How I Became A Junkie

It's no news to any of us that addiction is a disease of relapse.  Thing is, we never know if we're going to make it back.  What struck me about this woman's story is how easily it could have turned out otherwise.

What the fuck was in this stuff? Turns out, nothing beyond drugs; sometimes throwing up and convulsions are just going to happen.

Read the rest at The Fix

Research on drug use goes down the toilet

Analysis Of Waste Water May Be The Key To
Determining Community Drug Use

Sewers don’t lie. People may be less than forthright about what they put into their bodies, especially if that includes illicit drugs, but a chemical analysis of what comes out of their bodies removes all mystery. According to drug and addiction researchers, analysing wastewater for remnants of illicit substances provides the only truly objective indicator of drug use patterns in a community.

“Whatever you think about drugs, people need to have objective data so they can at least have an informed discussion,” says Caleb Banta-Green, a research scientist at the University of Washington’s Alcohol and Drug Abuse Institute in Seattle.

(Sorry… the rest of the article was removed from the internet. Sigh.)

Why Do Addicts Keep Using Despite The Consequences? — Part 2

Previously we mentioned that the pleasure center is a portion of the brain over which we have no conscious control, and that it can be stimulated by a variety of chemicals — some of them produced inside our bodies and some that we introduce from outside.  We said that the pleasure center rewards us for activities that it interprets as contributing in some way to our survival, whether they be social interactions, exercising, or more prosaic things such as eating.  We also stated that these pleasurable feelings, when pursued too far or for too long can create problems.  Now we need to examine how that happens.

While the actual mechanism of addiction is terrifically complicated, the underlying principles are reasonably simple.

  1. When we use drugs or are involved in pleasurable activities, they stimulate (or cause the stimulation of) receptor sites in the pleasure center and other areas of the brain. This causes us to feel good.
  2. With constant stimulation, the brain begins to adjust to the higher levels of brain chemicals by making physical changes that involve, among others, the growth of additional receptor sites to accommodate the excess neurotransmitters.  This leads to tolerance: needing more stimulation in order to achieve the same effects.  Tolerance is one of the first signs of developing addiction.
  3. As tolerance develops, we reach a point where our brain needs the presence of the stimulation in order for us to feel normal.  If we cease whatever is causing the stimulation, whether it be alcohol, other drugs or stimulating activity, for very long we begin to feel uncomfortable because all those extra receptors are telling us they need to be filled up.
  4. Eventually, we reach a point where any pleasure is short-lived, and we simply need the stimulation to keep going.  When we don’t have it, we experience withdrawal, feelings that, as a general rule, are the opposite of whatever good feelings the stimulation caused.  If we were using cocaine or other central nervous system stimulants, we feel depressed; if using downers, agitated; if we are a thrill junkie, bored and/or depressed, etc.  Because of the changes in other parts of the body there are often other symptoms.  For example, opiate withdrawal is like the worst case of flu you can imagine, doubled, combined with overpowering anxiety, nervousness and generally feeling terrible both physically and emotionally.
  5. At the point of marked, prolonged withdrawal in the absence of the drug or activity, we are definitely addicted.

But why can’t we quit?  We know using is causing us life problems, and we know withdrawal doesn’t last forever.  There are even medications to help.  What’s with the constant failures to stop using?

Remember that we said the pleasure center is a part of the brain over which we have no conscious control.  This part of the brain, because it is survival-oriented, interprets failure to meet its needs as survival issues.  We have created an artificial situation in which the brain needs extra stimulation to feel normal.  Therefore, when it does not get the extra stimulation, it sends messages to our subconscious that our very survival is threatened.  Addicts continue to use because their subconscious, over which they have no control, tells them that if they don't they're liable to die.

Those messages alone are enough to make it extremely difficult to stop using.  When reinforced with physical withdrawal, they are sometimes impossible to overcome with conscious effort because — again — we have no control over the feelings or the symptoms except for the use of more drugs.

Of course there is more to it.  The stresses created in our lives by addiction-related problems (and perhaps problems that preceded the addiction) make it even more difficult for us to allow ourselves to return to reality.  We must first detox from the drug, and then we need a lot of support and help while normalizing our social, emotional and health issues during the first months and years of sobriety.  We also need help getting through the “post acute withdrawal syndrome” (PAWS) that occurs while the brain and rest of the body are rebuilding and getting back to something like normal.  This can take a long time, and the issues associated with PAWS are a frequent (if not the most frequent) cause of relapse.

That, however, is a subject for another article of its own.  For now, understanding that addicts are subject to powerful emotional and physical experiences over which there can be no direct control will clarify a lot about addiction and the problems of getting clean.

Hepatitis Infection Soars in IV Drug Users Worldwide

In a study published July 28th, 2011 in The Lancet,  Paul Nelson, from the National Drug and Alcohol Research Center at the University of New South Wales in Sydney, and colleagues, reported their analysis of  data from multiple international reporting sources. They found that rates of hepatitis C infection among injection drug users (IDUs) were 60 to 80 percent in 25 countries and greater than 80 percent in 12 other countries. Hepatitis can lead to cirrhosis, liver cancer and liver failure. It is the number one reason for liver transplants in the US.

CDC Image

The results show that the top countries for infection were: The United Kingdom (50 percent), New Zealand (52 percent), Australia (55 percent), Spain (80 percent), Norway (76 percent), Germany (75 percent), France (74 percent), United States (73 percent), China (67 percent), Canada (64 percent), Italy (81 percent), Portugal (83 percent), Pakistan (84 percent), the Netherlands (86 percent), Thailand (90 percent) and Mexico (97 percent).

According to the researchers:

“The public-health response to blood-borne virus transmission in IDUs has mainly centered on HIV. Maintenance and strengthening of the response to HIV in IDUs remains crucial, but the significance of viral hepatitis needs to receive greater attention than it does at present,”

“Efforts to prevent, treat, and reduce harms related to liver disease in IDUs are essential — especially in situations in which HIV has successfully been prevented or managed — because the large numbers of IDUs infected with HCV and significant morbidity resulting from this infection mean that the health and economic costs of HCV transmitted by injected drug use might be as high as (or higher than) those of HIV.”

“Nonetheless, HCV treatment is underused. Part of the reason for this neglect is the high cost, which will remain a substantial barrier to increasing of treatment coverage in low-resource settings until costs are reduced”

Of course, enlightened clean-needle programs and similar measures could substantially reduce the incidence and cost of infections, but only a few countries — conspicuously not including the United States — have seen fit to implement such measures.

Injection Drug Users Need Targeted Help — Study

A study published in the July Journal of Addictive Diseases indicates what those of us in the treatment field have long known: that injection drug users, regardless of what kind of drugs they use, are at the greatest risk for associated medical problems, psychological problems and death, and most in need of effective intervention and treatment.  This is true despite the fact that injection users represent a relatively small percentage of alcohol and drug addicts as a whole.

Image - DEA

Because of the circumstances surrounding injection, which include overdose, infection, transmission of blood-borne diseases by dirty “works,” accompanying higher rates of abuse and addiction (as opposed to occasional use), and diverse psychological problems, the authors of the study believe that their findings can help spur targeting of these individuals.

The researchers analyzed data from the National Survey on Drug Abuse and Health, which is conducted annually on roughly 70,000 children and adults in order to gain a statistically accurate overview of the current state of drug use and abuse in the United States.  The study showed that injection drug users were likely to be older than other abusers and addicts, more likely to live in rural areas, be unemployed, and not have achieved graduation from high school or its equivalent in education.  Unemployment was one of the major issues defining the group.

Lead author Scott Novak, senior behavioral health epidemiologist at RTI International, stated “Our findings indicate that injection drug use is associated with substantially more substance abuse-related problems than non-injection drug use, including a higher prevalence of dependence, unemployment, and co-occurring mental and physical disorders.  “These problems appear to characterize a treatment-resistant population in need of specialized treatments.”

RTI International provides research and technical services to governments and businesses in the areas of health and pharmaceuticals, education and training, surveys and statistics, advanced technology, international development, economic and social policy, energy and the environment, and laboratory testing and chemical analysis.

These Are Our Lives

My older daughter, Tanya, turned me on to this site.  Its purpose is to provide oral histories in interview form, and I think it's a great idea.  As it happens, I know the woman who started it, and I think I probably know the young woman whose story I'm about to recommend.  (I'm not sure about the latter, though, and I don't need to know.)  However, that's not the reason I'm doing it.

In short, this is one of the best and — I believe — most honest stories about addiction and alcoholism that I've ever seen in print, and one of the best I've heard, period (and trust me: after more than 20 years of listening to stories, I'm no longer easily impressed).  Active addicts, those in recovery, and their families will get a lot out of  this interview with an extremely articulate woman who has clearly thought a lot about her life and how she got where she was — and is.

Please read it.  Pass it on, recommend it to your friends and acquaintances, link to it on your blogs.  Tweet about it.  Mention it on Facebook.  This is a story, and a site, that needs to be seen and heard.  I'd wish Molly good luck with her blog, but if she's able to keep this level of material coming, success is a foregone conclusion.

These Are Our Lives: Chrissy's Story

Adulterant in Cocaine Causes Skin Lesions

According to an article in the Journal of the American Academy of Dermatology, doctors across the country are finding numerous instances of a skin disease, known as purpura, linked to the consumption of cocaine.

Over the past few years, cocaine manufacturers have increasingly cut their product with a drug called levamisole.  Use for that purpose has skyrocketed, with the drug being found in only 30% of confiscated cocaine in 2008, but climbing to 70% in 2009, according to the DEA. Levamisole is a de-worming drug used by veterinarians, and was formerly used to treat colon cancer.  It is known to increase dopamine levels, triggering the brain’s pleasure center.  Experts at the DEA report that it is added to cocaine because it is a cheap way to dilute the drug to street strength, while adding some enhanced effects.

Purpura occurs when capillaries in the skin are blocked, cutting off the blood flow.  It causes skin death, which creates purplish, crusty areas of dead skin and is extremely painful.  The lesions can lead to serious infection.  This form of purpura appears most commonly around the ears, and its presence indicates the need of follow-up on the possibility of cocaine use.  Both inhaling and smoking cocaine cut with levamisole can cause the problem.