 50 times, suggesting that most adolescent patients have used medical marijuana on multiple occasions, according to Stacy Salomonsen-Sautel, PhD, a post-doctoral fellow at the University of Colorado Anschutz Medical Campus, Division of Substance Dependence. She reported the findings at the recent College on Problems of Drug Dependence, and the study appears online in the Journal of the American Academy of Child and Adolescent Psychiatry.

The study found that after adjusting for gender and race/ethnicity, teenage patients who used medical marijuana had an earlier age of regular marijuana use, more marijuana abuse and dependence symptoms, and more conduct disorder symptoms, compared with those who did not use medical marijuana.

As of the end of April 2012, Colorado has 48 registered medical marijuana users under the age of 18. Four of the 164 teenage patients in the study reported being evaluated for a medical marijuana card; however, only one teenage patient received a medical marijuana card. According to the Colorado Department of Public Health and Environment, 96,709 people in the state were registered as medical marijuana users as of April 30, 2012. This means 2.5 percent of the adults in Colorado are registered medical marijuana users, according to Salomonsen-Sautel.

“We don’t know what proportion of the marijuana they are using is medical marijuana,” Salomonsen-Sautel notes. She said the findings imply that there is substantial diversion from registered medical marijuana users. She and her colleagues say the results support the need for policy changes that protect against diversion of medical marijuana, and reduce teenager access to it.

From; The Partnership at Drugfree.org and Join Together

Genetics and Family Environment Influence Drug Abuse

Risk for Drug Abuse in Adopted Children Appears Influenced by Family, Genetics

In a national Swedish adoption study, the risk for drug abuse appears to be increased among adopted children whose biological parents had a history of drug abuse, according to a report published online by Archives of General Psychiatry.

Drug abuse is a worldwide public health problem and much effort has gone into understanding the nature of familial factors, the authors write in their study background.

Kenneth S. Kendler, and colleagues evaluated the association between genetic and environmental factors and the risk of drug abuse. Their study included 18,115 adopted children born in Sweden between 1950 and 1993, as well their biological and adoptive relatives. Researchers relied on national registries and health databases, as well as information about drug abuse from medical, legal or pharmacy records.

The adoptees, whose average age at last available information was 46.2 years, had a 4.5 percent prevalence of drug abuse compared with 2.9 percent in all of Sweden from the same birth years.

The authors suggest the risk for drug abuse among children given up for adoption by biological parents, of whom a least one had drug abuse, was 8.6 percent, which they note was "substantially and significantly elevated over that seen in children given up for adoption when neither biological parent had drug abuse (4.2 percent)."

"Risk for drug abuse in adopted children is increased by a history in biological parents and siblings not only of drug abuse but also of alcoholism, major psychiatric illness and criminal convictions," the authors note. "Risk for drug abuse in adopted children is increased by disruption in the adoptive parent-adopted child bond by death or divorce but also by a range of indices of a disturbed adoptive home environment and deviant peer influences such as parental alcoholism and sibling drug abuse, respectively."

Researchers also suggest a gene-environment interaction in the etiology (the study of the causes of a disease) of drug abuse.

"Adopted children at high genetic risk were more sensitive to the pathogenic effects of adverse family environments than those at low genetic risk. In other words, genetic effects on drug abuse were less potent in low-risk than high-risk environments," the authors conclude.

-0-

Top Reasons for Not Getting Alcohol or Drug Treatment

Lack of Motivation to Quit and Health Coverage Are the Top Reasons for Not Receiving Needed Alcohol or Drug Treatment

An estimated 20.5 million people needed but did not receive alcohol or drug treatment in the past year, according to data from the 2010 National Household Survey on Drug Use and Health (NSDUH). The primary reason for not receiving treatment among those who were classified as needing—and felt they needed—treatment was not being ready to stop using alcohol or illicit drugs (40.2%). The second most commonly cited reason for not receiving treatment was having no health coverage and not being able to afford the cost (32.9%). People in need of alcohol treatment were more likely than those in need of drug treatment to cite not being ready to stop using (45.1% vs. 30.7%; data not shown), while those needing drug treatment were more likely to cite not having health coverage and could not afford the cost (41.8% vs. 30.9%; data not shown). Other reasons given were not knowing where to go for treatment, thinking that going to treatment might have a negative effect on their job or social relationships, or thinking that they could handle the problem without treatment (see figure below).

(N=an estimated 1,341,000 U.S. residents ages 12 and older classified as needing and perceiving a need for—but not receiving—treatment)

• Not Ready to Stop Using 40.2%
• No Health Coverage and Could Not Afford Cost 32.9%
• Might Have Negative Effect on Job 11.5%
• Might Cause Neighbors/Community to Have Negative Opinion 11.3%
• Could Handle the Problem Without Treatment 9.9%
• Did Not Know Where to Go for Treatment 9.3%
• Did Not Feel Need for Treatment at the Time 7.8%
• Did Not Want Others to Find Out 6.8%
• No Transportation/Inconvenient 6.3%

-0-

Drug-addicted anesthesiologists pose danger

Anesthesiologists – the doctors who keep patients alive during surgery, who essentially take over our breathing – make up just three per cent of all doctors, but account for 20 to 30 per cent of drug-addicted MDs. Experts say anesthesiologists are overrepresented in addiction treatment programs by a ratio of three to one, compared with any other physician group, an occupational hazard that could pose catastrophic risks to their patients.

Their drugs of choice are most frequently fentanyl and sufentanil, opioids that are 100 and 1,000 times more potent than morphine. They “divert” a portion of the doses meant for their patients to themselves, slipping syringes into their pockets.

And later, alone in the bathroom or the call room, when the drug hits their own bloodstream, the relief, the sense that all is well in the world, the mild euphoria, is immediate.

See full story via Drug-addicted anesthesiologists pose danger.

Guide on Drug Treatment

Government Publishes Guide on Drug Abuse Treatment

The National Institute on Drug Abuse (NIDA) has published a free guide to choosing a drug abuse treatment program. “Seeking Drug Abuse Treatment: Know What to Ask” recommends questions that individuals and families who are struggling with addiction should ask to help them make an informed choice.

“Treatment options can vary considerably, and families often don’t know where to begin,” NIDA Director Nora Volkow said in a news release. “This booklet highlights the treatment components that research has shown are critical for success, to help people make an informed choice during a very stressful time.”

Many recent scientific advances have changed addiction treatment, but not all treatment centers have kept up with these changes, according to the Los Angeles Times. The guide recommends asking the following questions:

•    Does the program use treatments backed by scientific evidence?
•    Does the program tailor treatment to the needs of each patient?
•    Does the program adapt treatment as patients’ needs change?
•    Is the duration of treatment sufficient?
•    How do 12-step or similar recovery programs fit into drug addiction treatment?

The guide provides information on medications, evidence-based behavior therapies, the realities of relapse, and the role of community-level support.

By Join Together