Could The Sandy Hook Tragedy Have Been Avoided?

We at Sunrise wish to express our heartfelt sorrow and sympathy to the families and friends of the victims, and to the community of Newtown. Tragedies like this defy expression, and only time can lessen the pain. Along with the rest of the world, we try our best to convey our shock, sadness, prayers and good wishes to all.

There are lessons to be learned from tragedy.  We do not know if Adam Lanza's path could have been changed at some point by the observation of an alert practitioner, or if the freedoms inherent in our way of life would have permitted any sort of intervention, but it is possible.  We do not know if he was a substance abuser or addict.  Nonetheless, these events should stand as a reminder to all addiction professionals that we need to remain alert for the co-occurring conditions that so frequently accompany our specialty.

Prescription Drug Reduction Creates Unintended Consequences, But No Surprises

With crackdowns increasing on improperly-prescribed and illegal prescription drugs, more pill users are turning to heroin, according to studies in Maryland. Prescription drug overdoses are down by 15%, but heroin ODs are up 41%. The total number of combined overdoses is up about 6%. That’s probably because naïve users have greater difficulty managing heroin dosage than they do with the controlled strength of pills.

This shouldn’t have surprised anyone. Reducing the availability of prescription drugs will probably reduce the number of new addicts to a limited degree, but folks who are already addicted aren’t going to be kept from copping. Most prescription drug users, pushed by the fear or actuality of acute withdrawal, will have no trouble finding street drugs, and when the availability of pills drops on the street, the move to heroin is simple and obvious.

That might sound like I’m against nailing the pill mills. Not at all. Those sorry excuses for physicians are a blight on society, and need to be dealt with. Ditto the folks who sell drugs on the street. But anyone who thought addicts would come flocking to get help when their supplies got scarce really doesn’t get the facts of addiction.

Bottom line: addicts will find drugs. If treatment was supported nearly as well as the so-called “War On Drugs;” if addicts could more easily access detox and primary treatment; if the focus of society was less on punitive measures and more on curative ones, then our drug problems could be dealt with far more effectively.

We’re finally getting the idea across that addiction is a disease, and that addicts need to be dealt with as patients, not as offenders, but until society gets behind treatment instead of spending huge sums supporting the drug suppression/law enforcement industries, we don’t have much chance to make real inroads into the overall problem.

I’m a former law enforcement officer and a recovering addict. I’ve seen it from both sides, and I’m telling you that we are putting our priorities in the wrong place. Deal with the criminals on one end, but reduce the number of customers on the other. Put people first, and we have a shot at making real progress.

After Treatment, Veterans Fare Better Than Civilian Alcohol Abusers

ScienceDaily (Oct. 29, 2012) — Male military veterans with a history of heavy alcohol use are more likely to seek treatment, later report better overall health and less depression than their civilian counterparts, according to new research…

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Substance Abuse Treatment Cost Benefits — The Best Health Deal Around

In these last weeks leading up to the presidential election, health care and surrounding issues will be on everyone's mind. It is an ideal time to revisit the issue of substance abuse treatment cost benefits.

Roughly 9 to 10% of the population meet the definition “substance dependent.” These numbers represent between 31.5 to 35 million people. In any given year, roughly 16% of Americans who are classified as substance dependent or abusers actually get treatment.

Nationwide, between 8.3 and 8.5% of adults suffer from serious mental illness, and substance abuse itself can lead to psychological disorders. Adults who use illicit drugs or alcohol are more than twice as likely to have serious mental illness than non-users. Many victims find that using drugs blunts the effects of their other disorders, and/or makes them more manageable. When those things are combined with the addictive qualities of the drugs, the combination can lead to situations ranging from homelessness to psychotic breaks and violence.

There is no denying that substance addiction is chronic (it does not improve on its own), progressive (always getting worse, never better, over time), and relapsing (users tend to return to alcohol and drugs after abstinence unless their recovery is well-supported).

Untreated addicts devastate families, communities and themselves. The cost to society in dollars includes rising health costs over and above those of our inefficient healthcare system, reduced productivity of workers, absenteeism, theft, destruction of property, higher law enforcement costs, costs related to traffic crashes, and the expense of incarcerating people who could be given preventive treatment at far less overall expense. Intoxication impacts the health of users and the people around them, and often facilitates transmission of infectious diseases such as hepatitis and HIV.

According to government studies, prevention efforts are often successful in lowering rates of substance abuse in some parts of the population — generally the more educated portions — but it remains a pervasive problem among other segments. It has also been shown that treatment is a highly cost-effective way to break the cycle, using programs that combine assessment, matching of treatment to the patient, comprehensive services adapted to the individuals (including social services when needed) and programs of relapse prevention and accountability.

Treatment does work, but it is not a universal answer. Some cases, especially those combined with mental disorders, involve chronic relapsers with whom intervention seems to work less well. It is likely that if detoxification, treatment and follow-up programs are made a priority, along with research into the best procedures, medications and neurobiology associated with addiction, these percentages will improve. Even so, detox and treatment are effective in enough cases to make the pursuit of universal availability a priority, strictly on a monetary and societal basis.

The last comprehensive study of the economic costs of alcohol and other drug abuse in the US, completed in 1999, showed the annual cost of substance abuse to be $510.8 billion.  That amounts to roughly $799 billion annually in 2012 dollars — far more than the cost of effective treatment for every abuser of alcohol and other drugs in the entire country.

Substance abuse treatment cost benefits are the best health care deal around, and for every year an addict stays clean, the benefits increase.

U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Prevention

“Substance Abuse Prevention Dollars and
Cents: A Cost-Benefit Analysis”

Thoughts About Independence Day

Independence Day has a special meaning for those of us in recovery, and that's such an obvious connection that I'm not going to belabor it further. I do want to mention, however, that despite all our advantages here in the USA — and in Western civilization as a whole — there is still a lot to be done with regard to addictions of all kinds, from alcoholism to the currently popular prescription drugs.

One of the things we need to improve is the judgmental attitude of many Americans when it comes to addictive disease. This has changed for the better over the years, but we still have a long way to go educating people that addiction is a disease and that, regardless of our reasons for drinking alcohol or using other drugs initially, we did not choose to become addicts, nor to ruin our own lives or those of others.  It is perfectly natural for folks who have been impacted by the behavior of alcoholics and other addicts to resent us.  We leave trails of wreckage behind us in most cases, and there are few people in America who haven't had their lives or those of loved ones affected by addiction in some way.

But did I choose addiction? Did you?  I didn't, and I've never spoken with anyone who did. Did I choose to drink and use drugs?  Yes, but millions of people do that without problems, and I had no reason to think it would be any different for me.  Did I feel that I had no choice but to continue using alcohol and other drugs after I was addicted? Absolutely. I was convinced that I would die an addict, but that I would also die if I tried to quit using — a classic “double bind,” shrinks call it.  It's as close to a miracle as I could want, that the right combination of things happened to get me on the road to recovery.

The reality of addiction differs from what many believe. It is absolutely imperative that we get the people who consider addicts to be morally corrupt to understand the reality of the disease.

Major changes need to be made before we can approach the goal of getting the addiction epidemic under control. We need changes in the criminal justice system, so that addicts get the treatment they need instead of being incarcerated and then put back on the streets with no prospects. That's no way to keep people from using again and returning to criminal lives.  We need to throw a lot of money into research. We need sensible regulation of legal drugs that are addictive. The mish-mash of treatment protocols needs to be studied with an eye to determining best practices. And, while I am a rabid supporter of the 12-step model of recovery, we also need to develop continuing support systems for those who believe, for one reason or another, that the various fellowships are not for them.

My purpose on this Independence Day is to applaud and thank the many people in Federal, State, and even local government who are advocating for this critical health issue.  Addiction, including nicotine addiction is, by far, the primary cause of preventable death in America.  There is an overwhelming body of evidence to the effect that treatment is much cheaper than dealing with the results.  We can't afford to waste money on ineffective measures in this economy, and the waste in human lives lost and ruined is disgraceful in a country that aspires to be the best of the best.

Writers like me can only do so much.  We are preaching to the choir, since our audience is composed primarily of recovering people and addiction professionals.  I want to encourage you to get involved in these issues. Educate yourself about the politics of addiction. Advocate with your governmental representatives. Support any efforts toward dealing with this disease that you can. Spread the word, in a gentle way and by example, that we are good people. You are the only addiction educator that most people will ever meet, and are also the people best equipped to influence the actions of legislators and their advisors.

The recovery community stepped up when we needed help. Now it's our turn.

What Percentage Of Recovering People Never Relapse?

What percentage of recovering people never relapse?

This is one of those questions that we would love to be able to answer, but we can't.  It would be great if we could keep track of people's successes, because the ability to do so would be useful not only in evaluating treatment programs, but also for developing a better understanding of addiction itself.  Relapse is very much a part of addiction.

There are programs, and a variety of other sources, with figures that range from 15% to 75% for eventual sobriety — not necessarily on the first try.  However, there are several factors that tend to make us look toward pretty low figures for sobriety without a relapse.

One of those is simple observation.  While perhaps not statistically valid, all of us who have spent time around the 12-step rooms and/or worked in the treatment field have seen the number of folks who come in looking for help, contrasted with those who are around a year or so later.  Although those who have been through treatment seem to fare better than those who have not, it is also true that the folks with forty and fifty years clean and sober have rarely been through what we would call “treatment” today, simply because it didn't exist back then.

Another indicator is the number of people who repeat detox and other treatment.  Again, this is not statistically significant because we don't know what happened to those we never saw again.  Did they stay clean?  Did they relapse?  Did they die?  And if they didn't stay clean, how long were they abstinent before using again?  Did they get clean again?  We simply don't know, unless they tell us.

Equally, the rooms of AA, NA and the other recovery groups are not useful for gathering information.  It's that doggone “A.”  How do you track people who are in anonymous programs?  The 12-step programs don't even keep track of membership, beyond the occasional list of (voluntary) phone numbers.  If you're clean, and going to meetings, you're a member.  You resign when you leave.  If a person who has been attending meetings disappears, they may have relapsed — or they may simply be going to a different meeting.

Finally, there's the question, “What is relapse?”  It's not correct to say that it's simply picking up a drink or other drug.  It occurred before that, or we wouldn't have picked up.  Using just makes it official.

So there's no way to answer that question with accuracy — in numbers.  But I can tell you who is least likely to relapse.  It's the person who wants sobriety and recovery more than anything else in the world.  Because recovery isn't about abstinence, it's about dealing with life without using, and those who aren't willing to work at learning those skills are unlikely to make it in the long run.

Happy Mother’s Day From Sunrise!

We have an exciting week coming up at Sunrise Detox.  On Tuesday and Wednesday we have the Open House at our Ft. Lauderdale facility.  It’s located in northeast Ft. Lauderdale, near Federal Highway, convenient to Ft. Lauderdale-Hollywood International Airport and about 30 minutes from the Miami airport.  This new location will allow us to serve facilities in Broward and Miami-Dade Counties more efficiently, and the additional beds in our system will substantially increase the number of folks we’re able to help.

During the same period, we’re having a site visit from the Joint Commission (formerly JCAHO) at Lake Worth.  The Commission is the accrediting body for medical facilities, and we  expect re-accreditation this year with no problems.  Nonetheless, site visits are a busy time for staff, especially given the simultaneous Open House. Everyone will be relieved when the excitement is over and we can get back into our routine of helping our clients without distractions.

And, of course, tomorrow is Mother’s Day. If you're a Mom, congratulations, and we hope you have a wonderful day! 

Whether our moms were our staunchest support, or maybe not so much, they’re the reason we’re here.  If we’re in recovery — or trying to get there — we must be OK with that.  Let's be thankful for her, regardless of what our relationships were like.  She did the best she could, the same as we are — one day at a time.