Addiction

SOME MISCONCEPTIONS

Once it was thought that a person was addicted to a drug only if he needed the drug daily, or if he went through withdrawal symptoms (vomiting, seizures, cramps, death) when he abruptly stopped using the substance. It was thought that alcoholics and addicts were unemployed, poor, and from the inner city. These are misconceptions. Many addicted people do not use drugs or alcohol daily and do not experience physical withdrawal when they stop using. The majority of addicted people are employed and appear to be functioning normally. Another misconception dealt with the differences between physical and psychological addiction. Physical addiction was thought to be the determining factor in addiction, and little attention was paid to psychological addiction. For example, many people believed that cocaine was not a dangerous drug because it was psychologically, but not physically, addictive. The cocaine epidemic in this country broadened the understanding of addiction. It is now known that all addictions are characterized by physical and psychological changes. Addiction is far more than physical or psychological dependency. Drug addiction is a complex brain disease that is characterized by compulsive, at times uncontrollable, drug craving, seeking, and use that persist 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, with relapses possible even after long periods of abstinence.

CHARACTERISTICS OF ADDICTION

Loss of Control

The user cannot predict what will happen when he uses the substance. One day he may be able to stop after one drink or after one line of cocaine. The next day he may not be able to control his use at all.

Compulsive Preoccupation

The addict spends a great deal of time thinking about the substance.

Continued Use Despite Negative Consequences

If drinking or drug use causes problems, but the user continues to do it, he is tempting addiction or is already addicted. The person has lost voluntary control of the use of that substance.

A nonuser or casual alcohol/drug user may have difficulty understanding why addicts don't just stop. Use and abuse of psychoactive (mood-altering) drugs seem to be voluntary; addiction seems to be characterized by involuntary, compulsive use. In most cases, addicts don't stop because they are addicted; they cannot stop on their own. A person may start out taking drugs voluntarily. But as times passes, and drug use continues something happens that makes a person go from being a voluntary drug user to a compulsive drug user. Why? Because the continued use of addictive drugs changes your brain - at times in dramatic, toxic ways, at others in more subtle ways, but often in ways that result in compulsive and even uncontrollable drug use.

SIGNS OF ADDICTION

If a person is compulsively seeking and using a drug despite negative consequences, such as loss of job, debt, physical or mental problems brought on by drug abuse, or family problems, then he or she is probably addicted. The following are simple screening questions that health care professionals who screen for drug use employ to detect substance abuse.

• Have you ever ridden in a car driven by someone (including yourself) who had been using alcohol or drugs?
• Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
• Do you ever use alcohol or drugs when you are alone?
• Do you ever forget things you did while using alcohol or drugs?
• Do your family or friends ever tell you to cut down on your drinking or drug use?
• Have you ever gotten into trouble while you were using alcohol or drugs?

What Causes Addiction?

There has been controversy over the cause of addiction. Historically, it was thought that addiction was caused by lack of willpower, by poverty, moral weakness, mental illness, genetics, family socialization, anti-social personalities, and societal problems. Today addiction is seen as a disease; and like any other disease, many factors contribute to it.

Drug addiction is a brain disease. Every type of drug of abuse has its own individual mechanism for changing how the brain functions. But regardless of which drug a person is addicted to, many of the effects it has on the brain are similar: they range from changes in the molecules and cells that make up the brain, to mood changes, to changes in memory processes and thinking, and sometimes changes in motor skills such as walking and talking. And these changes have a huge influence on all aspects of a person's behavior. A drug can become the single most powerful motivator in a drug abuser's existence. He or she will do almost anything for the drug. This comes about because drug use has changed the individual's brain, their behavior, their social and other functioning in critical ways.

The Drug

Some drugs are more addictive than others. This is due to the pharmacology of the substance, and how it affects the mood of the user.

The User

The genetics of the user and his overall self-concept contribute to the potential for addiction. A person from a family with alcoholic or drug-addicted parents is twice as likely to develop an addiction. Studies are now being done to learn more about the genetics of addiction, and to develop early intervention programs for people who have a greater potential for becoming addicted.

Intervention - How to Help

An addict usually does not know he is out of control. He looks at his drug-using peers and his own use appears normal in comparison. He needs objective feedback on his behavior.

It was once thought that an alcoholic or other drug abuser had to "hit bottom" before help could be offered and accepted; that an addict could only get better if he was self-motivated to change. This has changed to the view that a skilled professional counselor can motivate an addict toward recovery. This is called intervention.

Intervention is a process that helps an addict recognize the extent of his problem. Through a non-judgmental, uncritical, systematic process, the addict is confronted with the impact of his alcoholism or drug use on others. The goal of intervention is for the addict to accept the reality of his drug- or alcohol-impaired lifestyle and to seek help. Most prevention and treatment facilities can help arrange an intervention and assist the addicted person and his family in finding appropriate treatment.

Groups such as Alcoholics Anonymous (AA), Cocaine Anonymous (CA) and Narcotics Anonymous (NA) provide continuing support for people with drug and alcohol problems. These "fellowship" programs exist in most communities and are free of charge. The only requirements are a willingness to choose total abstinence, and acceptance of recovery through fellowship with other recovering people, one day at a time. Fellowship groups are a valuable resource for the addict, his family and friends. The telephone numbers of local chapters of AA, CA, and NA are in the phone book.

Conclusion

Drug abuse is the excessive use of legal mood-altering substances and the use of illegal drugs. Addiction is the extreme end of a continuum that starts with the first use of drugs or alcohol, and progresses through experimentation and abuse to addiction.

Professional treatment and prevention programs and community-based organizations are available to help the addict and his family. These resources can help with education, intervention, and treatment of the addict and those who care about him.

REFERENCES:

NIDA For Teens: http://www.teens.drugabuse.gov/

Principles of Drug Addiction Treatment, National Institute on Drug Addiction, October 1999.

Funds for this document are provided by the Substance Abuse Program Office, Florida Department of Children and Families contract #LD079.

Heroin is an opiate drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as “black tar heroin.” How Is Heroin Abused? Heroin can be injected, snorted/sniffed, or smoked—routes of administration that rapidly deliver the drug to the brain. Injecting is the use of a needle to administer the drug directly into the bloodstream. Snorting is the process of inhaling heroin powder through the nose, where it is absorbed into the bloodstream through the nasal tissues. Smoking involves inhaling heroin smoke into the lungs. All three methods of administering heroin can lead to addiction and other severe health problems. How Does Heroin Affect the Brain? Heroin enters the brain, where it is converted to morphine and binds to receptors known as opioid receptors. These receptors are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem—important for automatic processes critical for life, such as breathing (respiration), blood pressure, and arousal. Heroin overdoses frequently involve a suppression of respiration. After an intravenous injection of heroin, users report feeling a surge of euphoria (“rush”) accompanied by dry mouth, a warm flushing of the skin, heaviness of the extremities, and clouded mental functioning. Following this initial euphoria, the user goes “on the nod,” an alternately wakeful and drowsy state. Users who do not inject the drug may not experience the initial rush, but other effects are the same. With regular heroin use, tolerance develops, in which the user’s physiological (and psychological) response to the drug decreases, and more heroin is needed to achieve the same intensity of effect. Heroin users are at high risk for addiction—it is estimated that about 23 percent of individuals who use heroin become dependent on it. What Other Adverse Effects Does Heroin Have on Health? Heroin abuse is associated with serious health conditions, including fatal overdose, spontaneous abortion, and—particularly in users who inject the drug—infectious diseases, including HIV/AIDS and hepatitis. Chronic users may develop collapsed veins, infection of the heart lining and valves, abscesses, and liver or kidney disease. Pulmonary complications, including various types of pneumonia, may result from the poor health of the abuser as well as from heroin’s depressing effects on respiration. In addition to the effects of the drug itself, street heroin often contains toxic contaminants or additives that can clog blood vessels leading to the lungs, liver, kidneys, or brain, causing permanent damage to vital organs. Chronic use of heroin leads to physical dependence, a state in which the body has adapted to the presence of the drug. If a dependent user reduces or stops use of the drug abruptly, he or she may experience severe symptoms of withdrawal. These symptoms—which can begin as early as a few hours after the last drug administration—can include restlessness, muscle and bone pain, insomnia, diarrhea and vomiting, cold flashes with goose bumps (“cold turkey”), and kicking movements (“kicking the habit”). Users also experience severe craving for the drug during withdrawal, which can precipitate continued abuse and/or relapse. Major withdrawal symptoms peak between 48 and 72 hours after the last dose of the drug and typically subside after about 1 week. Some individuals, however, may show persistent withdrawal symptoms for months. Although heroin withdrawal is considered less dangerous than alcohol or barbiturate withdrawal, sudden withdrawal by heavily dependent users who are in poor health is occasionally fatal. In addition, heroin craving can persist years after drug cessation, particularly upon exposure to triggers such as stress or people, places, and things associated with drug use. Heroin abuse during pregnancy, together with related factors like poor nutrition and inadequate prenatal care, has been associated with adverse consequences including low birthweight, an important risk factor for later developmental delay. If the mother is regularly abusing the drug, the infant may be born physically dependent on heroin and could suffer from serious medical complications requiring hospitalization. What Treatment Options Exist? A range of treatments exist for heroin addiction, including medications and behavioral therapies. Science has taught us that when medication treatment is combined with other supportive services, patients are often able to stop using heroin (or other opiates) and return to stable and productive lives. Treatment usually begins with medically assisted detoxification to help patients withdraw from the drug safely. Medications such as clonidine and buprenorphine can be used to help minimize symptoms of withdrawal. However, detoxification alone is not treatment and has not been shown to be effective in preventing relapse—it is merely the first step. Medications to help prevent relapse include the following: Methadone has been used for more than 30 years to treat heroin addiction. It is a synthetic opiate medication that binds to the same receptors as heroin; but when taken orally, it has a gradual onset of action and sustained effects, reducing the desire for other opioid drugs while preventing withdrawal symptoms. Properly administered, methadone is not intoxicating or sedating, and its effects do not interfere with ordinary daily activities. Methadone maintenance treatment is usually conducted in specialized opiate treatment programs. The most effective methadone maintenance programs include individual and/or group counseling, as well as provision of or referral to other needed medical, psychological, and social services. Buprenorphine is a more recently approved treatment for heroin addiction (and other opiates). Compared with methadone, buprenorphine produces less risk for overdose and withdrawal effects and produces a lower level of physical dependence, so patients who discontinue the medication generally have fewer withdrawal symptoms than those who stop taking methadone. The development of buprenorphine and its authorized use in physicians’ offices give opiate-addicted patients more medical options and extend the reach of addiction medication. Its accessibility may even prompt attempts to obtain treatment earlier. However, not all patients respond to buprenorphine—some continue to require treatment with methadone. Naltrexone is approved for treating heroin addiction but has not been widely utilized due to poor patient compliance. This medication blocks opioids from binding to their receptors and thus prevents an addicted individual from feeling the effects of the drug. Naltrexone as a treatment for opioid addiction is usually prescribed in outpatient medical settings, although initiation of the treatment often begins after medical detoxification in a residential setting. To prevent withdrawal symptoms, individuals must be medically detoxified and opioid-free for several days before taking naltrexone. Naloxone is a shorter-acting opioid receptor blocker, used to treat cases of overdose. For pregnant heroin abusers, methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the detrimental maternal and neonatal outcomes associated with untreated heroin abuse. Preliminary evidence suggests that buprenorphine may also be a safe and effective treatment during pregnancy, although infants exposed to either methadone or buprenorphine prenatally may still require treatment for withdrawal symptoms. For women who do not want or are not able to receive pharmacotherapy for their heroin addiction, detoxification from opiates during pregnancy can be accomplished with medical supervision, although potential risks to the fetus and the likelihood of relapse to heroin use should be considered. There are many effective behavioral treatments available for heroin addiction—usually in combination with medication. These can be delivered in residential or outpatient settings. Examples are individual or group counseling; contingency management, which uses a voucher-based system where patients earn “points” based on negative drug tests—these points can be exchanged for items that encourage healthy living; and cognitive-behavioral therapy, designed to help modify a patient’s expectations and behaviors related to drug abuse, and to increase skills in coping with various life stressors. How Widespread Is Heroin Abuse? Monitoring the Future Survey* According to the Monitoring the Future survey, there was little change between 2008 and 2009 in the proportion of 8th- and 12th-grade students reporting lifetime,†† past-year, and past-month use of heroin. There also were no significant changes in past-year and past-month use among 10th-graders; however, lifetime use increased significantly among this age group, from 1.2 percent to 1.5 percent. Survey measures indicate that injection use rose significantly among this population at the same time. Heroin Use by Students, 2009: Monitoring the Future Survey    8th Grade  10th Grade  12th Grade Lifetime 1.3% 1.5% 1.2% Past Year 0.7 0.9 0.7 Past Month 0.4 0.4 0.4 National Survey on Drug Use and Health (NSDUH)*** According to the 2008 National Survey on Drug Use and Health, the number of current (past-month) heroin users aged 12 or older in the United States increased from 153,000 in 2007 to 213,000 in 2008. There were 114,000 first-time users of heroin aged 12 or older in 2008. Other Information Sources For additional information on heroin, please refer to the following sources on NIDA’s Web site, www.drugabuse.gov: Heroin Abuse—Research Report Series Various issues of NIDA Notes (search by “heroin” or “opiates”) For a list of street terms used to refer to heroin and other drugs, visit www.whitehousedrugpolicy.gov/streetterms/default.asp. * These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov. ** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey. *** NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. Copies of the latest survey are available at www.samhsa.gov and from NIDA at 877–643–2644.. Revised 3/10

Anabolic-androgenic steroids (AAS) are synthetically produced variants of the naturally occurring male sex hormone testosterone. “Anabolic” refers to muscle-building, and “androgenic” refers to increased male sexual characteristics. “Steroids” refers to the class of drugs. These drugs can be legally prescribed to treat conditions resulting from steroid hormone deficiency, such as delayed puberty, as well as diseases that result in loss of lean muscle mass, such as cancer and AIDS.

How Are AAS Abused?

Some people, both athletes and non-athletes, abuse AAS in an attempt to enhance performance and/or improve physical appearance. AAS are taken orally or injected, typically in cycles rather than continuously. “Cycling” refers to a pattern of use in which steroids are taken for periods of weeks or months, after which use is stopped for a period of time and then restarted. In addition, users often combine several different types of steroids in an attempt to maximize their effectiveness, a practice referred to as “stacking.”

How Do AAS Affect the Brain?

The immediate effects of AAS in the brain are mediated by their binding to androgen (male sex hormone) and estrogen (female sex hormone) receptors on the surface of a cell. This AAS–receptor complex can then shuttle into the cell nucleus to influence patterns of gene expression. Because of this, the acute effects of AAS in the brain are substantially different from those of other drugs of abuse. The most important difference is that AAS are not euphorigenic, meaning they do not trigger rapid increases in the neurotransmitter dopamine, which is responsible for the “high” that often drives substance abuse behaviors. However, long-term use of AAS can eventually have an impact on some of the same brain pathways and chemicals—such as dopamine, serotonin, and opioid systems—that are affected by other drugs of abuse. Considering the combined effect of their complex direct and indirect actions, it is not surprising that AAS can affect mood and behavior in significant ways.

AAS and Mental Health
Preclinical, clinical, and anecdotal reports suggest that steroids may contribute to psychiatric dysfunction. Research shows that abuse of anabolic steroids may lead to aggression and other adverse effects.¹ For example, although many users report feeling good about themselves while on anabolic steroids, extreme mood swings can also occur, including manic-like symptoms that could lead to violence.² Researchers have also observed that users may suffer from paranoid jealousy, extreme irritability, delusions, and impaired judgment stemming from feelings of invincibility.

Addictive Potential
Animal studies have shown that AAS are reinforcing—that is, animals will self-administer AAS when given the opportunity, just as they do with other addictive drugs.^3,4 This property is more difficult to demonstrate in humans, but the potential for AAS abusers to become addicted is consistent with their continued abuse despite physical problems and negative effects on social relations.⁵ Also, steroid abusers typically spend large amounts of time and money obtaining the drug: this is another indication of addiction. Individuals who abuse steroids can experience withdrawal symptoms when they stop taking AAS—these include mood swings, fatigue, restlessness, loss of appetite, insomnia, reduced sex drive, and steroid cravings, all of which may contribute to continued abuse. One of the most dangerous withdrawal symptoms is depression— when persistent, it can sometimes lead to suicide attempts.

Research also indicates that some users might turn to other drugs to alleviate some of the negative effects of AAS. For example, a study of 227 men admitted in 1999 to a private treatment center for dependence on heroin or other opioids found that 9.3 percent had abused AAS before trying any other illicit drug. Of these, 86 percent first used opioids to counteract insomnia and irritability resulting from the steroids.⁶

What Other Adverse Effects Do AAS Have on Health?

Steroid abuse can lead to serious, even irreversible health problems. Some of the most dangerous among these include liver damage; jaundice (yellowish pigmentation of skin, tissues, and body fluids); fluid retention; high blood pressure; increases in LDL (“bad” cholesterol); and decreases in HDL (“good” cholesterol). Other reported effects include renal failure, severe acne, and trembling. In addition, there are some gender- and age-specific adverse effects:

• For men—shrinking of the testicles, reduced sperm count, infertility, baldness, development of breasts, increased risk for prostate cancer
  
• For women—growth of facial hair, male-pattern baldness, changes in or cessation of the menstrual cycle, enlargement of the clitoris, deepened voice
  
• For adolescents—stunted growth due to premature skeletal maturation and accelerated puberty changes; risk of not reaching expected height if AAS is taken before the typical adolescent growth spurt

In addition, people who inject AAS run the added risk of contracting or transmitting HIV/AIDS or hepatitis, which causes serious damage to the liver.

What Treatment Options Exist?

There has been very little research on treatment for AAS abuse. Current knowledge derives largely from the experiences of a small number of physicians who have worked with patients undergoing steroid withdrawal. They have learned that, in general, supportive therapy combined with education about possible withdrawal symptoms is sufficient in some cases. Sometimes, medications can be used to restore the balance of the hormonal system after its disruption by steroid abuse. If symptoms are severe or prolonged, symptomatic medications or hospitalization may be needed.

How Widespread Is AAS Abuse?

Monitoring the Future Survey*
Monitoring the Future is an annual survey used to assess drug use among the Nation’s 8th-, 10th-, and 12th-grade students. While steroid use remained stable among all grades from 2007 to 2008, there has been a significant reduction since 2001 for nearly all prevalence periods (i.e., lifetime,** past-year, and past-month use) among all grades surveyed. The exception was past-month use among 12th-graders, which has remained stable. Males consistently report higher rates of use than females: for example, in 2008, 2.5 percent of 12th-grade males, versus 0.6 percent of 12th-grade females, reported past-year use.

Other Information Sources

For a list of street terms used to refer to steroids and other drugs, visit www.whitehousedrugpolicy.gov/streetterms/default.asp.

For additional information on the effects of anabolic-androgenic steroids and information on healthy alternatives, please visit NIDA’s website on steroids, www.steroidabuse.org.

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* These data are from the 2008 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National Institutes of Health, Department of Health and Human Services, and conducted by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov.

** “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days preceding an individual’s response to the survey.

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1 Pope HG Jr, Kouri EM, Hudson JI. Effects of supraphysiologic doses of testosterone on mood and aggression in normal men: A randomized controlled trial. Arch Gen Psychiatry 57(2):133–140, 2000.

2 Pope HG Jr, Katz DL. Affective and psychotic symptoms associated with anabolic steroid use. Am J Psychiatry 145(4):487–490, 1988.

3 Arnedo MT, Salvador A, Martinez-Sanchis S, Gonzalez-Bono E. Rewarding properties of testosterone in intact male mice: A pilot study. Pharmacol Biochem Behav 65:327–332, 2000.

4 DiMeo AN, Wood RI. Self-administration of estrogen and dihydrotestosterone in male hamsters. Horm Behav 49(4):519–526, 2006.

5 Brower KJ. Anabolic steroid abuse and dependence. Curr Psychiatry Rep 4(5):377–387, 2002.

6 Arvary D, Pope HG Jr. Anabolic-androgenic steroids as a gateway to opioid dependence. N Engl J Med 342:1532, 2000.

What are some signs of problem drinking/using?

DOES THIS APPLY TO ME ?

	A lot	A little	Not at all
Cravings You have strong urges or needs to drink or use.
Loss of control You are unable to stop drinking or using once you have begun. You get drunk or high even when you don’t want or intend to. Even after alcohol and drugs cause major problems, you continue drinking or using.
Physical dependence You have withdrawal symptoms such as nausea, sweating, shakiness or anxiety when you stop drinking or using. You might take a drink or a drug as soon as you wake up.
Tolerance You need more alcohol or drugs to get the same effect.
Physical illnesses can be caused or worsened by drinking/drug use. Or it may take you longer to recover from illness when you’re drinking/using.
Lying about how much you are drinking/using.
Being annoyed when people point out or criticize your behavior.
Feeling guilty about your drinking or drug use.
Hiding your drinking or drug use from others. Drinking or using when you’re alone.
Not meeting responsibilities to family, friends, work or school.
Making rules for yourself in an effort to drink/use less, usually without success.
Risk-taking such as driving under the influence or sharing needles.
Blackouts Not remembering what you did when you were under the influence.

How do I know if I have a problem with alcohol or drugs? 
Be honest with yourself about your drinking and drug use. Talk honestly with a trusted friend or a health care professional about your drinking and/or using habits. Or try going to an open meeting of an alcohol or drug recovery group, where all are welcome. Spend some time with people who had problems with alcohol or drugs and are now clean and sober. Listen to their stories and ask yourself if you can relate.

How can I stop drinking/using? 
The first step in stopping is admitting that you need to stop. You need to admit and believe that alcohol or drug use is doing you more harm than good, and that it always will. You need to believe there is a better way to live, and be willing to try to live that way. Thinking about a life without alcohol or drugs can be scary. If thinking about the future makes you anxious, tell yourself you will stay clean and sober for just one day. If one day seems too long, tell yourself you won’t drink or use for the next hour. Take life day by day, hour by hour, or minute by minute, whatever you can manage. The most important thing is that you don’t pick up a drink or a drug right now. You don’t need to worry about the rest of your life right now. Just concentrate on staying away from the first drink or the first drug. As you meet people in support groups and build a network of support, you will have people to call when you feel like drinking or using, who can help you through the hard times.

How do alcohol/drug recovery groups work? 
There are many different kinds of alcohol and drug recovery groups. Most groups are made up of people who have learned to live successfully without drinking or using, and share their experience with others. Many groups use the 12-step method, which asks you to look at your behavior patterns, make amends for things you have done wrong in the past, and reach out to help others. Some drug and alcohol recovery groups have a spiritual element, and ask participants to believe in a higher power—a force that is greater than they are. This does not mean you have to accept religious ideas you don’t believe in. You may choose to believe in the power of the group—people coming together to help one another, or the power of the fact that others around you are able to stay clean and sober.

What if I relapse? 
A return to drinking or using after a period of being clean and sober is called a relapse or a slip. If you relapse, the best thing you can do is get sober or clean as soon as possible and get back to your treatment. Contact a trusted friend, family member or health professional for support. Keep going to your support groups and talk therapy. Stick with your treatment plan. Get additional medical help if you need it. If you slip, it doesn’t mean you won’t be able to build a clean and sober life. You don’t have to be ashamed, angry at yourself or discouraged about your recovery. Focus your energy on not taking a drink or drug right now. Ask yourself what you can learn from this slip. Were there triggers that led to it? Were you sticking with your treatment plan? Are there things you can do differently next time?

What else can I do to improve my health?

• Find ways to enjoy your clean and sober life. Explore new hobbies, do volunteer work, spend time with clean and sober family and friends.
• Stay away from the places, things and people that make you want to drink or use. Eventually, you may 12 be able to feel comfortable at gatherings where people are drinking if you have a good reason to be there. It’s best to avoid gatherings that are only for the purpose of drinking or using.
• Know that you can say no. In any situation, it’s ok not to drink. If you don’t want people to ask why you’re not drinking, drink juice or a soda with lemon or lime.
• Know your triggers and temptations. Learn what situations cause you to want a drink or a drug, such as a fight with a loved one or a bad day at work. With your support network, find other ways of coping with these triggers before they lead to a relapse.
• Be accountable. When you were drinking/using, you may have been inconsiderate of others. Where possible, apologize for things you’ve done if apologizing will not hurt the person more. Pay back money you owe. If you’ve stolen from people or businesses, return or pay for what you’ve taken, anonymously if necessary.
• Keep records of your moods, treatment and behavior. Use DBSA’s Personal Calendar to help discover behavior patterns and work on them.
• Learn relaxation exercises to help reduce stress.
• Eat healthy, balanced meals, exercise regularly and get a full night’s sleep every night.
• Stick to the treatment plan(s) prescribed by your health care provider(s).

How can I help a loved one?

• Educate yourself about mood disorders and alcohol/drug dependence.
• Don’t blame yourself. Keep in mind that your loved one has two treatable medical illnesses. You didn’t cause either one, and you can’t cure either one.
• Don’t take responsibility for making your loved one well. Encourage him or her to get professional medical help for both illnesses.
• Approach the person to talk about getting help when you are calm, and when s/he seems relatively sober/clean and calm. Don’t threaten to call the police or put the person in the hospital unless you mean it and are prepared to follow through.
• Don’t make it easier for your loved one to continue self-destructive behavior. Don’t loan money if you know it will be used to buy drugs or alcohol. Don’t lie to others to cover up your loved one’s drinking or drug use.
• Don’t preach or lecture. Talk to the person about specific things that have happened because of his or her substance abuse and untreated mood disorder that are visible and obvious. For example, s/he may have health, work, family or money problems.
• Don’t use guilt to motivate the person to get help.
• Realize that your loved one’s illnesses can affect his or her thoughts and views. Know that with good treatment, hopeless and self-defeating thoughts and attitudes can be overcome.
• Do your best to give support and be patient throughout the recovery process. Don’t expect the person to recover immediately.
• Allow your loved one to spend the time s/he needs with support groups and treatment as s/he recovers.
• Get support for yourself, whether or not your loved one gets help. Join a support group for friends and family. Seek professional help if you need it.
• Never give up hope.

 

Drug addiction is a complex illness characterized by intense and, at times, uncontrollable drug craving, along with compulsive drug seeking and use that persist even in the face of devastating consequences. While the path to drug addiction begins with the voluntary act of taking drugs, over time a person's ability to choose not to do so becomes compromised, and seeking and consuming the drug becomes compulsive. This behavior results largely from the effects of prolonged drug exposure on brain functioning. Addiction is a brain disease that affects multiple brain circuits, including those involved in reward and motivation, learning and memory, and inhibitory control over behavior.

Because drug abuse and addiction have so many dimensions and disrupt so many aspects of an individual's life, treatment is not simple. Effective treatment programs typically incorporate , each directed to a particular aspect of the illness and its consequences. addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

Too often, addiction goes untreated: According to SAMHSA's National Survey on Drug Use and Health (NSDUH), 23.2 million persons (9.4 percent of the U.S. population) aged 12 or older needed treatment for an illicit drug or alcohol use problem in 2007. Of these individuals, 2.4 million (10.4 percent of those who needed treatment) received treatment at a specialty facility (i.e., hospital, drug or alcohol rehabilitation or mental health center). Thus, 20.8 million persons (8.4 percent of the population aged 12 or older) needed treatment for an illicit drug or alcohol use problem but did not receive it. These estimates are similar to those in previous years.¹

Principles of Effective Treatment

Scientific research since the mid–1970s shows that treatment can help patients addicted to drugs stop using, avoid relapse, and successfully recover their lives. Based on this research, key principles have emerged that should form the basis of any effective treatment programs:

• Addiction is a complex but treatable disease that affects brain function and behavior.
• No single treatment is appropriate for everyone.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug abuse.
• Remaining in treatment for an adequate period of time is critical.
• Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment.
• Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
• An individual's treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs.
• Many drug–addicted individuals also have other mental disorders.
• Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long–term drug abuse.
• Treatment does not need to be voluntary to be effective.
• Drug use during treatment must be monitored continuously, as lapses during treatment do occur.
• Treatment programs should assess patients for the presence of HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk–reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases.

Effective Treatment Approaches

Medication and behavioral therapy, especially when combined, are important elements of an overall therapeutic process that often begins with detoxification, followed by treatment and relapse prevention. Easing withdrawal symptoms can be important in the initiation of treatment; preventing relapse is necessary for maintaining its effects. And sometimes, as with other chronic conditions, episodes of relapse may require a return to prior treatment components. A continuum of care that includes a customized treatment regimen—addressing all aspects of an individual's life, including medical and mental health services—and follow–up options (e.g., community – or family-based recovery support systems) can be crucial to a person's success in achieving and maintaining a drug–free lifestyle.

Medications

Medications can be used to help with different aspects of the treatment process.

Withdrawal. Medications offer help in suppressing withdrawal symptoms during detoxification. However, medically assisted detoxification is not in itself "treatment"—it is only the first step in the treatment process. Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated.

Treatment. Medications can be used to help reestablish normal brain function and to prevent relapse and diminish cravings. Currently, we have medications for opioids (heroin, morphine), tobacco (nicotine), and alcohol addiction and are developing others for treating stimulant (cocaine, methamphetamine) and cannabis (marijuana) addiction. Most people with severe addiction problems, however, are polydrug users (users of more than one drug) and will require treatment for all of the substances that they abuse.

• Opioids: Methadone, buprenorphine and, for some individuals, naltrexone are effective medications for the treatment of opiate addiction. Acting on the same targets in the brain as heroin and morphine, methadone and buprenorphine suppress withdrawal symptoms and relieve cravings. Naltrexone works by blocking the effects of heroin or other opioids at their receptor sites and should only be used in patients who have already been detoxified. Because of compliance issues, naltrexone is not as widely used as the other medications. All medications help patients disengage from drug seeking and related criminal behavior and become more receptive to behavioral treatments.
• Tobacco: A variety of formulations of nicotine replacement therapies now exist—including the patch, spray, gum, and lozenges—that are available over the counter. In addition, two prescription medications have been FDA–approved for tobacco addiction: bupropion and varenicline. They have different mechanisms of action in the brain, but both help prevent relapse in people trying to quit. Each of the above medications is recommended for use in combination with behavioral treatments, including group and individual therapies, as well as telephone quitlines.
• Alcohol: Three medications have been FDA–approved for treating alcohol dependence: naltrexone, acamprosate, and disulfiram. A fourth, topiramate, is showing encouraging results in clinical trials. Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and in the craving for alcohol. It reduces relapse to heavy drinking and is highly effective in some but not all patients—this is likely related to genetic differences. Acamprosate is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria (an unpleasant or uncomfortable emotional state, such as depression, anxiety, or irritability). It may be more effective in patients with severe dependence. Disulfiram interferes with the degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol. Compliance can be a problem, but among patients who are highly motivated, disulfiram can be very effective.

 

Behavioral Treatments

Behavioral treatments help patients engage in the treatment process, modify their attitudes and behaviors related to drug abuse, and increase healthy life skills. These treatments can also enhance the effectiveness of medications and help people stay in treatment longer. Treatment for drug abuse and addiction can be delivered in many different settings using a variety of behavioral approaches.

Outpatient behavioral treatment encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group drug counseling. Some programs also offer other forms of behavioral treatment such as—

• Cognitive–behavioral therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Multidimensional family therapy, which was developed for adolescents with drug abuse problems—as well as their families—addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning.
• Motivational interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Motivational incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.

 

Residential treatment programs can also be very effective, especially for those with more severe problems. For example, therapeutic communities (TCs) are highly structured programs in which patients remain at a residence, typically for 6 to 12 months. TCs differ from other treatment approaches principally in their use of the community—treatment staff and those in recovery—as a key agent of change to influence patient attitudes, perceptions, and behaviors associated with drug use. Patients in TCs may include those with relatively long histories of drug addiction, involvement in serious criminal activities, and seriously impaired social functioning. TCs are now also being designed to accommodate the needs of women who are pregnant or have children. The focus of the TC is on the resocialization of the patient to a drug-free, crime–free lifestyle.

Treatment Within the Criminal Justice System

Treatment in a criminal justice setting can succeed in preventing an offender's return to criminal behavior, particularly when treatment continues as the person transitions back into the community. Studies show that treatment does not need to be voluntary to be effective.

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1 Data is from the National Survey on Drug Use and Health (formerly known as the National Household Survey on Drug Abuse), which is an annual survey of Americans age 12 and older conducted by the Substance Abuse and Mental Health Services Administration. This survey is available online at www.samhsa.gov and from NIDA at 877-643-2644.

 

Sober Living Home A Good Idea When Leaving Rehab

When leaving an alcohol or drug treatment facility you are going to want to seriously consider relocating yourself to a sober living home.

When leaving an alcohol or drug treatment facility you are going to want to seriously consider relocating yourself to a sober living home. Having just completed a drug or alcohol rehabilitation program you most likely feel you are ready to change the way you live your life and move forward in a new direction; but trying to do so in the environment where you were engaging in those self destructive behavioral activities would most likely be a mistake. Making the positive changes in your life should begin with a new place to live. It is called a CLEAN slate for a reason.
Alcohol and drug addiction recovery is about initiating positive, pro active change in your life and how you live it. Many alcoholics and drug addicts believe that the definition of insanity is to do the same thing over and over expecting a different result each time. To get a different result you need to change what you do. It certainly can’t hurt to change where you do it as well, because where you lived is one of your most basic “things” that you need to change.
There are two things you need to do when you leave rehab. First, you should go to Alcoholics Anonymous meetings. Rehab taught you the importance of surrounding yourself with others in the recovery community. Go to AA and meet your fellow recovering addicts. The second thing you need to do is live with others in recovery and to under no circumstances live alone. Repeat: Do not live alone. The best place to meet others who are new to the road to recovery is by moving in to a sober living home.
Sober living homes will all have one common element: Zero tolerance for drug and alcohol use. Not only you, but NO ONE will be consuming drugs or alcohol which will give you a buffer zone as you learn to live with your addiction in an environment less structured than rehab. You will also most likely be surrounded by others who are new to sobriety like you. These people can help supply valuable support as well as letting you know you are not alone.
When choosing a sober living home there are many things to consider. First and foremost is who is running the house. You are going to want to feel comfortable around him, certain that he is honest and stable. And sober. Inquire about the house rules and what happens when they are broken. Some sober living homes will ask you to leave upon the first relapse; others will give you a second chance provided you prove to them it will not happen again. It should go without saying that there will be NO alcohol or drug use by you or any of the residents and staff. Ask anyway.
You’ll also want to ask about the homes other rules and policies. Some have more than just the no drugs or alcohol rule. Many require that you give up tobacco in any form, attend church, keep a tight lip on profanity, and most common attend 90 AA meetings in 90 days. You’ll want to know these rules ahead of time so you can decide which sober house is best for you.
Consider also the house itself. Is there sufficient room for you that you won’t feel crowded? Is the house kept up and kept clean? In a men only sober living environment things can get a bit messy. You want to pick a place where you feel comfortable.
Finally, if you can you should meet the people who are already living there. These people are going to not just be your peer group, but also your support structure. And you are going to be theirs. Working towards a healthy, sane, and sober life requires not just that you help yourself, but that there be others there to help you should you stumble.

Authored by R. Elizabeth C. Kitchen in Addiction 
Published on 11-27-2009

Helping a drug addict, especially if they are a loved one, can be very difficult. Many drug addicts do not want help, or at least make it seem as if they do not want help. However, getting them help can be the difference between them surviving and them dying. The first step in helping a drug addict is to educate yourself about addiction, particularly the addiction the person you are trying to help has. Though, many things are the same, all addictions have their own individual elements. For example, when helping an alcoholic, it is important to help them avoid bars and other places that serve alcohol, but when helping a heroin addict, it is important to help them avoid the places in which they purchase their drugs.

It is very important to realize that addiction can affect anyone. It can affect doctors, lawyers, college students, high school students, stay-at-home moms, and everyone in between. When helping a drug addict, it is important to realize this. Being in denial about which “type of person” can become a drug addict will lead to further problems.

When helping a drug addict, the person helping can also greatly benefit from getting help themselves. We are not able to control a drug addict, but we can control ourselves and our behavior. Groups such as Al-anon can be of great benefit to those trying to help a drug addict. Al-anon meetings can provide individuals with the help, support, and tools that they need to help an addict conquer their drug addiction. These meetings will teach us how to set boundaries and limits as well, to protect ourselves, as well as the drug addict.

When helping a drug addict, it is very important to set limits and boundaries with them. For example, tell the drug addict that you do not want them around you when they are high or drunk. When creating these limits and boundaries, they must be very specific as well. If they are not, there is a chance that they will be crossed, resulting in a setback in helping a drug addict recover. Setting boundaries and limits will also help to keep the person trying to help a drug addict healthy and sane. If they do not think of their own feelings and limits, they will be less likely to help the drug addict. Distance is also essential, both for the drug addict and the person trying to help them. If each person does have their own space, and respect each other’s space, both parties will eventually grow too far apart, resulting in the drug addict not being able to be helped.

Eventually, an intervention will be necessary if the drug addict does not seek help on their own. An intervention can be organized through a professional treatment organization or without one. Regardless of who organizes it, it is important that the drug addicts closest friends and family members are there. During the intervention all parties must pose ultimatums to the drug addict and stick to them. For example, the mother and father of the drug addict can tell them that they will no longer take care of them and let them live in their home if they do not get help today.

1. Don’t try to get through this all by yourself. Get connected with others who can support you in stayingclean and sober. It does not have to be your close friend or a partner. Your sponsor, your counselor/therapist,or someone who has had a few years of sobriety can also be quite helpful. It’s never too late to ask for help butit is better to let someone know about your needs a week or two before the actual risky time (e.g. a week or twobefore Thanksgiving).

2. Create and carry a list of phone numbers of people who can support you in your recovery. This can includea list of emergency numbers, a relapse prevention hotline or a drug line. The liSt can also include some 12-step 24-hour support numbers. You can also post the list in a visible place likeyour refrigerator or near your alarm clock.

3. Plan a clean and sober gathering at your house or help a friend organize one. Doing so can give your more control over potentia l triggers and allow another way to get support.

4. Go to meetings. In fact, go to more meetings then you normally do. It is important to spend some time with people who are going through similar experiences. Also, many meeting locations hold clean and sober celebrations during the holiday season, including parties on Christmas & New Years eve.

5. Get out of yourself. Focus on someone else’s wishes or needs. Help someone you know or volunteer.

6. Share your gratitude by writing letters or cards to people you care about or would like to get closer to. You can tell each person the traits that you value most in them, things they have done that meant a lot to you, and ways you value them as a friend /partner/co-worker. You can also offer to make them something (cake, dinner, sweater, etc) or do a chore they find difficult, or house-sit, farm-sit, pet-sit, babysit, etc.

7. Tell as many people as you can ahead of time that you are trying to avoid drinking and/or using drugs.

8. Avoid parties where alcohol and/or drugs might be present (this includes people who are high or drunk). If you must go: 1) before the party, make at least one commitment to call someone from your support list; 2) if you can manage it, come to the party late or leave early to have less time to be exposed to potential triggers; 3) go with someone who can help you avoid picking up a drink/drug; 4) make arrangements to do something clean and sober after the party.

9. Don’t feed the beast. A single craving has a physiological life of up to about 30 minutes. If you wait long enough without reinforcing the craving (like browsing through the liquor store or dialing your dealer’s number over and over again), its intensity will go down, which in turn can give you enough room for better coping.

10. Try to walk away from the trigger. If you can’t do it physically, try doing it mentally first - focus on something else, close your eyes, relax your body, breathe slowly, tell yourself that “this too shall pass.” 

11. Practice refusing an offer of alcohol and/or drugs. Go beyond “Just Say No” – think of several possible scenarios and write down your potential responses. The more you PRACTICE, the better you will get at it.

12. Play out the mental tape of what would happen if you got drunk and/or high. Make sure you do it all the way, not just for an hour or one day. Think about HOW NOT TO REPEAT the holidays that were ruined by your drinking or using drugs.

13. Imagine what your ideal holiday would look like. Then, think about REALISTIC WAYS you can make this holiday closer to that ideal. Invent your own traditions.

14. Create a list of things that can help you relax and distract yourself from the triggers (index cards can be handy). Your list can include things that cover your 5 senses (smell, touch, vision, taste, & hearing).

15. Don’t beat yourself up if things don’t go exactly the way you want them. Don’t punish yourself and remember that guilt & shame can be triggers too. Be kind to yourself and keep trying!

Courtesy of Mera M. Atlis, Ph.D.

www.yourwellnesszone.com

CHORES AND USEFUL TASKS (such as Cleaning, Cooking, Dishwashing, Ironing, Sewing).

EXERCISES (such as Jogging, Nautilus, Walking, Aerobic Dancing, Stretching or Aerobic Exercises, Shadow Boxing, Skipping Rope, Yoga, Weightlifting).

FOOD ACTIVITIES (such as Baking, Cooking, Barbecuing, Preparing Gourmet Meals, Shopping for Food).

GAMES (such as Bridge, Checkers, Chess, Go, Jigsaw Puzzles, Monopoly, Poker, Pinochle, Scrabble, Crosswords, Anagrams).

GRAPHIC ARTS (such as Cartooning, Drawing, Lettering, Mechanical Drawing, Painting, Photography, Silkscreening).

HANDICRAFT ACTIVITIES (such as Basketmaking, Bookbinding, Crocheting, Embroidering, Knitting, Leatherworking, Dressmaking, Decoupage, Needlepoint).

HUMOROUS ACTIVITIES (such as Cartooning, Improvisation Games, Charades, Jesting, Joke-making, Playing Practical Pranks and Jokes, Punning).

MARTIAL ARTS (Akido, Jujitsu, Judo, Karate, Fencing, Wrestling).

OUTDOORS ACTIVITIES AND SPORTS (such as Birdwatching, Gardening, Crabbing, Fishing, Canoeing, Sailing, Hunting, Walking, Ice-skating, Skiing, Rowing, Hiking).

PERFORMING ARTS (such as Dancing, Ballet, Mime, Acting, Improvisation, Modern Dance, Tap Dance, Singing).

PERSONAL GROWTH (Self-help Books, Workshops, Lectures, Skills-learning, Career Development).

READING (Fiction, Novels, Plays, Poems, Nonfiction).

SCIENTIFIC ACTIVITIES (such as Anatomy, Biology, Herpetology, Physics, Medicine, Zoology, Anthropology, Psychology, Sociology).

SOCIALIZING ACTIVITIES (such as Conversing, Group Activities, Attending or Giving Parties, Rap Sessions).

SPECTATING (watching Movies, Plays, Sports, Pageants, Circuses).

SPORTS (such as Baseball, Basketball, Golf, Gym, Football, Hockey, Dancing, Tennis, Skating, Running, Volleyball).

STUDYING ACADEMIC SUBJECTS (such as Art History, History, Language, Math, Music, Science, Social Science).

TRADES AND CRAFTS (such as Bricklayer, Builder, Carpenter, Foreman, Factory Worker, Gardener, Mechanic, Machinist, Police Officer).

VENTING FEELINGS (such as Punching Pillows, Yelling, Talking, Writing, Expressing Good Feelings).

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