Drug Addiction

The Last All-Nighter

From the New York Times blogs:

The first time I took Adderall I didn’t think twice. It was 2007. I was in my last year at U.C.L.A., where I had come down with a bad case of senioritis, and found myself cramming for finals. I bought it from a gangly kid with yellow skin and bags under his eyes who lived in the dorms. His hair was stringy. There were papers on the floor and piles of clothes on all the furniture in the room. Above his desk was a poster of John Belushi from “Animal House,” chugging a bottle of Jack Daniels and wearing a sweatshirt that read COLLEGE….

Read more: The Last All-Nighter

Why Can’t I Drink Or Smoke A Little Weed? I Was A Pill Addict!

Professionals refer to “addiction,” or “addictive disease,” rather than to heroin addiction, cocaine addiction, etc. The fact of the matter, little understood by the world at large, is that we don’t become addicted to drugs, but to the effects that they have on our brains — specifically on the pleasure center. The pleasure center is located in the sub-cortical region of the brain which means, among other things, that we can't control it directly.  (That's why “Just Say No” is a cruel joke.)

US Dept. of Transportation (dot.gov)

Drugs short-circuit the process by either stimulating the production of these neurotransmitters, or by mimicking their actions.  Drugs allow us to control the production of the good feelings. Since we are pre-programmed to seek those feelings, we tend to do it quite a lot. Over time, actual physical changes take place in our brains in order to accommodate the unnatural levels of chemicals.

This occurs in several ways, but we’ll simplify it by saying that our neurons grow additional receptor sites to deal with the surplus. This means, in turn, that we need more of the drug’s effects to reach the levels that give us pleasure. This tolerance is one of the first signs of developing addiction. Eventually we reach a point where we need the stimulation in order to function anything like normally, and we’re hooked for sure.

When we go “cold turkey,” the sudden absence of chemicals causes the syndromes that we call acute withdrawal. The length of the acute phase lasts anywhere from a few days to several weeks, depending on the drug. Simple drugs, like alcohol, have the shortest acute phases, while those that metabolize into other active compounds can take much longer. Methadone is an excellent example.  It has not only a longer but more severe acute withdrawal than other opiates. The symptoms of withdrawal, generally speaking, are the reverse of whatever effects the drugs had. Opioids, for example, calm us and slow the action of our digestive tract, and the withdrawal symptoms are the jitters, nausea, diarrhea and the creepy-crawlies, among others.

Those extra receptor sites slowly become dormant and stop pestering us for stimulation, but the main thing to remember is that while the body and brain recover from the changes, the changes do not necessarily go away, and if they do, it is usually over a period of years.

If we use drugs or alcohol in early recovery, we will interfere with the progression to normalcy. Any extra stimulation, whether by the drug of choice or another, can have this effect; we don’t have to get drunk or high. The neurotransmitters involved are the same combination, and using any mood-altering drug can lead back to an active addiction.  At the very least, it will prolong the recovery process.

Even after our brains are back as close to normal as they're going to get, exposure to drugs can reactivate those dormant receptor sites, and start the cravings all over again.  This is true of marijuana and booze, as well as other drugs, since they all work by stimulating the reward center.  In addition, drugs tend to make us more likely to do stupid things, like use more drugs. 

So we can obviously drink or use cannabis if we wish.  As addicts are so fond of pointing out, “It's my life!”*  However, if we do so even in small amounts, we are likely to end up deep in addiction again.

*How bogus is that?  Like we have no effect on anyone but ourselves.  Addict thinking.

What is the difference between psychological dependence and addiction?

Psychological dependence is shorthand, used to refer to situations where there is no apparent physical withdrawal, yet there is a compulsion to continue using a substance or carrying out an act. Sex addiction is a good example, as is the compulsion to eat sugar. Psychological dependence is not a medical term.

There is a gray area, and not necessarily a wide one, between psychological dependence and addiction. For example, some heavy users of marijuana suffer withdrawal when they stop using, which qualifies them as addicted. Others have no obvious physical symptoms, but become psychologically disturbed.  Also, many activities — gambling, relationships, shopping and so forth — are mood altering and actually create changes in brain chemistry similar to those that occur when we use drugs. Likewise, many activities that we associate with good health, such as running and other forms of exercise, produce changes in the levels of endorphins in our brains, stimulating the very same receptors that are affected by opiates.

As far as treatment is concerned, there is no real difference, apart from the possible need to detox from an addictive substance.  We are dealing with the need to change behavior that is causing us problems in our lives, but that we seem unable to stop.  The changes we need to make are basically the same, regardless of what we call the circumstances that caused us to seek help.

Medical Schools To Offer Residencies In Addiction Medicine

An article published July 10th in the New York Times heralds a much-needed addition to addiction treatment, aimed at making it a recognized specialty like surgery, endocrinology, obstetrics, etc.

In a move that recognizes addiction as a disease, rather than simply a psychological or moral problem, the program will provide a one-year residency in addiction medicine for doctors who have complete their basic training and are aiming for a specialty. They will spend their residency studying addiction and its connection with heredity, brain chemistry, and psychological issues while treating a broad variety of addictions ranging from alcohol and prescription drugs to nicotine.

According to Nora D. Volkow, of the National Institute on Drug Abuse, the prior lack of this kind of education for doctors was “a gap in our training program…a very serious problem.”

The American Board of Addiction Medicine (ABAM), formed in 2007 to address the issues surrounding medical training in addiction, expects to accredit 10 to 15 additional institutions this year.  Those currently accredited are:

Boston University Medical Center
University of Florida College of Medicine
St. Luke’s-Roosevelt Hospital in New York
New York University at Buffalo School of Medicine
University of Maryland Medical System
University of Cincinnati College of Medicine
University of Minnesota Medical School
University of Wisconsin School of Medicine and Public Health
Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, PA
and the John A. Burns School of Medicine at the University of Hawaii

Kudos to these institutions, ABAM, and the people in the medical and other professions who worked long and hard to accomplish this great stride forward in the understanding and treatment of addiction.

Suboxone and Opiate Detox

Suboxone (buprenorphine & naloxone)

Some detox centers do not medicate their patients during withdrawal. This is known as “cold turkey” and Sunrise Detox doesn’t believe in it. Opiate withdrawal symptoms can produce potentially dangerous health situations, including high blood pressure and dehydration. Left untreated, the pain of the withdrawal symptoms can make it psychologically difficult to stay in the detoxification facility, and makes the client more likely to leave prematurely.

At Sunrise Detox we use Suboxone®, buprenorphine-based medication that effectively manages opiate withdrawal symptoms. Read More…

The Extent of Drug Addiction and Alcohol Abuse in the United States

According to the latest National Survey on Drug Use and Health (2009), among Americans 12 years of age or older,

  • 18.6 million people abuse alcohol or are addicted to other drugs;
  • Nearly 0ne-quarter (23.7 percent) reported binge drinking at least once in the 30 days prior to the survey (5 or more standard drinks* for males, 4 for females within a 2 to 3 hour period);
  • 6.8 % (17.1 million people) reported heavy drinking (an average of more than two standard drinks a day for men, one for women).

21.8 million individuals 12 or older were current illicit drug users.

  • 16.7 million used marijuana at least 20 times a month.
  • 7 million used prescription drugs to mood alter, rather than for the reason prescribed (not including over-the-counter preparations).
  • 1.6 million used cocaine or crack cocaine.
  • 1.3 million used hallucinogens, such as LSC, PCP, psilocybin and similar drugs.
  • .6 million used inhalants, primarily youths younger than 21.
  • 200,000 used heroin, down about 75% from earlier results due to the increased availability of substitutes such as Oxycontin and similar, easily-obtained, prescription drugs.

The majority will not need treatment.  They may be able to stop on their own, influenced by a drug-intolerant social climate, and/or the threat of social, legal and employment sanctions. However, treatment will be required for those who cannot or will not stop on their own — those who have become physically or psychologically dependent.  Lacking intervention, compulsive users are usually unable to stop for more than a few days at a time, despite the consequences of their alcohol or other drug use. Their need for chemicals forces them to deny the reality of their addiction, in order to protect themselves from accepting the need to stop.

In the case of adolescents, who are still developing physically, emotionally and socially, any use of drugs outside limits prescribed for them by a doctor, is illegal and can be considered abuse — obviously true of alcohol as well. If the use is causing discernible problems, immediate intervention is warranted.  Not only can effective intervention stop the progression of abuse into addiction, but current research has shown that the development of the adolescent brain and nervous system are severely impacted by drugs, especially alcohol.  This may result in chronic cognitive and behavioral issues, beyond those associated with the drugs themselves, that may not be reversible with abstinence.

The annual economic cost of drug and alcohol abuse in the US is immense, estimated at nearly $215 billion ($651.52 a year for every man, woman and child in the country). This refers only to the monetary cost, and does not take into account the costs to individuals, families, friends and society in general of being deprived of the companionship and productivity of these people. Many studies have shown that treatment is not only essential, but is cost-effective** in terms of the price society and individuals pay for addiction that progresses.  Treatment appropriate to the needs of the individual has been shown to work in a significant percentage of cases, although more than one attempt may be necessary.
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*Standard drink: One 12-oz. beer, one 5-oz. glass of wine, or one 1.5 oz. shot of 80 proof liquor.

**http://www.justice.gov/ndic/pubs38/38661/drugImpact.htm#Top

How Do I Stage An Intervention?

The intervention concept has been popularized by the excellent A & E television series of the same name, several of which have been recorded right here at Sunrise Detox. Many folks have seen the show and are familiar with the basic idea, but I thought it might be a good idea to go over some points here.

First of all, we need to understand that interventions are the “big gun” when it comes to getting addicts (including alcoholics) to turn the corner and become willing to deal with their addictions. Done properly, they can have a terrific effect, allowing the client to see how his addiction has affected others, and getting him into treatment before his denial can kick in and before he can begin to justify his behavior.

On the other hand, an intervention is pretty much a one-shot deal. If it doesn't work the first time, it is highly unlikely to work on subsequent tries. It is, therefore, important to get it right.

A proper intervention involves an addiction professional (leader), and as many of the client's family members, friends and co-workers as can be gathered together at one place and time, including his employer or immediate supervisor if possible.

The leader will, ahead of time, instruct the participants to prepare carefully. Each person will need to think about the way the client's addiction has impacted their life, and be ready to tell the addict about it. A spouse can speak about how she misses the man she married; a child about how he felt when Dad missed his graduation. A friend can tell how much he misses his buddy, the employer about how the client is a valued worker, and how he would very much like to see him become his “old self” again (and keep his job).

It is important that the client not know what is going to happen. Sometimes the group can assemble at a restaurant meeting room. The home might be appropriate, or some other location. Ideally, the client will walk in unaware of anything in store, for maximum shock value.

Most important of all is that the participants talk about how the client's addiction has impacted them, about their feelings, and not direct comments at the client: “You did this to me,” “You ruined our family,” and so forth. The object is to let the person know how his actions have affected others, rather than putting him on the defensive. That can be nearly impossible for angry members, another reason the leader, trained in interventions, is necessary: to act as a guide for the participants and keep them on track, both before and during the actual intervention.

Finally, it is vitally important to have the next step ready to go. If the addict acknowledges the problem and promises to “do something about it,” he needs to be presented with packed bags, an open car door, and a prearranged admission to a treatment facility — another reason the professional is there.

As we saw above, this is a one-shot project. Once the client's denial is broken, the next steps have to be definite — and put into place before he can change his mind. It is easy to see how, once exposed to an intervention, the addict's likelihood of responding positively to a second one is vanishingly small. Done properly, however, an intervention can literally be the difference between life and death.

It was for this addict/alcoholic.