Category Archives: Mental Health

We Can All Do Better

The general disintegration of interpersonal relationships, the lack of respect for personal boundaries and the personal abusive verbal and physical attacks has caused me to speak out from my experience.
Being a white male of privilege I have never been the object of unwanted sexual advances or sexual acts such as rape. My perspective is not the same but I believe it is relevant.
About 60-65 years ago my stepfather physically abused me regularly. It was never sexual but it was painful. If you knew me as a child I was small and scrawny. He was big and muscular. I recall never offering much if any resistance, my objective was to cover up and hope it ended quickly.
None of this is the same as a sexual assault. But it made me feel ashamed and guilty.
Anyway my point is our culture and society have become numb to attacks on people because of their gender, looks (including race and religion), difference or beliefs.
Those being assaulted are not the issue!
NONE of it is OK!
What is particularly upsetting is it emanates out of the highest offices in government and businesses of all kinds.
It’s not acceptable.
Human beings were not created to fight, because nobody wins a fight.
If we show each other love, admiration and respect we can have a healthier culture and society. Our heart wants us to be happy and live in peace, but unfortunately we are being manipulated to see each other, as objects not people.
It’s proper to treat others with kindness without expectations.
We do the next right thing, just because it’s the right thing. To no longer be motivated by money and profit, but by what’s best for society.
It will require a massive effort by more than a few, more than just the women, or people of color or the minority groups; it will have to be the will of all the people. It will necessitate a new mindset by most men.
When it comes to sexual abuse and assault, I join with women everywhere.
We can all do better.

Addict Advocacy-Opioid Crisis

Overall, it seems as if addict advocacy, lobbying their service providers, and for society as a whole has become a zero-sum game.  The opioid crisis thrives.

There are apparently sides to be taken in a battle of “us” versus “them.” There have been and always will be addicts amongst us.

There will always be drug providers (be it at the street level, at the liquor store, the marijuana dispensary, or those who have medical degrees and write prescriptions for pills). There will always be prejudice. Their will always be a lack of sense of community when fear and mistrust is involved. The addicts and their families want to blame the healthcare industry. Society wants to blame the treatment industry. They want to blame anyone but themselves. We want to blame them as being morally inferior and mentally weak.

They have a comprehensive and robust report from the U.S. Surgeon General, unequivocally identifying addiction as a national disease. We have an independent Grand Jury investigation, Sober Homes Task Force Report, and extensive local investigative reporting from a multitude of press outlets, The Palm Beach Post in particular, identifying an overwhelmingly fraudulent industry that seems to have an insatiable appetite for consuming its own class of people.

Maybe we are all wrong, that the march towards decriminalization and deinstitutionalization of the addict has been a social experiment mistake? Maybe addicts need to be isolated from society for their own good? Perhaps the “integration” mandate of the Americans with Disabilities Act really did not take into consideration that the disabled in a wheelchair may really be different in kind than the disabled on heroin?

Maybe we do need to reopen and reexamine the ADA, not to discriminate, but because there now is clearly a different set of facts that requires a different modality of response?

While I subscribe to the inherently American values of individualism and self-responsibility, we must put aside philosophical differences and recognize the clear science that the modern opioid epidemic is a terrorist that hijacks the mind, body and spirit.

Even without the misuse of substances, what is true for all Americans is that greed is the most tolerated yet the most destructive addiction of them all.

We cannot demand that someone do something about “those addicts” but then refuse to offer the necessary funding, resources, infrastructure, housing, and services to care for this population, and we can therefore neither blame the addicts nor the treatment provider. We are the adults in the room. We cannot blame the unsupervised children for playing with matches and burning down the house.

If the disease of addiction is truly a public health crisis, rather than the now debunked theory that it is a moral failing, we seem to be left with only one choice – double our efforts, buckle down, and fix this system once and for all. Not later, not when it is more politically palatable. Now. We no longer have the luxury of time.

Self Worth


Author Unknown

I used to believe I was not worthy of happiness. I believed the first person that told me that. It became a subconscious mantra to myself. It defined the young woman I was I hid behind a mask pretending I was in control and I was “OK”. I ran from even looking at myself in the mirror because I had defined myself as less than. It was one of the most exhausting, debilitating, saddest times in my life. Using and drinking made me feel numb and gave me liquid courage, which was actually more, fear and pain. I didn’t know it at the time I just thought it was a fast and easy remedy. It was until it almost became my demise. It was then I decided I could no longer feel this way again. I didn’t know if I could recover but I had never gave it a true shot. I was truly scared to find out who I was. The REAL ME!. I must wholeheartedly say I’m grateful not only that I have given myself a chance at a beautiful life but I too was beautiful with every imperfection. I forgave my pain and what wreckage that came with. We all deserve to recover! I’m recovering and I’m the Best person I can be in a daily basis. Not perfect but better than yesterday

Ending America’s Opioid Addiction Epidemic

Putting politics aside, this is a comprehensive plan that needs bipartisan support. If you agree then contact your representatives on all levels and ask for their help. We can help end America’s quiet opioid addiction epidemic.

Governor Peter Shumlin began his remarks at the New Hampshire Roundtable on Addiction and the Heroin Epidemic by describing a phone call from Hillary Clinton a few months ago. According to Shumlin,“I figure it’s gonna be another politician talkin’ about how great they are.” But Clinton surprised him: “When I go to New Hampshire, when I go to Iowa, something strange has happened…” Clinton was told story after story about the “quiet epidemic” that had not even been on the table when she last ventured out as a candidate. She heard from families who were unable to help their loved ones and law enforcement officials who knew they couldn’t arrest their way out of the problem, so Clinton “resolved to do something about it.” She called the right person: Gov. Shumlin has been working to reframe the public debate around addiction for years. For the past two years he has dedicated his State of the State Message entirely to the topic of the heroin crisis in Vermont. Under his guidance, the state has implemented programs to address the complexity of addiction that have been imitated by states across the nation. Shumlin was struck by Clinton’s humility and patience, “She did what a lot of politicians aren’t very good at–she listened. For a second I thought she’d hung up.”

Clinton placed Shumlin’s advice amongst the advice of many others, and four weeks later “out came a policy” that the Governor believes, “if implemented, will give us the help from the federal government that we need to finally take this battle on and treat it as a disease and not a crime.” The plan would allocate 10 billion dollars to tackling America’s deadly epidemic of drug and alcohol addiction, and would address the following five points: Criminal Justice Reform, Treatment and Recovery, First Responders, Prescribers, Prevention.

In a statement about the indiscriminate reach of the epidemic, Clinton wrote: “Substance use disorders are a problem that touches Americans everywhere, from our biggest cities to our smallest towns, and from our richest enclaves to our poorest neighborhoods.”

I. Criminal Justice Reform

Governor Shumlin has visited treatment centers, jails, and detoxes all over Vermont to speak with those who have been impacted by the epidemic: “there are stories that make you want to sit down and cry,” he said. When he asked what kind of response was needed, “they told me that we were doing almost everything wrong.” Like most criminal justice systems across the nation, Vermont’s was slow and ineffective, especially when it came to dealing with drug-related crimes. Vermont has worked to try and turn the moment of arrest from a tragedy into an opportunity: “when your busted, when you’ve bottomed out, when the blue lights are flashing–that’s the most likely chance that we have to move someone from denial into treatment.”

Third party assessors are stationed in every county in the state and when someone is arrested, these experts determine whether the person needs treatment by asking: “is this someone that will hurt you or is this person more likely to hurt themselves?” Today, people who would have been arrested are told that if they participate in the “Hub/Spoke” treatment initiative with the wrap around services: “we’ll stick with you. You’ll never see a judge, you’ll never see a criminal record, you’ll never see a court.” And it’s working on all fronts, “they’ve got hope, they’ve got a job, they’ve got life and they’re getting back with their families.” Vermont has saved 50 million dollars since implementing the prison diversion program.

Clinton intends to “end the era of mass incarceration” by prioritizing treatment over incarceration for low-level, nonviolent drug offenses. In order for this to happen, greater collaboration and coordination must be fostered between public health and criminal justice institutions “to ensure continuity of care for those who suffer from substance use disorders.”

II. Treatment & Recovery

Gov. Shumlin introduced the second point of Clinton’s plan by talking about when his father, who is now deceased, was first diagnosed with lung cancer: “Why is it that when my dad is diagnosed with a cancer that’s created from behavior that we all know isn’t very smart—smoking—that we say ‘we will do everything we can to keep you on this earth as long as we can and you will not stand in line,’ but if you’re addicted to opiates, we say ‘get in line, we might serve you sometime—usually sometime later.”

Clinton’s plan involves building out more treatment centers, matching participating states 20/80 in federal funds, abolishing lengthy wait-lists and ultimately treating addiction like any other disease, “stop the discrimination—line up.”

Clinton’s plan makes sure that “everyone who needs support has access to continuing treatment.” This emphasis on continuity is key due to the fact that many treatment methods are too short-lived to be effective.

III. First Responders

Clinton’s plan ensures that states have adequate funding to get and dispense life-saving tools such as naloxone to anyone who wants it and that first responders are trained in proper practices.

IV. Prescribers

Clinton’s plan ensures that licensed prescribers meet training requirements and consult a prescription drug-monitoring program before writing a prescription for controlled medications. “Let’s make sure that we enhance the database so that we stop pill shopping across borders,” said Shumlin, “and doctor abuse, where folks can go in and line up this stuff, FDA approved Oxycodone and the rest, put it in their pockets, and keep getting more of it, with no questions asked.”

V. Prevention

“Let’s change the attitude about the disease. Let’s get rid of the stigma.” Clinton’s plan defines Substance Use Disorders as chronic diseases and insists that they be treated as such. Clinton emphasizes the importance of empowering communities to design their own “evidence-based programs tailored to their communities.” Such programs would focus on engaging adolescents through education and early intervention programs.

Letter To My Children

Doing Right

In a letter to my children, I want to express my unconditional love and support.
My daughter texted me Tuesday night, November 8, around the time it was clear that Hillary Rodham Clinton was not going to win in a landslide and that Donald J Trump was closer to being the winner. She was afraid for her freedom and her life. She thought “they” hate her because she is a woman and an outspoken member of the LBGTQ community. Her best solution was to leave the country and not risk her life at the hands of a government and people about to make laws restricting her ability to live in peace. Her fear was based on the nasty rhetoric she had received on social media aimed at her before the election, and the misogynistic, homophobic, anti-Semitic, anti-immigrant and bigoted racist comments made by Trump and his followers.
It was crushing for me. What do I say to an adult child who is in fear of our government? A person who has achieved a modicum of fame, who helps others, speaks out on behalf of those less fortunate, embraces the rights to freedom of women and the LGBTQ community. A young woman trying to do well, who now is afraid?
My best effort was to draw parallels to the 1960’s when we lost the Kennedy’s and King, and how we persevered and continued to speak out and not accept the War in Vietnam, and lack of Civil Rights for people of color.
And how to this day I believe that many people are living in fear and seeking a better way of life. And because unfortunately some are seeking to devalue or disenfranchise others we must stay strong. That this is a battle we must fight.
Our Government is made up of men, women, whites, blacks, browns, yellows, Christians, Jews, Muslims, young and old. Most of us want to live in peace with each other.
We cannot be silent and let the hateful and intolerant subjugate others. We cannot tolerate sacrificing our moral convictions because they are different. As long as we are not harming others, then our decisions about sexuality, health, lifestyle and safety are ours.
We must harness the power of all freedom loving peaceful people to protect each other from those who threaten the values of America and the pursuit of happiness of others.

“We hold these truths to be self-evident, that all are created equal, that they are endowed by their Creator with certain inalienable rights, that among these are Life, Liberty and the pursuit of Happiness…”

Now is the time to stand up and speak out, not to diminish others but ensure our pursuit of happiness.

If I am not for myself, who will be for me? But if I am only for myself, what am I? And if not now, when ?
Hillel – Pirke Avot 1:14

WE WILL NOT GO QUIETLY!!!

Dual Diagnosis and Addiction

Research shows that most people who struggle with addiction are also dealing with a mental health condition, such as depression, anxiety, or post-traumatic stress disorder. The technical term for this is dual diagnosis.

According to the National Alliance on Mental Illness (NAMI), “Among the 20.2 million adults in the US who experienced a substance use disorder, 50.5%—10.2 million adults—had a co-occurring mental illness.”

Proper treatment for mental illness involves professional therapy, not just coping skills. At the end of the day, the question is, Do you want to cope with your issues or heal them?

Combining Coping Skills for Addiction and Therapy

Dual diagnosis treatment isn’t about choosing between coping skills and therapy. Rather, it’s about combining the strengths of addiction coping skills and therapy to promote recovery. It’s about using a holistic model of healing, one that integrates all four levels of self:

  • The physical level (what we do)
  • The mental level (what we think and believe)
  • The emotional level (what we feel)
  • The spiritual level (who we really are)

In true dual diagnosis addiction treatment, trained clinicians use evidence-based tools and approaches to empower people to both encounter and heal their emotional wounds.

Emotional wounds are like physical ones in that if you open up a wound, it is important to know how to close it back up properly! Trained therapists can help individuals to close those inner wounds with love, compassion, and expertise.

In the process, people tap into the power within them and redirect it for good.

They learn to stop abusing themselves and begin to make self-honoring choices.

They start to counsel themselves and work through the issues that arise when they return to their normal lives.

The aftercare from treatment to normal living requires structure and discipline.

The Rest Of Your Life offers complete lifestyle changes for relapse prevention.

Overcoming Addiction

Alcohol Dependency & Detox

Reprinted from: http://www.lunaliving.org/

Alcohol is the drug of choice for most Americans. It can be the beginning of addiction.

Besides being legal, alcohol is relatively inexpensive and considered by most to be socially acceptable. Alcohol has been “sold” to us for thousands of years as a feature of good living. Our society celebrates special moments with champagne and drowns sorrows with drink.

From childhood we learn to hide or lie about liquor when we drink too much, or are underage. But apart from feeble resistance from a few religious groups, and a state’s legal restrictions, there is no barrier. Americans consume over $212 billion worth of alcohol per year.

If alcohol use is so widely accepted then what’s wrong with drinking? For most people alcohol isn’t a dangerous drug. But for the person with the chronic brain disease called Addiction, alcohol is pure poison and can be life-threatening.

Although the medical community acknowledges certain health benefits of moderate alcohol use (1 drink for women and 2 for men), they post a clear WARNING: More than three drinks a day for women, or four for men, puts you at high risk of irreparable brain damage.

An Alcohol Damaged Brain

Chronic alcohol abuse severely compromises your mental ability. In the short-term it can cause you to drink and drive. And, in the long-term it can irreversibly affect memory formation, abstract thinking, problem solving, attention, concentration, and emotions.

Alcoholics who abstain from drinking can recover from some alcohol-induced brain damage. But no one knows how much alcohol it takes to cause irreversible brain damage? Drinking can be like playing Russian roulette.

Alcohol immediately passes through the blood brain barrier, which is why people often say, “The drink went straight to my head”. Alcohol’s rapid absorption, in high concentrations (i.e., multiple drinks ingested quickly), can suppress the centers in the brain that control breathing causing you to pass out or even die.

Additionally, alcohol causes the release of a neurotransmitter in the brain called dopamine. Dopamine, labeled by neuroscientists, as the “addiction molecule” is responsible for the rewarding effect that keeps you drinking. For many this reward can be limited to a single cocktail but for an alcoholic this “pleasurable moment” can quickly turn into a life-threatening physical disease.

HOW MUCH CAN ONE DRINK depends on many factors – the rate of consumption, the quantity, how much fat and muscle mass you have, and whether or not you eat while drinking.

The kind of alcohol we drink is called ethanol. Once ethanol hits your bloodstream it travels to every organ in the body, which is why
heavy drinking is so physically, mentally, and spiritually debilitating.

HOW YOU DRINK ALCOHOL ALSO AFFECTS YOUR RISK. “Binge drinking” is particularly dangerous. When young people drink too much, too fast, they risk passing out and dying. Never leave someone who has passed out from alcohol alone. Too much alcohol suppresses normal breathing and is extremely dangerous. If in question, call 911.

Combining alcohol with drugs is a huge NO-NO! All sedatives can become deadly when combined with alcohol. Mixing alcohol with narcotics can result in overdose.

Alcohol should not be mixed with any drug that makes you sleepy – opiates (heroin, oxycodone, and morphine), Valium-like drugs (benzodiazepines, sleep medications (Ambien) and antihistamines found in cold medications.

• Mixing alcohol with antibiotics can cause convulsions (seizures), nausea, and vomiting.

• Mixing alcohol with antihistamines can enhance sedation and excessive dizziness, which is particularly dangerous for older adults.

• Mixing alcohol with Tylenol (acetaminophen) creates a chemical that causes liver damage.

• And, the list goes on.

Alcohol Dependence vs. Alcohol Abuse

In general, alcohol abuse refers to patterns of drinking that cause health problems or social problems, or both.

Alcohol dependence, more commonly known as alcoholism, refers to the brain disease we know as Addiction.

Addiction leads to lack of control over drinking and life. Signs of physical dependence (withdrawal) appear within hours of stopping to drink and may manifest as anxiety, hallucinations, seizures and tremors.

Alcohol dependence (alcoholism) is characterized by cravings. A person, who suddenly stops, without the proper medical care, can experience severe and sometimes deadly withdrawal symptoms. If you are an alcoholic do not try detox on your own. Seek medical help immediately! Don’t drink if you are pregnant

Fetal alcohol spectrum disorders (FASD) is the full range of neurological, cognitive, behavioral, and learning disabilities associated with prenatal alcohol exposure. Alcohol passes the blood brain barrier and immediately, and negatively, affects an unborn fetus. There is absolutely no safe level of drinking during pregnancy. Children born with Fetal Alcohol Syndrome (FAS) suffer learning impairments for life.

Addiction

Addiction is a primary, chronic brain disease that affects brain reward, motivation, memory, and related circuitry. Without treatment and engagement in recovery activities, it often results in disability or premature death.

HOW DO I KNOW I AM ADDICTED? Addiction is characterized by your inability to consistently abstain; cravings; a dysfunctional emotional response and a diminished recognition of significant problems with your behavior and interpersonal relationships. Like other chronic diseases, Addiction can involve cycles of relapse and remission and premature death if left untreated.

A widely used screening test is CAGE. If you have two or more positive responses it is likely you have a problem with alcohol.

• Have you ever felt the need to cut down on your drinking?

• Have you ever felt Annoyed by someone criticizing your drinking?

• Have you ever felt Guilty about your drinking?

• Have you ever felt the need for an Eye-opener? (a drink at the beginning of the day)?

NO ONE IN MY FAMILY IS AN ALCOHOLIC. AM I AT RISK? Overexposure to alcohol can lead to alcohol dependence. Alcohol changes the brain of everyone! Anyone that chronically abuses alcohol will eventually become dependent. If you drink to self-medicate for co-existing conditions it is likely you will become addicted, if you aren’t already.

ALCOHOL WITHDRAWAL

Alcohol sedates your brain. Your brain works 24/7 to protect you, to do its job the brain offsets the sedative effects of alcohol consumption by producing larger and larger quantities of norepinephrine, a chemical similar to adrenaline. Although you abruptly stop drinking, your brain needs time to respond. It may take a few days to rebalance your brain chemistry, which is why the excess norepinephrine in your bloodstream causes withdrawal symptoms.

Only about 5% of alcoholics experience a dangerous withdrawal, known as delirium tremens, or DTs. Because your brain is unable to adjust to the quickly changing chemistry, you can experience confusion, hallucinations, and you are at increased risk of a heart attack or stroke. There is no way of knowing in advance if you are one of the 5%, which is why you should seek medical care to detox your body.

An Open Letter To Families Where Addiction Is Present

by Alicia Cook

http://www.huffingtonpost.com/Alicia-cook/an-open-letter-to-families-where-addiction-is-present_b_8691970.html?utm_source=digg

Last night someone said to me, “For someone who writes about addiction, you are being judgmental!” Now, without going into specifics, I can tell you I was a lot of things last night: Mad. Hurt. Sad. Confused. Frustrated. At a loss — but judgmental? No. No way.

I wish it wasn’t me who was writing this blog. I really wish it wasn’t. I wish I wasn’t “qualified” to speak on the heroin epidemic from the perspective of the loved ones. I wish I wasn’t gaining notoriety for having one of the “best handles” on this subject. I wish I wasn’t a member of a community no one really wants to be a part of. No one ever says to themselves while reading articles like mine, “I wish I could relate to this.”

But I am. I am the non-addict who knows all too well what it’s like to love a person who suffers from addiction.

I know what it’s like to worry yourself sick. To cry yourself to sleep.

I know to watch out for pinhole pupils and subtle changes in behavior. To listen to them talk and make excuses and pile on lie after lie. I know what it’s like to pretend to believe them because you are just too mentally exhausted for an argument.

I know what it’s like to be confused all of the damn time; to see their potential, to know what they are throwing away. I know what it’s like to want their recovery more than they do. To be the one doing research on rehabs and other outlets for recovery.

I know what it’s like to miss someone who is still standing right in front of you.

I know what it’s like to wonder if each unexpected phone call is “the” phone call. I know what it’s like to be hurt so bad and be made so sick a part of you wishes you would just get “the” phone call if nothing is going to change. You want that finality. You need the cycle to end. I know what it’s like to hate yourself for even allowing yourself to find relief in that horrible thought.

I know what it’s like to get the worst news of your life, and still walk into the grocery store and run your errands and smile at the cashier.

I know what it’s like to become a part-time detective. You know you are going to find something, and you look until you do just so you feel less crazy. So you can say to yourself, “I am not paranoid. This is happening again.”

I know what it’s like to have your mind clouded; to turn into a functioning zombie. I know what it’s like to be physically present at board meetings and dinner dates, but mentally gone.

I know what it’s like to be really mad. Like, REALLY pissed off. Between the sadness there is a lot of anger. I know what it’s like to feel guilty for being so mad, even knowing all you know about addiction. You are allowed to be angry. This is not the life you signed up for.

I know what it’s like to scour a bookshelf and not find what you are looking for because this illness is still so hard to talk about, let alone write about.

I know what it’s like to hear someone argue that addiction is not an illness, but a choice or social disorder. I know all too well that feeling of heat rising in your face as they go on and on about something they know nothing about.

I know what it’s like to stop being angry with these people. They do not understand. They are lucky to not understand. I know what it is like to catch yourself wishing that you didn’t understand either.

I know the difference between enabling and empowering. I know there is a fine line between the two and the difference can mean life or death. I know what it’s like to the feel the weight of each day on your shoulders trying to balance the two.

I know what it’s like to have “good days” and “bad days” but never “normal days.” I have been through enough to know that things don’t just change for the worse overnight; they can change in a millisecond. In a blink of an eye. As quick as it takes two people to make a $4 exchange.

I know what it’s like to feel stigmatized. To be the “cousin of a drug addict,” a “friend of a drug addict,” a “sibling of a drug addict,” “a parent of a drug addict,” “a neighbor of a drug addict.” I know what it feels like to be handled with kid-gloves because no one outside of your toxic bubble knows what to say to help.

I don’t know what the future holds for anyone who loves a substance abuser today. One thing I know for sure is I am not alone. I write often on addiction from the family’s perspective. My last article, Lessons I Learned from Loving a Drug Addict, was picked up by numerous news outlets. My new essay series, The Other Side of Addiction, aims to help non-addicts and addicts alike share their story in a place free of, you guessed it…judgement. They often feel voiceless, so I wanted to give them a voice.

I write on addiction for a lot of reasons. I want to let you know you are not alone. I write on addiction because for far too long many have felt isolated, hopeless and stigmatized by this illness.

Today I am writing on addiction to let loved ones know you are allowed to feel angry without feeling guilty. You are allowed to feel sad, mad, or frustrated without feeling guilty. You are allowed to take a step back if you need a breather without feeling guilty.

With so many variables being out of your power, the one thing you are in control of is your well-being. Feeling any of this at any point does not mean you are suddenly a judgmental person who does not understand addiction. All of this does not mean you do not love this person unconditionally.

To Prevent Addiction In Adults, Help Teens Learn How To Cope


by Eliane Korry
Addiction is a pediatric disease,” says Dr. John Knight, founder and director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. “When adults entering addiction treatment are asked when they first began drinking or using drugs, the answer is almost always the same: They started when they were young — teenagers,” said Knight.

Smoking, drinking and some forms of drug use among teens have declined in the U.S. in recent years, but an estimated 2.2 million adolescents — 8.8 percent of youth aged 12 to 17 years old — are currently using an illicit drug, according to a 2014 Behavioral Health Barometer prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA).

Drug use changes brain development, and when substances are used during adolescence, young people are much more likely to become addicted, Knight said. “When people start using at younger ages, the changes in brain structure and function are very, very pronounced,” he explained. “If we could only get kids to postpone their first drink or their first use of drugs, we could greatly diminish the prevalence of addiction in the U.S.”

And in some places, teenagers may be using more, sooner. “In the last several years, it seems like the kids that we see in services are far sicker than in the past,” said Sara Ellsworth, clinical supervisor at True North Student Assistance and Treatment Services in Olympia, Wash.

Last year, True North served nearly 700 students in 44 mostly rural school districts. Increasingly, she said, kids who come for help have a history of victimization or significant trauma, such as domestic violence, physical or sexual abuse, parental incarceration or substance abuse, rape or homicide. More than half also had at least one mental health disorder.

Despite some improvements in the national youth substance abuse numbers, Ellsworth has witnessed a disturbing new pattern: kids who start using alcohol or marijuana at ever younger ages as a form of self-medication, who quickly escalate to more dangerous drugs, and who wind up using multiple substances in extreme amounts. “Maybe the average kid is using less and doing better, but the kids who are falling through the cracks are spiraling down, really fast,” she said.

About 10 percent of Americans will develop a substance-use disorder at some point in their lives and need therapeutic services, according to Rob Vincent, a SAMHSA public health analyst. But those services are hard to come by, especially for youth.

“Once a child 12 to 17 years old is identified as needing treatment, only 1 in 20 of those adolescents is actually getting treatment. That is not a good number,” said Vincent.

So public health officials and researchers are making the case for prevention instead. Dealing with drug and alcohol abuse after the fact is a costly, impractical approach, so public health officials and researchers are making the case for early detection and intervention instead.

The leading prevention strategy, dubbed SBIRT — Screening, Brief Intervention and Referral to Treatment — is deployed in schools, afterschool programs and most widely, in primary and public health care.

Most pediatricians routinely screen patients for substance problems during annual visits. That’s a big change from just 20 years ago, when the American Academy of Pediatrics found that fewer than half of pediatricians reported they were screening adolescents for substance use. By 2013, that percentage had risen to more than 80 percent, according to Dr. Sharon Levy, director of the adolescent substance abuse program at Boston Children’s Hospital.

“I interpret that as a real shift in culture, from one in which there was controversy over whether drug use was a legitimate topic for pediatricians to address to one in which it’s now part of the standard of care,” Levy said. She sees the pediatrician’s office as an ideal place to discuss substance abuse. “It’s a unique setting in which an adolescent gets to have a confidential conversation” with an adult who is not their parent.

Doctors use one of a variety of screening tools, including one, called CRAFFT, that was developed by Knight. It asks six questions, including: “Have you ever ridden in a car driven by someone (including yourself) who was “high” or had been using alcohol or drugs?”

In many doctors’ offices, the survey is now computerized or given as a questionnaire before the CRAFFT screening test here; it’s available in 13 languages, including Khmer and Haitian Creole.)

Other screening tools widely in use are called frequency-based screens. Those tools use multiple-choice questions, which ask teenagers how often they have used alcohol or marijuana to predict their risk of developing an addiction.

If screening turns up troubling behavior, the second step is brief intervention. In the doctor’s office, which could be a five-minute conversation with the two elements that Knight says comprise a good brief intervention: science and stories. “What they want from doctors is, ‘tell us what the science is, and don’t tell us what to do; give us the information and trust us to make the right decisions.’ ”

The intervener can also be a therapist, counselor or youth-development worker. They often use what’s called “motivational interviewing.” That’s the approach used by Elizabeth D’Amico, a licensed clinical psychologist and senior behavioral scientist at RAND Corporation, who developed CHOICE, a voluntary afterschool prevention and intervention program in California.

“Motivational interviewing is about guiding someone to make a healthy choice,” D’Amico said, “versus saying, ‘Okay, you have a problem and you need to change.’ ”

Counselors have to acknowledge there are reasons why young people use alcohol or drugs, D’Amico said. “You lose all your credibility if you just say, ‘It’s bad for you, stop.’ ”

Instead, motivational interviewing is more collaborative, said D’Amico. For example, if a teen says he drinks to relax, the counselor can help him to think of other, healthier ways to relieve stress. Studies have found a modest benefit in the program, with some students delaying drinking.

The third step of a prevention strategy, referral to treatment, connects youth who need more care with specialty treatment. Levy said most teenagers with a drug or alcohol problem don’t need a residential program, or even an intensive outpatient program. Instead, they’ll do fine working one-on-one with a counselor, she said.

In Washington, Ellsworth at True North Student Assistance and Treatment Services says that students served by the prevention programming have done better. In the last academic year, students said their use of marijuana and cocaine declined by half after participating in the program, and alcohol use declined by one-third. Participants also had better grades and fewer behavior problems at school.

Even the computerized CRAFFT screening, with a few minutes of counseling by a pediatrician, has been shown to deter substance use, according to a study led by

Knight and published in the journal Pediatrics in 2002. “The intervention resulted in 40 percent less substance use three months after the visit, and 12 months later there was still 25 percent less use, without any reinforcement. That’s pretty powerful,” said Knight.

Prevention is a cost-effective proposition, according to the National Institute on Drug Abuse (NIDA), with every dollar invested in keeping kids off drugs saving from $4 in health-care costs to $7 in law enforcement and other criminal justice costs. According to NIDA, research-based prevention programs can significantly reduce early use of tobacco, alcohol and illicit drugs.

Yet according to Knight, “of all the money that is spent by the federal government on the so-called war on drugs, only 5 percent goes to prevention.” That’s a shortsighted approach, he said. “The evidence is compelling that addiction is a pediatric disease, and if we don’t prevent it during the teen years, we’re really missing the boat.”

Addiction Now Defined As Brain Disorder, Not Behavior Issue

Addiction is a chronic brain disorder and not simply a behavior problem involving alcohol, drugs, gambling or sex, experts contend in a new definition of addiction, one that is not solely related to problematic substance abuse.
The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts.
“At its core, addiction isn’t just a social problem or a moral problem or a criminal problem. It’s a brain problem whose behaviors manifest in all these other areas,” said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. “Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It’s about underlying neurology, not outward actions.”
The new definition also describes addiction as a primary disease, meaning that it’s not the result of other causes, such as emotional or psychiatric problems. And like cardiovascular disease and diabetes, addiction is recognized as a chronic disease; so it must be treated, managed and monitored over a person’s lifetime, the researchers say.
Two decades of advancements in neuroscience convinced ASAM officials that addiction should be redefined by what’s going on in the brain. For instance, research has shown that addiction affects the brain’s reward circuitry, such that memories of previous experiences with food, sex, alcohol and other drugs trigger cravings and more addictive behaviors. Brain circuitry that governs impulse control and judgment is also altered in the brains of addicts, resulting in the nonsensical pursuit of “rewards,” such as alcohol and other drugs.
A long-standing debate has roiled over whether addicts have a choice over their behaviors, said Dr. Raju Hajela, former president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on addiction’s new definition.
“The disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them,” Hajela said in a statement. “Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause.”
Even so, Hajela pointed out, choice does play a role in getting help.
“Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary,” Hajela said.
This “choosing recovery” is akin to people with heart disease who may not choose the underlying genetic causes of their heart problems but do need to choose to eat healthier or begin exercising, in addition to medical or surgical interventions, the researchers said.
“So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment,” Miller said.

© 2012 LiveScience.com. All rights reserved