Living with Alcoholism and Addiction

LIVING with ALCOHOLISM AND DRUG ADDICTION also in the teen’s guides series Living with Allergies Living with Anxiet...

Author: Nicholas R. Lessa | Sara Dulaney Gilbert

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LIVING with ALCOHOLISM AND

DRUG ADDICTION

also in the teen’s guides series Living with Allergies Living with Anxiety Disorders Living with Asthma Living with Cancer Living with Depression Living with Diabetes Living with Eating Disorders

LIVING with

ALCOHOLISM AND DRUG ADDICTION Nicholas R. Lessa, with Sara Dulaney Gilbert

Living with Alcoholism and Drug Addiction Copyright © 2009 by Nicholas R. Lessa All rights reserved. No part of this book may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage or retrieval systems, without permission in writing from the publisher. For information contact: Facts On File, Inc. An imprint of Infobase Publishing, Inc. 132 West 31st Street New York NY 10001 Library of Congress Cataloging-in-Publication Data Lessa, Nicholas, 1957– Living with alcoholism and drug addiction / by Nicholas R. Lessa with Sara Dulaney Gilbert. p. cm. — (Teen’s guides series) Includes bibliographical references and index. ISBN-13: 978-0-8160-7326-9 (hardcover : alk. paper) ISBN-10: 0-8160-7326-0 (hardcover : alk. paper) 1. Drug abuse. 2. Alcoholism. I. Gilbert, Sara D. II. Title. HV5809.5.L47 2008 616.86—dc22 2008045347 Facts On File books are available at special discounts when purchased in bulk quantities for businesses, associations, institutions, or sales promotions. Please call our Special Sales Department in New York at (212) 967-8800 or (800) 322-8755. You can find Facts On File on the World Wide Web at http://www.factsonfile.com Text design by Annie O’Donnell Cover design by Jooyoung An Printed in the United States of America Bang Hermitage 10 9 8 7 6 5 4 3 2 1 This book is printed on acid-free paper.

contentS ■■

1 What Are Alcoholism and Addiction?

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Substances of Abuse

14

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Causes of Alcoholism and Drug Addiction

32

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Recognizing Alcoholism and Drug Addiction

44

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5 Dangers of Alcoholism and Drug Addiction

54

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6 Getting Support and Help

65

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Approaches to Treatment

77

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Managing Alcoholism and Drug Addiction:

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1

Life After Treatment

92

Helping a Friend or Relative

104

■ ■ 10 Paying for Care

115

■ ■ 11 What More Can You Do?

123

Appendix: Associations and Support Groups

132

Glossary

140

Read More About It

147

Index

151

1 What Are Alcoholism and Addiction?

a

Alcoholism and addiction are more widespread among teens—and even preteens—than many realize. We’re not just talking about the kind of beer parties that sometimes make the news, but also about situations like these: M Tommy keeps a bottle of cough syrup in his middle-school locker. He sips from it between classes—but he doesn’t think about being a drug addict. M Mary Anne’s parents let her—and sometimes her friends— drink beer and wine at their home. They are happy it’s “just alcohol.” M Lisa’s parents are alcoholics, and her grandparents too. At 14, Lisa is determined to never be like them. She busies herself with positive activities such as cheerleading and service clubs. But one evening at a party, she is offered some pot. She takes a couple of puffs and finds she likes the effects—and she knows it won’t make her a “sloppy drunk” like some of her family members. M Jason’s junior high class learned about the dangers of hard drugs, and they all hated smoking, but pills from his mom’s medicine cabinet seemed safe—and fun.

Putting aside questions of illegality, each of these stories might sound like mild examples of kids who have substance use “under

1

Living with Alcoholism and Drug Addiction

control.” Unfortunately, they are all-too-common scenarios of teens and preteens—some 8 million of them—on the road to alcoholism and other kinds of drug addiction, which science now says causes permanent changes in the developing brain. Many still think of alcoholics as drunks sleeping in the gutter, or addicts as junkies nodding out with needles in their arms, but here are some basic facts about alcohol and drug addictions. M A drug addict is not necessarily a strung-out street junkie—yet. Addiction can begin with repetitive and inappropriate use of something as seemingly innocuous as cough syrup. M There’s no such thing as “just alcohol.” Alcohol, in addition to being a dangerous substance on its own, is a potentially addicting drug. Alcoholism is an addiction. Addiction runs in families, whether from socially learned patM terns, from genetic inheritance, or both. M Alcoholism is not solely an adult problem. It doesn’t necessarily take a long time to become an alcoholic or an addict, and it can mean trouble for kids as young as 12. M The abuse of prescription medications is increasing, and it is potentially one of the more dangerous addictions. Another fact that’s only recently gaining acceptance is that addiction starts at a much younger age than was once thought. By high school, it’s often already time for treatment. According to a survey by the National Institute on Alcohol Abuse and Alcoholism, more than a fifth of all eighth-graders have used illegal drugs; more than a quarter have used alcohol; and a quarter report having been drunk at least once. The long-term dangers and effects of addiction are revealed by recent research, as you’ll learn in detail in this book. The impact of early use of alcohol and other drugs on the brain is more serious and long-lasting than once thought. The federal government tracks substance use among young people and reports that for almost all types of drugs, use by eighth-, 10th-, and 12th-graders was down during the first few years of the 21st century. Though surveys show that fewer teens are using drugs, large numbers are still using. The numbers show that use increases with age: Twice as many 12th-graders as eighth-graders use drugs. Twelve million teens are regular substance users, and as many as 3 million qualify as substance abusers or full-blown addicts. Chances are, you know at least one person your age (in addition to one or more substance-using adults in your life) who is dealing with

What Are Alcoholism and Addiction?

a drug or alcohol problem. Each of these teens has parents, siblings, and friends who are significantly affected by their problem. You’ve probably already been confronted with literature and lectures designed to scare young people away from drinking and drugging. The bad effects of alcohol and drugs are indeed something to be scared of, but as you probably also know, using fright to keep young people away from substance abuse often has the opposite effect—it makes danger seem attractive. Instead, this book presents facts about these widespread, serious disorders to help you figure out the best way to deal with them, whether you experience them in yourself, in a friend, or in a family member. You’re also surrounded by opportunities and even encouragement to at least try alcohol or another chemical substance. Even if your friends don’t use, TV shows, ads, and movies all make drugs and alcohol seem like a natural part of life. The more you know about alcoholism and addiction, the better you will be able to cope with them, whether they affect you directly or indirectly. In the first half of this book, you’ll learn about addiction and how it works. The second half of the book shows ways to deal with alcoholism and addiction, including, at the end of the book, resources for further support and information.

Substance Use Disorders Mary Anne, whose family let her drink at home, wouldn’t ever think of “using drugs.” Lisa, who chose pot at that party, believed it was much less messy than booze. They share the common misconception that “alcohol is not a drug.” In fact, alcohol is one of many psychoactive drugs—substances that affect the brain in very specific ways, including causing addiction. People can become addicted to alcohol just as they can become addicted to the whole range of other drugs—from pot to heroin to nicotine or even caffeine. Substances like some cough syrups or prescription medications contain a variety of ingredients that create an addictive reaction. Addictive substances may differ, but addictions themselves have so much in common that members of the medical profession use the term substance use disorder (SUD) to refer to any kind of dependence on an external chemical substance. The most common types of SUD are alcoholism and drug addiction. Addiction is a physical, mental, and emotional dependence on chemicals known as psychoactive drugs. Alcoholism, for example, is an addiction to alcohol. Addiction is a disease that includes the following four symptoms:


M craving—a strong and often overpowering urge to use a psychoactive drug M loss of control—not being able to stop using once a drug has been introduced to the body physical dependence—the need to maintain the level of drugs M in the body in order to avoid withdrawal symptoms, such as nausea, sweating, shakiness, and anxiety M tolerance—the need to use increasingly large quantities of a drug to get the same sensation Alcoholism and addiction are considered “biopsychosocial” disorders, in which biological (physical), psychological (mental), and social (interpersonal) factors are intertwined. Physical dependency on a chemical can lead to behavior that is extremely painful to the substance abusers and to all those connected to them. In some cases, a preexisting mental or psychological problem can cause an individual to self-medicate with an addictive drug. A social aspect of the disorder can refer to the impact of family on addiction, and vice versa. Since in today’s world “society” extends way beyond one’s home, a wide range of influences, including the media, have an impact on attitudes and addiction—and substance abusers can affect a wide range of social groups. A unique characteristic of both alcoholism and addiction is a process called denial. Denial is an inability on the part of substance abusers (as well as, often, their family and friends) to admit that the addiction exists. It adds to the puzzle of living with addiction, so we’ll be going into that important aspect of the disease in depth further along in the book.

How Substance Use Disorders Work Addiction and alcoholism were once thought to be “moral failings.” People thought that an alcoholic or addict simply had a “weak will” or a “bad character” and that punishment or moral improvement was the best way to handle them. Even today, despite the fact that substance abuse is a widely researched illness, many people continue to believe that people who struggle with alcohol or drugs are “weak,” “evil,” or “sinful.” Research into body chemistry and the brain itself has revealed scientific facts that show that addiction is, in simplest terms, a brain disease. Alcohol and drugs have a major impact on nerves controlled by the brain, for example. One area that heavy drinking affects is our ability to manage stress. Alcohol, often taken to relieve stress, can

What Are Alcoholism and Addiction? 5

What’s the Problem? At 14, Jamie tried marijuana at a party, since his friends told him smoking cigarettes was not cool. Now, at 16, Jamie smokes marijuana every day, because he “needs” it to chill from his problems, including his Dad’s drinking and his own dropping grades. He says he can’t be an addict because marijuana isn’t a “real” drug. Besides, he (almost) always smokes with his friends, which makes it “social.” So what’s the problem? 1. Jamie is under legal age, so any drug use (including tobacco) is illegal. 2. A daily need for a substance to ease problems is a clear sign of addiction. 3. Marijuana is a real drug, which is addictive, and his use has increased. 4. Jamie’s family history of alcohol problems is a sign of likely addiction. 5. Jamie’s drug use is causing problems, not solving them. 6. Calling drug use “social” is a form of denial—finding an excuse to use a substance. Not seeing there’s a problem is a good clue that there is a problem.

actually make the brain feel more stress. Other drugs create changes in the brain’s centers for pleasure and other emotions, as well as for memory and motivation, and can create a need for more drugs, leading to addiction. Different types of drugs have different effects on the chemistry of the brain, and over time repeated use alters brain structure and activity, so that effects last long after use has stopped. Chapter 2 describes these brain connections and explains much more about this exciting new field of research. The knowledge of how alcohol and drugs act on the brain will help improve treatment of the disease of addiction. More importantly, this brain research has also shown that young people are especially affected by addiction:

6 Living with Alcoholism and Drug Addiction

By the Numbers The federal government keeps track of substance use among young people and reports that for almost all types of drugs, use by eighth-, 10th-, and 12th-graders is down over the past few years. But 65 percent of all 12th-graders have smoked cigarettes, and almost a quarter smoke every day. Other drugs on the rise are steroids, prescription drugs, and nonprescription cough medicine. For the whole picture, check out http://www.monitoringthefuture.org, a service provided by the University of Michigan and funded by the National Institute on Drug Abuse (NIDA).

Since your brain is still developing and will continue to until you’re about 21, the addiction to any foreign substance can alter your brain’s healthy development and result in serious and long-term changes in how it works.

wHy aDDiction iS a DiSeaSe Harry, 16, needs to smoke a joint before school and during lunch, and Angela, 17, needs a beer at breakfast, at mid-morning, and at lunch. The two of them have the same problem—and it’s not just that both substances are illegal. Angela might not think of smoking, and Harry can’t stand the idea of beer. But both are displaying addictive behavior, and as the previous section noted, addiction and alcoholism are two versions of the same disease—substance use disorders. It’s not hard to see that these teens are in trouble, and that it doesn’t matter whether it’s drugs or alcohol causing the problem. But the idea that they have a “disease” is not always easy for some to accept. The National Institutes of Health considers alcoholism and addiction diseases, as does the American Medical Association and the insurance companies that pay for their treatment. But to many it may still seem like a “cop-out” to say, “I have a disease.” According to a dictionary definition of disease, it’s “a condition of the living animal . . . that impairs normal functioning and is typically manifested


by distinguishing signs and symptoms.” Government health experts agree that alcoholism and addiction are brain diseases. Drug addiction is a complex brain disease. It is characterized by compulsive and at times uncontrollable drug craving, seeking, and use that persists even in the face of extremely negative consequences. Drug-seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and on behavior. For many people, drug addiction becomes chronic. Alcoholism is a chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodically impaired control over drinking, preoccupation with the drug alcohol, and use of alcohol despite adverse consequences. So why is it hard for some people to call them diseases? Perhaps it’s because it seems to be something that people choose to inflict on themselves. It may be that the bad behavior that alcoholism and addiction can trigger makes people so angry that it’s hard to take a clear look at the illness. Also, studies show what many nonprofessionals have observed—that there is an element of mental illness that runs through addiction, and that frightens some.

Mental Illness Alcoholics and addicts feel a compulsion to ingest chemicals known to be dangerous despite experiencing progressively more negative and painful results. A compulsion is an overwhelming urge to take an action that makes no sense. For example, Angela and Harry need those daytime hits—they don’t necessary want them. A fundamental element of this compulsion is the fact that users use despite the adverse consequences. They keep using even though they know that it will lead to problems in physical health, psychological functioning, relationships, the workplace, and finance. Few people who are addicted to alcohol and drugs want to admit that they are mentally ill, but the American Psychiatric Association considers addiction a mental illness that causes significant impairments in a person’s ability to function. Another key feature of substance use disorders is denial, which the National Council on Alcoholism and Drug Dependence defines as a defense mechanism disavowing the significance of events, and a range of psychological maneuvers designed to reduce awareness of the fact that alcohol use is the cause of an individual’s problems. In other words, an alcoholic or addict knowingly hurts him or herself but then is unable to see or admit the problem.


Research The 21st century has an additional way of looking at substance use disorders, thanks to breakthroughs in the scientific study of the brain. Today, addiction is seen as a chronic but treatable brain disorder, according to NIDA. People who are addicted cannot control their need for alcohol or other drugs, NIDA explains, even in the face of negative health, social, or legal consequences. This lack of control is the result of alcohol- or drug-induced changes in the brain. Those changes, in turn, cause behavior changes, especially those related to motivation, decision-making, and pleasure-seeking. In other words, the source of a lot of the behavior that addicts, alcoholics, and their friends and family have observed over many years can be seen inside the brain. Whatever the label, alcoholism, addiction, or any kind of substance abuse is not something people choose. What’s key is to realize that people like Harry or Angela, who “need” to use a drug during their day at school, are not troublemakers or slackers who are simply making bad choices. They are troubled and suffering from forces they can’t control. Some people don’t like the idea that they may have a disease because they may think of diseases as being dirty or catching. For them the term disorder may be more acceptable. A disorder implies a system that just doesn’t work right—diabetes, for example, or high blood pressure. These are conditions in which an internal system is out of order, through no “fault” of the sufferer. The source may be inherited, and the condition may be worsened by lifestyle—just as in addiction and alcoholism. Like diabetes or high blood pressure, alcoholism is chronic, meaning that it lasts a person’s lifetime, usually follows a predictable course, and has symptoms. The risk for developing alcoholism is influenced both by a person’s genes and by his or her lifestyle.

Disability Alcoholism and addiction also can be considered a disability. Federal law, under the Americans with Disabilities Act, includes alcoholism and addiction as disabilities. It defines a disability as a physical or mental impairment that substantially limits or restricts the condition, manner, or duration under which an average person in the population can perform a major life activity, such as walking, seeing, hearing, speaking, breathing, learning, working, or taking care of oneself. Does this mean that if you drink too much you get federal financial support? Of course not—but the long-term effects of substance abuse can cripple people.


Spiritual Search Some who treat those suffering addiction report finding a sense of “spiritual impairment” or a search for spirituality among addicts. They are observing what some alcoholics and addicts refer to as “a hole in their soul,” a sense of a gaping inner space that must be filled with something. William C. Moyers, a recovering crack addict and alcoholic who leads the nationally recognized Hazelden treatment center, explained to scientists at a brain-study conference, “I have an illness with origins in the brain . . . but I also suffered with the other component of this illness. I was born with what I like to call a hole in my soul . . . A pain that came from the reality that I just wasn’t good enough. That I wasn’t deserving enough.”

Those at Higher Risk Some people are also at higher risk of addiction than others, including children of alcoholics or addicts, due possibly to genes, difficult upbringing, or both; young people with psychological problems, such as conduct disorders, who self-medicate to feel better; people with attention-deficit/hyperactivity disorder or other learning disabilities, and others who find it difficult to fit in to school or social settings; and children of poverty who lack access to opportunities to succeed and to resources when they’re in trouble. But if you’re not in one of these vulnerable groups, why should substance use disorders matter to you?

Why Substance Use Disorders Matter to You—Now Gaining a solid understanding of substance use disorders is important for you, no matter what your circumstances, because even casual use of alcohol and other drugs can cause special problems for teens. The best way to treat SUDs is to prevent them. Anyone has the potential for suffering from substance use disorders, directly or indirectly, and almost everyone in the country is affected by substance use disorders, whether they realize it or not. Even casual use of alcohol and other drugs can cause special problems for teens. We’ve outlined the negative effects

of chemical substances on brain development, but there are more reasons why their use matters especially to adolescents. Alcohol and other drugs impair judgment, and brain studies show that the


judgment center of adolescents is still not fully developed, so that teens are in extra trouble when it comes to making decisions after using even a small quantity. This may explain why alcohol is a factor in the three leading causes of death among persons ages 10 to 24: car and other accidents, homicide, and suicide. In less deadly situations, when combined with teens’ developmental drive to rebel against family, this judgment impairment can also make for extra painful conflicts. And for those many teens who struggle to fit in, alcohol and various other drugs are often used to make that situation feel better. Some drug use leads to more: It’s no myth that so-called “soft” drugs can lead to “hard” drugs. It has been found that more than 67 percent of young people who start drinking before the age of 15 will try an illicit drug. Young people who drink are 7.5 times more likely to use any illicit drug, more than 22 times more likely to use marijuana, and 50 times more likely to use cocaine than young people who never drank. The best way to treat SUDs is to prevent them. Perhaps the biggest reason for understanding addiction and alcoholism has to do with prevention. Columbia University research shows that a person who reaches age 21 without abusing alcohol or using drugs is virtually certain never to do so. Remember those statistics about the use of many drugs by teens going down? That’s because studies show what you know—kids are smart. When they have information about potential harm, many of them tend to avoid it. The more you know about alcohol and other drugs, the more likely you are to use caution when approaching them. Anyone has the potential for suffering from substance use disorders. No one plans to be an addict or alcoholic, but some

people are at higher risk for addiction, and for others, repeated use of chemical substances can create nerve links in the brain that cause addiction. According to research by the National Institute on Alcohol Abuse and Alcoholism, adolescents who begin drinking before age 15 are four times more likely to develop alcohol dependence than those who begin drinking in adulthood. Addiction also causes suffering in those around the addict: Living with someone who is afflicted with an SUD can be extremely painful and requires special guidance for living. Whatever your situation, the more facts you have, the more ammunition you have against the kind of denial that fools people into thinking they don’t have a problem.


True or False? People have a lot of misconceptions about substance abuse. The more facts you have, the fewer false claims you will believe. Which are true and which are false? 1. You have to use an illegal drug to be addicted.

T/F

2. You have to drink in the morning to be an alcoholic.

T/F

3. If you’ve just used alcohol or drugs for a short time, you can’t be addicted.

T/F

4. Only addicts get in trouble for using.

T/F

5. Some drugs are safer than others.

T/F

6. It’s normal for kids to “party” during their teens.

T/F

7. Alcoholism and addiction can’t be cured.

T/F

8. My best friend would tell me if he was hooked.

T/F

Answers 1. False. Nicotine, prescription medications, and alcohol are legal for adults and can cause addiction. 2. False. Wake-up drinking can be a sign of alcoholism but is not a requirement. 3. False. Addiction can take hold very quickly. 4. False. All teen use of all substances is illegal; and behavior while high even for a short time can bring on trouble. 5. False. You can’t count on a safe reaction from any drug, especially as a teen. 6. False. Teens have fun, of course, but kids who use drugs to party are a tiny and shrinking minority. 7. True. There is no cure yet, though they can be treated and managed. 8. False. Probably not: Secrecy, denial, and dishonesty are characteristics of the disease.

12 Living with Alcoholism and Drug Addiction Almost everyone in the country is affected by substance use disorders, whether they realize it or not. According to govern-

ment statistics, abuse and addiction to alcohol, nicotine, and illegal substances cost Americans upwards of half a trillion dollars a year, in terms of combined medical, economic, criminal, and social impact. Every year, abuse of illicit drugs and alcohol contributes to the death of more than 100,000 Americans, while tobacco is linked to an estimated 440,000 deaths per year. People of all ages suffer the harmful consequences of drug abuse and addiction. M Babies born to addicted mothers tend to be premature and underweight and slow to develop. M Adolescent drug abusers act out, do poorly academically, and risk violence and disease. Adult addicts have problems thinking clearly, remembering, M and performing well socially and on the job. M Parents’ drug abuse makes for stress-filled homes and child abuse and neglect, harming the next generation. It’s estimated that every alcoholic or addict directly affects the lives of at least four other people. The simple arithmetic says that if one parent is an addict, the other parent and the kids are emotionally damaged. It gets more complex: If your Dad’s boss is an alcoholic, he can make your Dad’s life miserable—and that can affect you. If Grandma was a “secret drinker,” she raised her children with some emotional weaknesses, which get passed to you because your mother missed out emotionally. This is one reason that addiction is called “a family disease”—and why understanding it matters to every family member. It’s not just that kids with a family history of alcohol dependence have four times the risk of becoming alcoholics, but the roles that children must play in those families change the way they live their own lives. Knowledge can protect you from the side effects of such family situations. But you don’t have to literally live with them. In your own home you may get the “do as I say and not as I do” order about substance use. The same goes for outside the home, too, where our society has very mixed feelings about the use of chemical substances. This only complicates an understanding of the facts. We see shows daily detailing family dysfunction and hear news every week about yet another famous name going to rehab or falling off the wagon. There are other ways that the media makes substance use matter to everyone. Reporting the dangers of drug use while commercials celebrate the use of alcohol sends mixed messages at best, and it’s tough


for teens not to get sucked into the media hype that’s trying to make you the next big market for alcohol. Nicotine is more strictly regulated than ever and can’t legally even be advertised let alone sold to minors—yet 65 percent of teens report smoking. Since it’s been shown that the younger people start drinking and smoking, the more likely they are to become chronic drinkers and smokers, it’s to the producers’ advantage to encourage young drinking and smoking. Corporate spokespeople will deny any such unattractive motivations, but their promotions continue to glamorize alcohol and cigarettes for the young. However, the media also helps to open up some truths about addiction. By now, thanks to popular information in the news, on TV, and on the Internet, most people know that addiction has many faces. The addict can be a 12-year-old prep school student, a 35-year-old female teacher, or a 60-year-old homeless veteran. There is no set profile. This kind of knowledge can help you break through the denial that blocks people from getting treatment. Science, psychology, biology, society, family, the media: The many and connected aspects of substance use disorders make them especially hard to live with. Substance use disorders are not simple diseases, so dealing with them, in oneself or in others, is not simple either. Understanding how these substances work is the first step toward learning to manage them.

What You Need to Know M Alcoholism and addiction are two versions of the same disease— substance use disorders. M Kids as young as eight are drinking or using other drugs. Onefifth of all eighth-graders have used drugs, and by the end of high school over three million teens are alcoholics or addicts. The misuse of alcohol and other addictive substances is espeM cially dangerous for teens and preteens. It’s not just about short-term consequences like accidents and legal trouble, but more importantly, the impact of chemical substances on the developing brain can cause lifelong damage. M Alcoholism and addiction are chronic, progressive diseases, characterized by mental obsession and physical compulsion. They affect the body, mind, and spirit and are characterized by M a feature called denial, which slows or prevents treatment. M Alcoholism and addiction indirectly affect many people who don’t use alcohol or drugs themselves. M Addiction cannot yet be cured, but it can be treated and managed. Prevention is the most effective known treatment.

2 Substances of Abuse

D

Drugs are categorized according to the eﬀ ects they have: stimulants, depressants, narcotics, and hallucinogens. Stimulants speed up the activities of the brain, producing feelings of wellbeing and alertness. Depressants slow down activities of the brain, producing a sedating effect. Narcotics alleviate pain and affect the brain’s pleasure-control center, causing feelings of well-being. Hallucinogens cause hallucinations, or distortions in the perception of reality, and produce a sense of detachment from reality. Different as their specific effects are, all substances of abuse share one characteristic in common, in addition to their addictive nature: Almost any drug taken for one effect will end up having the opposite. “It’s like backlash—you use cocaine [a stimulant] to get high and then you get depressed,” as one addict puts it. And as addictive substances, each of those drugs requires increasing amounts to achieve the same result.

an olD Story Is addiction new? No. It’s thought that one of our ancestors may have discovered the effects of fermented fruit or grain by accident, or inadvertently inhaled smoke from herb leaves tossed on a fire. As a result, getting high or intoxicated—getting out of oneself in an artificial way—has been a goal or at least part of every culture. “Drunkenness” has been seen as a problem in various societies for a long time, and when it gets out of hand, it has been punished. Until fairly recently,

1

Substances of Abuse 15

however, most psychoactive drugs were legal. Nineteenth-century America has been called a “dope fiend’s paradise,” and it was only in the early 20th century that drugs began to be seen as sources of “abuse” that needed to be regulated by laws. Even alcohol was outlawed in the United States in the early 20th century. But laws have not stopped people from using alcohol or drugs. When these substances were declared illegal, the whole process went underground and got otherwise complicated, with, for example, more people pointing fingers at the evils of drink and fewer potential professional hands available to help. In the second half of the 20th century, the drug scene got even more dramatic. In the 1960s, due partly to the “hippie” culture and partly to addictions fostered overseas during the Vietnam War, the use of drugs became more socially acceptable or at least widespread. During the same period, the pharmaceutical industry developed increasingly sophisticated prescription drugs, which started to be abused. Those scared away from criminally connected illegal drugs devised creative ways to use prescription drugs and other substances to alter their consciousness. Statistics show that teens’ use of such substances has grown as use of other substances has declined, but pharmaceuticals are potentially just as dangerous as other drugs. Though potions for “curing” drunkenness were on the market hundreds of years ago, the primary approach to dealing with alcoholism and addiction has historically been to make it illegal or shameful or both. Even with the advent of serious research in the 1930s, people addicted to drugs were thought to have a moral failing rather than a health problem, so approaches stressed punishment rather than prevention or therapy. The idea that alcoholism might be a disease spread in this country only around 1940, in part because of the popularization of Alcoholics Anonymous, and later by the acceptance of the disease concept by the American Medical Association. Today, thanks to scientific breakthroughs in brain studies, the approach to addiction has changed dramatically, showing that it is a disease that affects both the brain and behavior. The path of nicotine illustrates the process by which substances move from popular fad to social outcast. Cigarettes were once used just by a small segment of society, but then they were marketed as a sign of sophistication and reached a wider slice of the population. As time passed, the facts about nicotine came to light, and people of all ages found ways to stop lighting up. The same can be true of any substance of abuse.


With new knowledge of how addiction works, you and your generation have the power to change the future, to take actions that will stop the history of addiction and alcoholism from repeating itself. Because the good news about substance use disorders is that they can be successfully treated, and the more that is known about the addictive properties of each substance, the more effectively they can be treated. The process of addiction is quite similar for most kinds of addictive drugs, but each type has its own characteristics. Though substances of abuse act on the dopamine pathway in the brain, alcohol and drugs can each affect different neurological circuits. Abuse of alcohol, for instance, may create changes in the brain that result in increased feelings of stress that may trigger further compulsive drinking. Other drugs affect the parts of the brain that control pleasure, motivation, emotion, and memory, which can lead to addiction. Here are some basic facts about how drugs work, according to the effects they have: stimulants, depressants, narcotics, and hallucinogens. As the most commonly abused drugs, alcohol and marijuana receive special attention.

Alcohol Probably the oldest psychoactive substance around, with evidence of use for at least 10,000 years, starting in the Stone Age, alcohol is also available in the widest variety of forms. A chemical called ethanol is the basis of alcoholic substances, which is made through simple processes of fermenting or distilling sugar-based products. Strength and flavors depend on the process and the products used. Fermentation, or the chemical breakdown of agricultural products like grains, fruits, and vegetables, produces wine and beer. Distillation—the purification by evaporation and condensation—of those products makes hard liquor. Beer, wine, liquor, coolers, and malt liquor are all forms of alcohol. Even some nonalcoholic products actually contain small percentages of alcohol, such as ice cream. Ethanol is also present in a wide variety of products, including mouthwash, toothpaste, cough syrup, prescription drugs, and many foods. Taken orally, alcohol is characterized as a depressant, although it may seem to have stimulant or “upper” qualities. Users feel high because the inhibitions and judgment sections of the brain are depressed. Alcohol also seems to stimulate blood flow, causing flushing, because it relaxes the passages of the circulatory system. After an initial high, users often experience depression. Other short-term effects include dizziness, slurred speech, disturbed sleep, impaired


motor skills, nausea, and sometimes violence. High doses can lead to respiratory depression and death. Blackouts frequently occur during drinking episodes—a kind of amnesia during which drinkers may act normal but not be conscious of their behavior. Hangovers—sick feelings following drinking episodes—are common. Over the long term, alcohol ingestion can lead to learning impairments and addiction (alcoholism).

Marijuana Marijuana, or cannabis, has been used as a psychoactive substance since prehistoric times, whether smoked, eaten, or used as tea. It is considered a “quasi-psychedelic” because it is not strictly a hallucinogen but provides hallucinatory effects to some users. Because of those cases, it has often been made part of spiritual practices. The main active chemical is delta-9-tetrahydrocannabinol, abbreviated THC, which triggers brain cells to release the chemical dopamine. Marijuana is the dried leaves and flower tops of the cannabis hemp plant, grown throughout the world. “Pot” is a common nickname for marijuana. In fact, there are hundreds of slang terms for marijuana, including ganja, weed, grass, herb, Mary Jane, gangster, and sinsemilla. Hashish is a stronger version of marijuana, made from concentrated resins of the cannabis plant and smoked as cigarettes or in pipes called bongs. While widely used, it is an illegal controlled substance in most parts of the world. Marijuana makes people feel high because of its effect on dopamine levels, but the drug is characterized more as a hallucinogen because it can create varieties of hallucinations. Marijuana’s effects on the user depend on its strength, related to the amount of THC it contains. The THC content of marijuana has been increasing since the 1970s, so what was once considered a mild substance now has more potentially ill effects. Short-term effects include euphoria, slowed thinking and reaction time, confusion, and impaired balance and coordination. Longer-term effects can include memory and learning problems, distorted perception, and difficulty thinking. Cannabis can cause physical dependence and withdrawal symptoms.

Stimulants Stimulants are a group of drugs that excite the neurons in the brain, speeding up activities of the brain and many organs controlled by the brain. Some stimulants are very addictive, such as cocaine and nicotine; others, like caffeine, are less dangerous.

18 Living with Alcoholism and Drug Addiction Amphetamines. Stimulants take many forms. Dexedrine and meth-

amphetamine, also known as crystal, crank, and speed, increase alertness and physical activity and so are called uppers. Heart and breathing rates and blood pressure go up, as does a sense of energy. Pupils dilate and appetite decreases. They have nicknames such as ups, hearts, black beauties, pep pills, copilots, and bumble bees. Taken orally, injected, snorted, or smoked, stimulants are also often in the form of pills, sometimes prescribed (see Prescription Drugs section below). Uppers can cause sweating, dry mouth, blurred vision, insomnia, loss of appetite, and dizziness. Users can feel restless, anxious, and have a false sense of power. Uppers also cause increased blood pressure and convulsions, and over a longer term they can cause overaggressive behavior, depression, and paranoia. They are highly addictive, and if injected, raise the risk of exposure to HIV, hepatitis, and other infectious diseases. Methamphetamine is the most commonly abused amphetamine, in part because it is so easy to manufacture that its off-the-shelf ingredients have now been restricted. Called, among other nicknames, speed, meth, crank, crystal ice, fire, croak, crypto, white cross, or glass, it is taken orally, injected, snorted, or smoked. Meth has effects similar to any other amphetamine, but usually more intense. The addiction can be more powerful too. Chronic use can cause violent behavior, anxiety, confusion, insomnia, auditory hallucinations, mood disturbances, delusions, and paranoia. Delusions include “formication,” the feeling that the skin is crawling with bugs. Damage to the brain caused by meth usage is similar to Alzheimer’s disease, stroke, and epilepsy. Cocaine and crack. Cocaine and crack are stimulants that are extremely addictive and produce intense euphoria. A powerfully addictive stimulant, cocaine directly affects the brain, causing quick highs and triggering intense cravings. Since the high these drugs produce is short-lived, users typically use repeatedly. They are often taken to “level off” the effects of downers, and to allow drinkers to consume increased quantities for long periods. One of the oldest known drugs, pure cocaine is extracted from the leaves of the coca plant, the Erythroxylon bush, which grows primarily in Peru and Bolivia. It is powdered and usually mixed with other substances. Coca leaves have been ingested for thousands of years, and the pure chemical—cocaine hydrochloride—has been an abused substance for more than a century. The hydrochloride salt, or powdered form of cocaine, can be taken intranasally, or through the nose (“snorted”), or when dissolved


in water can be injected. Cocaine is generally sold on the street as a fine white crystalline powder, known as coke, C, snow, flake, or blow, among more than 100 nicknames. On the street it may be diluted with such substances as cornstarch, talcum powder, sugar, or with such active drugs as the anesthetic procaine or stimulants like amphetamines. Short-term effects include increased heart rate, blood pressure, and metabolism; feelings of exhilaration, energy, increased mental alertness, and increased temperature. Once used widely as medication, it is still used as specialized anesthetic and high-altitude remedy in mountainous countries. Its abuse or continued use produces insomnia, hyperactivity, anxiousness, agitation, and malnutrition. Overdoses can be lethal, often from heart attacks. Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. Crack is the street name given to the freebase form of cocaine that has been processed into a smokable substance. The term crack refers to the crackling sound heard when the mixture is smoked. Because crack is smoked, the user experiences an immediate high. This fact and the relatively low cost of the drug made it popular, but addiction is extremely powerful and triggers almost constant use, so long-term costs are high and withdrawal difficult. Smoking crack cocaine can produce a particularly aggressive paranoid behavior in users. In addition, it carries the same risks as any kind of smoking. The duration of cocaine’s immediate “upper” effects is short, and the faster the absorption, the more intense the high. Snorting it may create a 30-minute high; smoking, a five- or 10-minute one. Long-term effects include rapid or irregular heartbeat, reduced appetite, weight loss, heart failure, chest pain, respiratory failure, nausea, abdominal pain, stroke, seizure, headache, and malnutrition. Physical effects of cocaine use include constricted peripheral blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. Because it can severely inhibit the brain’s production of dopamine, long-term cocaine use can cause serious depression. Nicotine. According to NIDA, nicotine is one of the most heavily used addictive drugs in the United States. Cigarette smoking has been the most popular method of taking nicotine since the beginning of the 20th century. In 1998, 60 million Americans were current cigarette smokers (28 percent of all Americans aged 12 and older), and 4.1 million were between the ages of 12 and 17 (18 percent of youth in this age bracket). Prior to that, it was more often smoked in pipes, taken orally as chewing tobacco, or snorted as snuff.


Nicotine is found in tobacco leaves, which are dried, processed, and cut up to roll into cigarettes or bag for pipe and chewed tobacco, or powdered for snuff. Whether tobacco is smoked, chewed, or sniffed, it delivers nicotine to the brain—about one to two milligrams of nicotine from each cigarette. Note that nicotine is used in farming as a pesticide, and a drop of pure nicotine can kill a person. In addition to that dangerous substance, cigarettes contain as many as seven types of glue, as well as other chemicals used in the growing of the tobacco and the treating of the paper and filters. Tobacco smoke itself contains more dangerous chemicals, including tar and carbon monoxide, which cause lung and heart disease. Nicotine is the most highly addictive substance in tobacco. Nicotine is so addictive because its molecules are shaped like those of the

The Hit Parade Alcohol is the most abused drug in the United States, and marijuana is the most abused illegal drug, according to the 2006 National Survey on Drug Use and Health reported by the Substance Abuse and Mental Health Services Administration (SAMHSA). Four million people received some kind of treatment in 2006 for substance abuse problems: M 2.5 million received treatment for alcohol M 1.2 million received treatment for marijuana M 928,000 received treatment for cocaine M 547,000 received treatment for pain relievers M 535,000 received treatment for stimulants M 466,000 received treatment for heroin M 442,000 received treatment for hallucinogens Of those who were classified by SAMHSA as needing treatment, about 15.6 million needed treatment for alcohol disorders only; 3.8 million needed treatment for drug abuse only.


natural brain chemical acetylcholine, a neurotransmitter that carries signals. Nicotine easily locks into the receptors of brain-cell neurons, and then can cause rapid changes in the body and brain, raising the heart and breathing rate, and causing more glucose, or blood sugar, to be released into the blood and creating a sense of alertness. Nicotine also attaches to neurons (brain cells) that release a neurotransmitter called dopamine. Nicotine stimulates neurons to release unusually large amounts of dopamine, which stimulates the brain’s pleasure and reward circuit, creating a sense of well-being. These multiple effects last about 40 minutes in most brains, so smokers soon crave more, and repeated intake increases craving, as the brain structure changes and can produce less of its own dopamine (just like the longterm effects of heroin and cocaine). Because early use of tobacco leads to long-term addiction and can permanently affect a young person’s brain, tobacco use is officially illegal for teens. Still, more than 3.5 million people between the ages of 12 and 17 use tobacco—that’s about 15 percent of teens that age. Of those, just over 3 million, or 13 percent, smoke cigarettes. In the United States, 66.5 million people, or about 29 percent of the population, use tobacco.

Depressants Depressants are a group of drugs that slow down activity in brain and body. They are also known as CNS depressants, as they slow the normal function of the central nervous system. They can impair thinking and memory and repeated use can lead to addiction. Alcohol is the most common. As medicines, depressants are drugs that relieve anxiety and produce sleep when safely used as prescribed in medical and psychiatric treatments. They are dangerous only when abused. In higher doses, some CNS depressants can become general anesthetics. There are many CNS depressants, all of which affect the neurotransmitter gamma-aminobutyric acid (GABA), which slows brain activity and results in a sense of calm or drowsiness. Medications that are CNS depressants can be divided into two groups, based on their pharmacology. Barbiturates, also known as tranquilizers and sedatives, include mephobarbital (Mebaral) and pentobarbital (Nembutal), and are used to treat anxiety, tension, and sleep disorders. Benzodiazepines, such as diazepam (Valium), chlordiazepoxide (Librium), and alprazolam (Xanax), treat anxiety, acute stress reactions, and panic attacks. Some that have a more sedating effect, such as estazolam (ProSom), may be prescribed for short-term treatment of sleep disorders.


Despite these beneficial effects for people suffering from anxiety or sleep disorders, barbiturates and benzodiazepines should be used only as prescribed. CNS depressants are addictive and discontinuing them can lead to withdrawal. Because they work by slowing the brain’s activity, withdrawal can lead to seizures.

Narcotics Narcotics are drugs that, when taken exactly as prescribed, can be used to manage pain effectively. When these compounds attach to certain receptors in the brain and spinal cord, they can effectively change the way a person experiences pain. They are abused for this very painkilling quality. Narcotics include opiates, which can be compounds derived from natural substances like the opium poppy or man-made substances that have similar effects. The body produces its own internal painkilling substances, labeled opioids, and external opiates attach to the receptors intended for those internal chemicals. Opiate compounds include morphine, codeine, oxycodone (OxyContin—an oral, controlled-release form of the drug), propoxyphene (Darvon), hydrocodone (Vicodin), hydromorphone (Dilaudid), and meperidine (Demerol). Opiates affect regions of the brain that mediate pleasure, resulting in the initial euphoria that opioids produce. They can also produce drowsiness, cause constipation, and, depending upon the amount taken, depress breathing. Taking a large single dose could cause severe respiratory depression or death. Long-term use also can lead to physical dependence—all narcotics are extremely physically and psychologically addictive. Medical complications can include congested lungs, liver disease, tetanus, infection of the heart valves, skin abscesses, anemia, and pneumonia. Death can occur from overdose. Heroin. Heroin is a highly addictive narcotic derived from morphine. It can be injected, but recently many users are snorting or smoking it because of concerns regarding injection’s risk and the misconception that these forms of use will not lead to addiction. The short-term effects of heroin abuse include a surge of euphoria (rush) accompanied by a warm flushing of the skin. Then the user goes “on the nod,” an alternately wakeful and drowsy state. Mental functioning becomes clouded due to the depression of the central nervous system. Even though it’s a depressant or “downer,” it can make people feel high because of the experience of “nodding out.” Long-term heroin abuse is associated with serious health conditions


including spontaneous abortion, collapsed veins, infectious diseases including HIV/AIDS and hepatitis, and fatal overdose.

Hallucinogens Hallucinogen is a word coined to describe a substance that creates the imaginary visions or hallucinations. Hallucinogens disrupt the interaction of nerve cells and the neurotransmitter serotonin. Marijuana can be considered a hallucinogen, and hallucinations are often experienced by alcoholics or addicts in withdrawal. The major hallucinogenic drugs are psychedelics. Psychedelic comes from a combination of Greek words meaning to “show the mind,” because of the sense that these drugs reveal psychic truths. Psychedelics may be “natural” substances like certain mushrooms, as well as chemically produced substances including LSD, PCP, and various club drugs. LSD (lysergic acid diethylamide) is one of the major hallucinogens. LSD was discovered in 1938 and is manufactured from lysergic acid, which is found in ergot, a fungus that grows on rye and other grains. LSD is called purple flats, Lucy in the sky with diamonds, peace tablets, and yellow dimples, among many other nicknames. A very small amount of LSD can cause huge distortions in the perception of reality. Under the influence of hallucinogens, people see images, hear sounds, and feel sensations that seem real but do not exist. Some hallucinogens also produce rapid, intense emotional swings. Users refer to their experience with LSD as a “trip” and to acute adverse reactions as a “bad trip.” These experiences are long—typically they begin to clear after about 12 hours. Effects also include nausea; increased body temperature, heart rate, and blood pressure; sleeplessness; numbness; weakness; tremors; and loss of appetite. Over the long term, LSD can lead to chronic mental disorders such as persisting perception disorder (flashbacks). LSD is not considered an addictive drug since it does not produce compulsive drug-seeking behavior, but it produces tolerance, so some users who take the drug repeatedly must take progressively higher doses. This is extremely dangerous since the drug is unpredictable. While there are technically no withdrawal symptoms, flashbacks are a long-term problem. PCP, or phencyclidine, another hallucinogen, is illegally manufactured in labs and sold as tablets, capsules, or colored powder. Developed in the 1950s as an anesthetic, PCP was never approved for human use because of problems revealed in testing, including intensely negative psychological effects. But it can be easily produced and is used for those same characteristics, causing highs, hallucinations, and


intense physiological experiences. PCP—also called angel dust, ozone, wack, rocket fuel, and many others names—is snorted, smoked, or taken orally.

Club Drugs Club drugs, typically used by teenagers and young adults at bars, clubs, concerts, and parties, are a form of “designer drugs,” so called because they are man-made. Club drugs include ecstasy (MDMA or methylenedioxymethamphetamine), Rohypnol (flunitrazepam), GHB, ketamine, and methamphetamine (see Amphetamines section above). Ecstasy. Ecstasy, one nickname for MDMA, a synthetic, psychoactive

drug chemically similar to the stimulant methamphetamine and the hallucinogen mescaline, acts as both a stimulant and a psychedelic. Among the other nicknames for MDMA are street, as well as hug and love drug, due to its effect of providing what NIDA calls “enhanced enjoyment from tactile experiences.” MDMA acts primarily on neurons that use the chemical serotonin, which is key in regulating mood, aggression, sexual activity, sleep, and pain sensitivity. MDMA can be addictive: A survey of young adult and adolescent MDMA users found that 43 percent of those who reported ecstasy use met the criteria for dependence, and 60 percent experienced withdrawal. Its harmful effects include memory loss and a lessened ability to regulate body temperature, which can damage organs and in some cases be fatal. Harm can occur quickly because MDMA is difficult for the body to break down, so dangerous levels can build up in a short time. Other side effects include increases in heart rate and blood pressure, teeth clenching, nausea, and blurred vision. Psychological reactions such as confusion, depression, sleep problems, drug craving, and severe anxiety can occur both while and sometimes days or weeks after taking MDMA. Rohypnol. Rohypnol is a central nervous system depressant, designed as a prescription painkiller but banned for use in the United States because of its potential hazards. A trade name for flunitrazepam, Rohypnol, nicknamed “roofies,” belongs to a class of drugs known as benzodiazepines. When mixed with alcohol, Rohypnol can incapacitate victims and prevent them from resisting sexual assault. It can produce anterograde amnesia, which means individuals may not remember events they experienced while under the effects of the drug. Also, Rohypnol may be lethal when mixed with alcohol or other depressants.

Substances of Abuse 25 GHB. GHB (gamma hydroxybutyrate) has been used in the United

States for its euphoric, sedative, and anabolic (bodybuilding) effects. It is a central nervous system depressant that was widely available over the counter in health-food stores during the 1980s and until 1992. It was purchased largely by bodybuilders to aid in fat reduction and muscle building. Street names include liquid ecstasy, soap, easy lay, vita-G, and Georgia home boy. Coma and seizures can occur following use of GHB. Combining use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB may also produce withdrawal effects, including insomnia, anxiety, tremors, and sweating. Because they are often colorless, tasteless, and odorless, both Rohypnol and GHB can be secretly added to beverages, so these drugs emerged as “date rape” drugs. In 1996 Congress passed the DrugInduced Rape Prevention and Punishment Act, which increased federal penalties for use of any controlled substance to aid in sexual assault. Ketamine. Ketamine is an anesthetic that has been approved for

both human and animal use in medical settings since 1970; about 90 percent of the ketamine legally sold is intended for veterinary use. However, it is rarely used as an anesthetic because of its dangerous side effects. As a club drug, ketamine is also known as special K or vitamin K. Injected or snorted, ketamine can cause dreamlike states and hallucinations. In high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems. Most club drugs are stimulants, hallucinogens, dissociative drugs (which cause a person to temporarily separate from reality), or amnesiacs (which make a person forget what happened while on the substance). Partyers may experience a cheap and easy high, but chronic use of club drugs has long-term effects. For instance, MDMA may lead to changes in brain function. GHB abuse can cause coma and seizures. High doses of ketamine can cause delirium, amnesia, and other problems. Mixed with alcohol, Rohypnol can incapacitate users and cause amnesia. One potential hazard of all club or “designer” drugs is that, because they are often made in haphazard laboratories, the quality of the chemicals is often poor, and the resulting drug impurities can pose serious dangers.

Prescription Drugs Use of prescription drugs is on the increase among young people. They are viewed as safe and legal, but they aren’t unless they are


prescribed by a medical professional and used only as prescribed. Pills can be uppers or downers and can be dangerous if misused. They are difficult and often dangerous to detox from. They can be stimulants, depressants, or narcotics. Stimulants. Historically, stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorders, and a variety of other ailments. As their potential for abuse and addiction became apparent, the use of stimulants was restricted, and they are now prescribed for only a few health conditions, including ADHD and some respiratory problems. When taken as prescribed, they don’t appear to be addictive. Substance abusers misuse prescribed stimulants such as dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) for the sense of euphoria that comes from overstimulating the production of norepinephrine and dopamine. The consequences of stimulant abuse can be extremely dangerous. Taking high doses of a stimulant can result in an irregular heartbeat, dangerously high body temperatures, and the potential for cardiovascular failure or seizures. Sedatives. Sedatives like Valium or Xanax are also abused. They are

prescribed for anxiety, stress, and insomnia and when overused can produce over-sedation. Narcotics. Prescription pain relievers, a form of narcotic, have also

become widely misused. For example, OxyContin (a controlled-release form of oxycodone), Vicodin (hydrocodone), and Percocet are highly useful drugs when used as prescribed but can cause severe health problems and serious addiction if abused. OxyContin alone has been used without prescription by about 10 percent of high school seniors. It’s important to remember that just because a doctor prescribes these medications—or they’re advertised on TV—does not make them safe, and they are often dangerous when not used as indicated. For more information, go to http://www.drugabuse.gov.

Over-the-Counter Drugs and Products Nonprescription drugs can be used for coughs, colds, sleep, and weight loss. They are frequently abused, and many now have restricted sales. Other products like glues and aerosol-spray products can be misused by inhaling them, and they are just as dangerous as many of the “harder” drugs. Finally, there is nicotine: Cigarette smoking is one of the most dangerously addictive drug habits. Since this drug is easily accessible, if illegally, to young people, it is a major health threat.


Nicotine addiction is also an example of how young people have been able to resist the use of a dangerous drug, as smoking rates are sharply down among teens since anti-nicotine campaigns began.

Combinations Many addicts are like chemists, who know exactly what they need for what result. Others just take anything for thrills. Some very deliberately combine substances to maximize results: They use an upper so they can drink more, or use pot or alcohol to come down from uppers without crashing. When people mix two or more drugs, they compound the danger each drug poses. For instance, mixing cocaine and alcohol forms a complex chemical compound in the liver, cocaethylene, which intensifies cocaine’s euphoric effects, while possibly increasing the risk of sudden death. Narcotics, too, may interact dangerously with other medications. They should not be used with substances such as alcohol, antihistamines, barbiturates, or benzodiazepines. Since these substances slow breathing, their combined effects could lead to coma or death from respiratory depression. Finally, it’s not just substances that are addictive—gambling, spending, and sex can also be practiced compulsively and have been found to have brain effects similar to the substances that directly affect neurons. For some people, these are primary addictions. For others, they become substitutes for substance addictions. Many find that when they put down a drug, for example, they eat compulsively. If you want to know more about these types of addictions, check the lists at the back of the book.

Progression: The Bad News Addiction does start off as “just a beer” or “only pot.” Many people can drink “just a beer” every now and then, and it’s not the start of addiction. For others, though, a drink or a drug—alcohol or substances in other forms like pills—triggers a craving for more. As time goes on, it takes a greater amount of the substance to achieve the same level of pleasurable response, so the amount used increases. Ashley starts with one cigarette, and if she becomes addicted to the nicotine, sooner or later she is smoking a pack a day. Robert sniffs a little heroin, and if he is an addict, he will most likely end up injecting it. This is called progression—a moving onward from the first use to the full-blown addictive compulsion. Veteran members of Alcoholics Anonymous put it dramatically: “The first drink will take me to the


jailhouse, the nuthouse, or the morgue.” Today scientists understand why initial use causes many bodies to demand more, no matter how bad the consequences. The first time someone uses a drug of abuse, he or she experiences unnaturally intense feelings of pleasure. The limbic system is flooded with dopamine. Of course, drugs have other effects too; a first-time smoker may also cough and feel nauseated from the toxic chemicals in a tobacco or marijuana cigarette. But the brain starts changing right away as a result of the unnatural flood of neurotransmitters. No one knows how many times a person can use a drug without changing his or her brain and becoming addicted. A person’s genetic makeup probably plays a role. But after enough doses, an addicted teen’s limbic system craves the drug as it craves food, water, or friends. Without a dose of the drug, dopamine levels in the drug abuser’s brain are low. The abuser feels flat, lifeless, depressed. Now the abuser needs larger amounts of drugs just to bring dopamine levels up to normal levels—an effect known as tolerance. Drugs also change the way the addicted brain works. Drug abuse and addiction lead to long-term changes in the brain. These changes cause addicted drug users to lose the ability to control their drug use. Teens who first use drugs—and the initial uses are by choice— never believe “it can happen to me.” But when they first pick up, they become a statistic. NIDA researchers have found, for instance, that first use of marijuana occurs on average at age 18, and roughly 9 percent of users will become dependent on the drug, most likely before age 25. For cocaine, first use is most likely at age 20, and progression to dependence is more rapid—the peak incidence of dependence occurs between ages 23 and 25. Roughly 21 percent of persons who use cocaine at least once will become dependent, most likely by age 45. Further, researchers find that among cocaine users, more than 5 percent develop dependence during their first year of using the drug. Marijuana dependence develops less dramatically, but the likelihood is greatest in the first years of use. The progression of use is evident. One young alcoholic tells his story as follows: I had my first drink at age eleven. I had seen drinking as a kid. I noticed before people started drinking they were quiet. But after a few drinks, they seemed to be happy. I wanted what they had. So a friend and I raided his mother’s liquor cabinet one night. I had a little bit of everything. And then it happened! For the first time in my life, I felt okay. The fear was gone. I knew then that I was going to drink whenever I could. I always figured since I was a kid it didn’t

Substances of Abuse really matter. But when I hit 16 I began to get in trouble about driving. So I switched. I smoked pot because I figured it wouldn’t show on a Breathalyzer. Then after a while that just wasn’t enough. My life just felt empty—and I was really bummed when I got rejected by college. I started drinking again and tried to stay out of my car. First it was a beer with a joint, then a sixpack. Then I’d get a whole case for a weekend and it would be gone by Saturday.

What Does Addiction Look Like? How can you tell if someone is suffering from—or headed toward—an addictive disease? Here are some of the signs to watch for: M frequent illnesses, accidents, fights, school absences M declining school performance M the ability (and desire) to use more than anyone else M near-constant use or talk of use M always using to the point of intoxication M getting drunk or high when it’s not appropriate M tendency to isolate and withdraw from usual friends and activities M irritation at comments about drinking or drug use M increasing secrecy about habits M apparent memory lapses M increasingly extreme mood swings M changes in health: coughing, eye or nose problems, sleep or weight changes If you notice changes like these in your friend, you may or may not be able to talk with or help him or her, but you do need to be aware of their problem and protect yourself from the effects of his or her condition.


Some may scoff at the idea of “a fatal glass of beer”—that a deathly addiction can arise from a single use of a substance many people enjoy. But brain science now shows that it is true in some cases. Not all drinkers and users—even habitually frequent ones—are alcoholics or addicts. Science separates “abuse,” which is unhealthy use that nevertheless can be stopped, from “dependence,” which is the stage at which it takes more and more of the substance to achieve the original result, and stopping triggers a withdrawal (with the withdrawal becoming increasingly difficult each time it is tried). NIDA research describes what recovering addicts and alcoholics have described for many years: As their illness deepens, addicted people need more alcohol or other drugs. They may use more often, and use in situations they never imagined they would when they first began to drink or take drugs. They may or may not end up living on the streets, but they put themselves into a wide variety of dangerous situations, and they truly suffer. But there’s good news—the more we know about these diseases, the more we understand how to turn them around.

Progress: The Good News When a parent promises again and again to stop drinking and be there for a son’s game and never follows through, it’s natural to be angry and hurt—not to think about addiction as a “disease.” Do you know any kids who seem to keep partying after everyone else has gone home? When you see them cutting class, laughing and smoking pot when you’re stuck in school, you probably don’t think, they have a disease. But those who feel compelled to use alcohol or drugs in increasing amounts—those whose use of substances is disordered— do have a disease. As researchers note, the craving that an alcoholic feels for alcohol can be as strong as the need for food or water. An alcoholic will continue to drink despite serious family, health, or legal problems. The good news is that increasing amounts of serious research efforts are being directed at alcoholism and drug addiction, which once were simply disdained. More good news is that as a disease, addiction is highly treatable. At this point substance use disorders are not curable, but the more that science learns, the closer we are to more effective treatments. We can look at the conditions from two angles: “Addiction is a progressive, incurable, potentially fatal disorder” or “Addiction is a chronic, but treatable, brain disorder.” Drug addiction therapy is a program of behavior change or modification that slowly retrains the brain. Like


people with diabetes or heart disease, people in treatment for drug addiction learn behavioral changes and often take medications as part of their treatment regimen. Treatment may vary for each person depending on the type of drug(s) being used and the individual’s specific circumstances. In many cases, more than one effort may be needed. But the more facts are revealed, the more accurate the treatment can be. The progression of addiction—and the chaos it can cause for those close to the substance abuser—can be stopped. As you can tell from the facts presented so far, the disease of addiction is tough and complicated to deal with. Perhaps you’ve observed on your own how destructive addictions can be. But millions do recover from them. The first step toward treating any disease is to understand its causes—so that’s where we begin in the next chapter.

What You Need to Know M Alcohol and other drugs have been a part of human life for thousands of years. M Stimulants (“uppers”) and depressants (“downers”) come in a wide variety of forms and have useful value in medical and psychiatric treatment. Alcohol and other drugs become substances of abuse when M they are used for purposes and in quantities other than those for which they were designed. M Addicts crave the use of more and more psychoactive substances, requiring increasing amounts to attain a similar result, and experiencing withdrawal when substances are absent. M Addiction takes control of an addict’s brain and body, but its hold can be broken through various forms of treatment.

3 Causes of Alcoholism and Drug Addiction

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now is a great time to be learning about substance use disorders because science is learning a whole lot about them and their causes. And it’s a great time for anyone considering treatment for alcoholism or addiction, because science is leading the way to new treatment approaches. The government, which for many decades focused mainly on finding ways to limit or punish addiction, is now supporting research into and sharing scientific information about how addiction happens. Much of the recent research focuses on how the brain becomes addicted. Our brains are far more complex and sophisticated than any computer ever devised. Made up of several specialized sections, the brain runs the whole show—everything that goes on in our bodies, including everything we think and feel. The brain sends messages to the body through a system of nerves and fluids. A “message” gets sent along a nerve, then jumps to the next nerve ending through an intersection filled with chemicals called neurotransmitters. One of the most important neurotransmitters is dopamine, which is found in regions of the brain that regulate movement, emotion, motivation, and pleasure. Various parts or lobes of the brain process information from your sense organs: the occipital lobe receives information from your eyes, for example. And the cerebral cortex, on top of the whole brain, is the “thinking” part of you. That’s where you store and process language, math, and strategies: It’s the thinking center. Buried deep within the

Causes of Alcoholism and Drug Addiction 33

cerebral cortex is the limbic system, which is responsible for survival— it remembers and creates an appetite for the things that keep you alive, such as good food and the company of other human beings. Neurons in your brain release many different neurotransmitters as you go about your day thinking, feeling, reacting, breathing, and digesting. When you learn new information or a new skill, your brain builds more axons and dendrites first, as a tree grows roots and branches. With more branches, neurons can communicate and send their messages more efficiently.

Drugs and the Brain Some drugs work in the brain because they have a similar molecular size and shape as natural neurotransmitters. In the right amount or dose, these drugs lock into brain receptors and start an unnatural chain reaction of electrical charges, causing neurons to release large amounts of their own neurotransmitter. Some drugs lock onto the neuron and act like a pump, so the neuron releases more neurotransmitter. Other drugs block reabsorption or reuptake and cause unnatural floods of neurotransmitter. All drugs of abuse, such as nicotine, cocaine, and marijuana, primarily affect the brain’s limbic system. Scientists call this the “reward” system. Normally, the limbic system responds to pleasurable experiences by releasing the neurotransmitter dopamine, which creates feelings of pleasure. Think about how you feel when something good happens—maybe your team wins a game, you’re praised for something you’ve done well, or you drink a cold lemonade on a hot day—and that’s your limbic system at work. Because natural pleasures in our lives are necessary for survival, the limbic system creates an appetite that drives you to seek those things. The first time someone uses a drug of abuse, he or she experiences unnaturally intense feelings of pleasure. The limbic system is flooded with dopamine. Of course, drugs have other effects too; a first-time smoker may also cough and feel sick from toxic chemicals in a tobacco or marijuana cigarette. But the brain starts changing right away as a result of the unnatural flood of neurotransmitters. Because they sense the presence of more than enough dopamine, for example, neurons begin to reduce the number of dopamine receptors. Neurons may also make less dopamine. The result is less dopamine in the brain: This is called down regulation. Because some drugs are toxic, some neurons may also die.


The limbic system, sometimes called the “pleasure pathway,” is the route along which drugs of abuse travel—at first triggering the brain to send out a big “feel good” message. The brain then senses that it has enough of its own “feel good” neurotransmitter and causes less dopamine to be produced. As a result, the outside chemical becomes needed to complete the necessary nerve connections, and an addiction is born. The brain comes to count on the substance the user puts into it, and the user keeps looking for that big feel-good rush. An added factor is that brains are equipped with a certain number of “D2” dopamine receptors. Some people seem to have fewer than others, which means they have to add extra substance to get the same result as other users—which may have something to do with why some users become addicts and others do not. Researchers’ descriptions of the process echo the way addicts and alcoholics themselves recount the experiences of their addictions: The initial rush, the craving for more, and an inability to recapture the initial euphoric experience all are connected to the activity of dopamine receptors in the brain. These areas of the brain also influence the ability to make decisions and judgments, which may be part of the reason that a substance user can’t decide to resist the urge to use once drugs are in the system. The idea that addiction and alcoholism are “character flaws” or weak-willed choices is disproved by the scientific research. What’s less clear is what causes the first use of a drug.

Causes of Addiction Science has a lot of news about how addiction happens, reinforcing the idea that substance use disorders are not the result of “bad character” or weak wills. But we still face the question of why some people become addicted and others do not. Researchers for the leading government studies say that some people may be naturally better protected against addiction than others. But they note that almost anyone can become addicted with enough “practice.” As we’ll see, some users, probably no more than half, are genetically prone to addiction. Then there are factors in individuals’ backgrounds. Scientists have done studies on rats in labs to connect stress and trauma with addictive behavior, and research has begun on large numbers of humans to look for connections. Researchers are seeing that growing up in a safe and caring setting, without much stress, can protect a person from addiction—directly perhaps, but also because we learn in our families how to handle stress, and if our parents couldn’t do it


Quiz: The Brain and Addiction The National Institute on Drug Abuse, part of the government’s National Institutes of Health, is one of the best sources for information on all aspects of addiction. See their site at http://www.drugabuse.gov. They make material like this to help nonexperts understand the complicated topics of substance abuse. 1. When you do something you enjoy, like watch a good movie, your _______ system “rewards” you. a) limbic b) digestive c) nervous 2. When someone uses drugs repeatedly, his or her brain is _______. a) trained to crave the drug b) smaller than before c) not changed 3. After a prolonged period of drug abuse, the brain _______. a) needs less drug to get the same effect b) needs more drug to get the same effect c) experiences increasing amounts of dopamine 4. Drugs work in the brain because they have similar _______. a) electrical charges as brain cells b) sizes and shapes as natural brain chemicals c) nerve cells as the brain 5. Drugs of abuse create intense feelings because they _______. a) depress the nervous system b) shut off receptors in the occipital lobe c) cause a flood of dopamine in the limbic system (continues)


(continued)

Answer Key: The Brain and Addiction Quiz 1. a) The “reward” system of the brain is called the limbic system. It rewards you by releasing a brain chemical called dopamine, which produces feelings of pleasure. 2. a) The brain is wired to remember feelings of pleasure, including those produced by drugs unnaturally. The brain then strives to repeat those feelings, which the drug user feels/experiences as a craving for the drug. 3. b) At first, drug use may cause floods of dopamine. But prolonged drug abuse causes the brain’s dopamine levels to decrease. That means the brain will need more of the drug just to get the dopamine levels back to normal and even more to produce the high that it craves. 4. b) Drugs “fool” the brain because they are similar in size and shape as the natural brain chemicals called neurotransmitters. 5. c) Drugs of abuse cause dopamine, the neurotransmitter that produces feelings of pleasure, to be released by the brain’s limbic system.

well, then we’re more likely to turn to chemical supports when under stress. Brain studies alone don’t explain why we choose one particular substance of addiction over another. Why do some of us become addicted to cocaine, while others are hooked on alcohol or addicted to gambling? Our choices may depend on family background or what’s available. And it would make sense that people whose personalities tend to be depressed would not want depressants, for instance, but researchers don’t know for sure, especially because many addicts are addicted to more than one thing. A dopamine imbalance can have various causes (including those related to mental or emotional illnesses) and addiction to multiple substances can be a response to those imbalances.

Causes of Alcoholism and Drug Addiction

geneticS If Lisa’s parents and grandparents were alcoholics, and she is too, it would seem that alcoholism is an inherited genetic trait, right? Maybe. This is one of the big questions scientists are working on. Heredity might be a factor in the development of the D2 brain receptors that seem to act as protection against addiction. But when they study families, scientists find that only half of the people with addiction in their family background seem to develop substance abuse issues on their own, so DNA studies may offer other clues. In a recent

What Do You Think? Janice started smoking cigarettes when she was 13 and drinking when she was 14. By 16, she was a daily drinker and a regular heroin user. Three of her grandparents had been alcoholics. Her father was a drug addict who died young, leaving Janice’s mom to raise three kids and hold two jobs. They couldn’t afford to live in a very good neighborhood—their apartment was above a bar—and drug deals happened on their corner. Janice’s mother tried to control her, to keep her grounded and punish her, but it didn’t work. What do you think? Is Janice an addict because of (1) her heredity? (2) her psychological losses? (3) her confusing home life? (4) her use of drugs? (5) her bad neighborhood? (6) her bad nature? (7) all of the above? (8) none of the above? The best answers are 1, 2, 3, 4, and 5. No single explanation accounts for most addictions.


large-scale genetic study, National Institute on Drug Abuse researchers used new genomic technology to identify genes in people most at risk for developing alcoholism and other substance abuse. DNA research is one of the great medical frontiers of the 21st century, and it may be that developments in that area will bring hope for effective treatments. So much research is being done about causes of alcoholism that the results come with great frequency. All individuals with a family history of alcoholism are at risk for developing alcohol abuse disorders, but males who also have behavioral disinhibition are at the greatest risk, according to research at the Behavioral Sciences Laboratories. Parental alcoholism is a risk factor for children to become alcoholics themselves, but that risk increases significantly if the children, especially boys, have novelty-seeking personalities, with risk-taking, thrill-seeking, and impulsive characteristics. Individuals with a family history of alcoholism tend to have a biological dysfunction in their response to stress before they develop drinking problems that others exhibit only after alcohol problems arise. Scientists have also uncovered genetic evidence linked to alcoholdependent persons that could lead to the development of medication to treat alcoholism. How alcohol makes a person feel can play a part in whether or not that drinker develops alcohol problems, and now researchers believe they have found the gene that is directly linked to a drinker’s level of response to alcohol. According to NIDA, family factors do influence alcoholism. 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. Your risk for addiction increases if you are from 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. If you are worried that your family’s history of alcohol problems or your troubled family life puts you at risk, you can take steps to protect yourself.


M Don’t drink when you’re young. Not only is it illegal, but research also shows that the younger you start, the greater your risk for addiction. M Drink cautiously as an adult. Even those adults without a family history of alcoholism do well to be moderate. U.S. guidelines suggest no more than one drink a day for most women, and no more than two a day for most men, but you would do well to not drink daily. If you feel that you “need” a drink, that should be a signal to back off alcohol or drugs. M 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 or can assess your drinking habits and offer advice. If you are reluctant to talk about your drinking, that can be a warning sign (see the next chapter for clues).

Mental Illness The American Psychiatric Association (APA) classifies substance abuse as a mental illness. The APA also recognizes the mental problems that result from substance abuse, and mental illness itself is a recognized cause of substance abuse. For instance, it’s found that children diagnosed with attention-deficit/hyperactivity disorder (ADHD) are at risk for developing alcohol and other substance abuse–related disorders, especially if they have an alcoholic parent or otherwise stressful families. Children diagnosed with anxiety or depression are also more likely to become substance abusers. As researchers learn more about post-traumatic stress disorder (PTSD), they are finding that it is often linked to substance abuse. PTSD can stem from violent experiences in the past or from something as simple as the early or sudden loss of a loved one. Patients with a variety of personal histories describe the relief from painful memories and stress that alcohol or drugs offer. In people of all ages, “self-medicating” for emotional or mental problems can lead to addiction. Some frequently occurring mental illnesses have especially close connections with substance abuse. Those experiencing anxiety or depression find that alcohol or other drugs can improve their mood, at least at first. Young people with a history of major depression have been shown to be more prone to alcohol abuse, and people with schizophrenia sometimes find that alcohol brings some relief from the mental “voices” or auditory hallucinations that they often experience. These various connections between substances and mental


problems can make treatment complicated. When addiction and a separate mental illness are present, a patient is diagnosed with “cooccurring” or “co-morbid” conditions. Shorthand for these diagnoses is “CAMI,” for chemically addicted and also mentally ill, or “MICA,” where the mental illness may be more dominant than the chemical addiction. In any of these cases, both the mental illness and the substance use disorder need to be diagnosed and treated. The fact that both types of disorders are conditions that people often conceal or deny makes effective care difficult. Some people with both disorders seem to feel comfortable with being called “addicts” and are afraid of being labeled “crazy.” Others would rather be considered mentally ill, because the idea of having to give up using their drugs of choice is too overwhelming. As one “MICA” patient describes his life, “Ever since I was a little kid, people punished me for ‘acting crazy.’ No matter what I did, I couldn’t control my behavior. When I found beer and pot, I learned I could deal with it. Those substances helped me to be both calm and cheerful. I got along better until the beer and pot got me in trouble! It wasn’t till a judge sent me for a psych exam that I learned I had some mental problems. I was given medications for those problems and was sent to rehab for my substance use. Now, as long as I keep taking my meds, I can stay pretty much okay.” Mental and emotional illnesses like depression and anxiety can also be the result of substance abuse, as the drug-dangers information in chapter 5 will detail.

A Hole in the Soul Alcoholics and other addicts have been said to be on a spiritual search to fill a “hole in their soul.” As a cause for addiction, this can be hard to understand for those who have not experienced it. It’s also hard to discuss because the very idea of what is “spiritual” is hard to grasp. The simplest dictionary definition of it as “incorporeal,” meaning not related to the body, separates it from those physical cravings addicts experience. “Spirit” comes from old Latin words meaning “breath,” and there’s a connection between that sense we have of “feeling spirit” and feeling alive. Various cultures have used substances in religious ceremonies as a way to achieve out-of-body experiences, and the fact that alcohol is also called “spirits” may demonstrate a connection between alcohol and “spirit.” A British report on medical research actually refers to a “Hole in the Nation’s Soul,” and enough alcoholics and addicts have described a need to fill an inner hunger or emptiness that increasing numbers


of professionals in the addiction and health fields are making serious efforts to understand and explain the “spiritual connection” to addiction. They are working on everything from clearly defining spirituality to the power of prayer. This is not an easy topic for scientific research, but surveys have shown that a spiritual component does improve the success rates in the treatment of addiction, giving a sense of meaning and purpose in life. In other words, it may be that the absence of a sense of meaning and purpose could contribute to substance abuse. Teens concerned about developing substance use disorders may be especially interested in a study reported in the Journal of the American Academy of Child and Adolescent Psychiatry that showed that adolescents with strong religious or spiritual beliefs are half as likely to become alcoholics or drug addicts or even try illegal drugs than those who have no religious beliefs or training.

Social Influences Peer pressure is often identified as the source of all sorts of teen behavior. As adolescents are separating from their families and exploring new ways of living life on their own, they rely heavily on connections with people their own age. “Hanging with a bad crowd” is blamed as the cause of many teens’ problems with substances and other unhealthy habits. Or they may find themselves in places like concerts and sports events where “everybody” seems to be drinking or smoking. As we’ve noted, the judgment center of the brain is one of the later parts to develop, so teens are more likely to make bad decisions in such circumstances. In the 21st century, social influences are not just down on the corner or at the mall—they’re in the media and on the Internet, and messages there can have a big impact. The Center for Media Literacy (http://www.medialit.org) focuses on the impact of the media—television, radio, magazines, advertising—on the lives of young people. Some of its research shows the special power that mass communication has on teens. It also shows ways that advertisers plan to target teens. It’s been shown that when companies can “sell” teens on their products, they’re likely to have those people as customers for life. One of the many studies the center supports shows how misleading messages about alcohol can be, making it look as though drinking is only fun and sociable. Until recently, television voluntarily avoided ads for hard liquor. Then hardliquor advertisers joined the beer-brewers on television—combining scenes of great fun and excitement with the advice, “Please drink


responsibly.” Which is more appealing—excitement or responsibility? Studies have shown that alcohol advertising has increased rapidly, especially in the promotion of “low-alcohol,” “fun” beverages with teens as targets. Concerns over young people and smoking were a big factor leading to laws regulating cigarette advertising and to later discussions about giving movies with smoking in them an “R” rating. The power

Take a Look What influences you most? Rate the power of the factors in your life contributing to alcoholism/addiction or to your feelings about it: No Influence

Some Influence

Very Powerful

Family substance abuse Peer pressure Spiritual seeking Physical problems Mental/emotional problems Home life Heredity Neighborhood School life Advertising Music, movies, TV Internet Think about ways to counteract influences that may be making up your mind for you!


of these influences is widely recognized, and even though society has worked to limit them, corporations connected with alcohol and cigarettes seem able to work around them. Try this sometime: Keep a journal for one day noting all the references to alcohol, cigarettes, or other drugs you observe on TV, radio, magazines, and outside advertisements. The Center for Media Literacy offers a number of other exercises to help make you aware of the power of what you see and hear 24/7 from sources that want to influence you. Beyond these traditional forms of communication today is, of course, the Internet. This is the source of more misinformation, delivered faster, than any previous form of communication. It can also link people up to sources of drugs that can’t be tracked or regulated. But can we really say that media influence causes addiction? Perhaps not directly. But it can encourage young people to pick up their first psychoactive substance. And as current brain research shows, it’s the first use of a substance than can start the process that leads to addiction.

What You Need to Know M In some cases, addiction is inherited through family genes; in others, it may arise from frequent and repeated use of substances that create new pathways in the brain. M Addiction occurs in the brain, where substances interfere with dopamine production and can create dependence on the substance. M Mental illness is a factor in addiction and alcoholism. M Substance use disorders are also social conditions, triggered by media and other social and cultural influences.

4 Recognizing Alcoholism and Drug Addiction

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larry and lynn had been friends since they were little kids. When they were both at the same college for a while, Larry noticed Lynn was harder to talk with. He’d leave messages for her and sometimes she called back or sometimes she would disappear for a long time, but then she’d be really friendly. He was confused by this until he noticed that when they got together for a beer, Lynn always drank until she got drunk. She didn’t drink all the time, but once she started she didn’t stop. Larry had family members who drank a lot. He also knew that when she was home Lynn sometimes smoked pot with her family. The drinking scared him, and he tried to talk with his friend about it. Lynn just acted angry and backed away from him. As time went by, whenever he saw her in a social situation, he noticed she put her beer down and came over to him drinking a soda. After a while she stayed away from him, and he heard that she dropped out of school. This story contains each of these characteristics of substance abuse: denial, deceit, secrecy, loss, and obsession. A simple way of defining a substance use problem is that it causes problems in your relationships, school and social activities, or affects how you think and feel.

a DiSHoneSt DiSeaSe “I have a disease that tells me I don’t have a disease,” is how one longtime recovering alcoholic puts it. Dishonesty is a hallmark of substance abuse. Addicts and alcoholics often lie to themselves, wanting to

Recognizing Alcoholism and Drug Addiction 45

believe “It’s not that bad.” This type of dishonesty is denial on the part of the user. Psychiatrists explain denial as a range of psychological maneuvers designed to reduce awareness of the fact that alcohol or drug use is the cause of an individual’s problems rather than a solution to those problems. Alcoholics Anonymous and Narcotics Anonymous members say the letters in “denial” stand for “Don’t Even kNow I Am Lying.” That’s a good description of the process, because people who practice denial have often convinced themselves that they’re telling the truth. To someone trying to deal with a substance abuser, this kind of dishonesty can be troubling: Most people find it hurtful to be lied to and hard to understand that the liar isn’t quite doing it on purpose. Many will hide how much they use by lying about or downplaying their use. Young users keep secret the extent of their use because it is illegal, and because there’s a part of them that wants to protect their habit from those who would try to make them stop. Others will go to great lengths if they need money to feed their habit, including lying, cheating, and stealing. It’s not that they don’t know that these things are wrong, but rather that the obsession and compulsion are overpowering. Since illegal drugs usually take more effort to get than alcohol, an addict’s dishonesty can be more devious than an alcoholic’s. Does this mean that they’re “bad” people? No. It means that the substance use disorder drives them to bad behavior. Secrecy and deceit keep the disease going—but the best way to manage life with substance use disorders, in one’s self or in those we live with, is to face facts, so we need to find ways to break through that secrecy. One way to do that is to put aside what addicts and alcoholics say to us and make our own observations.

Signs and Symptoms “Bad behavior” is one sign of a substance abuser. But since users are not likely to be forthright about their condition, anyone who wants to find out if someone is an alcoholic or addict may have to sort through the secrecy for clues. Here are some clues to possible substance abuse among young people: M changes in school performance: falling grades, skipping school, tardiness changes in peer group: hanging out with drug-using, antisoM cial, older friends M breaking rules at home or school or in the community


M extreme mood swings, depression, irritability, anger, negative attitude M sudden increases or decreases in activity level M withdrawal from the family; keeping secrets M changes in physical appearance: weight loss, lack of cleanliness, strange smells red, watery, glassy eyes or runny nose not due to allergies or M cold M changes in eating or sleeping habits M lack of motivation or interest in things other teenagers enjoy (hobbies, sports) M lying, stealing, hiding things M using street or drug language or possession of drug-use items M cigarette smoking We began this chapter talking about the dishonesty that is a core feature of addiction and alcoholism. Dishonesty kills by keeping people hooked. Honesty can save lives. A multitude of simple tests have been devised to profile alcoholics and addicts. You have a chance now to answer some questions privately to find out if you or a loved one has a drinking or drug problem. M Have you ever felt you should cut down on your drinking/ drugging? M Have people annoyed you by criticizing your drinking/ drugging? M Have you ever felt bad or guilty about your drinking/ drugging? Have you ever had a drink first thing in the morning to steady M your nerves or to get rid of a hangover? One “yes” answer suggests a possible problem. More than one “yes” answer means it is highly likely that a problem exists. If you think that you or someone you know might have an alcohol or drug problem, it is important to see a doctor or other health care provider right away. They can help you determine if a drinking/drugging problem exists and plan the best course of action. Here are some other ways of looking at the situation: M Do you sometimes drink or use more than you mean to? M Have you tried to cut back on your drinking/drugging and failed?

Recognizing Alcoholism and Drug Addiction

M Do you black out (have trouble remembering things that happened) while drinking/drugging? M Have your problems at school, work, or with your relationships gotten worse since you started drinking/drugging? M Do you keep drinking/drugging even though you know it’s causing problems? M Do you drink or use when you feel stressed? M Do you drink or use alone? M Can you drink or drug much more now than you used to be able to? M Do you ever feel uncomfortable when you haven’t had a drink? M Do you drink even when it’s important to stay sober? M What about your situation? How do you think it compares to “normal”? Have you progressed to the point of having a real problem that needs to be addressed?

Here are some surveys that health professionals use in evaluating alcohol or drug problems. Note that they have nicknames—“CAGE” and “TACE.” That’s an indication of how common these problems are. C: Have you ever felt you should cut down on your drinking/ drugging? A: Have people annoyed you by criticizing your drinking/drugging? G: Have you ever felt bad or guilty about your drinking/drugging? E: Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? T: Does it take more than three drinks to make you feel high? A: Have you ever been annoyed by people’s criticism of your drinking? C: Are you trying to cut down on drinking? E: Have you ever used alcohol as an eye-opener in the morning?


How can one recognize the signs and symptoms of the disease? Here are some examples: M Tommy didn’t drink often but every time he did, he got drunk. Alice had a “hollow leg” and could drink so much more than M her classmates that she was usually the one with a clear enough head to drive home. M Howard could stop drinking for long periods of time—as long as he had marijuana as a substitute. It is said that alcoholics are either drinking, or thinking about drinking, or thinking about not drinking—so that even if they aren’t intoxicated all the time, they can still be under the control of the mental obsession. A common explanation for why “I can’t be an alcoholic” offered by young people goes like this: “I only drink on Saturdays” or “at parties” or “with the guys.” You don’t have to drink regularly for alcohol to cause problems. In fact, binge drinking—drinking a lot at one time—can be particularly dangerous. It’s just as illegal as any other kind of drinking for underage drinkers, of course, but it’s one of the most popular drinking patterns among young people, especially by people in the 18- to 21-year-old age range. Researchers often define binge drinking as the consumption of five or more drinks at one sitting for males and three or more drinks at one sitting for females. Binge drinkers on college campuses are more likely to get into trouble and cause trouble for others than other types of drinkers. Another definition for binge drinking is simply drinking to get drunk. It is the most common drinking problem for people under age 21. Physical side effects of alcohol abuse. Hangovers are another aspect of drinking that movies, comedians, and frat-house partyers make into a joke. When you think about what alcohol does to your brain, it’s no surprise it can leave you with a headache. But hangovers are also common signs of withdrawal from the substance. Not everyone experiences hangovers, but when drinkers who do have reached a serious stage of alcohol dependence, they keep drinking to avoid the withdrawal symptoms. Blackouts are usually thought of as a typical sign of fairly advanced alcohol abuse. This is not just a state of being foggy while in a buzzed condition. A blackout is a lack of memory for events that occur during a night of heavy drinking without a loss of consciousness. The drinker looks as though he or she is functioning but has no awareness


of what’s going on. Blackouts were once thought to be a symptom of advanced adult alcoholism, but researchers have recently discovered just how frequent they are among teenagers as well, with over half of college-age drinkers reporting at least one blackout in their drinking lifetimes; they reported an average of three blackouts apiece. Researchers have found that they’re likely caused by a shutdown of key cells in the brain. This can’t be good for the brain—but of more significance is the behavior that happens during blackouts (more on that in the next chapter.) Physical side effects of drug abuse. Note that the side effects

of drug-withdrawal are different from alcoholic ones. Depending on the drug, they can be more or less painful, but they often include a greater pull toward using more drugs.

Stages of Substance Abuse Since for many users it’s possible to stop before serious addiction occurs, it’s important to recognize what each stage of substance abuse looks like. For instance, alcohol abuse may be categorized as follows: M Alcohol abuse can cause problems, like missing school or lying to friends, but it is not yet a full-blown addiction. Alcohol dependence is what people commonly call alcoholism: M a disease that is chronic, or persistent, and often progressive, meaning that it gets worse over time. Health care professionals consider it “alcoholism” when the sufferer experiences at least three of seven symptoms within one year. These symptoms include repeated unsuccessful attempts to stop or cut down, physical craving for alcohol, a persistent pattern of drinking despite known negative consequences, an unreasonable amount of time and effort spent on obtaining alcohol, the organization of one’s social or work life to accommodate drinking, need for increased amounts of alcohol (tolerance), and symptoms of withdrawal upon cessation of drinking (physical dependence). People who promise to “never drink again” and then get drunk are at this stage. Likewise, not everyone who uses drugs becomes addicted, but substance abuse can cause problems for individuals whether they are technically addicted or not. There are different levels of substance abuse, and all of them can be dangerous, so it’s important to be aware of different behavior at different stages.


M Substance abuse disorder: Using drugs or other substances becomes a “disorder” when the use begins to cause continuing or growing problems in the user’s life. A friend may seem to turn away as he is pulled away by the obsession. Chemical dependency: Dependency usually becomes noticeM able in substance abusers when they continue their pattern of drug use in spite of incurring significant problems in their lives. They’ve gotten to the stage where they need the substance, even though it’s stopped being fun. M Chemical addiction: Addiction can best be described as a compulsive continued use of a drug or substance and a complete inability to stop despite negative consequences. This is when people start looking the way we might expect junkies to look.

Symptom Questionnaires Recovering addicts in Narcotics Anonymous developed this questionnaire based on their own experience. They urge you to answer them as honestly as you can. M Do you ever use alone? M Have you ever substituted one drug for another, thinking that one particular drug was the problem? M Have you ever manipulated or lied to a doctor to obtain prescription drugs? M Have you ever stolen drugs or stolen to obtain drugs? M Do you regularly use a drug when you wake up or when you go to bed? Have you ever taken one drug to overcome the effects of M another? M Do you avoid people or places that do not approve of you using drugs? M Have you ever used a drug without knowing what it was or what it would do? M Has your job or school performance ever suffered from the effects of your drug use? Have you ever been arrested as a result of using drugs? M Have you ever lied about what or how much you use? M Do you put the purchase of drugs ahead of your financial M responsibilities? M Have you ever tried to stop or control your using? M Have you ever been in a jail, hospital, or drug rehabilitation center because of your using?


M M M M M M M M M M

Does using interfere with your sleeping or eating? Does the thought of running out of drugs terrify you? Do you feel it is impossible for you to live without drugs? Do you ever question your own sanity? Is your drug use making life at home unhappy? Have you ever thought you couldn’t fit in or have a good time without drugs? Have you ever felt defensive, guilty, or ashamed about your using? Do you think a lot about drugs? Have you had irrational or indefinable fears? Has using affected your sexual relationships?

10 Ways to Tell When Drinking or Getting High Has Become Addictive Behavior 1. Getting high on drugs or getting drunk when it’s not a party. 2. Always using more drugs or alcohol than other kids. 3. Lying about things, or about the amount of drugs or alcohol being used. 4. Having to use more alcohol or other illicit drugs to get the same effects. 5. Believing that in order to have fun they need to drink or use marijuana or other drugs. 6. Pressuring others to use drugs or drink. 7. Getting into trouble with the law. 8. Taking risks, including sexual risks and driving under the influence of alcohol and/or drugs. 9. Not showing up—for work, school, or friendship. 10. Unexplained mood swings, including irritability.


Old Connections In studying alcoholism and addictions, researchers have come up with some perhaps unexpected connections. For instance: M When you were a child, did you have a “sweet tooth”—did you crave and eat a lot of sugary foods? M Were you diagnosed with attention-deficit/hyperactivity disorder (ADHD)? Whether or not you were diagnosed, were you a restless child who got bored easily? M Was the home you grew up in chaotic and confusing rather than calm and organized? If the answer to any of those is yes, especially along with some yeses to the other questions in this chapter, you may be at risk for addiction. Sugar cravings, restlessness, and early turmoil seem connected to later substance abuse.

M M M M M

Have you ever taken drugs you didn’t prefer? Have you ever used drugs because of emotional pain or stress? Have you ever overdosed on any drugs? Do you continue to use despite negative consequences? Do you think you might have a drug problem?

Here’s how Alcoholics Anonymous poses the questions when it addresses teenagers with possible problems: M Do you drink because you have problems? To relax? M Do you drink when you get mad at other people, your friends or parents? M Do you prefer to drink alone rather than with others? M Are your grades starting to slip? Are you goofing off on your job? M Did you ever try to stop drinking/drugging or drink less—and fail?


M Have you begun to drink in the morning, before school or work? M Do you gulp your drinks? M Do you ever have loss of memory due to your drinking/ drugging? Do you lie about your drinking/drugging? M M Do you ever get into trouble when you’re drinking/drugging? M Do you get drunk when you drink, even when you don’t mean to? M Do you think it’s cool to be able to hold your liquor? Only you can answer these questions for yourself, and being honest about them is crucial. If even a few answers to all of those questions is a yes, chances are good that you have a problem that should cause you some concern. To learn more about the symptoms of substance abuse disorders, go online or consult a health professional. “Read More About It” at the back of this book provides some Web sites that may be helpful.

What You Need to Know M People with substance use disorders often do not tell the truth about how much they use, because that is the nature of the disease. M For young people, the use of any chemical substance is illegal, making lies and concealment essential to survival. M Symptoms are different at different stages of addiction/ alcoholism. You can evaluate your own need for managing your own or M another’s SUD by answering questions honestly for yourself.

5 Dangers of Alcoholism and Drug Addiction

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before you skip this chapter thinking it’s going to be the same old preaching against the “evils of drink and drugs,” hang on: Recent brain research shows that teens face special dangers from substance abuse. Read on for these facts you need to know—it’s your brain! But first this important reminder about the dangers of substance use: It’s illegal. If you’re under a legal age in your state for use of alcohol or tobacco, you’re breaking the law—and that has consequences. Plenty of other drugs—including misuse of prescription drugs—are illegal no matter what your age, but until you’re of legal age, one big danger is that you could be arrested.

brain DaMage One result of the current brain-research projects are findings suggesting that alcohol causes more damage to the developing brains of teenagers than was previously thought. It can injure them much more than it does adult brains, and it has long-lasting effects. Alcohol affects the very parts of the brain that develop during adolescence, where teens learn adult decision-making skills, like the ability to focus, to discriminate, to decide between right and wrong. Researchers say that early drinking also affects a developing brain in a way that promotes the progression to addiction. The research even suggests that early heavy drinking may undermine the precise brain links needed to protect oneself from alcoholism, which may be why the younger that people start drinking, the more likely they are to become alcoholics.

5

Dangers of Alcoholism and Drug Addiction 55

It has long been known that adults’ brains shrink with extended alcohol use, but recent research shows that youth drinking also affects brain size, shrinking the important prefrontal cortex. Researchers used magnetic resonance imaging to measure prefrontal cortex, thalamic, and cerebellar volumes in 14 subjects (8 males, 6 females) with alcohol use disorders, and in 28 (16 males, 12 females) sociodemographically similar individuals without alcohol use disorders, known as “controls.” “This is the first study to examine the sizes of these brain structures in adolescents and young adults,” said Michael D. De Bellis, M.D., professor of psychiatry and behavioral sciences and director of the Healthy Childhood Brain Development Research Program at Duke University Medical Center, as well as corresponding author for the study. “Studies on adults with alcoholism have generally shown smaller brain sizes, but this is after many years of very heavy drinking,” added Susan Tapert, Ph.D., associate professor of psychiatry at the University of California at San Diego. “Before this study, it really wasn’t clear that adolescents, with briefer drinking histories, would show any differences in brain size. However, with nearly one in three high school seniors binge drinking at least once per month, it is critical that we understand precisely how drinking affects the brains of these young people.” And it’s not just alcohol. Other research shows that drugs may cause similar brain changes in dopamine signaling, which may play a role in addiction. Researchers have also found that heavy abuse of drugs by young people, whose brains are still developing, can cause damage usually seen only in much older people and similar to the early stages of Alzheimer’s disease.

It’s Your Body Alcohol and drugs inflict plenty of other long-term damage to parts of the body in addition to the brain. Both alcohol and drugs can result in cirrhosis of the liver, pancreatitis, diabetes, hepatitis, heart problems, seizures, and strokes. These can make you very sick and can kill you. Such ailments, however—and even death itself—are often distant and vague concepts for young people. If death doesn’t seem real, how about acne? Alcohol will make you gain weight and feel sick, give you bad breath, and make your skin break out. Drug use isn’t conducive to nice skin or general good looks either. And both alcohol and drugs interfere seriously with sleep


functions, so even though substance users may feel as though they’re functioning well, they are not. There are other alcohol-related problems that affect young people more than others: Binge drinking is most common among teens and young adults and is probably the most dangerous form of drinking. It can result in serious damage to the teenage brain and increasing memory loss later in adulthood, according to research. In the short term, it’s important to remember that binge drinkers are much more likely to hurt themselves than other kinds of drinkers. The rush of a large quantity of alcohol is just more than the brain or body can handle. It’s not just sudden heavy drinking can cause often forgotten hazards of drinking. Remember that the sense first impaired by alcohol is the sense of judgment—so people tend to make decisions and take actions that they wouldn’t when sober. Unintended pregnancy can result from poor judgment while intoxicated—and so can HIV/AIDS. According to the National Institutes of Health, injection of drugs such as heroin, cocaine, and methamphetamine accounts for more than a third of new AIDS cases. Injection drug use is also a major factor in the spread of hepatitis C, a potentially fatal liver disease. It’s easy to believe that just intravenous drug users can get AIDS through drug use, but we tend to forget that, under the influence of alcohol or drugs, people engage in unsafe activities they may not even remember. Drinking or drug use doubles the risk of sexually transmitted diseases (STDs) among young people, and drinking combined with drug use increases the risk even more, especially for females. STDs carry long-term consequences, including cancer and infertility. Drinkers are three times as likely to die from injuries of all kinds as are nondrinkers. Yet many kids and their parents continue to consider “drugs” more of a threat than drinking. The fact is, whether or not teen use of alcohol marks the onset of a lifelong problem, it is a danger in itself. Anyone who underestimates the drinking epidemic needs to consider these facts: M According to the U.S. Centers for Disease Control, the three leading causes of death for 15- to 24-year-olds are automobile crashes, homicides, and suicides. Alcohol is a key factor in all three. Early-age drinking is associated with alcohol-related violence. M This is particularly true for people under 21. But those who do begin early also tend to be more violent in their later adult years. M The vast majority of all criminal convictions in the United States for all age groups are alcohol or drug-related. This is not


just about stealing for drug money; it’s about crimes committed while under the influence, sometimes when in blackouts. M Teens and their families tend to down play alcohol and “soft” drugs like marijuana. But both alcohol and marijuana have been shown to be “gateway drugs”—ones that lead to other use. Illegal use of any substance (underage drinking included) makes it easier for teens to get accustomed to using illegal substances.

practical MatterS What’s your most prized possession? For most teens, it’s their driver’s license. And of all the losses that alcohol and drugs can cause, it may well be that the driver’s license is the first thing to go. It used to be that drunk driving was brushed off as a minor offense. No more! In most states and communities throughout the country, a zero-tolerance rule for teen drivers applies. This means that if you are found to have any drugs or alcohol in your system while driving, you lose your license. Short-term effect: grounded! Longer term effect: insurance cost. Teens have much higher rates for car insurance than any other group. A DUI (driving under the influence) conviction can cause those rates to go up for at least three years. Scarier effect: You can kill yourself, your friends, or total strangers in an instant. But think about this: Most people in car accidents don’t die—they’re more likely to be

Interactions with Medications Another drug-related danger we tend to forget about: interactions with medications. Alcohol interacts negatively with more than 150 medications. For example, if you are taking antihistamines for a cold or allergy and drink alcohol, the alcohol will increase the drowsiness that the medication alone can cause, making driving or operating machinery even more hazardous. And if you are taking large doses of the painkiller acetaminophen and drinking alcohol, you are risking serious liver damage. How often do you remember to check with your doctor or pharmacist before drinking any amount of alcohol if you are taking any over-the-counter or prescription medications?


permanently crippled. It’s kind of like diving into a swimming pool without checking to see if there’s any water in it: You may not die but you’ll probably be paralyzed for life. And in case you think you can get around that “zero tolerance” rule by acting sober, consider this fact from the National Institutes of Health: You don’t need to drink much alcohol before your ability to drive becomes impaired. For example, certain driving skills—such as steering a car while, at the same time, responding to changes in traffic—can be impaired by blood alcohol concentrations (BACs) as low as 0.02 percent. A 160-pound man will have a BAC of about 0.04 percent one hour after consuming two 12-ounce beers or two other standard drinks on an empty stomach.

Daily Hassles Alcohol has been called the “great remover.” It causes the removal and disappearance of things that matter—money, freedom, and health, for a few. But another painful side effect of addiction and alcoholism is the loss of people and values we care about. Ruined relationships. If you’re like most people, you began drinking or drugging in some kind of social setting, and you did it to feel a part of the crowd, to get along with people more easily. After some use, however, people get to feel “apart” from others. In fact, the more heavily you drink, the greater the potential for problems at home, at work, with friends, and even with strangers. These problems may include

M arguments with or estrangement from family and friends, who over time don’t want to deal with the kind of behavior that substance use brings on M the forming of relationships based mainly on substance use, which can leave you pretty lonely when the drugs or money run out M committing or being the victim of violence: The rates of involvement in violence soar for young addicts and alcoholics—due to dangerous acts being committed under the influence or over the possession of substances of abuse A young addict sums it up: “I didn’t get into trouble every time I drank—but every time I had trouble, I had been drinking.” Failing grades. Want to do well in school? Stay away from SUDs:

Research shows that even mild to moderate drinking can adversely


affect cognitive functioning—mental activities that involve acquiring, storing, retrieving, and using information. In other words, forget about test-success if you choose drug use. Alcoholic teenagers performed poorly on tests of verbal and nonverbal memory, attention focusing, and exercising spatial skills. Long-term studies reported by the National Clearinghouse for Alcohol and Drug Information of substance-using teens found that those who had relapsed and who continued to get drunk frequently performed the worst on tests requiring focused attention, while those who reported the most hangovers performed the worst on spatial tasks. On the other hand, the teenagers and young adults in the group who stayed sober—28 percent of the total—performed almost as well at both the four-year and the eight-year mark as other teenagers who had rarely, if ever, had a drink. Further, the study found that 15- to 16year-olds who said they had been drunk at least 100 times performed significantly more poorly than their matched nondrinking peers on tests of verbal and nonverbal memory. These teenagers, who were sober during the testing, had been drunk an average of 750 times in the course of their young lives. “Heavy alcohol involvement during adolescence is associated with cognitive deficits that worsen as drinking continues into late adolescence and young adulthood,” the study concluded. Why do tests seem easier to those who get high? Researchers figure it’s because we feel less anxious or tense, but bottom-line results are worse, and it’s the grade that matters. Long term, the distractions of drug use combine with the brain effects to produce really poor school and work performance. Mental illness. Many, if not most, of the substances that people use

to get high, feel happy, or go mellow can end up having the opposite effect. Alcohol is a depressant, so even if it offers an initial giddy rush, it can lead to depression. Cocaine, crack, and other uppers can lead to chronic depression because they destroy the brain’s ability to produce naturally the chemicals that make humans feel happy. Hallucinogens and similar substances can create brain patterns that permanently distort reality, in ways similar to schizophrenia. Sometimes these conditions can be reversed once the substance use is stopped, but not always. It sometimes happens, too, that doctors who are not aware of the extent of a patient’s use of alcohol or other drugs may use the symptoms that the drugs cause to diagnose conditions like bipolar disorder, depression, or even schizophrenia. Pharmaceuticals prescribed for those disorders can make the effects of the secret drugtaking even more harmful.


Detailed Dangers These are the hazards of some of the most commonly used drugs, according to the National Clearinghouse for Alcohol and Drug Information, part of the U.S. Department of Health. Marijuana. Marijuana is the most widely used illicit drug in the United States and tends to be the first illegal drug teens use. The physical effects of marijuana use, particularly on developing adolescents, can be acute. Short-term effects of use include

M sleepiness M difficulty keeping track of time; impaired or reduced shortterm memory M reduced ability to perform tasks requiring concentration and coordination, such as driving a car increased heart rate M potential cardiac dangers for those with preexisting heart M disease M bloodshot eyes M dry mouth and throat M decreased social inhibitions M paranoia, hallucinations Long-term effects of marijuana use include M enhanced cancer risk M decrease in testosterone levels for men; also lower sperm counts and difficulty having children increase in testosterone levels for women; also increased risk M of infertility M diminished or extinguished sexual pleasure M psychological dependence requiring more of the drug to get the same effect Marijuana blocks the messages going to your brain and alters your perceptions and emotions, vision, hearing, and coordination. A recent study of 1,023 trauma patients admitted to a shock trauma unit found that one-third had marijuana in their blood. Cigarette smoking. Although many people smoke because they

believe cigarettes calm their nerves, smoking releases epinephrine, a hormone that creates physiological stress in the smoker, rather than relaxation. The use of tobacco is addictive. Most users develop tolerance


for nicotine and need greater amounts to produce a desired effect. Smokers become physically and psychologically dependent and will suffer withdrawal symptoms including changes in body temperature, heart rate, digestion, muscle tone, and appetite. Psychological symptoms include irritability, anxiety, sleep disturbances, nervousness, headaches, fatigue, nausea, and cravings for tobacco that can last days, weeks, months, years, or an entire lifetime. Risks associated with smoking cigarettes include diminished or extinguished sense of smell and taste; smoker’s cough; gastric ulcers; chronic bronchitis; increase in heart rate and blood pressure; premature and more abundant facial wrinkles; emphysema; heart disease; stroke; and cancer of the mouth, larynx, pharynx, esophagus, lungs, pancreas, cervix, uterus, and bladder. Cigarette smoking is perhaps the most devastating preventable cause of disease and premature death. Smoking is particularly dangerous for teens because their bodies are still developing and changing, and the 4,000 chemicals (including 200 known poisons) in cigarette smoke can adversely affect this process. Cigarettes are highly addictive. One-third of young people who are just “experimenting” end up being addicted by the time they are 20. Alcohol. Alcohol abuse is a pattern of problem drinking that results in health consequences, social problems, or both. However, alcohol dependence, or alcoholism, refers to a disease that is characterized by abnormal alcohol-seeking behavior that leads to impaired control over drinking. Short-term effects of alcohol use include distorted vision, hearing, and coordination; altered perceptions and emotions; impaired judgment; bad breath; and hangovers. Long-term effects of heavy alcohol use include loss of appetite, vitamin deficiencies, stomach ailments, skin problems, sexual impotence, liver damage, and heart and central nervous system damage. Methamphetamine. Methamphetamine is a stimulant drug chemically related to amphetamine but with stronger effects on the central nervous system. Street names for the drug include speed, meth, and crank. Methamphetamine is used in pill form or in powdered form by snorting or injecting. Crystallized methamphetamine known as ice, crystal, or glass is a smokable and more powerful form of the drug. The effects of methamphetamine use include increased heart rate and blood pressure; increased wakefulness; insomnia; increased physical activity; decreased appetite; respiratory problems; extreme anorexia; hypothermia, convulsions, and cardiovascular problems, which can lead to death; euphoria; irritability; confusion; tremors; and anxiety,


paranoia, or violent behavior. Meth can also cause irreversible damage to blood vessels in the brain, producing strokes. Methamphetamine users who inject the drug and share needles are at risk for acquiring HIV/AIDS. Methamphetamine is an increasingly popular drug at raves (all-night dancing parties) and as part of a number of drugs used by college-aged students. Marijuana and alcohol are commonly listed as additional drugs of abuse among methamphetamine treatment admissions. Most of the methamphetamine-related deaths (92 percent) reported in 1994 involved methamphetamine in combination with at least one other drug, most often alcohol (30 percent), heroin (23 percent), or cocaine (21 percent). Researchers continue to study the long-term effects of methamphetamine use. Cocaine and crack cocaine. Cocaine is a white powder that

comes from the leaves of the South American coca plant. Cocaine is either “snorted” through the nasal passages or injected intravenously. Cocaine belongs to a class of drugs known as stimulants, which tend to give a temporary illusion of limitless power and energy that leave the user feeling depressed, edgy, and craving more. Crack is a smokable form of cocaine that has been chemically altered. Cocaine and crack are highly addictive. This addiction can erode physical and mental health and can become so strong that these drugs dominate all aspects of an addict’s life. Physical risks associated with using any amount of cocaine and crack include increases in blood pressure, heart rate, breathing rate, and body temperature; heart attacks, strokes, and respiratory failure; hepatitis or AIDS through shared needles; brain seizures; and reduction of the body’s ability to resist and combat infection. Psychological risks of cocaine and crack use include violent, erratic, or paranoid behavior; hallucinations and “coke bugs” (a sensation of imaginary insects crawling over the skin); confusion, anxiety and depression; loss of interest in food or sex; and “cocaine psychosis” (losing touch with reality, loss of interest in friends, family, sports, hobbies, and other activities). Some users spend hundreds or thousands of dollars on cocaine and crack each week and will do anything to support their habit. Many turn to drug selling, prostitution, or other crimes. Cocaine and crack use has been a contributing factor in a number of drownings, car crashes, falls, burns, and suicides. Cocaine and crack addicts often become unable to function sexually. Even first-time users may experience seizures or heart attacks, which can be fatal. Hallucinogens. Hallucinogenic drugs are substances that distort the

perception of objective reality. The most well-known hallucinogens


include phencyclidine, otherwise known as PCP, angel dust, or loveboat; lysergic acid diethylamide, commonly known as LSD or acid; mescaline and peyote; and psilocybin, or “magic” mushrooms. Under the influence of hallucinogens, the senses of direction, distance, and time become disoriented. These drugs can produce unpredictable, erratic, and violent behavior in users that sometimes leads to serious injuries and death. The effect of hallucinogens can last for 12 hours. LSD produces tolerance, so that users who take the drug repeatedly must take higher and higher doses in order to achieve the same state of intoxication. This is extremely dangerous, given the unpredictability of the drug, and can result in increased risk of convulsions, coma, heart and lung failure, and even death. Physical risks associated with using hallucinogens include increased heart rate and blood pressure; sleeplessness and tremors; lack of muscular coordination; sparse, mangled, and incoherent speech; decreased awareness of touch and pain that can result in self-inflicted injuries; convulsions; coma; and heart and lung failure. Psychological risks associated with using hallucinogens include a sense of distance and estrangement; depression, anxiety, and paranoia; violent behavior; confusion, suspicion, and loss of control; flashbacks; behavior similar to schizophrenic psychosis; and catatonic syndrome, whereby the user becomes mute, lethargic, disoriented, and makes meaningless repetitive movements. Everyone reacts differently to hallucinogens—there’s no way to predict if you can avoid a “bad trip.” Inhalants. Inhalants refer to substances that are sniffed or huffed to give the user an immediate head rush or high. They include a diverse group of chemicals that are found in consumer products such as aerosols and cleaning solvents. Inhalant use can cause a number of physical and emotional problems, and even one-time use can result in death. Using inhalants even one time can put you at risk for sudden death; suffocation; visual hallucinations and severe mood swings; and numbness and tingling of the hands and feet. Short-term effects of inhalants include heart palpitations, breathing difficulty, dizziness, and headaches. Prolonged use can result in headache; muscle weakness; abdominal pain; decrease or loss of sense of smell; nausea and nosebleeds; hepatitis; violent behaviors; irregular heartbeat; irreversible brain damage; nervous system damage; dangerous chemical imbalances in the body; involuntary passing of urine and feces; and liver, lung, and kidney impairment. Remember, using inhalants, even one time, can kill you. According to medical experts, death can occur in at least five ways:


1. asphyxia—solvent gases can significantly limit available oxygen in the air, causing breathing to stop 2. suffocation—typically seen with inhalant users who use bags 3. choking on vomit 4. careless behaviors in potentially dangerous settings 5. sudden sniffing death syndrome, presumably from cardiac arrest While dangers associated with substance use disorders vary from short- to long-term and practical to fatal, there’s a common solution to all the problems: The best treatment is prevention. Think it’s tough? Take a look at cigarette smoking: Once the dangers were promoted and the access was limited, cigarette use dropped sharply. If that can happen, so can the use of other drugs.

What You Need to Know M The use of any psychoactive substance (other than caffeine), including nicotine, is illegal for any underaged person. M Brain research shows special damage to adolescent brains. M The first part of the brain to be affected relates to judgment and short-term memory. Harmful effects may be direct, like physical damage to your M body, or indirect, like poor grades. M The substances most often abused by teens are not “street drugs” but those available in neighborhood stores—tobacco and alcohol.

6 Getting Support and Help

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if you have ever thought you might need help with a drinking, drug, or other addiction problem, you may have found the very thought of dealing with it frightening. If so, you’re not alone: Most people resist the idea of treatment at fi rst. Some 23.6 million people over the age of 12 in the United States met the criteria for substance abuse or dependence in the previous year, according to the federal government’s 2006 National Survey on Drug Use and Health (NSDUH). But of that 23.6 million, only about 4 million people received treatment for their disorder. Teens, too, are going untreated: Among youths aged 12 to 17, an estimated 1.4 million needed treatment for an illicit drug use problem in 2004, but only 134,000 received treatment at a specialty facility. In 2004, there were 1.6 million youths aged 12 to 17 who needed treatment for an alcohol use problem. Of this group, only 126,000, or 8 percent, received treatment at a specialty facility. The process of getting into treatment is so difficult and so important that this chapter will focus on just that, while the next will detail treatment itself.

StageS of cHange Recovery from addiction is not just about treating a disease. It is really about making a major life change, and social scientists observe common patterns in making such changes. The specific process of getting

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to treatment is so similar among so many people that the steps toward it can be labeled. M Precontemplation: Not yet acknowledging a behavior problem that needs to be changed Contemplation: Acknowledging that there may be a problem M but not yet ready or sure of wanting to make a change M Preparation: Getting ready to change M Action: Taking steps to change behavior M Maintenance: Continuing the new behavior M Relapse: Returning to older behaviors and abandoning changes, at least for a time Note that the precontemplation, contemplation, and preparation steps carry more weight than the action steps, because those are the crucial stages where someone is just moving into awareness that he or she may have a problem that needs solving. In fact, a perhaps more familiar way of labeling the stages necessary to reach recovery is the following: M Awareness: Admitting one has a problem M Attitude: Acknowledging the possibility of change M Action: Making the decision to change Most people with SUDs aren’t even aware that they have a problem or are not ready to admit or acknowledge it. It’s estimated that only a small percentage of all who need SUD treatment acknowledge that they need help. According to the NSDUH survey, of the 23.6 million people in 2006 over the age of 12 identified as needing specialized treatment and did not receive it, only 940,000 reported that they felt they could benefit from it. In other words, the vast majority of people each year who need treatment are still in the precontemplation stage. Entering the contemplation stage means people may be aware of the need but don’t pursue it: Of that 940,000 people who said they needed treatment in a specialty facility, only 314,000 made an effort to get treatment, while 625,000 made no effort, according to the NSDUH study.

Awareness How is it possible to be unaware of having an alcohol or drug problem? Denial is a form of self-deception that keeps someone from seeing the problem. For instance, teens who don’t see cough syrup

Getting Support and Help 6

or pills as a “real” problem are in denial. Let’s look at some of the individuals introduced in chapter 1 and see how they approach treatment. Each one of these teens is an addict or a potential addict: M Tommy, who kept a bottle of cough syrup in his middle-school locker and sipped from it between classes—but didn’t think about being a drug addict. M Mary Anne, whose parents let her drink beer and wine at home (since it was “just alcohol”), did a lot of partying there with her friends. M Lisa, from an alcoholic family, resisted drinking but finally started smoking pot. M Jason, who was afraid of hard drugs and smoking, but who used pills from his mom’s medicine cabinet to get high. Like millions of other teens, none of these individuals was able to admit at first that drugs were a problem. So what will it take to get them to the first stage toward treatment? M Tommy started using “real” drugs and got in enough trouble to be forced into treatment. M Mary Anne almost flunked out of college because her partying didn’t stop. M Lisa’s pot smoking opened the way to using other drugs, and her family, despite their own alcoholism, turned their back on her.

Are You Aware? M Have you been drunk or high at least once in the past month? M Have you ever taken prescription drugs not meant for you? M Think about five times in your life when you were in trouble. Were drugs or alcohol connected with any of those times? If you answered yes to any of those questions, it’s likely that drugs or alcohol is causing a problem for you.


M Jason went in and out of several emergency rooms before his family finally pressured him to enter more serious treatment. Why did it take such an effort to get to the first stage of recovery? Sometimes it takes a lot to get someone’s attention to make them aware. When a person has a problem with alcohol or drugs, getting ready to get clean and sober is almost as big a process as actually doing it.

Resisting Recovery People fight recovery. Why? The addiction itself resists recovery. Some Alcoholics Anonymous members refer to addiction as “the disease,” as though it were a real creature inside of the addict or alcoholic. When they hear people making excuses for using deadly substances, they may comment, “That’s your disease talking.” Recent brain research into the mechanism of addiction shows that, in a way, the AA members may be right. Those receptors in the pleasure centers of the brain have become used to being stimulated by artificial chemicals, which are more powerful than the natural substances the body produces for itself, so there’s at least a strong recollection of pleasure—and that’s hard to give up, even though it’s a dangerous process. “The disease” remembers only the fun parts. This is why people in recovery are urged to remember how bad it got, not how good it was—and one reason why people who are still sick from their last drug or alcohol use are the most likely candidates for treatment. The disease keeps you unaware. Many people, like Jason above, truly don’t believe they have a problem—they feel they’re too young, perhaps. Or maybe they live in an environment where “everybody” drinks or uses drugs, so they consider it normal. The first step in chipping away at resistance to recovery is to be aware of the problem. This applies to any situation—you wouldn’t fix something until you knew it was broken, right? Lack of awareness is one form of denial. Someone who manages to stay unaware of a problem can deny that there is a problem. Denial has many voices. People use denial to deceive themselves by minimizing the effects of substance abuse. They also minimize the substance itself, just as Lisa didn’t acknowledge a problem because it was “only pot,” not liquor. Or how about, “It’s only beer” or “I’m too young to have a problem”? Have you ever heard any of those? Have you heard families say them too? Family members often aren’t willing or able to see their kids’ addiction problems clearly. It takes a lot of


courage to be honest about these conditions—and an honest appraisal of the situation is needed in order to deal with it. The disease of addiction uses denial in many ways to create an anti-treatment negative attitude. How about, “I’m an alcoholic, my whole family says I’m an alcoholic, so why fight it?” Or even, “What’s the point of treatment if they can’t cure it?” The disease triggers fear. Fear may be open or hidden. Fear often drives the addiction itself as the addict uses an external substance to relieve fearful feelings; fear is almost as powerful as denial in blocking treatment. There’s also fear about what it’s like to give up a substance that, at least at the beginning, may have seemed such a powerful and positive force. Fear of withdrawal symptoms also keeps people using. The physical and emotional reactions that occur when the drug level in the body is reduced can be so unpleasant that they frighten an addict or alcoholic into maintaining the status quo. Withdrawal is a major sign of addiction to most substances, and withdrawal can be difficult. Once the pleasure is gone, addicts keep using. They keep up their habits to avoid the pain of withdrawal, which happens whenever they wait too long for the next “hit.” (Withdrawal refers to that period during which somebody addicted to a drug or other addictive substance stops taking it. As the next chapter details, it can cause painful or uncomfortable symptoms, which do pass when treated properly.) Sometimes what holds a person back is a fear of what the recovery process is like. The next chapters of this book will talk about what happens along various treatment paths. Some young addicts or alcoholics have a hidden fear that “it won’t work for me.” They may want to get better but are frightened that they will fail. Perhaps they have relatives who never got clean and maybe died from addiction. Or they may see those celebrities who can’t seem to “get it.” Fear and denial is often also fueled by shame. It might be too embarrassing to admit the path that addiction has taken a person down—so out of fear they close their eyes to what’s really happening. Someone like Mary Anne once had fun with alcohol, and when it almost tore her life apart, she might blame her teachers for being unfair or blame school for being too hard, because she was at first too embarrassed to take responsibility for her own actions. It’s also hard to admit we have a problem to which there is still a stigma attached: In a 2005 report on its national survey of drug use, the U.S. Department of Health and Human Services stated that twothirds of the general public say they believe that a stigma, or mark of


shame, exists for people in recovery from addiction. However, the very forces that may prevent someone from getting help for addiction may finally push them into recovery. Mary Anne’s shame at almost failing at school became a wake-up call to get help. Tommy’s big trouble created enough fear to get him into a program. This kind of alarm bell can drown out denial and kick in a willingness to explore recovery.

Exploring Recovery The old myth that you have to “hit bottom” before getting help is just that—a myth. Instead, if you begin to think you may have a problem with alcohol or drugs, you can check it out. The idea that you have to plunge immediately into rehab is one that may have developed from celebrity-watching, but one that has little basis in real life. Instead, take a clear look at yourself and keep it simple. Check your answers to self-tests like those in the earlier chapters of the book or on sites like http://alcoholism.about.com or http://www. teens.drugabuse.gov. Think of someone you really trust—a good friend, a doctor, a member of the clergy, or coach—and ask what he or she thinks about your drug use. Be aware that your close family members may not be the best source of an evaluation, because they may have their own level of denial. And double-check yourself: Are you looking for advice from someone who’s likely to reinforce your denial? You may want to go to some open meetings of Alcoholics Anonymous or Narcotics Anonymous. Find them online or in your phone book. Anyone is welcome at open meetings, and no one will ask you anything—just listen and see if the stories you hear apply to your own life. Family members of people dealing with addiction can also learn a great deal about the disease and the process of recovery by checking out similar support groups, where they can gain some perspective on the effects of the problem. Increasing numbers of middle schools and high schools have support groups related to addiction, and a guidance counselor or school nurse can be a good resource. Professionals trained in substance use disorders can give you and family members a clear evaluation and may be covered by insurance. Ask a physician or psychotherapist for references to these specialists, or search the Web or even the Yellow Pages for chemical dependency counselors in your area. Therapists and counselors that are certified or licensed by a state or a professional organization, or both, are more likely to be reliable than others. Some of the associations that certify counseling professionals are listed in the appendix of this book.


Finding a Guide In considering treatment for substance abuse, many seek expert advice as part of the decision-making process. These practitioners—especially when they have had special training in substance use disorders—can help most. M Physicians M Psychiatrists, psychologists M Social workers M Family therapists M Certified addictions counselors The best choice at this point is someone who has special training in substance abuse treatment. A religious counselor with appropriate training may also help. A substance abuse hotline may be of use too.

preparing for recovery Anyone taking those suggested steps toward exploring the recovery process is at the stage of preparing for treatment. But sometimes, especially if the alcoholic/addict is endangering him or herself, it takes an energetic “push” to get them there. This is where intervention is an option. In an intervention, family and friends, sometimes with the aid of a professional, confront the addict or alcoholic with how his or her chemical abuse causes a problem in his or her life. It sometimes can backfire into negative results, so a modified version has been developed to make it a more positive experience. Further details about interventions and their costs and benefits are in chapter 9, but as part of “preparing for treatment” it’s important to decide on the best type of treatment program. Since the purpose of any type of formal or informal intervention is to get the addict/alcoholic to go into treatment, it’s especially critical to have a program lined up. Here are the factors to consider in choosing one.


M Does the program accept your insurance? Or will they help you find a way to pay, such as helping you to sign on for Medicaid or apply for any grants or other supplements available? M Is the program licensed and accredited by state agencies? Is it staffed by credentialed professionals to provide a full range of social, psychological, medical, and vocational services that meet the coverage criteria of your insurance? M Does it have a good reputation in the local medical community and recovery communities? M Does it provide for follow-up treatment or aftercare? M Is there a family education or support program? How strong is the family-involvement program? Parents’ participation is key in the success of a teen’s ongoing recovery. Does it offer the specific treatments needed? For instance, M “MICA” treatments for those who are Mentally Ill and Chemically Addicted, appropriate approaches to the specific drugs in question, and, if necessary, special attention to the needs of adolescents. M Does the facility work with the legal system? This is important because often a teen’s substance abuse problems come to light when they have gotten into some kind of behavioral trouble, and often they are linked to issues of family abuse that may require legal intervention. As a teen, you have special needs and circumstances related to addiction, given adolescent developmental patterns and your need to continue your education as well. So in searching for a treatment, some special approaches are needed. In a program specifically designed for teens, social and educational issues need attention. Motivational enhancement therapy and cognitive behavioral therapy have proven especially effective with adolescents, so a program for teens should include this kind of treatment along with group counseling. Outpatient services are especially important for adolescents. Many teens are treated, at least initially, in an outpatient setting, going into residential treatment if they have physical or mental complications or repeated relapses. Outpatient services should include regular urine and Breathalyzer tests. Structured follow-up is especially important for teens, and thorough programs will help them connect with adolescent-oriented self-help groups, substance-free structured activities, and recoveryoriented schools. Whether you’re seeking the best center for yourself or are part of an intervention for a friend or loved one, the more you know about

Getting Support and Help

Free Help in Finding a Treatment Program The government’s Substance Abuse and Mental Health Services Administration (SAMHSA) suggests guidelines for teen treatment facilities and offers a “Substance Abuse Treatment Facility Locator” at its Web site (http://www.samhsa.gov), which shows the location of facilities around the country that treat alcoholism, alcohol abuse, and drug abuse problems. The locator includes more than 10,000 addiction treatment programs, including residential treatment centers, outpatient treatment programs, and hospital inpatient programs for drug addiction and alcoholism. Listings include treatment programs for marijuana, cocaine, and heroin addiction, as well as drug and alcohol treatment programs for adolescents and adults. New facilities are added monthly. Updates to facility names, addresses, telephone numbers, and services are made weekly. Information is also available at (800) 662-HELP [4357].

possible programs, the better prepared you’ll be. Within the limits of your insurance coverage, you may choose: M to attempt recovery in a self-help setting rather than a treatment program M to start out with a substance abuse counselor M to try the approach of medication plus psychotherapy M to go into a residential setting or try outpatient first Families, schools, doctors, the legal system—all may pressure a young person into treatment, but it’s important that the young person participate in the decision. The more choice a young person has, the better his or her attitude for recovery.

attituDe MatterS Whether by choice, by intervention, or by persuasion, when a person’s attitude has changed from denial to “I’ll try it,” he or she has moved from the state of awareness of a problem to being ready to


consider change. He or she is at the turning point at which he or she is preparing to change. He or she is getting ready to take action. A positive attitude around addiction treatment can simply be a mental position that says, “I just might check this out”—a some-

Stages of Change These are the stages a person goes through before deciding on treatment. A. Precontemplation: Not yet acknowledging a behavior problem that needs to be changed B. Contemplation: Acknowledging that there may be a problem but not yet ready or sure of wanting to make a change C. Preparation: Getting ready to change Which stage are these examples at? 1. A teen who thinks prescription drugs aren’t real drugs 2. A girl who has decided she doesn’t want to drink like her alcoholic parents 3. A family blaming a teen’s mood swings on “hormones” 4. A pot-smoking guy phoning a friend who’s in NA 5. An eighth-grader who makes a point of not drinking before school Answers: 1. (A) She doesn’t yet acknowledge a problem 2. (B) She’s beginning to see a problem but not the whole solution 3. (A) In full denial about the possibility of drug use 4. (C) He’s getting ready, through his friend, to change 5. (B) Aware that drinking is a problem but not ready to stop


times brief opening of willingness to try recovery. So it’s important that an action plan be ready when preparing for treatment. Some people are able to take themselves to treatment; for others, it’s wise to take them, since that opening of willingness may shut down quickly and someone may change his or her mind about treatment before arriving.

Deciding on Recovery Making a decision to enter treatment for a substance use disorder can be the most important action you take in your life. The decision to look toward treatment rather than to find ways to hold onto addiction is a sign that an addict is ready for the next stage of recovery. Ideally, when someone enters treatment, it should be by choice. One element that can make treatment for young people more difficult is that if they are under 18, they can be forced into treatment by their family, and so they may begin with a negative attitude. Professionals in the field of adolescent treatment need special skills in involving teens in their own process of decision-making. If you are considering treatment for yourself, pat yourself on the back because you’ve moved one step closer to helping yourself. Your family may wish you would move faster and may be pressuring you—and maybe you can consider that. On the other hand, though, those closest to an addict or alcoholic can sometimes resist treatment even more than the patients—because they have their own denial and other issues to deal with. Families may have strong feelings of shame or fear that fuel denial about addiction in one of their kids. It may take involvement of another adult—doctor, teacher, counselor—to get them on board. You will need your family’s support to enter treatment, especially if you are still a minor. They will need to give permission for treatment, and their insurance is likely to be needed to pay for it. They—and you—can likely handle the idea of treatment with less fear and resistance if you take it one step at a time. Unless addiction has progressed so far that outside authorities are forcing treatment decisions, you can choose how to proceed. Treatment can begin with individual counseling, or with outpatient programs, or with an inpatient program at a residential facility. The more you understand the process, the easier it may be to enter, so the next chapter provides details about treatment. Most people are not happy to enter a treatment program or facility, but many describe a sense of relief. Many express anxiety and fear, which is natural when entering the unknown. But the willingness to try is what matters.


What You Need to Know M Most people who need treatment for SUDs are not aware of it. M Most people who know they need treatment do not seek it. M People with addictions may resist treatment. M The process of getting to treatment moves through standard stages. M Many types and formats of treatment are available, and the more someone knows about them, the more likely he or she is to seek treatment.

7 Approaches to Treatment

i

it’s good news that alcoholism and drug addiction can be treated. Until fairly recently, the best that could be done for sufferers was to take the substance away: to send the alcoholic to a “drying-out farm,” or to lock an addict up to go “cold turkey,” with only a bit of dubious medication to ease the process. That kind of treatment was better than the punishment that earlier society infl icted on “drunks,” who were often locked up in jails or insane asylums. Unfortunately, many people still believe that addiction is not a disease but a choice of behavior. According to a survey conducted by the National Council on Alcoholism and Drug Dependence in 2005, half of the U.S. population considers addiction a “personal weakness.” Among those who did feel it is a disease, the majority labeled it part of a special group of illnesses caused by people making “poor choices.” This kind of public opinion makes it that much harder for an addict or alcoholic (and their families) to develop a positive attitude of their own about recovery. In fact, the same survey showed that more than 20 percent of those who did not seek treatment chose not to because of the stigma attached to it. Anyone feeling uncomfortable about going into treatment should know that he or she isn’t unique: 2.5 million people received treatment in 2006 in facilities specializing in substance abuse treatment. Add those who sought help from nonprofessional support groups, and the total receiving some form of treatment in 2006 was 4 million.


tHe treatMent proceSS Recent brain research confirms that alcoholism and addiction are physiologically identifiable conditions, and the more they are understood by medicine, the faster effective treatments are being developed for them. As with most serious disease, the earlier treatment is started, the better. Treatment proceeds from detoxification, or acute care, through treatment using multiple approaches including pharmaceutical drugs and continuing with follow-up care. If there is any difference, it’s the frequent addition of “spiritual” work to the medical and psychological ingredients—but it still remains a step-by-step process. Treatment can be in a hospital, a rehabilitation center, a therapeutic community, an outpatient program, with a therapist or counselor, or in the rooms of a support group—or a combination of some or all of them. Wherever it happens, it begins with a separation from the substance—or detox, works through a learning phase, and looks toward long-term maintenance of health.

Detoxification The first step in treatment for any substance abuse is detoxification, or detox. Most physical addictions require this removal of the substance from the body. While people do manage this on their own, “cold turkey,” it can be extremely dangerous. It can also make treatment difficult to begin, because the cravings triggered by withdrawal can cause an addict or alcoholic to give up before detoxing is complete. Some drugs, like cocaine, don’t require a physical detoxification but may require early care due to intense psychological dependence.

Opening the Door The first step, for both outpatient and inpatient programs, is an intake process during which professional staff will take information about medical and personal details. For many people this is the first time they have seen their condition as part of a whole. And as one young addict commented, “It felt like kind of a relief to be open about stuff I always lied about, with someone who didn’t seem to judge me.”

Approaches to Treatment 79

During detoxification, health care practitioners physically stabilize an addicted person and get alcohol or other drugs out of his or her system so that cravings can be lessened and treatment can begin. Detox is almost always covered by insurance, so many consider it a good way to begin treatment for alcoholism and addiction. (Chapter 10 details issues of paying for treatment.) In most areas, if you live within the hospital’s “catchment area” or service zone, you must be admitted even without insurance. Or, if you are endangered by any drug, you can go to the nearest emergency room, where medical staff can evaluate your condition and if need be refer you to treatment. Anyone concerned about another’s condition after drinking or drugging should not hesitate to take him or her to a hospital or to call an ambulance for help. Many hospitals offer medical detoxification, so their services can be widely available. To be accepted into detox a patient needs to be drunk or actively high on another drug that requires detoxification. Someone with only a cocaine or crack habit does not qualify, so if they want help in the initial stages of recovery there must be another drug involved to begin treatment through a detox. Withdrawal is one of the signs of addiction: If the body overreacts to the removal of a substance, that shows the body has become dependent on the substance. Since addiction is progressive, requiring more and more to maintain a “normal” condition, each time an addict or alcoholic tries to withdraw the process may be more painful. Not only is unsupervised detoxing dangerous, but detox under medical supervision—including close monitoring of vital signs, supportive care, and medications—is more likely to result in a successful recovery because treatment can make withdrawal less painful. Alcohol detox, which lasts from three days to two weeks, can cause tremors (“the shakes”), headaches, vomiting, perspiration, restlessness, loss of appetite, and insomnia, and, more severely, delirium tremens (D.T.’s) and seizures (convulsions). One-quarter of detoxing alcoholics suffer seizures if not treated medically. During medical detox a patient’s vital signs are monitored regularly and medications are administered, including Buprenex, certain benzodiazepines (tranquilizers such as Valium, Librium, Ativan, or Serax), and anticonvulsants. Drug withdrawal is caused by stopping or sharply reducing drug intake after intense use. Reactions include sweating, tremors, headache, drug craving, nausea, abdominal cramping, diarrhea, muscle aches, and insomnia, as well as confusion, agitation, depression, or anxiety, and other behavioral changes. Not all drugs require a medical detox. Opiates, including heroin and methadone, do require


Warning Signs If you or someone you know displays the following symptoms, you should find immediate treatment at a detox center or emergency room, by ambulance if necessary: M unconsciousness M seizures M hallucinations M intense agitation; irrational behavior M vomiting M shaking M chills or profuse sweating Source: National Institutes of Health

detox, using anticonvulsant and anti-craving prescriptions. Other illegal drugs, such as marijuana, crystal meth, and cocaine (crack) do not, although the psychological dependence on these substances call for structured stabilization. Prescription drugs such as OxyContin, Xanax, Vicodin, and Lortab all require medically supervised detox.

reHabilitation Rehabilitation (rehab) is the stage of treatment that offers the opportunity to develop positive motivation for recovery; stabilize health status through longer-term withdrawal symptoms, using medications if needed; learn skills for stopping drug and alcohol use and avoiding relapse; gain positive incentives to encourage participation in both treatment and follow-up programs; and learn new ways of dealing with family and friends. All programs—residential and outpatient—have group and individual counseling. Many now offer medications for addiction and


psychiatric problems and help patients become aware of “Post Acute Withdrawal Syndrome” (PAWS) that may disturb patients during the first year or so of recovery. The programs are designed to provide structure in their curriculum, trained and supervised therapists and counselors, individualized treatment planning, and monitoring for any alcohol and drug use during treatment. Treatment programs arrange for continuing and follow-up care after discharge (many state agencies require rehabilitation programs to do this). The more thorough programs offer social services to help gain better employment, deal with pending legal problems, improve parenting and marital relationships, and even obtain drug-free housing. Rehabilitation centers may be residential, outpatient, therapeutic communities, long- or short-term, or support groups. A recent study of alcohol treatment by the National Institutes of Health found that treatment with the medication naltrexone, when combined with brief counseling from a doctor or nurse, was as effective as up to 20 sessions of specialized alcohol counseling. Detoxification from many drugs can be accomplished fairly quickly, and with the help of medication, but the psychological dependence is so strong that longer treatment is needed for lasting recovery. Virtually all current research shows that a combination of treatments, with pharmaceutical support as necessary and professional counseling plus follow-up connection with support groups, works the best and for the longest time. Remember how the disease is described as “mental, physical, and spiritual”? The treatments have to cover all those aspects: physical detox alone, medication alone, psychotherapy alone, or spiritual energy gained from religious experiences or support-group fellowships alone aren’t as effective as the interaction of all those ingredients. Research sponsored by agencies of the National Institutes of Health finds that most inpatient treatment and longer-term intensive outpatient programs, which include regular monitoring against alcohol or drug use, work equally well. Combining medication use with professional counseling followed up by specialized support groups like NA or AA or the non–12-step groups fosters the longest periods of recovery. You’ll find an inclusive list of follow-up groups on page 135.

What Happens in Treatment The elements of the treatment process are similar for any setting, including detox. Whether rehab is inpatient or outpatient, in a facility or with a counselor, the basics should be the same.

82 Living with Alcoholism and Drug Addiction Treatment planning. A first step in any effective rehab program is

to make an individualized plan and goals for each patient. The plan is devised to address any special circumstances, including physical or mental conditions, personal background, and the special characteristics of various drugs (for instance, cocaine/crack addiction may need to be addressed differently from heroin or alcohol addiction). In a general way, most approaches share similar ingredients, which are listed below. Counseling and psychotherapy. Earlier approaches using psychotherapy for substance use disorders stressed long-term approaches to “finding the cause” of the drinking or drugging behavior in the person’s psyche, then eliminating that cause and thus the habit. While that approach may be practiced somewhat today, much more effective in both individual therapy and treatment facilities are techniques of behavioral therapy, which address recovery from the disease of addiction rather than from a specific drug. Cognitive-behavioral therapy (CBT) works from the idea that feelings and behaviors are caused by a person’s thoughts rather than outside influences. People may not be able to change their circumstances, but they can change how they think about them and, therefore, change how they feel and behave, according to cognitive-behavioral therapists. The goal of CBT is to teach the person to recognize situations in which he or she is most likely to drink or use drugs, avoid these circumstances if possible, and cope with other problems and behaviors that may lead to his or her substance abuse problems—and to learn or relearn better coping skills. Motivational interviewing (MI) is a client-centered approach to helping people move through the stages of change. Motivational enhancement therapy (MET) is a technique based on MI that was developed specifically for addiction treatment, with the assumption that the responsibility and capacity for change lie within the client. The therapist works with the client to set and achieve treatment goals. Combined medications and behavioral therapy. Research shows

that this combination works best for treatment of addictions, and today increasing numbers of facilities and programs employ this multifaceted approach. The process is usually short-term. Although other forms of therapy and psychoanalysis can take years, cognitive-behavioral therapy is usually completed in 12 to 16 sessions with the therapist. As with other treatments for alcoholism and drug abuse, cognitivebehavioral therapy works best when combined with other recovery efforts, such as participation in support groups.


Treatment by the Numbers According to the National Survey on Drug Use and Health, of the 4 million people aged 12 or over who received some kind of treatment in 2006: M 2.2 million received treatment at a self-help group. M 1.6 million received outpatient treatment at a rehabilitation facility. M 1.1 million received outpatient treatment at a mental health center. M 934,000 received inpatient treatment at a rehabilitation facility. M 816,000 received inpatient treatment at a hospital. M 610,000 received treatment at a private doctor’s office. M 420,000 received treatment at a prison or jail. M 297,000 received treatment at an emergency room.

Socialization. An important part of treatment is the enhancement of

social skills that have usually been ignored or undeveloped during a life of addiction. Group therapy and the promotion of group activities are central to inpatient and outpatient programs, which focus on the lifestyle changes necessary for preventing the return of the problems.

MeDicationS Old-fashioned potions and powders were part of treatment for “chronic drunkenness” for hundreds of years, without much effect. Twentieth-century medications included formaldehyde and vitamin B12 shots, and later Antabuse, which makes people violently ill when they drink. Until quite recently, most so-called “drunks” were just “dried out” or sent away to a so-called “farm” to separate them from the alcohol for a time. Given the lack of chemical treatments, counseling became the leading technique, especially after it was realized that jailing alcoholics did little, and support did a lot. More recently, perhaps


because of the rise in drug addiction late in the 20th century, alcoholism and addiction have become the subjects of serious research, with new drugs resulting from some of that study. In addition to medications to ease the process of detoxification, medications for treatment of opiate addiction—levo-alpha-acetylmethadol (LAAM) and naltrexone—are available, and an increasing variety of preparations have been developed to help nicotine addicts. In some cases, medications developed for one addiction have proven useful for another. For example, naltrexone, which blocks the high from heroin to help users stay clean, is now also proving to be effective in treating alcoholism. For multiple addictions. Since most people seek treatment for both alcohol and drug addiction to more than one drug, some combined approaches to treatment are effective, using medication and therapy to deal with all of a patient’s addictions.

The Prescription Connection Some drugs can help addicts and alcoholics deal with their symptoms and cravings. M Antabuse (disulfiram) causes intense nausea and vomiting when a patient drinks, intended to act as a deterrent. M Naltrexone was designed to lessen opiate dependency and has been found to reduce alcohol dependence and opioid addiction. Naltrexone is sold under the brand names ReVia, Depade, and Vivitrol. For those who are addicted to opioids, naltrexone works by blocking the effects of drugs like heroin in the brain. It is not fully understood how naltrexone works to reduce the craving for alcohol, but it is thought to affect dopamine levels. M Campral (acamprosate) is the most recent medication approved for the treatment of alcohol dependence or alcoholism in the United States. It works by reducing the physical distress and emotional discomfort people usually experience when they quit drinking.


Special circuMStanceS Increasing numbers of patients come in with “comorbid” or co-occurring conditions, meaning that they have emotional or serious physical problems as well as their addictions. Alcoholism and addiction can cause various medical and psychiatric conditions or increase their severity, including liver disease and heart trouble. These need treatment. Alcoholics and addicts tend not to eat properly, so nutrition needs to be improved. HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases are all commonly associated with alcohol and drug abuse, so counseling is needed to help patients modify or change behaviors that place themselves or others at risk of infection. Addiction and alcoholism themselves are categorized as mental illnesses, and health care practitioners traditionally may not look beyond the substance-abuse symptoms. That is changing in many

M Methadone and LAAM, used in maintenance treatment for heroin addiction, are heroin substitutes that are deemed safe and effective medications for opiate addiction when administered by mouth in regular, fixed doses. M Acupuncture, an ancient form of treatment developed in China that makes use of small needles, has been shown to reduce drug and alcohol cravings when administered properly. It is offered in some states’ treatment centers. You may see claims about other, less well-recognized alternatives to medical treatments for alcoholism and addiction. Beware of any big promises. The treatments that are in use have taken a long time to develop. Be wary of medications offered for the treatment of cocaine, marijuana, tranquilizer, or methamphetamine dependence; the U.S. Food and Drug Administration has not approved any medications for these problems. Ask to see the evidence for the effectiveness of these medications. No matter how good the medications and other treatments may be, people must be willing to use them appropriately—no treatment works by itself.


settings, and today psychiatric issues are looked for more frequently. In some instances, patients may use alcohol or drugs in an attempt to medicate their psychiatric or emotional problems, making the substance that much harder to give up. In some cases, the emotional problem is a cause of the addiction; in other cases, addiction triggers psychiatric illness. Both types need treatment, yet in many rehab settings, patients are not even screened for psychiatric problems. Psychiatric disorders that are associated with alcoholism and addiction include M antisocial personality disorder M bulimia, an eating disorder M depression M anxiety and panic disorders M bipolar disorder Whether these conditions are causes or results of substance use disorders, they need to be treated along with the SUD. Medications like antidepressants and mood stabilizers may be critical for treatment success when patients have co-occurring mental disorders.

Keys to Success As you know by now, alcoholism and addiction are not simple to explain or easy to treat using cookie-cutter treatment plans. So it should be no surprise that some of the approaches to managing them are also less “scientific” in their definitions. Despite all the research and new developments in scientifically sound treatment for addiction and alcoholism, the success of a recovery program comes down to two simple factors: attitude and time. Attitude. To benefit from treatment, a patient has to want it, and

be willing to participate in the recovery program. Many teenagers are pressured into treatment before they are fully ready. Effective programs and therapists use intervention and behavioral therapy to increase motivation. Nonprofessional recovery programs urge new participants to keep the negative aspects of their substance use fresh in their minds and to work to care about themselves enough to stay clean. But if you are entering treatment it all comes down to this: Do you want to stay clean more than you want to get high? Time. Whatever treatment you receive, the longer you stay in treatment, the more likely you are to succeed. This commonsense obser-


Sandra’s Story: Honesty, Open-Mindedness, and Willingness I had been in trouble with drugs and booze since I started drinking when I was 12 years old. I had a lot of stepfathers, and we moved a lot, so I didn’t do very well in school. So, of course, I had a lot of people to blame my troubles on. I was mad all the time and made my mother even madder. I got sent to reform school, put in boot-camp programs, sent to a mental hospital. All I ever wanted to do was get out. They made me go to rehab a couple of times too, and I’d just leave as soon as I began feeling better. When I turned 18, things got more serious and I was given a choice between jail and rehab. It was a hard choice, really. But what that did was to force me to stay in the rehab a little longer than before. A therapist there decided I had Post-Traumatic Stress Disorder because of a lot of bad stuff in my past, and they gave me some medication that seemed to keep me calmer and clearer. I was able to be still and listen more, and I heard people talk about stuff they had gone through and how drugs helped and then hurt them—and what they were doing about it anyway. I got to see older people who were in really bad shape from drinking their whole lives. And that made me begin to think maybe I wanted to choose a better life for myself. I tried doing what the rehab people asked me to do, and I began talking about my own stuff. I felt better and began getting hopeful about going back to school when I got out. That’s what I’m doing. And I keep taking those meds and am going to support groups. So far, so good!

vation is supported by research funded by the National Institute on Drug Abuse (NIDA). Those studies showed that alcohol treatment for 90 days or drug-use treatment for up to 18 months is the most effective. Funding for such long stays can be difficult to find, which is another reason why combining multiple approaches is effective. For instance, a few days in detox followed by a relatively short stay in residential treatment (long enough to stabilize an addict or alcoholic and determine what medications might be needed), followed then by outpatient sessions and an introduction into an ongoing support


Stage of Change Entering treatment represents the “Action” stage of change in the path to recovery. “HOW” does it work? Recovery groups say it takes Honesty, Open-mindedness, and Willingness. Whatever specific actions are taken at this stage, a person who can be honest, open-minded, and willing to change and learn stands a good chance for success.

group can add up to as much time as the extra-long-term treatment that was once commonplace. The benefits of early focused professional or nonprofessional treatment are backed up by research that shows physiological realignments in the brain require three months. And data on PAWS (Post Acute Withdrawal Syndrome) indicate it can last at least one year. Alcoholics Anonymous and Narcotics Anonymous have customarily urged their new members to attend meetings daily for 90 days and to stay especially close to program activities for the first year of recovery—recommendations that now are supported by professional research findings.

Spiritual work Addiction is called a mental, physical, and spiritual disorder, and its treatment needs to include all three aspects. The idea of “spirit” confuses some people and turns others off. As the next chapter will explore, “spiritual” in the sense it is used here refers to those intangible qualities that make a person unique and is an important part of treatment. There are those who can abate their drinking and drugging by active participation in a religious organization, but church dogma is not what others identify as “spiritual.” Psychiatrist Carl Jung called alcoholism a “low-level spiritual search”: perhaps because the physical and emotional sensations produced by alcohol and drugs are similar to those of spiritual experiences, or perhaps because of what addicts describe as “a hole in the soul”—the “big empty” that needs filling up. Some identify a spiritual experience as getting them into recovery: a radical and inexplicable change in one’s life that comes on suddenly. Spirit comes from a Latin word for breath, and spirituality can be something as simple as taking a deep breath of relief at letting go of


destructive habits. Or it can be the act of opening up to the caring support of another person (which means it happens even in “nonspiritual” support groups). However it’s defined or experienced, it has to do with beginning a new life—as a newborn breathes in air for the first time. Many in recovery find spiritual explorations to be an exciting and rewarding part of life as recovery proceeds. Whatever it is, it is not a concept that should discourage someone from seeking help. In fact, many treatment facilities include spiritual guidance in their programs, and some research shows that it is not about a belief in God or participation in a specific religion but a sense of being open to connection with a larger reality. An important part of treatment, whether in a professional or a support-group setting, can be to help addicts get in touch with their inner selves, to break down the barriers with others. Simply being open to the possibility of a better life can be a spiritual experience—and the sense of well-being that addicts or alcoholics feel as a result of being able to stay clean can also be seen as a “spiritual” reward.

wHat workS for you? No matter how much pressure is on you to get into treatment, you do have some choices, and the more input you make in the decision,

Harm Reduction Harm reduction is a phrase used to describe approaches to alcoholism and addiction with the goal of helping people stay reasonably safe even if they aren’t able to totally stop using. For addicts, this may include promoting needle exchange programs, for instance. For people with “moderate” alcohol abuse problems who want to reduce their drinking, this approach may be effective. While most treatment calls for total abstinence, there are approaches to reduce harm from drugs and alcohol by techniques like “moderation management.” This calls for reduction and control of intake, which sounds appealing to many who fear letting go of the substance but tends to work only for people who have only recently become dependent on a chemical.


the more commitment you’re likely to have to it. For those who do not go into a professional treatment program, whether by choice or for financial reasons, there are alternatives. In any setting, though, the process of recovery is similar: an initial period of withdrawal followed by stages of stabilizing the body and learning new behavior.

Course of Treatments Choose the word that best fits the facts in each sentence. 1. A crack addict does/doesn’t need detox. 2. Someone who can’t afford rehab can/can’t be treated. 3. An 18-year-old alcoholic must/needn’t enter a residential program for treatment. 4. To benefit from treatment an addict must/needn’t “hit bottom.” 5. You do/don’t have to believe in God to recover. 6. All drugs, including alcohol, are/aren’t equal. Answers: 1. There’s no detox for cocaine. Crack addicts need drug rehab. 2. Public and private insurance plans cover some treatment; individual counseling costs less than hospitalization; support groups work and cost nothing. 3. Unless he or she is mandated by some legal authority, he or she can find treatment in a variety of formats. 4. With current medical and psychiatric approaches, anyone willing to get better can. 5. While effective treatments often have a spiritual component, specific beliefs or nonbeliefs don’t matter. Even the Twelve Steps’ “power greater than ourselves” doesn’t need to mean “God.” 6. Treatment deals with the disease of addiction and needs to take different approaches for different substances because of differences in their causes of addiction and effects.


M Try seeing a private practice psychiatrist, psychologist, or counselor—one who is trained and licensed to deal with addictive issues. M Try medication under a doctor’s supervision, with counseling. Try AA or other types of groups. Many people get clean and sober just by going to group-support meetings. Research shows they work even better in combination with other treatment efforts. Try “moderation management.” If the abuse disorder is fairly new or mild, it may be possible to turn it around. M Start with an outpatient program: If more independent efforts don’t work, outpatient is the next step. It’s the most common approach for teens, and the approach most likely to be covered by insurance. Unless a person’s state of health is dangerously critical due to addiction, trying out different types of treatment can be a good learning experience: One less intense form of treatment may work, or the substance abuser can learn firsthand how much extra help is needed. Whatever form of treatment is chosen, it is a new beginning—just a beginning. As a director of a well-respected treatment program says, “We get people ready to begin recovery.”

What You Need to Know M Treatment of alcoholism and addiction is more effective than it ever has been, and the earlier in the stages of substance abuse treatment begins, the better. M Outdated attitudes still make the public want to punish or cover up the disease. Treatment does not have to be voluntary to be effective, and a M patient does not need to “hit bottom” to benefit. M There are effective medications for the treatment of nicotine, opiate, and alcohol addiction. There are effective individual psychotherapies for the treatment of virtually all addictions. M Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use. The most effective treatments—the ones that result in the lonM gest periods of sobriety—are those that combine professional counseling and medical attention with ongoing participation in support programs.

8 Managing Alcoholism and Drug Addiction: Life After Treatment

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one fear that kept tommy out of treatment was the idea that “There’s no cure, so what’s the point?” Meanwhile, Mary Anne’s family and friends thought that after rehab she’d be a “normal” drinker, and they couldn’t understand why she still wouldn’t drink. Embarking on the path to recovery from a substance use disorder marks a turning point for anyone. Whether by entering treatment or by joining a support group, recovering alcoholics and addicts find that life is not the same, either for them or for those around them.

your life after treatMent Once the initial phase of separation from the substance is over, many people feel a sense of relief. While they were using, withdrawal for even a short time was painful, so they’re happy to get through what seems like the hard part. But as noted earlier, SUD treatment is really about making a major life change. The “action” phase of change began upon entering treatment. It continues after treatment, when a person in recovery enters the “maintenance” stage, focusing on continuing the new behavior. Addiction can be treated, but, with no cure currently available, it must be managed over the long term. In this respect, it’s like diabetes, hypertension, or many other disorders. For instance, anyone who has to have a gall bladder removed will need to watch his or her diet for the rest of his or her life. Even a broken leg can affect the way

Managing Alcoholism and Drug Addiction: Life After after Treatment 93

you manage your body for the long term. It’s the same for long-term management of a substance use disorder. In the case of SUD recovery, follow-up is an essential part of treatment. Planning for continuing care—including ongoing participation in a support group—is a necessary part of professional treatment programs. Those who begin recovery without professional help are strongly encouraged to get involved in their support groups on a daily basis for at least a few months, to get a good start. In the early months, the addicted brain is still reworking the electrochemical connections that were the basis for addiction, so newcomers to recovery need to work hard to keep moving away from the addiction. They need to learn new patterns of behavior as well, while at the same time taking care of their physical and medical needs. So the more support they can get, from therapists, peers, and family, the better! As they move on to further stages of recovery, the intensity of need decreases, but they’ve learned through early practice how to make use of a variety of assistance to stay on an even keel while navigating life.

Maintaining Recovery Whatever the format of treatment used to begin recovery, a combination of efforts can be used to maintain it. Continuing all the good you’re doing for yourself is the best way to keep life moving in a positive direction. Does that mean “going to those meetings”? Support groups. Recovery experts are in almost universal agreement that becoming part of a focused support group is a critical aspect of staying clean and sober. To avoid any misconceptions, though, be clear: “those meetings” are not just Alcoholics Anonymous (AA). A huge number of support groups, in the AA model as well as others, are available. Being able to connect with people who have experience similar to yours can help you get from one stage to another in the process of moving away from substance abuse. When cravings or a desire to get high kick in, a fellow addict is the most likely to understand. But those meetings are not just about “maintaining recovery.” When you find the group that’s right for you, you’ll find tremendous support and companionship for all aspects of life, and you’ll enjoy the kind of fun that is only possible among people who share a deep understanding of each other.


Teens in Recovery Young people were once a tiny minority in recovery meetings, and oldtimers were known to make fun of them. More recently, support groups have tended to welcome them, and they have found and created groups among their peers. A 23-year-old celebrating four years of sobriety comments, “Instead of thinking that being young is a handicap, I’m glad I have my whole life ahead of me, and it’s already an adventure.”

References to “12-Step” support groups can cause some confusion. The “Twelve Steps” were conceived during the early years of Alcoholics Anonymous as a pattern of recovery based in part on principles of older personal development groups. 1. We admitted we were powerless over alcohol—that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over to the care of God as we understood Him. 4. Made a searching and fearless moral inventory of ourselves. 5. Admitted to God, to ourselves and to another human being the exact nature of our wrongs. 6. Were entirely ready to have God remove all these defects of character. 7. Humbly asked Him to remove our shortcomings. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. 10. Continued to take personal inventory and when we were wrong promptly admitted it. 11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him,


praying only for knowledge of His will for us and the power to carry that out. 12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs. They have been adopted and adapted by hundreds of other organizations with the goal of helping members overcome addictions and other serious difficulties. For these groups, the process outlined in the steps has been successful as a means to separate from self-destructive behaviors. It begins with the admission of an awareness that a serious problem exists that the sufferer can’t solve alone. A willingness to seek help then opens the way to a process of major personal change. The God referred to is a concept that varies from individual to individual and can be a deity as taught by a formal religion or a less well-defined spiritual force. This combination of structure with flexibility probably helps people of all backgrounds to use the steps as a pathway to change. Groups based on the 12-step approach also use the “mutual self-help” pattern, which means that members help each other as a way of finding strength themselves. They do not make use of facilitators or other professionals but are self-organized. Organized support groups have proven to be of great value in helping people through personal crises, including addiction. Psychotherapy. Support groups do not—and are not supposed to—

provide psychotherapy or medical advice. Many people, especially in early recovery, find therapy useful. Once the mind is clear of alcohol and drugs, they find that psychotherapy can provide important insights as well as guidance toward healthy recovery. Medication. Physicians or psychiatrists can prescribe the medica-

tions that many people in recovery find necessary or helpful. Sometimes when people begin to feel better, they stop taking their “meds,” and that can lead to relapse or worse. Sometimes even support-group members discourage the use of prescriptions, as if their special method is the only way that works. Watch out! It’s important to continue with medications as long as a doctor considers them necessary. Moderation. Often people in early recovery go overboard in their “get-

ting better” activities, just as they did in their drug use. For instance, some exercise is good to stimulate the brain chemicals that lift your mood and help your body feel better, but too much can actually stir up


more stress hormones than is good for you, and overexercise can lead to unhealthy over-fatigue. Likewise, improving nutrition is important, but going on radical diets when the body is still trying to get back in balance is not a good idea. People in early recovery are advised to treat themselves as they would “a friend who is just getting over a bad case of flu”—eat well, rest well, and be good to themselves. What’s fun? If recovery were about only “meds, meetings, modera-

tion, and maintenance,” it would get pretty boring pretty fast. And if it’s boring, who wants it? Not many people—especially young people who have gotten used to a regular dose of more than a little excitement. So making plans for having a good time is important. Think about taking some of the money you would have spent on getting high and using it for high-tech or travel or whatever gets you excited. As one teen in recovery says, “As long as I don’t drink, I can do anything legal I want.”

Most Likely to Succeed Which new recovery addicts are the most likely to stay clean and sober? 1. Tony hangs out with his old friends, drinking soda. He says they’re cool with his recovery. 2. Marisa blames her family for her pain but has begun family therapy with them. 3. Alex has gone back to school, started a new job, and joined the gym. He doesn’t have much time for meetings. 4. Chandra took a leave of absence from school and decided to stay in her outpatient program for a while. 5. Ken says he really doesn’t like having to go to the NA meetings that the court mandates, but he’s beginning to make friends. 6. Stephanie’s family is so happy she’s sober that they’re planning a homecoming party for her and have bought tickets for a Walt Disney World trip.

Managing Alcoholism and Drug Addiction: Life After after Treatment Attitude counts. Someone who thinks in terms of giving up his

favorite substance and feeling sorry for himself is not going to enjoy life after treatment—and if he’s not enjoying life, he’s likely to pick up again. Someone who is constantly envying “others who can drug” has lost the focus on what she can do, and even if she doesn’t pick up again can make herself miserable. People in recovery who are enjoying their lives are the ones who manage to be grateful for being free from their addictions and can focus on what they have rather than on what they don’t have.

finDing joy People in early recovery are cautioned about staying away from the “people, places, and things” that are associated with their substance abuse. Alcoholics need to stay out of bars and liquor stores. Addicts need to stay away from the drug spot. It’s also a good idea to take a

7. Craig’s new support group has told him that the medications he’s on mean he’s not clean, so he’s weaning himself off them. Answers: Each example has something positive and something less so. The most likely to stay clean would be numbers 4 and 5: Chandra may need to lighten up a little, and Ken should stick with meetings till he wants to go to them and so see those friends. As for the others: It’s good that number 1, Tony, is drinking soda, but hanging with his old friends can lead to trouble. Marisa, number 2, has negative feelings but is dealing with them in a positive way. It’s good to be energetic, as in example 3, but Alex needs to keep his priorities in order. Stephanie, number 6, is lucky to have a supportive family, but they need to be aware of the more basic needs of early recovery—partying may not be what she needs at first. Finally, it’s good that Craig, number 7, is attending meetings—but no support group can tell anyone to go off medications that a doctor deems necessary. Prescription drugs taken as prescribed maintain the balance of many in recovery; they are not relapses.


look at friendships: Which friends are supportive of recovery and which are pals from using? Does this mean locking yourself up away from the world? No. It means taking a new look at friends, parties, entertainment, and hobbies and finding ways to enjoy them, substance-free. Dream a little. What do you really want to do with your life?

Once past the demands of maintaining a drinking or drugging habit, teens in recovery find they can reach almost any goal they set for themselves. Sean is a writer who had to find other work to support his habit, then had to find some recovery before he could return to his writing career, but he persisted and has seen success. For Rita— whose dreams of being a musician had to wait till she’d been clean for a while—the experience of getting clean has helped her work and her career. Harold is a good enough pool player to go professional, he says—but he’s willing to wait till he feels comfortable going into a pool hall without drinking. What’s your dream? What about spirituality? Research has shown that spiritual experiences increase the time away from a drink or a drug. For many in recovery, it becomes an adventure in itself. As one young woman in recovery observes, “Today I don’t need alcohol or drugs to flee from their shadows. My recovery journey continues to deepen my experience of self and my fullness of living. I wouldn’t miss this adventure for the world!” Though some equate spirituality with religion (which is one reason people who object to religious ritual organize their own groups), others note the spiritual aspects of addiction. They note a similarity between the experiences of “getting high,” which has been called a “counterfeit spirituality,” and spiritual transcendence. Part of recovery is finding new ways to achieve those experiences. Some may find that new experiences with music take them out of themselves; others turn to art or hikes in the woods. “Spirit comes from the Latin word for breath,” one recovering alcoholic explains, “and I look for experiences that ‘take my breath away.’ ” A spiritual journey also contributes to a sense of purpose in life, which can be exciting, and also keeps people in recovery. Researchers found that this spiritual adventure is not about religion, not connected with AA or its like, and not necessarily a matter of believing in one interpretation of God or even belief in a God of any kind. Rather, they found, it is about a pursuit of new and unique experiences.

Issues in Recovery “There are highs and lows in recovery,” a recovering addict comments, “but so far I haven’t had to fall back on my drug of choice.”

Managing Alcoholism and Drug Addiction: Life After after Treatment

How Recovery Works in the Brain When the brain’s limbic system is deprived of the drugs that have given it extra boosts, it begins to retrain itself to produce more dopamine on its own. Neural connections in the parts of the brain that exert judgment also need time away from addictive drugs to reestablish. So the suggestions for forming new habits and behaviors in early sobriety have the effect of giving the brain time to reestablish normal connections. Research continues on whether some changes in the brain from addiction are permanent—especially when addiction has begun during early adolescence.

Is relapse failure? Relapse—a returning to older behaviors and

abandoning changes, at least for a time—is one of the recognized stages of change. This doesn’t mean everyone has to temporarily return to old behavior as part of recovery, but it happens often. By some estimates, approximately 90 percent of alcoholics are likely to experience at least one relapse over the four-year period following treatment. People with other chronic diseases also relapse frequently, so it’s not unusual, but it remains a major challenge in treatment. Early in sobriety, news articles, TV commercials, smells, and songs play on the brain’s uncertain state, but that trigger mechanism fades over time. People with long periods of recovery note that the triggers fade, and brain studies confirm that: Cues that stimulate the addictive regions of the brain in early recovery get little or no response in brains of people with long-term recovery. NIDA researchers report that the brain remains sensitive to triggers, and until a way is found to change that, what is needed is to “train” the other parts of the brain to outweigh the addictive messages. With other chronic diseases, relapse serves as a signal for returning to treatment. The same response is just as necessary with drug addiction. As a chronic, recurring illness, addiction may require repeated treatments until abstinence is achieved. Relapse can be viewed as a learning experience, if only as a way of showing that a particular person can’t be a controlled or moderate user—but a return to drug or alcohol use can also be dangerous.


Tools that exist to postpone or prevent relapse and to counter those triggers include: M drugs like acamprosate and naltrexone, used to prevent relapse M desensitization programs help people learn to be calm around triggers M avoidance—early on, staying away from triggering situations is important M time—cravings along with the risk of relapse lessen greatly over time, apparently as new brain patterns are established What is success? If relapse is not about “failure,” then what is “success” in recovery? Some research would say one year without the use of a chemical substance; other research would say five years. Experts describe three levels of sobriety: early—from one to 12 months of abstinence; sustained—one to five years of abstinence;

One Defi nition of Recovery A voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship. This is the working definition of recovery agreed upon by a panel of interested researchers, treatment providers, recovery advocates, and policymakers convened by the Betty Ford Institute, an addiction recovery center. Many people are able to quit drinking or taking drugs and feel that this is all that is required to achieve recovery. The Betty Ford panel of experts believes, however, that more is required to achieve a sustained, stable recovery from alcohol or drugs. Achieving the other components of recovery—personal health and citizenship—affects not only the person trying to recover, but his or her family, friends, and society as a whole. “Personal health” refers not only to physical and mental health, but also to what they call “social health,” or active participation in family and social roles. Source: The Betty Ford Institute Consensus Panel. “What Is Recovery? A Working Definition from the Betty Ford Institute.” Journal of Substance Abuse Treatment, October 2007.


and stable—more than five years of sobriety. The longer one stays safe from destructive chemicals, the better, but rather than put a time limit on the absence of drugs, many people in recovery look to the enhanced quality of life they experience as the mark of “success.” If treatment is about dealing with the disease, “recovery” is about a lot more: It’s about recovering life. Someone who can see sobriety as the opportunity to do new things has a chance to start a new and exciting life. Over time, it is the comparison of the positive quality of life to the negative experiences during active addiction that reinforces an addict’s ability to maintain recovery.

Life Around You After Treatment When you take the big life-changing step into recovery, it may seem that your whole world should shake. Usually, life goes on and the recovering alcoholic or addict needs to adapt to that. The “new” life may be complicated by “old” patterns of family and friends. Rocking the boat. It’s useful to think of your life as a rowboat. It

may have gone through some choppy seas and not been the easiest of rides, but everyone you know has a seat in that boat. When you get out, to go into treatment, you set the boat off balance. Now that you’re back, family and friends may be looking to you to get back in that same seat. But it’s important that you let them get that boat back in balance—you don’t need to take up your old patterns. On the other hand, recently treated substance abusers would be unrealistic to think that family and friends are guaranteed to meet all their needs. After treatment and during early recovery, the body is still going through changes and needs to be treated with care, and in early recovery stress should be avoided. If you’re lucky your family and friends will be supportive but laid-back about your new way of life. But it’s understandable that they may resent having to go out of their way to make life easy for someone who may not have made their lives easy during active addiction. Family and friends. A new study by the State University of New York reports that offering “understanding and encouragement” to those with drinking problems is the best approach family members can take in dealing with the problem. That may be the ideal, but many newcomers to recovery find that those around them respond to their new status not so positively. Family and friends may relate to newly recovering young people in a range of styles, from “walking on eggshells” to healthy support to sabotage that can result in relapse for


the addict or alcoholic. Says Don M., “My family just didn’t understand why I had to go to meetings! They said they saw less of me than when I was using. They made it tough for me—especially since I needed rides to meetings—until four relapses convinced them that taking that time for myself was worth it!” The next chapter goes into more detail about the family dynamics of recovery, but anyone wondering why his family isn’t welcoming him back with open arms after treatment might learn from some of those surveyed by USA Today and HBO in 2006. M Seven out of 10 U.S. adults who have a family member suffering from the disease of drug or alcohol addiction say that a family member’s addiction has had a major or minor effect on their emotional or mental health. Almost one in 10 of those who say a family member’s addicM tion has had a major negative impact on their financial situation say they have had to take out a loan or run up credit card bills as a direct result of this addiction. M About a fifth of those who say a family member’s addiction has had a major negative impact on their marriage, family relationships, or emotional health say they sought professional counseling. New connections. The need to pull away from old relationships

provides another argument for connecting with support groups. More than 1 million Americans seek recovery only from support groups each year, and research sponsored by the National Institute on Alcohol Abuse and Alcoholism attributes their beneficial effects in part to the replacement of the participant’s social network of drinking friends with a fellowship that can provide motivation and support for maintaining abstinence. There are also online groups and meetings. Check out http://www. stayingcyber.org or http://www.nachatroom.org for an example of 12-steps in cyberspace. You’ll find e-mail meetings, live-chat rooms, and support and processes similar to face-to-face meetings. Online support groups are handy for people with disabilities, and they’re a good way to show family and friends what groups are like. They may also be especially attractive to teens.

How to Deal with “Real Life” Luckily people in recovery have a lot of new friends with whom to spend time. Those who’ve been around a while can tell you that life


is richer, more rewarding, easier, and more fun than it was while chained to their drug of choice. One of the big fears that keep people out of treatment is fear of life without the substance. While addicted, separation from the substance for even a short time can be painful, so it’s hard to imagine a happy life without it. But those who take the chance say it’s worth the effort. Substance abuse was for most addicts and alcoholics a 24-7 activity, so their recovery needs to mean more than just staying clean and going to meetings. Luckily, young people will always find ways to have fun—and there are those who say clean and sober fun is better than the other kind. It can be more intense, they say, and it has no “downsides” of hangovers or arrests. Young people in AA began networking not long after the organization was founded in 1935, and today there are “Young People in Alcoholics Anonymous” groups socializing throughout the United States. Their international organization says it “provides visible evidence that large numbers of young people are achieving a lasting and comfortable sobriety in Alcoholics Anonymous.” Other examples of clean and sober fun include sober cruises, retreats, and matchup sites. Old friends may be among those you have to stay away from, or they just may not quite understand your new outlook. So it becomes even more important to be open to forming new friendships.

What You Need to Know M Recovery is an ongoing process. M Family and friends may or may not be of help, but support groups are needed. Fun, adventure, and dreams are important to life in recovery. M Relapse is common and is not the end of recovery. M Spirituality in various forms is part of the recovery adventure M for many. M Recovery is about more than not using; it’s about recovering life.

9 Helping a Friend or Relative

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alcoholics and addicts need a lot of help. as you’ve read, they often need more help than they realize. They need help before they get treatment, and they need help after. What’s interesting is no matter how difficult their disease can make them, there are always plenty of people ready to help them—and a lot of those people need support too. This story may seem familiar: Rachel and Andy had done a lot of partying together—and it was often fun, if not the kind of thing they’d tell mom and dad about. Rachel still managed to go on with her straight life—doing pretty well in school and making plans to go to college. But Andy was having a hard time. He was in trouble at school for not showing up, in trouble at home for failing at school, and in trouble with his old friends for being in trouble, and into a lot of drugs Rachel hadn’t even heard of. Rachel wanted to help him. Whether it’s a friend or family member, helping an addict or alcoholic can sometimes be a tricky business. If an addict is not ready for recovery, there’s little anyone else can do to force it. Even helping another to inch closer to treatment can require a careful balancing act to be sure you aren’t hurting yourself more than you’re helping the other person. “Helpers” usually take approaches that range from enabling to intervention, with the most effective being support. If there’s an addict or alcoholic in your life, whether one needs treatment or has completed treatment, you may well want to seek help for yourself.

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Helping a Friend or Relative 105

relating to tHe active SubStance abuSer If there is an alcoholic or addict in your life, you are not alone: It’s estimated that each substance abuser directly affects four other people—family, friends, coworkers—and each of those affects a wider circle of people. Think about it: How many people feel direct impact from the behavior of alcoholics and addicts that you know? In the 2006 USA Today/HBO survey of family members of alcoholics, many respondents say the effects of the addiction are “emotional” and “devastating/horrible.” Enabling. Given that description of the effects of addiction, it seems especially puzzling that so many people will bend over backwards to help the addict or cover up his or her behavior. If Rachel, in wanting to help Andy, goes out of her way to cover up his addiction and even

Finding Bottom It was once thought—and is still widely believed—that an addict or alcoholic had to “hit bottom” (lose everything) before seeking help. People do have to be ready to benefit from treatment, but they can be persuaded to move closer toward it. In a poll conducted in 2006 by Gallup for USA Today and HBO, just over half of the respondents say the addicted family member has admitted their addiction to them, while just under half say they have not. Seven out of 10 of the respondents say they have personally confronted the family member about the addiction. Family support/pressure was most often cited as the primary reason the family member was able to overcome addiction. As a teen, you may have even more influence: According to the White House Office of National Drug Control Policy (ONDCP), 68 percent of teens said they would turn to a friend or sibling about a serious problem related to substance abuse. This means that when you talk, your friends will listen.


help him get drugs, she is said to be “enabling” him. She means to be helping, but in fact she is hurting him by allowing his addiction to continue. Enabling isn’t limited to providing someone with a substance or a cover-up. Family and friends of addicts and alcoholics take on a variety of unhealthy and unhelpful roles. M The Rescuer cleans up after and covers up for the substance abuser, denies there is a problem, and takes on extra responsibilities, so the substance abuser has no incentive to get better. M The Provoker scolds, ridicules, belittles, and nags. The constant stream of anger seems to bring its own kind of energy, though the provoker threatens to leave—and it helps neither one. The Martyr is ashamed of the addict/alcoholic’s behavior and M lets everyone know it but makes no move to correct it or to leave, as though enjoying the suffering. (The Gallup survey showed that almost half of U.S. adults who have a family member suffering from the disease of drug or alcohol addiction say they have felt a sense of shame about that family member’s addiction.) Those roles just help the addict feel worse and less able to get help—and the enabler can feel miserable but powerful. Do you know any of these types? Have you had encounters with them yourself? Supporting. Someone like Rachel learns that it’s possible to care

about a person and hate the disease or the substance that is making him sick. So she can be supportive without going overboard. For example, she can be direct about her feelings, letting Andy know that she wants him to get help but won’t get pulled into his troubles. Experts in dealing with teens’ substance abuse at the U.S. Public Health Service offer some suggestions. When discussing difficult subjects with a friend or sibling, it is just as important to consider how you say something as it is to decide what to say. Words are powerful, and a supportive, caring tone usually goes much further than the judgmental approach. They would suggest that Rachel do the following in talking with Andy: M Talk in a private place where no one is likely to overhear the details of their conversation. M Speak in a positive manner, in the context of “I care about you.”


M Speak with some knowledge of the subject—Rachel might go online to learn about the drugs Andy uses (good sources are listed at the back of this book in Read More about It). M Be prepared with some solutions to suggest—even if the suggestion is only the idea of talking to a professional. This approach may work. Or it may not. Not everyone wants help. He or she might be in denial or might not be ready to approach recovery. If this is the case, what should you do next?

Do’s and Don’ts for Helping The U.S. Office of National Drug Control Policy offers this advice to teens concerned about a friend. Helping a friend with a drug or alcohol problem is hard work and can be a very difficult experience for you as well as your friend. You may feel a great deal of pressure to get your friend to stop drinking or doing drugs. Or you may get discouraged if your efforts to convince your friend to stop using drugs or alcohol don’t work. But it is important to know that your friend’s drug or alcohol use is not your fault. Remember that it’s ultimately up to your friend to make that change and you can’t do that for him. Sometimes, as much as you may try to get your friend to quit or seek help, you just can’t seem to make it happen. If this becomes the situation you are in, you should do one of the following: M Seek support from other friends or trusted adults—your friend is not the only one who needs help in this situation. M Limit the time you spend with your drug- or alcohol-using friend. Remember, your friend’s use may also be putting you at risk. M Start thinking about yourself—get out and participate in activities that you enjoy to take your mind off of the situation.

108 Living with Alcoholism and Drug Addiction “Detach with love.” Al-Anon, the organization for people whose lives are affected by alcoholism, was started shortly after the founding of Alcoholics Anonymous. When alcoholics began getting sober, the people who had cleaned up after them realized they had issues of their own to deal with. Today Al-Anon helps people “detach with love” from the active addict or alcoholic in their lives. This means to continue to care about the person while hating the disease. They suggest that people with alcoholic/addict friends and family members keep the focus on themselves and do the following:

M Stop suffering because of the actions and reaction of others. M Stop being used or abused by others. M Stop doing for others what they could do for themselves. M Stop manipulating situations so others will get through a day and not use. M Stop covering up for anyone’s mistakes or misdeeds. Once you start focusing on yourself instead of the addict, the substance abuser may feel forced to seek help—but in the meantime, you have helped yourself. Try Alateen. Alateen is Al-Anon’s recovery program for young

people. Alateen groups are sponsored by Al-Anon members. It is a free program open to any young person who has an alcoholic in their life. Alateen explains the ripple effect of substance abuse this way: The disease affects all those who have a relationship with a problem drinker. Those of us closest to the alcoholic suffer the most, and those who care the most can easily get caught up in the behavior of another person. We react to their behavior. We focus on them, what they do, where they are, how much they drink. We try to control them. We take on the blame, guilt, and shame that really belong to them. We can become as addicted to the addict or alcoholic as they are to the substance. In Alateen meetings you will meet others who share your feelings and frustrations, if not your exact situation. Members share experiences about what they can change in their lives and what they can’t, and how they can live a better life. Interventions. One way that people living with an alcoholic or addict

can take action against the disease is when an addiction becomes lifethreatening and an “intervention” may be used. You may have seen the television program called Intervention, which is a clear depiction of how it works. It’s worth watching, if only as a reminder that many people go through painful times with those close to them.


Been There . . . Here’s what one Al-Anon member says about learning to live with addiction in the family: When someone I love drinks and drugs too much, I get lost in it all. I don’t know what to do, I think I caused the problem, I think I can control the problem, and I do my best to fix my loved one. What I have learned in Al-Anon is that I can’t do anything for the one who suffers from alcoholism, I can only help myself. I can learn about the disease, educate myself in that area, keeping the focus on me and what I’m doing. I also found others in Al-Anon just like me. I learn there is hope, I can take care of me, and my needs, get healthy and strong within myself, then the rest of the world and all of my problems in it and with it seem to get better. For more experiences from people who have “been there,” check out http://www.facesandvoicesofrecovery.org.

In an intervention, an alcoholic’s or addict’s family, friends, and employers say in their own words how his or her drinking or drugging has been a problem in their lives. Interventions need to be carefully planned with the aid of experienced professionals, and they sometimes cause more harm than good. Another method called CRAFT (Community Reinforcement and Family Training) has proven to be especially effective with adolescents. Research reported in the March 2007 issue of the Journal of Substance Abuse Treatment showed that 71 percent of parents trained in using CRAFT techniques were successful in engaging their youths in treatment. When this less confrontational method is used, patients enter treatment with less resentment and are more likely to benefit. If you have drug problems yourself, you may be the focus on an intervention. You may be asked to be part of one for a friend or relative. They can be very successful, once the addict realizes that the most important people in his life are meeting about his problem and that they care. And if it doesn’t work? Then it’s healthiest to let go and move on.

110 Living with Alcoholism and Drug Addiction Letting go. At least as much recent study has been done of those affected by addicts as of the addicts and alcoholics themselves— you’ve probably heard the phrases “co-dependency” or “rescuing,” concepts that relate to conditions that arise when another person’s life becomes more important than your own. Al-Anon and related counseling techniques focus on helping people live their own lives. No individual is responsible for another person’s disease or recovery from it. Once you’ve done what you can, you need to let it go. For the friends and family of the alcoholic/addict, the key is learning the difference between what they can and cannot change. As they say in Al-Anon, “It’s simple, but it isn’t easy.”

Helping the Substance Abuser After Treatment Treatment opens the way to recovery. It is just the beginning of a long-term process. Family, friends, and substance abusers alike need to realize that this is a major life change that takes regular attention. On the one hand, expectations may be very high that everything will be okay now. It’s easy to think of rehab as a fix-it program. If an addict was like someone with a bad appendix, he would go to the hospital have the appendix removed, and the family could count on him to be all better almost immediately. Recovery from addiction isn’t that short or simple. On the other hand, some of the bad memories of active addiction can cause continuing resentments. Though recovery is a process, at some point it’s healthier to be able to let go of past problems and move forward. It’s important to remember that recovery is primarily the substance abuser’s responsibility. Family members can find out what continuing care programs have been planned and support the recovering person’s involvement in aftercare treatment meetings and recovery support groups. It will be helpful if you educate yourself on the recovery process for individuals and families, and if your family member is living with you, to provide a sober environment to support that recovery. But it’s not your responsibility to save anyone, so you may want to seek professional and peer support (from a group like Al-Anon) for your own physical and emotional health. Families have tendencies either to try to micromanage recovery and meeting attendance or to express resentment and resistance on the lines of, “We saw you more before you stopped using.” This is especially true for parents who try to overmanage their teen’s recov-


ery. It’s useful to set out ground rules right after treatment: What the family will do (find housing? provide transportation? pay expenses? or not?) and what is expected of the recovering person (help out at home? find a job? not miss recovery programs?). That way, boundaries are established and tensions can be reduced.

What About Relapse? One situation in which a family needs to intervene is in the case of relapse—but it’s best without anger or accusations, realizing that relapse can be part of the recovery process. The 2006 USA Today/ HBO survey confirmed what recovery specialists know: Over half of the respondents whose family member sought treatment say the family member had to repeat treatment. Almost four out of 10 of the respondents whose family member sought treatment say their family member completely recovered, but about six out of 10 say their family member either showed no improvement or got better but did not completely recover. So try not to be discouraged or accusatory. Remember that research also indicates that treatment for addictive diseases has approximately the ongoing success rate as the management of other chronic disorders.

Finding Help for Yourself When a substance abuser gets help and begins a new life in recovery, one would think the family would be happy and relieved. But remember the “rowboat” described in the last chapter? Family and friends of alcoholism and addicts have investments in continuing the same relationship patterns. M Someone who feels powerful because the addict is weak needs to find power elsewhere. M Someone whose emotional life has been filled by caring for the alcoholic needs a new source of satisfaction. M Someone who may have a substance problem himself may not like having to look at his own abuse. M A parent who has tried to get a child “cured” may resent the fact that someone else was able to accomplish it. In addition, built-up feelings about all the years of pain and anger caused by the addict don’t just go away by themselves: Old anger and resentment continue to build and may be used against the recovering person as shame or guilt.


Rachel and Andy Rachel’s relationship with Andy, described at the beginning of this chapter, can have several outcomes. M He might convince her into a more intimate relationship so he can keep a caretaker (that’s called “taking someone hostage”). M She might be so worried about his feelings that she provides him with drugs or money for drugs. M He might accuse her of abandoning him by going away to school (addicts often prefer to blame others for their problems, not wanting to look at themselves). M She might start using drugs herself to keep him company (people whose self-esteem is low will cling to even bad relationships in desperation). M She might get so angry and hurt that she calls him names and ends their friendship badly. M She might tell him how his self-destructive behavior hurts her and find support for herself. M She might give him information about treatment programs and offer to help him get started. The last two scenarios represent the healthiest responses, both for Rachel and for Andy. The next scene would have to be that Andy responds or not—and Rachel moves on with her life.

One of the best ways to help a recovering alcoholic or addict is for family members to get help for themselves. They may need to work on issues like low self-esteem, abandonment issues, a need to be needed, control issues, no boundaries, addiction to excitement, or a martyr complex. Recovering from an unhealthy dependency on a substance abuser follows the same steps as recovery from the addictive disease:


Awareness that there’s a problem, then attitude about what you can and can’t change, and actions to improve your own life.

cHilDren of alcoHolicS As you can see, there is a process for helping the alcoholic, just as there is one for recovering from the disease. But in some ways the process of helping another is at least as hard as detox and rehab. It sounds sensible, but it can be tough. And it can be especially hard when the alcoholic or addict you’re dealing with is a family member—even more so if it’s a parent. An estimated 6.6 million children under the age of 18 years live in households with at least one alcoholic parent. Kids in these homes have special problems in living with the disease. According to the National Institute of Alcohol Abuse and Addiction, current research findings suggest that children of alcoholics are at risk for a range of cognitive, emotional, and behavioral problems. The ripple effects of alcoholism can be particularly rough for children of alcoholics and addicts. Psychologists see patterns of problems in children of alcoholics as they grow up—negative patterns that last a lifetime and can affect their own children. Yet some investigators

It’s Not Your Fault The National Association for Children of Alcoholics suggests that children dealing with family addiction learn and use the following “7 C’s of Addiction”: I didn’t cause it. I can’t cure it. I can’t control it. I can care for myself by communicating my feelings, making healthy choices, and by celebrating myself.


also report that many children from alcoholic homes develop neither psychopathology nor alcoholism. What may make the difference is finding extra support and help outside the home. If you’re in this situation, turn to more stable family members or for special help and support try Al-Anon or Alateen or go to a school counselor or spiritual adviser. Remember that the addicted family member may not want the truth told, and that’s one of the patterns you’ll get help with from people and organizations who have knowledge and experience with situations like this. Check out the National Association for Children of Alcoholics (NACoA) at http://www.nacoa.org. They can help you learn how alcohol and other drugs hurt everyone in a family and find new ways to deal with it, even if your parents don’t change. Alcohol and drug dependency is an illness. It is not your fault that your parent drinks too much or uses drugs, and you are not responsible for correcting it. It is a parent’s responsibility to seek treatment. You can take care of yourself by talking with a trusted person and making healthy choices in your own life.

What You Need to Know M There are healthy and unhealthy ways to help an addict or alcoholic. The best goal is to help him or her decide to get treatment. M M An intervention is one way to help him or her do that. M People close to substance abusers have issues of their own that need addressing. M Support groups exist to provide guidance and strength to those with alcoholics and addicts in their lives. Children of alcoholics need special help, and it is available. M If you have an alcoholic or addict in your life, the most imporM tant thing you can do is to live your own life.

10 Paying for Care

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first, a person has to become aware of having a substance abuse problem. Then the addict or alcoholic must become willing to seek treatment. Then decisions about what kind of treatment must be carefully made. And then things can get complicated, because finding ways to pay for addiction treatment, either through private or public funds, can be a tricky matter. On the one hand, research demonstrates that remaining in treatment for an extended time has beneficial outcomes for people in residential or outpatient drug treatment programs. On the other hand, insurers are actually reducing the length of stay they’ll pay for. After all the effort to convince someone to go to treatment, it’s an extra pain to find out the cost can’t be covered. Some financial facts about paying for substance abuse treatment: M Among people who needed, felt they needed, but did not receive illicit drug use treatment (based on 2003–04 combined data), the most often reported reasons (38.8 percent) for not receiving treatment were cost or insurance barriers. M Slightly less than half of the respondents in the 2006 USA Today/HBO poll say their addicted family member currently has health insurance. M Almost every U.S. state requires insurers to cover addictions and mental illness, but actually benefiting from that requirement is often difficult.

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Like a lot of other aspects of this disease, payment policies for it often don’t make sense. But in another quirk, treatment for substance use disorders can also be absolutely free. (Only three out of 10 respondents to that 2006 USA Today/HBO survey say their addicted family member consulted with a medical doctor or other medical professional specializing in the treatment of addiction.) Children are covered by parents’ insurance policies until they turn 19, or older if they are full-time students. What those insurance policies cover varies from state to state, company to company, and even according to the individual contracts an insurer may have with an employer or with the insured. For individuals or families with no insurance, public funding—such as Medicaid or the State Children’s Health Insurance Program (SCHIP)—is available for young people. The average cost for treatment of alcohol or drug abuse in outpatient facilities was an estimated $1,433 per course of treatment in 2002, according to a report released by the Substance Abuse and Mental Health Services Administration (SAMHSA). Although you may have to fight hard to gain coverage, insurance companies will usually support at least part of the cost—about $100 to $200 per week. The report, “Alcohol and Drug Services Cost Study,” found that residential treatment for alcohol or drug abuse cost $3,840 per admission, and outpatient methadone treatment cost $7,415 per admission in 2002, the most recent date available. Nonhospital residential care

What It Costs to Not Treat Addiction When treatment is compared to expenditures for jails, foster care for children, and health complications that often accompany addiction, treatment of substance abuse is a bargain, returning at least $2 in social benefit for every $1 spent. On an individual level, the financial and physical costs of liver disease, car accidents, brain damage, and all the other physical damages from addiction are much higher than the cost of care for substance abuse at its earliest point. There’s rarely a question about insurers covering those medical problems.

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had the highest mean cost per enrolled client day ($76.13). Costs for this treatment, like that for all health care, have increased sharply since then. Costs for inpatient care in a specialty facility can be as much as $25,000 to $30,000.

Rules of Coverage Forty-four states require private health insurance plans to cover substance abuse treatment in some fashion, with some laws requiring wider coverage than others. If companies choose to self-insure, or administer their own health plans, they are exempt from state insurance laws. Just under half of all workers who have health insurance through their jobs are covered by self-insured plans, which means the rules don’t apply to them. According to a recent report from the National Governors Association, “Private insurers traditionally have been reluctant to provide coverage for substance abuse treatment, mainly because of its perceived costs and the availability of government-supported services.” Many health plans provide fewer benefits for alcohol treatment than for other chronic diseases. Higher co-payments and deductibles make it harder for even those with insurance to get the help they need. On the other hand, coverage by private and public agencies for both individual and inpatient treatment may be more forthcoming if there is a psychiatric problem in addition to the substance abuse. Details of the extent of coverage varies widely too. Increasingly, insurers—including Medicaid—are more likely to pay only for detox, or for medical treatments and outpatient care or for a limited and closely monitored inpatient stay. Depending on the state and the policy, coverage is more likely—for both individual therapy and inpatient stays—if there is a co-occurring psychiatric or medical problem. Trying to make sense of the payment process gets even tougher as public and private rules about coverage keep changing. Efforts at developing federal laws requiring addiction and mental health coverage may result in more sensible approaches to paying for these diseases. For now, your family can get some kind of coverage for addiction treatment, whether through private or public sources. The benefits or employee assistance program office at your parent’s workplace, a funding expert at the treatment facility, or a caseworker at a public or private agency can help make the most of coverage. Here are some resources that can be tapped: M State and local governments are picking up the largest portion of the public tab—19.2 percent, not including Medicaid.


M Federal government programs—block grants, entitlements and categorical grants—also provide some support. M Individuals pay almost 8 percent of the cost of alcohol treatment services themselves, out of pocket. Private health coverage and other insurance make up 34.5 M percent of the funding for alcohol treatment services. As of early 2008, proposals may be close to enactment that would make insurance coverage for alcoholism and addiction easier to obtain: The Paul Wellstone Mental Health and Addiction Equity Act of 2007 was passed by the U.S. House of Representatives for consideration by the U.S. Senate. As of this writing, it has not been signed into law. If it is, it will assure equal coverage for mental health issues as for other medical problems. Anyone concerned with paying for addictive care would do well to pay attention. On the other hand, the provisions for coverage by Medicaid are becoming increasingly tight: This public coverage varies by state, and anyone seeking payment by public funds for addiction treatment should check his or her state’s rules. Have insurance but can’t get paid? Though almost every state in

the country requires insurers to cover these conditions, sometimes people have to fight for that coverage. One reason for that is, once again, the stigma of alcoholism or addiction causes people not to reveal their need for coverage. So they’re not as likely as people with other health problems to go for help to their employer or a government agency. The organization Faces and Voices of Recovery, a recovery advocacy group, can be of help in speaking up for insurance coverage. Pick care that’s covered. You’re more likely to get better coverage if you pick a facility that uses “evidence-based treatments.” These services are grounded in medical science rather than hunches and can demonstrate progress in a way that insurers can measure. Professionals in the field note that one of the reasons good treatment is so difficult to find is that there have not been published standards for “effective addiction treatment.” Thus, virtually any therapist, program, or service can claim expertise and effectiveness. Increasingly, insurers are demanding to see results and will monitor a patient’s stay to see if progress is being made. So when choosing a treatment program, ask specific questions to find out if the program uses practices supported by research. Find out if the program follows the latest scientific knowledge, uses credentialed mental health/addiction professionals, and prescribes medication, when available, to assist in the recovery process.

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Where to Find Help with Insurance Issues Parents should go to their employer’s human-resources department for clarification of their coverage. Rehab facilities have specialists who are expert in interpreting insurance policies. Every state has an insurance department that can provide information and compliance. A caseworker or advocate with your local social-services agency can help unravel the rules.

If the program follows evidence-based practices, you will have a better chance of having effective care and improved chances for recovery. Now, care providers have begun to establish standards of treatment. In 2007 more than 350 American health care organizations announced that they had endorsed a set of voluntary standards for the treatment of substance use conditions. Adoption of these standards by health care providers will dramatically improve the diagnosis and treatment of substance use conditions in the United States. SUD treatment organizations that use the following guidelines are more likely to meet demands by insurers: M Brief intervention, by a health care practitioner trained in this technique, for patients identified with SUDs (both drug and alcohol) M A written treatment “prescription” for needed services for all patients assessed and diagnosed with SUD M Initiation of effective psychosocial interventions for all patients referred for specialty SUD treatment M Consideration of addiction-focused pharmacotherapy for patients with alcohol or opioid dependence M Systematic activities to promote patient engagement and retention in treatment by specialty SUD providers M Processes for engaging SUD patients in long-term monitoring/management through collaboration between specialty and primary care providers


if you can’t pay If you have no insurance coverage for substance abuse treatment, and you don’t qualify for Medicaid, there are still ways to get treatment. All states have designated a lead agency to plan and administer drug and alcohol abuse prevention and addiction treatment services. This lead agency has some limited funding to provide addiction treatment services for people with no insurance or inadequate insurance coverage. Go to your state’s Web site to find the insurance-regulating office, and call or click to find out how you qualify for help. States also have special coverage for young people. Coverage and age limits vary, but some is available for substance abuse. Some nonprofit organizations have developed specialties in substance abuse treatment. Among the leaders are Catholic Charities (http://www.catholiccharitiesusa.org) and the Salvation Army (http://www.salvationarmy.org). Most of their local agencies offer substance abuse treatment at little or no cost. Check their Web sites for a nearby office. Also, look in your local telephone Yellow Pages under “Alcoholism Treatment” and its cross-references to find localarea nonprofits that might help. The federal government provides a system to reimburse hospitals for “uncompensated care”—treatment of those who can’t pay. The Hill-Burton Free Care Act provides that hospitals that receive certain federal funds are required to, in turn, offer free care to those in need. Not all hospitals or health facilities subscribe to this program, but most do. When looking for care, find out if the local hospitals that provide rehab services are covered by the Hill-Burton plan. On admission to those facilities, a patient routinely fills out an application for

To Get Help in a Hurry In case of acute need for medical care for a substance abuser, go to your local emergency room! Emergency care must be given. An ER may refer an addict or alcoholic for detoxification. In many localities, if you are a resident of the detox unit’s county or “catchment area,” you must be admitted to detox for treatment, insurance or no insurance.

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Hill-Burton funding, and the hospital can then be repaid for treatment costs. Go to http://www.hrsa.gov/hillburton for details. Finally, if you have no other options, most addiction treatment programs do provide some free services on a case-by-case basis. It’s worth asking to see if an individual “scholarship” can be arranged for treatment.

Help with Medications Now that more medications are available to treat alcoholism and drug addiction and more co-occurring conditions are recognized that require medications, the need has grown to stick with prescription drug treatment. As the cost of those medications has risen, the challenge of finding affordable pharmaceuticals is great. Pharmaceutical companies have developed ways to provide their products at a lowered cost via various sources, and many other organizations provide access as well. The National Alliance on Mental Illness reports that the Partnership for Prescription Assistance brings together America’s pharmaceutical companies, doctors and other health care providers, patient advocacy organizations, and community groups to help qualifying patients who lack prescription coverage get the medicines they need—including those for substance recovery and other mental-health issues—through the public or private program that’s right for them. The Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including more than 180 programs offered by pharmaceutical companies. To access the Partnership for Prescription Assistance by phone, you can call toll-free, (888) 4PPA-NOW [477-2669]. In order to find out what patient assistance programs you may qualify for, all you have to do is answer a few short eligibility questions. The Partnership for Prescription Assistance Web site (http://www.pparx. org) will help supply you with the information you need to get involved in a program and even allow you to download applications online. You can then follow the instructions on the application to apply. Many individual companies offer assistance as well. If you prefer to contact the manufacturer of your particular medications, you can find listings at these sites: http://www.rxassist.org and http://www. rxhope.com.

Recovery for Free For many years effective medical treatment for alcoholism and addiction didn’t exist. Increasingly during the 20th century, people turned


to free support groups like AA. That remains one piece of good news about treating substance use disorders: They are one disease (perhaps the only one) that can be treated without medical care. Today, you have many choices in nonmedical settings—free approaches. Following the programs that most of them lay out, you can move, with strong group support, from the early days of withdrawal and stabilization through the post acute “fuzzy” stages to learning about how to live happily without substances. Information is available for free too, by phone or online, about AA and NA and other groups listed in the Appendix. The recovery rate from attending 12-step meetings alone is close to that for treatment plans alone, since they are purely voluntary and have less structure than a formal program, and persistence requires a great deal of willingness and self-discipline. But those are requirements for any kind of recovery program: They work for those who want them to work. One and a half million Americans seek recovery only from support groups each year, and many of them are successful, clean, and sober. Research sponsored by NIAAA notes that AA’s and NA’s approach often results in the development of coping skills, many of which are similar to those taught in more structured psychosocial treatment settings, thereby leading to reductions in alcohol and drug consumption.

What You Need to Know M Financing for addiction and alcohol treatment is available from private and public sources. M Rules governing coverage are changing and often difficult to interpret, but expert information is available. Patients or their families may have to push and explore to get M the maximum amount of coverage. M The more scientifically based the treatment, the more likely the extensive coverage. M Emergency treatment is always available for acute symptoms of addiction or withdrawal. M Nonprofessionally led recovery through 12-step and other programs is available to anyone for free.

11 What More Can You Do?

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it can be frustrating to feel that you want to do something about addiction and keep being told there’s nothing to do but let someone find recovery—that there is not even a cure. The only true cure for substance use disorders is prevention, according to reports by, among others, the National Center on Addiction and Substance Abuse at Columbia University. You may know from personal experience how difficult it is to prevent these insidious and widespread conditions. Maybe you’re dealing with your own addiction, or you’re living with family or friends who are struggling with it. Prevention may seem impossible, especially when you think about some of the prevention campaigns that badly miss the mark. For instance, it’s only recently that antidrug programs were introduced that aimed at audiences young enough to make a difference. The fact is prevention programs do work, as demonstrated by the reduction in “hard” drug use and cigarette smoking among young people. You can be part of that prevention effort. Teens can work to prevent SUDs in themselves, in others, and in society at large.

prevention in yourSelf Use the knowledge you gain through books like this and from organizations listed at the back of this book as guides to behavior that makes sense for you. The quick take on how to prevent problems in yourself, from the U.S. Office of National Drug Control Policy, goes a step beyond “just say no.” If someone is pressuring you to do anything

1


that’s not right or good for you, you have the right to resist. You have the right to say no, the right not to give a reason why, and the right to just walk away from a situation. Resisting pressure can be hard for some people, those experts note. Why? They may be afraid of being rejected by others, or they want to be liked and don’t want to lose a friend. They don’t want to be made fun of. Perhaps they don’t want to hurt someone’s feelings, or aren’t sure of what they really want, or don’t know how to get out of the situation. Sometimes resisting isn’t easy, but you can do it with practice and a little know-how. Keep trying, even if you don’t get it right at first. Get all the facts you can about drug use and its dangers. Begin with the information you’ve read here and follow up all the facts on the links included. A great place to start is http://www.freevibe.com and www.drugabuse.gov—both well-researched sites. They focus on the facts and not the “morality” of underage drug use. Learn about your own family history. The NIAAA offers recommendations if you are among the millions of people in this country who have a parent, grandparent, or other close relative with alcoholism. Are you worried about what your family’s history of alcoholism

Turning Points Here are some life events that can make the difference between addiction and nonaddiction. M A 12-year-old does not have access to his mother’s prescriptions. M A 14-year-old’s big brother refuses to buy beer for him. M A 16-year-old turns down drugs because he plays sports and doesn’t want to get kicked off the team. M An 18-year-old getting ready for exams has no neighborhood drug dealers to buy from. These are examples of results that you can help create by taking actions in your community.

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means for you? 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? The good news is that many children of alcoholics from even the most troubled families do not develop drinking problems. 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 the child of an alcoholic parent will automatically become an alcoholic too. The risk is higher, but it does not have to happen. Awareness is the first step, and 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 commonsense advice to help you. M 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. M Drink moderately as an adult. Adults who choose to drink alcohol should do so in moderation. People with a family history of alcoholism, who have a higher risk for becoming dependent on alcohol, should approach even moderate drinking carefully. M Talk to a health care professional. Discuss your concerns about your risks with a doctor, nurse, nurse practitioner, or other health care provider. M Watch out for drugs. People with family histories of alcoholism may assume other substances are safe. In some cases there may be “an addictive personality” involved. In any case, drugs not only cause problems of their own, they can lower anyone’s ability to resist drinking. Be aware and especially careful around times of stress: According to NIDA, the key risk periods for drug abuse are during major transitions in kids’ lives. The first big transition for children is when they leave the security of the family and enter school. Later, when they advance from elementary school to middle school, they often experience new academic and social situations, such as learning to get along with a wider group of peers. This can be quite stressful, and it is at this stage—early adolescence—that children are likely to encounter drugs for the first time.


Joe’s Story: Breaking the Cycle Joe’s dad was an alcoholic. From a very early age, Joe lived through the kind of chaos that an alcoholic parent can stir up in the household: excitement, fights, disappearances. Over time, this grew worse, and soon Joe’s parents separated. His dad’s drinking escalated, and caused him to slip in and out of Joe’s life. It was scary and upsetting for little Joe, and by the time he was growing into adolescence, his dad’s behavior and lack of support made him very angry. He saw the pain it caused his mother. He made up his mind that he would never drink. Since his mother came from an alcoholic family too, she supported him and stayed away from alcohol herself. Many people have similar experiences, and they stay angry but become addicted themselves. Joe could have let his life be negatively fueled by his anger and his determination to be a nondrinker. Instead, he opted to go into therapy, and he got help in figuring out what positive paths he wanted to follow in his own life. He was able to come to terms with his father before the man died from his alcoholism. Joe made some highly personalized choices about school and career. As a young man, he became a father himself, and rather than reenacting his own childhood, he is being a careful parent to his children. He is living his own life.

When they enter high school, adolescents face additional social, emotional, and educational challenges. At the same time, they may be exposed to greater availability of drugs, to drug abusers, and to social activities involving drugs. These challenges can increase the risk that they will abuse alcohol, tobacco, and other substances. When young adults leave home for college or work and are on their own for the first time, their risk for drug and alcohol abuse is very high. Consequently, young adult interventions are needed as well. If other stressful events happen around the times of these transition periods—anything from a friend moving away to a family illness or divorce—a young person can be that much more vulnerable. Be aware and take care. Another good way to check on your own tendencies to alcoholism or addictions is to attend open meetings of AA and NA and hear


stories of people’s experiences with substance abuse. Or go online and “sit in” on meetings there. Since the meetings are open to all and anonymous, your concern stays private. But if you hear anything that you identify with, you might want to look further into your own situation.

Prevention Through Education You’ve probably gotten a lot of education over the years about drugs, but you can be a part of the education process yourself and that might be more effective. Research proved years ago that young people who drink before age 15 are four times more likely to develop serious alcohol problems than those who abstain until their 21st birthday, and school systems began to teach alcohol and other drug-prevention lessons. However, though such lessons were mandated, national surveys have shown that teachers don’t always have time for them, and they’re often offered too late anyway, since kids start using as young as eight. Drug education doesn’t happen at home either—a NIDA survey showed that only 12 percent of parents of 12th-graders thought their children had tried drugs, while 45 percent guessed they had used alcohol. Although schools can and should play a role in prevention education, they “should not be relied upon to act as the principal provider of general prevention programs,” according to Join Together, a nonprofit group focused on alcohol and drug abuse. Jim Together has studied the situation and concluded that what works best is a comprehensive community prevention strategy that includes parents and other social institutions. Communities can help prevention efforts by implementing strategies that help reduce underage drinking, such as raising alcohol taxes (the five states with the highest beer taxes have much lower rates of teen binge drinking); tightening the age and terms of driver’s licenses for adolescents; adopting social-host laws where adults who serve alcohol to minors are held accountable; controlling the number of alcohol outlets in a particular area; and doing frequent compliance checks to deter sales to minors. You can get involved with that kind of education program and feel that you’re really learning something and sharing the news too. One approach is sponsored by the White House Office of National Drug Control Policy. It has created the Freevibe Web site as part of a national effort to prevent or reduce the use of drugs among young people and finds that the ads and interactive communications they sponsor have an impact. Check it out at http://www.freevibe.com.


More effective education comes from teens themselves. Sixtyeight percent of addicts or potential addicts say they would turn to a peer for help, so who better to help with drug problems than teens themselves? That’s what the peer program is about. A peer helper program is a team of teens trained by a certified peer program educator to provide services to others. Peer helping groups may focus on one issue, such as drugs or suicide, or focus on many issues. If you think you’re a great listener and could be a great peer helper and are willing to take the time to train, you might want to consider joining or starting a peer helping program in your community or at your school.

Prevention in Society Service has always been an important part of recovery group membership. In your support group you’ll find that the more that you can do to help another in recovery, the better you can feel about yourself. You can provide that kind of rewarding service on a wider scale as well. One important way to prevent substance use disorders—in others as well as in yourself or those close to you—is to work against them. (And the more active one is in working against the problem, the greater the possibility of avoiding addiction in oneself.) The National Center for Alcohol and Substance Abuse at Columbia University notes that you don’t have to be an adult to make a real impact. Although many conflicting messages about drug and alcohol use may compete for your attention, you can empower yourself by getting informed and getting active. By making your voice heard, you can make your community a healthier place for your neighbors, your friends, and yourself. M Be a role model for your peers by making healthy lifestyle decisions about drug and alcohol use. M Help your school to organize after-school activities. M Voice your concern to friends if you think they are having a problem with alcohol or drugs. M Get involved in a community coalition or advocacy group. It is important that the youth in the community have a voice. Volunteer your time at a local family shelter or treatment cenM ter. This is not just about caring for someone who may be in trouble as the result of a substance use problem—it can show you what can happen—and it can show them that someone cares. You never know whom you might inspire.


You might start or join a chapter of Students Against Destructive Decisions (SADD). Originally the mission of SADD was to help young people say no to drinking and driving. Today, the mission has expanded. Students have explained that positive peer pressure, role models, and other strategies can help them say no to more than drinking and driving. And that is why SADD has become a peer leadership organization dedicated to preventing destructive decisions, particularly underage drinking, other drug use, impaired driving, teen violence, and teen depression and suicide. Other associations are listed at the back of this book. There are enough to choose from that you can find a group that fits you. As a teen you have an advantage in helping other young people because

Here are a couple of the many practical recovery-related issues that any teen can help with. Go to http://www.ensuringsolutions.org. Figure out the effects of young substance abuse in your area. Let people know how serious things are in their own neighborhood. M Calculate how many kids in your state have serious alcohol problems. M Calculate how many kids in your community have serious alcohol problems and calculate how much it costs society at large. Write a story about it for your school or local newspaper, or use it as the topic of a school report. Or, think about what you can do with this kind of news: “CASA’s 2007 Teen Survey Reveals America’s Schools Infested with Drugs; Popular Kids at Drug-Infested Schools Much Likelier to Get Drunk and Use Drugs.” You might join with a local group of teens to check out the conditions of their own schools or organize recovery groups for school-aged friends. Look around your neighborhood and see how you could prevent someone from getting hooked. Contact CASA (The National Center for Alcohol and Substance Abuse) at http://www.casacolumbia.org for more ideas. Check out the Web site http://www.facesandvoicesofrecovery. org for a lot of action-ideas for bringing help and attention to people affected by the disease of addiction.


they are more likely to accept a message that is not judgmental or authoritarian. A fairly new group that promotes issues that matter to people in recovery, including fair insurance coverage, is Faces and Voices of Recovery. Go to http://www.facesandvoicesofrecovery.org. This energetic non-anonymous group is one of the first signs that people affected by addictive diseases are not hiding in shame but speaking up for themselves and their own interests and concerns.

Using Your Head The more you think and observe for yourself, the more reason you’ll find not to use and to encourage others not to. For instance, now that you know more, how differently would you answer this quiz from earlier in the book? True or False? Which are true and which are false? 1. You have to use an illegal drug to be addicted. 2. You have to drink in the morning to be an alcoholic. 3. If you’ve just used alcohol or drugs for a short time, you can’t be addicted. 4. Only addicts get in trouble for using. 5. Some drugs are safer than others. 6. It’s normal for kids to “party” during their teens. 7. Alcoholism and addiction can’t be cured. 8. My best friend would tell me if he was hooked.

T/F T/F T T T T T T

/ / / / / /

F F F F F F

And how do you think your friends would answer those questions? Ask!

Be Media Smart If you want to know one big source for all the wrong ideas about SUDs, play close attention to what you hear and see. Next time you see or hear messages in ads, TV shows, online, or wherever, think about it a little. And talk about it with whoever you’re with. Keep your eyes and ears open, and you can stay independent. Be smart about the Internet too. Some sites spread misinformation about how drugs really work or spread people’s stories about their socalled adventures in the world of drugs. You’re smart enough to know that not everything you see online is true. But you can find sources of positive information online too. To keep up with real trends related to


addiction and recovery, check out http://alcohol.about.com or any of the other sites listed throughout this book and in the sections at the back. Look for sites where you can tell your own story too. When you find recovery from your own addiction or find ways to get involved in helping prevent addiction, your story becomes a powerful tool to help others.

What You Need to Know M Young people can take effective action against addiction and alcoholism. M They can educate themselves about drugs and about their own vulnerability. They can learn ways to work with other teens at risk. M They can join with others to work toward better prevention M and treatment programs. M They can become media aware so that they can help themselves and their peers to make their own responsible decisions about substances of abuse.

appenDix Associations and Support Groups The groups and organizations listed here are good sources to consider for aid or information. Note that addresses and Web site URLs are subject to change, but an Internet search of an association’s name or key related terms can turn up new Web sites and additional resources. For some groups that emphasize their online presence, only Web site URLs are listed. For quick and reliable information and referral to drug and alcohol treatment centers, use this toll-free number to reach the U.S. Department of Health and Human Services’ Center for Substance Abuse Treatment Referrals: (800) 662-HELP [4357]. (For immediate emergencies, dial 911.) These are the most thorough and reliable sources for information on all aspects of addiction and alcoholism. They can provide up-to-date facts via phone, mail, and e-mail.

governMent agencieS anD aDvocacy organizationS

Center for Substance Abuse Prevention (CSAP) Substance Abuse and Mental Health Services Administration 5600 Fishers Lane, Rockwall II Building, Suite 900 Rockville, MD 20857 (301) 443-0365 http://prevention.samhsa.gov Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration P.O. Box 2345 Rockville, MD 20847-2345 (800) 662-HELP [4357] http://csat.samhsa.gov

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Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 (800) 311-3435 http://www.cdc.gov Drug Enforcement Administration U.S. Department of Justice 2401 Jefferson Davis Highway Alexandria, VA 22301 (202) 307-1000 http://www.dea.gov Mental Health America 2000 N. Beauregard Street, 6th Floor Alexandria, VA 22311 (800) 969-6642 (800) 273-TALK [8255] (hotline) http://www.nmha.org National Alliance on Mental Illness Colonial Place Three 2107 Wilson Boulevard, Suite 300 Arlington, VA 22201-3042 (800) 950-6264 http://www.nami.org National Clearinghouse for Alcohol and Drug Information P.O. Box 2345 Rockville, MD 20847-2345 (800) 729-6686 http://www.ncadi.gov National Council on Alcoholism and Drug Dependence 12 West 21st Street, 7th Floor New York, NY 10010 (800) NCA-CALL [622-2255] http://www.ncadd.org National Institute of Mental Health 6001 Executive Boulevard, Room 8184, MSC 9663


Bethesda, MD 20892-9663 (866) 615-6464 (866) 415-8051 (TTY) [email protected] http://www.nimh.nih.gov National Institute on Alcohol Abuse and Alcoholism 5635 Fishers Lane, MSC 9304 Bethesda, MD 20892-9304 (301) 443-3860 http://www.niaaa.nih.gov National Institute on Drug Abuse 5600 Fishers Lane Rockville, MD 20857 (301) 443-1124 http://www.nida.nih.gov Office of National Drug Control Policy Drug Policy Information Clearinghouse P.O. Box 6000 Rockville, MD 20849-6000 (800) 666-3332 http://www.whitehousedrugpolicy.gov Substance Abuse and Mental Health Services Administration/ National Clearinghouse for Alcohol and Drug Information P.O. Box 2345 Rockville, MD 20847-2345 (800) SAY-NOTO [729-6686] http://www.health.org

Professional Associations

American Academy of Child and Adolescent Psychiatry 3615 Wisconsin Avenue NW Washington, DC 20016-3007 (202) 966-7300 http://www.aacap.org American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village, IL 60007


(847) 434-4000 http://www.aap.org American Psychological Association 750 First Street NE Washington, DC 20002-4242 (800) 374-2121 http://www.apa.org American Society of Addiction Medicine 4601 N. Park Avenue, Upper Arcade #101 Chevy Chase, MD 20815 (301) 656-3920 http://www.asam.org Center on Addiction and Substance Abuse Columbia University 633 Third Avenue, 19th Floor New York, NY 10017-6706 (212) 841-5200 http://www.casacolumbia.org

Support Groups These groups provide free mutual emotional and personal support for people dealing with virtually every aspect of substance abuse. Most have local or regional meetings, and many offer connections via the Internet and telephone. They provide informational literature as well as interpersonal interaction. Some (mostly, those with “anonymous” in their name) take the “12-step” approach; others do not. Adult Children of Alcoholics P.O. Box 3216 Torrance, CA 90510 (310) 534-1815 http://www.adultchildren.org Al-Anon/Alateen Family Group Headquarters, Inc. P.O. Box 862 Midtown Station New York, NY 10018-0862


(888) 4AL-ANON [425-2666] http://www.al-anon.alateen.org Alcoholics Anonymous World Services, Inc. 475 Riverside Drive New York, NY 10115 (212) 870-3400 http://www.alcoholics-anonymous.org http://www.aa-intergroup.org (for online AA groups) Children of Alcoholics Foundation, Inc. 555 Madison Avenue, 20th Floor New York, NY 10022 (800) 359-COAF [2623] http://www.coaf.org Cocaine Anonymous World Service Office 3740 Overland Avenue, Suite C Los Angeles, CA 90034 (800) 347-8998 http://www.ca.org Families Anonymous P.O. Box 35475 Culver City, CA 90231 (800) 736-9805 http://www.familiesanonymous.org Marijuana Anonymous World Services P.O. Box 2912 Van Nuys, CA 91404 (800) 766-6779 http://www.marijuana-anonymous.org Nar-Anon Family Group Headquarters, Inc. P.O. Box 2562 Palos Verdes Peninsula, CA 90274 (310) 547-5800 http://www.nar-anon.org


Narcotics Anonymous P.O. Box 9999 Van Nuys, CA 91409 (818) 773-9999 http://www.na.org National Association for Children of Alcoholics 11426 Rockville Pike, Suite 301 Rockville, MD 20852 (301) 468-0985 http://www.nacoa.net Rational Recovery Systems P.O. Box 800 Lotus, CA 95651 (800) 303-CURE [2873] http://www.rational.org Secular Organizations for Sobriety P.O. Box 5 Buffalo, NY 14215 (310) 821-8430 http://www.secularsobriety.org Women for Sobriety P.O. Box 618 Quakertown, PA 18951 (800) 333-1606 http://www.womenforsobriety.org

Action Organizations These groups are organized to be more active in working against addictions than those whose purpose is information or support. All offer Web sites for information or opportunities for involvement. Community Anti-Drug Coalitions of America 625 Slaters Lane, Suite 300 Alexandria, VA 22314 (800) 542-2322 http://www.cadca.org


Drug Strategies, Inc. 1616 P Street NW, Suite 220 Washington, DC 20036 (202) 289-9070 http://www.drugstrategies.org Faces and Voices of Recovery 1010 Vermont Avenue, Suite 708 Washington, DC 20005 (202) 737-0690 http://www.facesandvoicesofrecovery.org Join Together 715 Albany Street, Suite 580 Boston, MA 02118 (617) 437-1500 http://www.jointogether.org Latino Behavioral Health Institute P.O. Box 1008 Thousand Oaks, CA 91360 (818) 831-3395 http://www.lbhi.org Mothers Against Drunk Driving 511 E. John Carpenter Freeway, Suite 700 Irving, TX 75062 (214) 744-6233 (800) GET-MADD [438-6233] (victim hotline) http://www.madd.org National Asian Pacific American Families Against Substance Abuse 340 East 2nd Street, Suite 409 Los Angeles, CA 90012 (213) 625-5795 http://www.napafasa.org National Families in Action 2957 Clairmont Road NE, Suite 150 Atlanta, GA 30329 (404) 248-9676 http://www.nationalfamilies.org


National Hispanic/Latino Community Prevention Network P.O. Box 33800 Los Angeles, CA 90033 (916) 442-3760 National Prevention Network National Association of State Alcohol/Drug Abuse Directors 1025 Connecticut Avenue NW, Suite 605 Washington, DC 20036 (202) 293-0090 http://www.nasadad.org/index.php?doc_id=6 National PTA Drug and Alcohol Abuse Prevention Project 330 North Wabash Avenue, Suite 2100 Chicago, IL 60611-3690 (800) 307-4782 http://www.pta.org Office of Safe and Drug-Free Schools U.S. Department of Education (DoE) (800) 872-5327 http://www.ed.gov/about/offices/list/osdfs/index.html Parent to Parent http://www.p2pusa.org Partnership for a Drug-Free America 405 Lexington Avenue, Suite 1601 New York, NY 10174 (212) 922-1560 http://www.drugfreeamerica.org PRIDE Youth Programs 3610 DeKalb Technology Parkway, Suite 105 Atlanta, GA 30340 (800) 853-7867 http://www.prideyouthprograms.org Students Against Destructive Decisions SADD National 255 Main Street Marlborough, MA 01752 (877) SADD-INC [723-3462] http://www.sadd.org

gloSSary absorption The process by which elements move from outside of the body into the blood and other tissues. Food is absorbed through the stomach and intestines. When tobacco is smoked, nicotine is absorbed through the lungs. acute Refers to a disease or condition that has a relatively rapid onset, marked intensity, and a short duration. addiction A chronic brain disorder characterized by the loss of control of drug-taking behavior, despite adverse health, social, or legal consequences to continued drug use. Addiction is characterized by relapses during recovery and by long-lasting chemical changes in the brain. adolescence The period of human maturation between about ages 12 and 20, during which the brain and the body’s reproductive organs are undergoing critical development processes. AIDS (Acquired Immunodefi ciency Syndrome) A condition characterized by a potentially fatal defect in the body’s natural immunity to diseases. alcohol A complex psychoactive drug found in beverages such as beer, wine, and whiskey. Alcohol is a depressant drug with potential for abuse and addiction. alcoholism A primary, chronic disease with genetic, psychosocial, and environmental factors influencing its development and manifestations. The disease is often progressive and fatal. It is characterized by continuous or periodic impaired control over drinking, preoccupation with the drug alcohol, and use of alcohol despite adverse consequences. amphetamine Stimulant drug whose effects are very similar to cocaine. amyl nitrite A yellowish oily volatile liquid used in certain diagnostic procedures and prescribed to some patients for heart pain. Illegally diverted ampules of amyl nitrite are called “poppers” or “snappers” on the street. analgesics A group of medications that reduce pain.

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Glossary 141

anesthetic An agent that causes insensitivity to pain and is used for surgeries and other medical procedures. barbiturates Depressant drugs that produce relaxation and sleep. Sleeping pills such as pentobarbital and secobarbital are barbiturates. blackouts A kind of amnesia during which drinkers may act normal but not be conscious of their behavior. blood-brain barrier A network of tightly packed cells in the walls of capillaries in the brain that prevents many molecules, including poisons, from entering the brain. Psychoactive substances are capable of penetrating the barrier. brainstem The major route by which the forebrain sends information to, and receives information from, the spinal cord and peripheral nerves. buprenorphine A long-lasting opiate analgesic that has both opiate agonist and antagonist properties. Buprenorphine may be useful for treating heroin addiction. caffeine A mild stimulant found in coffee and kola nuts. Caffeine is the most widely used drug in the world. cannabis The botanical name for the plant from which marijuana comes. carcinogen Any substance that causes cancer. cardiovascular system The heart and blood vessels. central nervous system The brain and spinal cord. cerebellum A portion of the brain that helps regulate posture, balance, and coordination. cerebral cortex The outer layer of the cerebral hemispheres that controls conscious experience, including perception, emotion, thought, and planning. cerebral hemispheres The two specialized halves of the brain. The left hemisphere is specialized for speech, writing, language, and calculation; the right hemisphere is specialized for spatial abilities, face recognition in vision, and some aspects of music perception and production. cerebrum The upper part of the brain consisting of the left and right hemispheres. chemical dependency The stage of substance abuse when substance users continue their pattern of drug use in spite of incurring significant problems in their lives. chronic Refers to a disease or condition that persists over a long period of time. coca The plant Erythroxylon, from which cocaine is derived. Also refers to the leaves of this plant.


cocaethylene A substance created in the body when cocaine and alcohol are used together; chemically similar to cocaine. cocaine A highly addictive stimulant drug derived from the coca plant that produces profound feelings of pleasure. cognitive-behavioral therapy (CBT) A form of interpersonal psychotherapy used in treating addictions, based on the idea that feelings and behaviors are caused by a person’s thoughts rather than outside influences. The goal of cognitive-behavioral therapy is to get the person to learn or relearn better coping skills. crack Slang term for a smokeable form of cocaine. craving A powerful, often uncontrollable desire for drugs, caused by drug-induced changes that arise from a need of the brain to maintain a condition created by the presence of the drug. dendrite The specialized branches that extend from a neuron’s cell body and function to receive messages from other neurons. depressants Drugs that relieve anxiety and produce sleep. Depressants include barbiturates, benzodiazepines, and alcohol. dopamine A brain chemical, classified as a neurotransmitter, found in regions of the brain that regulate movement, emotion, motivation, and when released by the brain-reward system, feelings of pleasure. drug A chemical compound or substance that can alter the structure and function of the body. drug abuse The repeated use of illegal drugs or the inappropriate use of legal drugs, to change mood or alter perceptions of reality. drug addiction The continued compulsive use of drugs in spite of adverse health or social consequences. Drug addiction is a complex brain disease. It is characterized by compulsive, at times uncontrollable drug craving, seeking, and use that persists even in the face of extremely negative consequences. ecstasy (MDMA) A chemically modified amphetamine that has hallucinogenic as well as stimulant properties. electroencephalogram (EEG) A graphic record of the electrical activity of the brain made by attaching electrodes to the scalp. emphysema A lung disease in which tissue deterioration results in increased air retention and reduced exchange of gases. The result is difficult breathing and shortness of breath. It is often caused by smoking. endorphins Brain chemicals with opiatelike effects that bind to opiate receptors. Endorphins are made by neurons and used as neurotransmitters. enzyme A large molecule that living organisms use to catalyze chemical reactions. Enzymes are used to build, modify, or break

Glossary 143

down different molecules without themselves being permanently altered or destroyed. ether A volatile liquid with a characteristic odor. Used as a medical anesthetic gas. euphoria A feeling of extreme well-being or elation. forebrain The largest division of the brain, which includes the cerebral cortex and basal ganglia. It is credited with the highest intellectual functions. frontal lobe One of the four divisions of each cerebral hemisphere. The frontal lobe is important for controlling movement and associating the functions of other cortical areas. hallucinations Perceptions of something (such as a visual image or a sound) that does not really exist. Hallucinations usually arise from a disorder of the nervous system or in response to drugs (such as LSD). hallucinogens A diverse group of drugs that alter perceptions, thoughts, and feelings. Hallucinogenic drugs include LSD, mescaline, MDMA (ecstasy), PCP, and psilocybin (“magic mushrooms”). hangover Sick feelings following a drinking episode. hepatitis Inflammation of the liver. heroin The potent, widely abused opiate that produces addiction. It consists of two morphine molecules linked together chemically. hippocampus A brain structure that is involved in emotions, motivation, learning, and memory. HIV (human immunodeficiency virus) The virus that causes AIDS (acquired immunodeficiency syndrome). hormone A chemical substance formed in glands in the body and carried in the blood to organs and tissues, where it influences function, structure, and behavior. hypothalamus The part of the brain that controls many bodily functions, including feeding, drinking, and the release of many hormones. ingestion The act of taking in food or other material into the body through the mouth. inhalant Any drug administered by breathing in its vapors. Inhalants commonly are organic solvents, such as glue and paint thinner, or anesthetic gases, such as ether and nitrous oxide. inhalation The act of administering a drug or combination of drugs by nasal or oral respiration. injection A method of administering a substance such as a drug into the skin, subcutaneous tissue, muscle, blood vessels, or body cavities, usually by means of a needle.


limbic system A set of brain structures that generates our feelings, emotions, and motivations. It is also important in learning and memory. LSD (lysergic acid diethylamide) A hallucinogenic drug that acts on the serotonin receptor. magnetic resonance imaging (MRI) An imaging technique that uses magnetic fields to take pictures of the structure of the brain. marijuana A drug, usually smoked but sometimes eaten, that is made from the leaves of the cannabis plant. The main psychoactive ingredient is THC. medication A drug that is used to treat an illness or disease according to established medical guidelines. metabolism The processes by which the body breaks things down or alters them so they can be eliminated. methadone A synthetic opiate used to treat cancer pain and heroin addiction. methamphetamine A commonly abused, potent stimulant drug that is part of a larger family of amphetamines. morphine The most potent natural opiate compound produced by the opium poppy. Morphine is a very effective medicine for treating pain. naltrexone An opiate antagonist used to treat heroin addiction and more recently for the treatment of alcohol addiction. neuron (nerve cell) A unique type of cell found in the brain and body that is specialized to process and transmit information. neurotransmission The process that occurs when a neuron releases neurotransmitters to communicate with another neuron across the synapse. neurotransmitter A chemical produced by neurons to carry messages to other neurons. nicotine The addictive drug in tobacco. Nicotine activates a specific type of acetylcholine receptor. nitrous oxide Medical anesthetic gas, especially used in dentistry. Also called “laughing gas.” Found in whipped-cream dispensers and gas cylinders. noradrenaline A chemical neurotransmitter that is made in the brain and can affect the heart. norepinephrine A neurotransmitter and a hormone. It is released by the sympathetic nervous system onto the heart, blood vessels, and other organs, and by the adrenal gland into the bloodstream as part of the fight-or-flight response. Norepinephrine in the brain is used as a neurotransmitter in normal brain processes.

Glossary 145

occipital lobe The lobe of the cerebral cortex at the back of the head that includes the visual cortex. opiate receptors Receptors that recognize both opiates and endogenous opioids. When activated, they slow down or inhibit the activity of neurons on which they reside. opiates Any of the psychoactive drugs that originate from the opium poppy or that have a man-made chemical structure like the drugs derived from opium. opioid Any chemical that has opiatelike effects; commonly used to refer to endogenous neurochemicals that activate opiate receptors. parietal lobe One of the four subdivisions of the cerebral cortex; it is involved in sensory processes, attention, and language. physical dependence An adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped. pituitary gland An endocrine organ closely linked with the hypothalamus. The pituitary secretes a number of hormones that regulate the activity of other endocrine organs in the human body. polyneuropathy Permanent change or malfunction of nerves. Can lead to sudden sniffing death—this can occur when inhaled fumes fill up the cells in the lungs with poisonous chemicals, leaving no room for the oxygen needed to breathe. This lack of oxygen can lead to suffocation, respiratory failure, and death. progression A characteristic of addictive diseases, which are marked by the increasing need (tolerance) for a drug to maintain a comfortable level, despite the deterioration of the user’s condition. psychedelic drug A drug (like LSD or PCP) that dramatically distorts perception, thought, and feeling. psychoactive drug A drug that changes the way the brain works. psychosocial therapy Therapy that uses a combination of individual psychotherapy and group (social) therapy approaches to rehabilitate or provide the interpersonal and intrapersonal skills an addict needs to live without drugs. receptor A large molecule that recognizes specific chemicals (like neurotransmitters or hormones) and transmits the message carried by the chemical into a cell. relapse In drug abuse, relapse is the resumption of drug use after trying to stop taking drugs. reward system (or brain reward system) A brain circuit that, when activated, reinforces behaviors. The circuit includes the dopamine-containing neurons of the ventral tegmental area and


part of the prefrontal cortex. The activation of this circuit causes feelings of pleasure. rush A surge of pleasure that rapidly follows administration of some drugs. sensitization An increased response to a drug caused by repeated administration. Sensitization is most commonly seen in some responses to stimulants. serotonin A neurotransmitter that regulates many functions, including mood, appetite, and sensory perception. stimulants A class of drugs that has a powerful effect on the reward system, elevating mood, increasing feelings of wellbeing, energy, and alertness. Stimulants include cocaine, methamphetamine, and methylphenidate (Ritalin). synapse The site between neurons across which the nerve cells communicate with each other. temporal lobe One of the four major subdivisions of each hemisphere of the cerebral cortex. It functions in auditory perception, speech, and visual perceptions. tetrahydrocannabinol (THC) The active ingredient in marijuana that is primarily responsible for producing the drug’s psychoactive effects. tobacco A plant widely cultivated for its leaves, which are used primarily for smoking. tolerance A condition in which higher doses of a drug are required to produce the same effect as during initial use; often leads to physical dependence. toluene A light, colorless liquid solvent found in many commonly abused inhalants, including airplane glue, paint sprays, and paint and nail polish removers. transporter A large protein on the cell membrane of the axon terminals. It removes neurotransmitter molecules from the synapse by carrying them back into the axon terminal that released them. ventral tegmental area (VTA) The group of dopamine-containing neurons that make up a key part of the brain reward system. vertigo The sensation of dizziness. withdrawal Symptoms that occur after chronic use of a drug is reduced or stopped. Definitions were adapted from a variety of sources, including NIDA (http://www.drugabuse.gov), the National Institutes of Health, and the Society for Neuroscience.

reaD More about it nonfiction anD reference These are additional resources for detailed information about aspects of alcoholism and addiction. Bellenic, Karen, ed. Tobacco Information for Teens. Detroit, Mich.: Omnigraphics, 2007. Borchert, William. The Lois Wilson Story: When Love Is Not Enough: The Authorized Biography of the Co-Founder of Al-Anon. Center City, Minn.: Hazelden, 2005. Cheever, Susan. My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous. New York: Simon & Schuster, 2004. Colvin, Rod. Prescription Drug Addiction: The Hidden Epidemic. Omaha, Nebr.: Addicus Books, 2002. DiClemente, Carlo C. Addiction and Change: How Addictions Develop and Addicted People Recover. Center City, Minn.: Hazelden, 1996. Friel, John, and Linda Friel. Adult Children: The Secrets of Dysfunctional Families. Deerfield Beach, Ill.: Health Communications, 1990. Gerdes, Louse L., ed. Addiction. Farmington Hills, Mich.: Gale Publishing, 2004. Johnson, Marlys C., and Phyllis Alberici. Cross-Addiction: The Hidden Risk of Multiple Addictions. New York: Rosen, 1998. Lessa, Nicholas R., and Walter F. Scanlon. Substance Use Disorders. Hoboken, N.J.: John Wiley & Sons, 2006. Nagle, Jeanne M. Everything You Need to Know about Drug Addiction. New York: Rosen, 1998. Nakken, Craig. The Addictive Personality: Understanding the Addictive Process. New York: HarperCollins, 1988. Rebman, Renée C. Addictions and Risky Behaviors: Cutting, Bingeing, Snorting, and Other Dangers. Berkeley Heights, N.J.: Enslow, 2006. Woititz, Janey G. Adult Children of Alcoholics. Deerfield Beach, Ill.: Health Communications Inc., 1990.

1


Self-Help These are reliable guides to finding your way through problems related to addiction and alcoholism. Alateen. A Day at a Time. New York: Al-Anon Family Group Headquarters, Inc., 1983. Alcoholics Anonymous World Services. Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism. 4th ed. New York: AAWS, 2001. Covey, Sean. The 6 Most Important Decisions You’ll Ever Make: A Guide for Teens. New York: Simon & Schuster, 2006. Drews, Toby Rice. Getting Them Sober: An Introduction to Al-Anon and Alateen. Baltimore, Md.: Recovery Communications Inc., 1998. Gilbert, Sara D. Trouble at Home. New York: Lothrop, l981. ———. What Happens in Therapy. New York: Lothrop, 1982. ———. Get Help. New York: Morrow Jr. Books, 1989. Hazelden. How Teens Help Friends with Alcohol. Center City, Minn.: Hazelden/Wisconsin Clearinghouse, 1999. Kettlehack, Guy. First-Year Sobriety: When All That Changes Is Everything. New York: Harper Sobriety Series, 1998. ———. Sober and Free: Making Your Recovery Work for You. New York: Simon and Schuster, 1996. Narcotics Anonymous Worldwide. Narcotics Anonymous. Van Nuys, Calif.: NAWS, 1988. Roos, Stephen. A Young Person’s Guide to the Twelve Steps. Center City, Minn.: Hazelden, 1992.

Inspiration and Personal Experience

The books listed here reflect more individual approaches to recovery. AA Grapevine. In Our Own Words: Stories of Young AAs in Recovery. New York: AA Grapevine Inc., 2007. Anonymous. Go Ask Alice. New York: Simon & Schuster, 1971. Beckman, Chris. Clean: A New Generation in Recovery Speaks Out. Center City, Minn.: Hazelden, 2005. Black, Claudia. My Dad Loves Me, My Dad Has a Disease: A Child’s View: Living with Addiction. San Francisco: MAC Publishing, 1997. D., Lisa. Stepping Stones to Recovery for Young People: Experience the Miracle of 12 Step Recovery. Center City, Minn.: Hazelden, 1991.

Read More More about AboutItIt 149 Read Ketcham, Katherine, and William C. Moyers. Broken: My Story of Addiction and Redemption. Center City, Minn.: Hazelden, 2006. Marshall, Shelly. Young Sober and Free. 2nd ed. Center City, Minn.: Hazelden, 2003. McGinnis, Sheryl Letzgus, and Heiko Ganzer. I Am Your Disease: The Many Faces of Addiction. Parker, Colo.: Outskirts Press, 2006. Roper, Dr. Charles N., Ph.D. High Bottom Drunk: A Novel . . . and the Truth about Addiction & Recovery. Buda, Tex.: Small Change Publishing, 2000. Volkmann, Chris, and Toren Volkmann. From Binge to Blackout: A Mother and Son Struggle with Teen Drinking. New York: Penguin, 2006. White, W. Let’s Go Make Some History: Chronicles of the New Addiction Recovery Advocacy Movement. Washington, D.C.: Johnson Institute and Faces and Voices of Recovery, 2006. Zailckas, Koren. Smashed: Story of a Drunken Girlhood. New York: Viking/Penguin, 2006.

Web Sites

These are some of the most useful informational and support Web sites on alcoholism and addiction. You will find many more as you surf the Web. Take care, as always when getting information from the Internet, that the source material is reliable. Government and recognized professional associations are your best resources on these topics. About.com: Alcoholism http://www.alcoholism.about.com About.com is an excellent resource for information on a variety of topics. The alcoholism section at this site offers information, news updates, and reliable links on all aspects of addiction. Bubblemonkey.com http://www.bubblemonkey.com Gives teens anonymous access to accurate information about drugs, from Drug Strategies, a nonprofit research institute. Faces and Voices of Recovery http://www.facesandvoicesofrecovery.org An advocacy group for people in all aspects of recovery. Freevibe.com http://www.freevibe.com


An interactive site with helpful information on all aspects of addiction and recovery, from the National Youth Anti-Drug Media Campaign of the White House Office of Drug Control Policy. National Institute on Drug Abuse http://www.drugabuse.gov A division of the National Institutes of Health, NIDA’s Web site provides information on all aspects of drug abuse, particularly the effects of drugs on the brain and body, in easy-to-use format. NIDA also has a site specially designed for teens: http://teens. drugabuse.gov. National Mental Health Information Center http://www.mentalhealth.org A useful site of the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA). TeensHealth http://www.kidshealth.org/teen Straight talk on all health topics from the Nemours Foundation.

inDex A AA. See Alcoholics Anonymous absorption 19, 23 acamprosate 84, 100 acetaminophen 57 acne 55 action stage of change 66, 113 acupuncture 85 addiction. See also specific addictions age of addiction 2, 10, 13, 28, 56 awareness 66–68 causes of 32–43 chemical 50 chronic nature of 7 dangers of 54–64 defined 3 disability 8 disease of 6–7, 8, 13, 15, 30–31, 44–45, 68–69 education and prevention 127–128 family/friend, helping with 104–114 family history 2, 38, 124–125 fear in 69 long-term dangers 2 multiple, treatment of 84 paying for care 115–122 perceptions of addicts 2 prevention 123–130 progression 16, 27–31 recovery, resisting 68–70 research 8, 30–31 shame of 69–70 signs/symptoms of 29, 44–53

stages of 49–50 stages of change 65–66, 74 substance use disorders 3–6 symptoms 3–4 treatable brain disorder 8, 13 ADHD. See attention-deficit/ hyperactivity disorder adolescence period 54, 94, 125–126 advertising 42. See also media influences age of addiction. See addiction, age of AIDS 23, 56 Al-Anon 108, 109, 110, 114 Alateen 108, 114 alcohol 16–17 abuse 49 addiction. See addiction affect on brain 4–6, 54–55 age of addiction. See addiction, age of age of first use 28–29 alcoholism 2, 4–5. See also addiction avoidance using scare tactics 3 children of alcoholics 113–114 dangers of 56–57, 61 dependence 49 family influences 38 genetics and use 37–39 impact on daily life 58–59 interaction with drugs 57 legal issues 54, 64, 127 mental illness 59 parental use 38 physical side effects 48–49

151

152 Index research 30–31 stages of abuse. See addiction, stages of treatment 79. See also treatment programs use statistics 10, 20 “Alcohol and Drug Services Cost Study” 116 Alcoholics Anonymous (AA) 45, 52, 68, 70, 81, 88, 91, 93–94, 103, 108, 115, 122, 126–127 alcoholism. See alcohol, alcoholism alprazolam 21, 26. See also benzodiazepines American Medical Association 6, 15 American Psychiatric Association 7, 39 Americans with Disabilities Act 8 amphetamines 18 angel dust. See PCP Antabuse 83, 84 antisocial personality disorder 86 anxiety disorder 86 associations, listing of 132–139 Ativan 79. See also benzodiazepines attention-deficit/hyperactivity disorder (ADHD) 39, 52 attitude in recovery/treatment 66, 86, 97, 113 automobile crashes 56 awareness stage of recovery 66–68, 113, 125

B BAC. See blood alcohol concentration “bad behavior” 45–46 barbiturates 21. See also depressants behavioral therapy treatment element 82 benzodiazepines 21, 24, 79. See also depressants binge drinking 56 “biopsychosocial” disorder 4

bipolar disorder 59, 86 black beauties. See amphetamines blackouts 17, 48–49 blood alcohol concentration (BAC) 58 blow. See cocaine/crack body, long-term damage 55–57 brain addiction and 35–36 addiction as treatable disorder of 8 cerebral cortex 32–33 damage 54–55 depressants and activity of 21 dopamine production. See dopamine drug addiction as complex disease of 7, 13 drugs and activity of 33–34 effects from alcoholism 4–5 judgment center 9–10, 64 lobes 32–33 nicotine and 21 occipital lobe 32 recovery and 99 research on adolescent 54, 64 size 55 Breathalyzer tests 72 bulimia 86 bumble bees. See amphetamines Buprenex 79

C C. See cocaine/crack caffeine 3 CAGE survey 47 CAMI. See chemically addicted and also mentally ill (CAMI) Campral 84 cancer 56 cannabis. See marijuana CASA (Center for Alcohol and Substance Abuse) 123, 128, 129 “catchment area” 120

Index 153 Catholic Charities 120 CBT. See cognitive behavioral therapy Center for Alcohol and Substance Abuse. See CASA Center for Medical Literacy 41 Centers for Disease Control and Prevention, U.S. 56 central nervous system (CNS) 21 cerebral cortex 32–33 chemical addiction 50 chemical dependency (symptom of addiction) 50 chemical dependency counselors 70 chemically addicted and also mentally ill (CAMI) 40 chewing tobacco 19. See also nicotine chlordiazepoxide 21. See also benzodiazepines cigarettes. See nicotine cirrhosis 55 club drugs 23–25. See also hallucinogens CNS. See central nervous system coaethylene 27 cocaine/crack 10, 18–19, 28, 59, 62, 80 cocaine psychosis 62 coca plant 18 codeine 22 “co-dependency” concepts 110 cognitive behavioral therapy (CBT) 72, 82 coke. See cocaine/crack coke bugs 62 “cold turkey” 77, 78. See also treatment programs Columbia University 10, 123, 128 Community Reinforcement and Family Training. See CRAFT comorbid 85 contemplation stage of change 66, 74 control, loss of (symptom of addiction) 4

copilots. See amphetamines cough syrup 3 counseling/psychotherapy treatment element 82 counselors. See therapists/counselors crack. See cocaine/crack CRAFT (Community Reinforcement and Family Training) 109 crank. See methamphetamines craving (symptom of addiction) 4 criminal convictions 56–57 croak. See methamphetamines crypto. See methamphetamines crystal. See amphetamines crystal ice. See methamphetamines crystallized methamphetamine 61, 80. See also methamphetamines

D Darvon. See propoxyphene date rape drugs 25 De Bellis, Michael D. 55 delirium tremens (D.T.’s) 79 delta-9-tetrahydrocannabinol (THC) 17 delusions 18 Demerol. See meperidine dendrites 33 denial 4, 7, 13, 45, 68–69 Depade 84 depressants 14, 21–22, 31, 59 depression 59, 86 designer drugs 24. See also club drugs detox. See detoxification detoxification 78–80 Dexedrine. See dextroamphetamine dextroamphetamine 26. See also stimulants diabetes 55 diazepam 21, 26. See also benzodiazepines Dilaudid. See hydromorphone

154 Index disability considerations 8 disease. See addiction, disease of dishonesty (characteristic of substance abuse) 44–45, 46, 53 dopamine 16, 26, 28, 33, 43, 55, 99 downers. See depressants down regulation 33 DNA research 37–38 driver’s license 57, 127 driving under the influence (DUI) 57 Drug-Induced Rape Prevention and Punishment Act 25 drug interaction 57 drugs, categories of 16–27 drug use abuse, stages of. See addiction, stages of addiction. See addiction avoidance using scare tactics 3 brain activity and 33–34 dangers of 56–57 history of 14–16 impact on daily life 58–59 injection 56 legal issues 15, 54, 64 mental illness 59 physical side effects 49 research 30–31 treatment 79–80. See also treatment programs “drying-out” farm 77, 83. See also treatment programs D.T.’s. See delirium tremens (D.T.’s) DUI. See driving under the influence (DUI) Duke University Medical Center 5

E easy lay. See GHB ecstasy 24. See also club drugs education and prevention of addiction 127–128 emphysema 61

enabling characteristics 105–106 epinephrine 60 estazolam. See also benzodiazepines ethanol 16 euphoria 17 “evidence-based treatments” 118–119

F Faces and Voices of Recovery 118, 130 family and addiction 101–102, 104–114 family history. See addiction, family history fear in addiction 69 fire. See methamphetamines flake. See cocaine/crack flashbacks 23 flunitrazepam. See Rohypnol Food and Drug Administration, U.S. 85 Ford, Betty 100 formication 18 freebase 19 Freevibe Web 127 friendships and addiction 97–98, 104–114

G GABA. See gamma-aminobutyric acid Gallup poll 105 gamma-aminobutyric acid (GABA) 21 gangster. See marijuana ganja. See marijuana gateway drugs 57 genetic inheritance. See genetics genetics 2, 37–39, 43 Georgia home boy. See GHB GHB 25. See also club drugs glass. See methamphetamines grades, failing 58–59 grass. See marijuana

Index 155

H hallucinogens 14, 23–24, 59, 62–63 hangovers 17, 59 hard drugs 10 harm reduction 89 hashish. See marijuana Hazelden treatment center 9 HBO 102, 105, 111, 115, 116 heart problems 55 hearts. See amphetamines Health, U.S. Department of 60, 69 health insurance coverage, rules of 115–119 Healthy Childhood Brain Development Research Program 55 hepatitis 18, 23, 55, 56 hepatitis B 85 hepatitis C 56, 85 herb. See marijuana heroin 3, 22–23, 79–80 Hill-Burton Free Care Act 120–121 “hippie” culture 15 HIV 18, 23, 56, 85 “Hole in the Nation’s Soul” 40–41 homicides 56 honesty in treatment success 87, 88 hydrocodone 22, 26 hydromorphone 22

I ice. See methamphetamines infectious diseases 23 infertility 56 inhalants 63–64 injection drug use 56 insurance coverage. See health insurance coverage, rules of interaction (drug) 57 intervention 71, 108–109

J Join Together 127

Journal of Substance Abuse Treatment 109 Journal of the American Academy of Child and Adolescent Psychiatry 41 judgment impairment 9–10, 64 Jung, Carl 88 “Just Say No” campaign 123–124

K ketamine 25. See also club drugs

L LAAM. See levo-alpha-acetylmethadol levo-alpha-acetylmethadol (LAAM) 84, 85 Librium 79. See also chlordiazepoxide lifestyle changes 95–96, 100 limbic system 28, 33–34 liquid ecstasy. See GHB liver damage 55, 56, 57 Lortab 80 loveboat. See PCP LSD 23. See also hallucinogens Lucy in the sky with diamonds. See LSD lysergic acid diethylamide. See LSD

M “magic” mushrooms. See PCP magnetic resonance imaging 55 maintenance stage of change 66 marijuana 3, 5, 10, 17, 20, 28, 57, 60, 80 “Martyr” role in enabling 106 Mary Jane. See marijuana MDMA. See ecstasy Mebaral. See mephobarbital media influences 41–42, 43, 130– 131 Medicaid 116, 117 medications. See prescription drugs

156 Index memory 64 mental illness 7, 13, 39–40, 43, 59 mentally ill and chemically addicted (MICA) 40 meperidine 22 mephobarbital. See also barbiturates mescaline. See PCP MET. See motivational enhancement therapy metabolism 19 meth. See methamphetamines methadone 79, 85 methamphetamines 18, 61–62. See also amphetamines methylene-dioxymethamphetamine. See ecstasy methylphenidate 26. See also stimulants MI. See motivational interviewing MICA. See mentally ill and chemically addicted “moderation management” 89 morphine 22 motivational enhancement therapy (MET) 72, 82 motivational interviewing (MI) 82 Moyers, William C. 9

N NACoA. See National Association for Children of Alcoholics naltrexone 81, 84, 100 narcotics 22–23, 26 Narcotics Anonymous 45, 50–52, 70, 81, 88, 122, 126–127 National Alliance on Mental Illness 121 National Association for Children of Alcoholics (NACoA) 113–114 National Center on Addiction and Substance Abuse. See CASA National Clearinghouse for Alcohol and Drug Information 59, 60

National Council on Alcoholism and Drug Dependence 7, 77 National Governors Association 117 National Institute on Alcohol Abuse and Alcoholism (NIAAA) 2, 10, 102, 113, 122, 124–125 National Institute on Drug Abuse (NIDA) 6, 8, 19, 28, 38, 87, 99, 125–126, 127 National Institutes of Health 6, 35, 56, 58, 81 National Survey on Drug Use and Health (NSDUH) 20, 65, 66, 83 Nembutal. See phenobarbital neuron 33 neurotransmitter 21, 33–34 NIAAA. See National Institute on Alcohol Abuse and Alcoholism nicotine addiction to 3, 15–16 dangers of 60–61 described 19–21 effects of 60–61 legal issues 54, 64 teens’ smoking patterns 42 NIDA. See National Institute on Drug Abuse norepinephrine 26 NSDUH. See National Survey on Drug Use and Health

O occipital lobe 32 Office of National Drug Control Policy. See White House Office of National Drug Control Policy ONDCP. See White House Office of National Drug Control Policy online support groups 102 open-mindedness in treatment success 87, 88 opiates 22, 79 opioids 22

Index 157 opium poppy 22 outpatient services 72, 80, 91 overdose 22, 23, 80 over-the-counter drugs and products 26–27 oxycodone 22, 26 OxyContin 80. See also oxycodone ozone. See PCP

P pancreatitis 55 panic disorder 86 parental alcoholism 38 Partnership for Prescription Assistance 121 PAWS. See Post Acute Withdrawal Syndrome paying for care 115–222 PCP 23–24, 63. See also hallucinogens peace tablets. See LSD peer pressure 41 peer program educational program 128 pep pills. See amphetamines Percocet 26 peyote. See PCP phencyclidine. See PCP phenobarbital. See also barbiturates physical dependency (symptom of addiction) 4, 13, 48–49 “pleasure pathway” 34 Post Acute Withdrawal Syndrome (PAWS) 81, 88 post-traumatic stress disorder (PTSD) 39, 87 pot. See marijuana precontemplation stage of change 66, 74 pregnancy 56 preparation stage of change 66, 74 prescription drugs 25–26 abuse of 2 addictive ingredients 3

treatment element 82 legal issues 54 narcotics 26 paying for 121 sedatives 26 stimulants 26 in treatment programs 79, 80, 83–86, 95 prevention of addiction 123–130 progression of addiction. See addiction, progression propoxyphene 22 ProSom. See estazolam Provider role in enabling 106 psilocybin. See PCP psychedelic drugs 23. See also hallucinogens psychoactive drugs 3 psychotherapy, 95. See also counseling/psychotherapy treatment element PTSD. See post-traumatic stress disorder Public Health Service, U.S. 106 purple flats. See LSD

Q questionnaires (symptom) 47, 50–53

R raves 62 receptors 21 recovery attitude toward 73–75 brain and 99 deciding on 75 defined 100 exploring 70 free 121–122 issues 98–101 maintaining 93–97 preparing for 71–73

158 Index resisting 68–70 self-tests 70 stages of 66 rehab. See rehabilitation rehabilitation 80–81 relapse stage of change 66, 99–100, 111 relationships, impact of addiction and alcoholism 58 Rescuer role in enabling 106 “rescuing” concepts 110 residential treatment 72, 80 ReVia 84 “reward” system 33 Ritalin. See methylphenidate rocket fuel. See PCP Rohypnol 24. See also benzodiazepines; club drugs roofies. See Rohypnol rush 22

S SADD. See Students Against Destructive Decisions Salvation Army 120 SAMHSA. See Substance Abuse and Mental Health Services Administration SCHIP. See State Children’s Health Insurance Program schizophrenia 59 sedatives 21, 26. See also barbiturates; prescription drugs seizures 55, 79 self-medication risks 9, 39 Serax 79. See also benzodiazepines serotonin 23 “7 C’s of Addiction” 113 sexually transmitted disease (STD) 56 shame of addiction 69 signs/symptoms of addiction 29, 44–53

sinsemilla. See marijuana sleep functions 55–56 “snorted” drug 18, 19 snow. See cocaine/crack snuff 19. See also nicotine soap. See GHB social-host laws 127 social influences 2, 41–43 socialization treatment element 83 soft drugs 10, 57 special K. See ketamine speed. See methamphetamines spirituality, search for 9, 40–41, 88–89, 98 stages of addiction 49–50 State Children’s Health Insurance Program (SCHIP) 116 State University of New York 101 STD. See sexually transmitted disease stimulants 14, 17–21, 26, 31, 59 stress 4–5 strokes 55 Students Against Destructive Decisions (SADD) 129 substance abuse. See addiction Substance Abuse and Mental Health Services Administration (SAMHSA) 20, 73, 116 substance use disorder (SUD) 3–6, 9–13, 50 SUD. See substance use disorder suicide 56 support for family/friend 106–107 support groups, 93–95, 102, 132– 139. See also Al-Anon; Alateen; Alcoholics Anonymous; Narcotics Anonymous surveys. See questionnaires (symptom) symptom questionnaires. See questionnaires (symptom) symptoms of addiction. See signs/ symptoms of addiction

Index 159

T TACE survey 47 Tapert, Susan 55 THC. See delta-9tetrahydrocannabinol therapists/counselors 70, 71 therapy. See treatment programs time in treatment success 86–87, 100 tobacco. See nicotine tolerance (symptom of addiction) 4, 28 tranquilizers 79. See also barbiturates treatment management 92–114 treatment programs 65–91 tremors 79 trip 23 tuberculosis 85 12-step groups 81, 94–95, 102, 122

U underage drinking, reducing 127 University of California–San Diego 55 University of Michigan, substance use statistics 6 uppers. See stimulants ups. See amphetamines urine tests 72 USA Today 102, 105, 111, 115, 116

V Valium 79. See also diazepam veins, collapsed 23

Vicodin 80. See also hydrocodone Vietnam War 15 violence 56 vita-G. See GHB vitamin K. See ketamine Vivitrol 84

W wack. See PCP weed. See marijuana weight gain 55 Wellstone Mental Health and Addiction Equity Act, Paul 118 white cross. See methamphetamines White House Office of National Drug Control Policy (ONDCP) 105, 107, 127 willingness in treatment success 87, 88 withdrawal symptoms 69, 79, 81

X Xanax 80. See also alprazolam

Y yellow dimples. See LSD Young People in Alcoholics Anonymous 103

Z zero tolerance rule 57–58

Living with Alcoholism and Addiction

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Living with Alcoholism and Addiction

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