Tuesday, April 29, 2008

Retirees pushing pills to get by

enice, Florida —- The battle against drug addiction is one that Norman Shewman has waged for 41 years.

Since Vietnam, the 57-year-old's addictions have centered on heroin and alcohol, but for the past seven years he's been clean. Now he's helping save the lives of others as the CEO of Home Detox, the only home detox center in the state. Unfortunately, with the boom in pharmacies in recent years, business is too good. Shewman saw 125 patients in 2007. He also began to see a trend.

“I've had patients tell me that they go to older people for the drugs,” says Shewman.

By older, he means seniors. More and more are pushing what they have access to in order to just get by.

“If you're only making $600-$700 a month and that is your social security, well, they find out they can sell their pills for $50 a piece. All of a sudden $50 times 30, what is that? $1500,” says Shewman.

Some Bay area residents that we spoke with have heard of seniors cashing in. For them, the concept is almost too difficult to fathom even in these economic times.

“It's sad that for such a great nation we have to get to the point where elderly have to be selling their drugs to provide for themselves,” says Tonya Van Fossen of Bradenton.

Another bitter pill of reality that makes it difficult for many to swallow is the fact that the Bay area has seen a rash of robberies at pharmacies in recent weeks.

“I'd be a little nervous about being a pharmacist because these kids are coming in fully armed and holding up the pharmacist,” says Mike Dyer, a retiree from New York.

If the economy continues to turn south, the potential for more drug-related crimes is expected to intensify.

Monday, April 28, 2008

Environment Key Early: Genes' Role Expands In Alcohol Dependence

ScienceDaily (Apr. 24, 2008) — The influence of genetics increases as young women transition from taking their first drink to becoming alcoholics. A team of researchers at Washington University School of Medicine in St. Louis found that although environment is most influential in determining when girls begin to drink, genes play a larger role if they advance to problem drinking and alcohol dependence.

The researchers studied 3,546 female twins ages 18 to 29 to ferret out the influences of genes and environment in the development of alcohol dependence.

The road to alcohol dependence involves transitions through many stages of drinking behaviors: from the first drink to the first alcohol-related problems (such as drinking and driving, difficulty at school or work related to alcohol use) to alcohol dependence.

Environmental factors the twins shared, such as exposure to conflict between parents or alcohol use among peers in school, exerted the largest influence on initiation of alcohol use. The study found that females who had their first drink at an earlier age were more likely to develop serious alcohol problems. The researchers found that all transitions were attributable in part to genetic factors, increasing from 30 percent for the timing of first drink to 47 percent for the speed at which women progressed from problem drinking to alcohol dependence. But genetics did not explain everything.

"Even when genetic factors are most influential, they account for less than half of the influence on drinking behavior," says lead author Carolyn E. Sartor, Ph.D., a postdoctoral research fellow at the School of Medicine. "That's good news in terms of modifying these behaviors and reducing the risk of developing alcohol dependence. Genetics are not destiny, and our findings suggest that there are opportunities to intervene at all stages of alcohol use."

Friday, April 25, 2008

New Generation Gap as Older Addicts Seek Help

WEST PALM BEACH, Fla. — All is peaceful and orderly on the older adult unit at Hanley Center, where substance abusers over the age of 55 are spared the noisy swagger of addicts half their age across the campus.

In their separate oasis, alcoholics and prescription drug abusers of a certain age do not curse at one another, raise their voices in anger or blast music at midnight. They don’t brag about their macho pasts or stage drama-queen breakups on the communal pay phone. They show up on time for therapy groups.

“We have different health issues, different emotional issues, different grief issues,” said Patrick Gallagher, 66, who was treated here for a dual addiction to pain medication and alcohol. “We need more peace and quiet and a different pace.”

Across the country, substance abuse centers are reaching out to older addicts whose numbers are growing and who have historically been ignored. There are now residential and outpatient clinics dedicated to those over 50, special counselors just for them at clinics that serve all ages, and screenings at centers for older Americans and physicians’ offices to identify older people unaware of their risk.

Addiction specialists and organizations for the elderly anticipate a tidal wave of baby boomers needing help for addictions, often for different substances and with different attitudes toward treatment than the generation that came before them. Federal data shows the shifting demographics: In 2005, 184,400 Americans who were admitted to drug treatment programs — roughly 10 percent of the total — were over 50, up from 143,000, or 8 percent of the total, in 2001.

The same report, by the Substance Abuse and Mental Health Services Administration, foresees 4.4 million older substance abusers by 2020, compared with 1.7 million in 2001 — numbers that are “likely to swamp the current system,” said Deborah Trunzo, who coordinates research for the agency.

At Hanley Center, Carol Colleran, a 71-year-old counselor, pioneered age-segregated residential treatment, challenging one-size-fits-all programs that mix people of all ages. Odyssey House in East Harlem, with its low-income clientele, has followed Hanley’s lead. Older adults are harder to lure into treatment, officials say, because of a generational aversion to airing one’s laundry in public. But once there, they are often highly motivated and more likely to complete a program.

“We are reticent and don’t readily share our feelings in a group,” Mr. Gallagher said. “That’s not something we’ve grown up with.”

But living with people of a similar background, he said, had given him a “comfort level and a sense of belonging” conducive to success.

Treatment providers are seeing signs that the 50-and-over group is not, in fact, monolithic. Rather, it is divided between the “old old” and the “young old,” the Silent Generation and the Me Generation. Neither feels much kinship with the Lindsay Lohan set. But neither do they necessarily feel much kinship with each other, and counselors are bracing for a collision of cultures.

According to the federal report, 83 percent of older addicts were 50 to 59, and the trailing edge of the baby boom, age 50 to 54, is the fastest-growing older group: They were 6 percent of all admissions in 2005, from 3 percent a decade earlier.

“It’s already changing,” said Tom Early, a counselor on Hanley’s older-adult unit, where the patients, all alcoholics or prescription drug abusers, are 55 to 78. “We can see it. We can feel it.”

Alcohol remains the dominant problem for both groups, although that is changing quickly. Among patients over 65, 76 percent abuse alcohol; many have allowed social drinking to get out of hand after the isolation of retirement or loss of a spouse. In the 50-to-54 age group, by contrast, 55 percent cite alcohol, followed by opiates, cocaine, marijuana and methamphetamines. Prescription drug abuse is climbing in both groups, led by anti-anxiety drugs like Xanax and pain-killers like Oxycontin.

Ms. Colleran said prescription drug abuse among the “old old” was usually accidental. They have faith that anything a doctor prescribes must be safe, she said. In the younger group, these medications are knowingly abused, experts said, by buying them online or borrowing from friends.

As the age group skews younger, Ms. Colleran said: “They say, ‘I’m not like anyone else.’ They challenge everything.”

These characteristics, she added, make treatment tricky and require new techniques, like cognitive behavior therapy and lectures on anger management by the noted male-consciousness-raiser Iron John (a k a Robert Bly). Anger and stubbornness are more prevalent among those in their 50s. At Senior Hope, an outpatient clinic for older adults in Albany, 55-year-old Ken Einbinder described fantasies of violence that seemed to dismay or embarrass group members in their 70s.

Only John Quinn, 54, nodded knowingly. He was struggling after a recent relapse and had been prescribed an antidepressant. Mr. Quinn tossed out the pills without telling anyone because, he told the group, they caused erectile dysfunction. Dr. William Rockwood, founder of Senior Hope, said older clients, even if they complained of the same side effect, would have complied with medical advice.

On Hanley’s older-adult unit, there is disdain for street drugs, which “very few of us have used,” Mr. Gallagher said. On the patio where residents take cigarette breaks , a half dozen said the harmony of the group would be compromised by the addition of crack, heroin or even marijuana abusers.

One 61-year-old alcoholic said that “if the numbers flipped so there were more of them than me, I’d be out of here.” He added that he had stopped attending Alcoholic Anonymous meetings, and relapsed, because of an influx of young drug addicts.

The antipathy toward street drugs is a function of socio-economic class, said Frederic Blow, who studies elderly substance abuse at the Addiction Research Center at the University of Michigan. For Hanley’s clients, who pay $24,500 for a 28-day rehab, “it’s not part of their culture.”

Indeed, no such distinction is made at the unit for older adults at Odyssey House, where clients are mostly poor, addicted to heroin or crack, and remanded by the courts for 12 to 18 months of subsidized care.

But across social class, many older substance abusers said, they no longer consider themselves invincible.

A 66-year-old chief of staff at a veterans’ hospital, recently treated at Hanley, said he had no patience with men in their 20s and 30s who “aren’t finished drinking and drugging and think their war stories are a badge of honor.”

The doctor, since retired, pointed to “all we have to lose — the social binding” that accumulates with age. In his case, that included a 40-year marriage and children and grandchildren who refused to see him until he was sober.

“I just wanted to stop drinking and get on with my life,” he said.

At Odyssey House, Charles White, 57, said of the younger clients: “They think they have another run in them. And as far as the ladies go, they have no respect.”

Mr. White was dignified in a dark suit and tie and chivalrous as he held a chair for Doris Ellison, 55, another longtime heroin addict, also dressed in her Sunday best.

“It was a different era,” Ms. Ellison said. “We had a lot of guidance growing up. They don’t have that at home. Their parents — and that includes some of us — are out there drugging. But now, for however many years we have left, we can try and do the right thing.”

For Ms. Ellison, that includes setting an example for 26-year-old Milagros Bonilla, who lives on a separate floor and attends separate therapy groups but got to know the older woman on long bus rides to high school equivalency classes.

Ms. Bonilla said people her age were “kind of loud and obnoxious” and often less disciplined than their elders. She credits Ms. Ellison with inspiring her to get clean, stick to her studies and remain hopeful that she will regain custody of three daughters in foster care.

“She’s more motivating to me than anyone my age, because she makes me feel anything is possible,” Ms. Bonilla, whose own mother is dead, said of Ms. Ellison.

Officials at these age-segregated programs promote the success of their clients. But, Dr. Blow said, completion rates are poor statistical measures of long-term sobriety. Nevertheless, he is persuaded, based on years of observation, that age-specific treatment “makes total sense.”

At Senior Hope in Albany, Dan Fitzsimmons, 79, an executive for a major utility, and Tom Hyde, 76, who owned a sheet music business, became good friends.

Both let their drinking get out of hand in retirement, when they had too much time on their hands and a shrinking circle of companions. Both relapsed once and helped each other get back on the wagon. Now, they are determined to leave a proper legacy for their grandchildren.

Mr. Fitzsimmons needs only to think back to his own adolescence, when he was assigned the task of finding his grandfather in neighborhood bars. All these years later, Mr. Fitzsimmons said, he carries the indelible memory of “an old gray-haired guy out on another toot.”

“I’m not going to let that happen to me,” he said. “It’s not the way I want to be remembered.”


Wednesday, April 23, 2008

Vatican Makes Drug Use a Deadly Sin

New York, NY (1888PressRelease) April 23, 2008 - With Pope Benedict XVI currently visiting the United States, many American Catholics are wondering: Could their “innocent” drug use be putting their mortal souls at risk?

Yes, it could, according the Vatican, which recently added seven new offenses to its list of deadly sins—among them, genetic modification, polluting the environment and taking drugs.

“I don’t think this is going to help anyone,” says Stephen Della Valle, author of the new addiction and recovery memoir Rising Above the Influence. “Addicts already feel hopeless and worthless. With the Pope now telling them that they’re eternally damned, and that there’s nothing they can do about it, how likely will they be to seek help?”

The Catholic Church has not updated its list of deadly sins in 1,500 years. This current modification, which also lists “contributing to the widening divide between the rich and poor” and “‘morally dubious’ experiments such as stem cell research,” seeks to address today’s more secular world and what the Pope has referred to as our “decreasing sense of sin.”

Today, there’s no doubt that drug use is an international epidemic. Surveys have shown disturbing addiction trends in nations around the world, including:
• Mexico: marijuana, cocaine and inhalants reported as the most-used drugs
• East and South Asia: heroin is the number-one choice; cannabis comes in second
• Australia: while marijuana and amphetamines remain most popular, heroin is becoming more widely available
• Various European countries: heroin and other opiates continue to top the list
• Canada: marijuana is most widely used, but heroin is a growing problem, and cocaine is considered a major health issue

“I understand where the Vatican is coming from on this,” says Mr. Della Valle. “Drug abuse is a serious problem in many countries. But I’d be more impressed if they created a Church-based recovery program to help the drug and alcohol abusers of the world, instead of condemning them.”

Tuesday, April 22, 2008

Who Are We? Coming of Age on Antidepressants

“I’ve grown up on medication,” my patient Julie told me recently. “I don’t have a sense of who I really am without it.”

At 31, she had been on one antidepressant or another nearly continuously since she was 14. There was little question that she had very serious depression and had survived several suicide attempts. In fact, she credited the medication with saving her life.

But now she was raising an equally fundamental question: how the drugs might have affected her psychological development and core identity.

It was not an issue I had seriously considered before. Most of my patients, who are adults, developed their psychiatric problems after they had a pretty clear idea of who they were as individuals. During treatment, most of them could tell me whether they were back to their normal baseline.

Julie could certainly remember what depression felt like, but she could not recall feeling well except during her long treatment with antidepressant medications. And since she had not grown up before getting depressed, she could not gauge the hypothetical effects of antidepressants on her emotional and psychological development.

Her experience is far from unique. Since their emergence in the late 1980s, serotonin reuptake inhibitors like Prozac and Zoloft have become some of the most widely prescribed drugs in the world, for depressed teenagers as well as adults. Because depression is often a chronic, recurring illness, there are certain to be many young people, like Julie, who are coming of age on these newer antidepressants.

We know a lot about the course of untreated depression, probably more than we do about very long-term antidepressant use in this population. We know, for example, that depression in young people is a very serious problem; suicide is the third-leading cause of death in adolescents, not to mention the untold suffering and impaired functioning this disease exacts.

By contrast, the risk of antidepressant treatment is small. A 2004 review by the Food and Drug Administration, analyzing clinical trials of the drugs, did show an elevated risk of suicidal thinking and nonlethal suicide attempts in young people taking antidepressants — 3.5 percent, compared with 1.7 percent of those taking a placebo. But since the lifetime risk of actual suicide in depressed people ranges from 2.2 to 12 percent, risk from treatment is dwarfed by the risks of the disease itself.

Still, what do we know about the effects of, say, 15 to 20 years of antidepressant drug treatment that begins in adolescence or childhood? Not enough.

The reason has to do with the way drugs are tested and approved. To get F.D.A. approval, a drug has to beat a placebo in two randomized clinical trials that typically involve a few hundred subjects who are treated for relatively short periods, usually 4 to 12 weeks.

So drugs are approved based on short-term studies for what turns out to be long-term — often lifelong — use in the world of clinical practice. The longest maintenance study to date of one of the newer antidepressants, Effexor, lasted only two years and showed the drug to be superior to a placebo in preventing relapses of depression.

What do I say to a depressed patient who is doing well after five years on such a drug but can’t stop without a depressive relapse and who wants reassurance that the drug has no long-term adverse effects?

I usually say that we have no evidence that the drug poses a risk with long-term use; and since the risk of untreated depression is much greater than the hypothetical risk of the drug, it makes sense to stay on it.

This large gap in our clinical knowledge is compounded by the public’s growing and well-founded skepticism about research sponsored by drug makers. A study in the January 2008 issue of The New England Journal of Medicine, involving 74 clinical trials with 12 antidepressants, found that 97 percent of positive studies were published, versus 12 percent of negative studies.

Clearly, physicians and the public need much better data on the safety and efficacy of drugs after they hit the market, which at present consists mainly of anecdotes and case reports.

Congress recently reauthorized the Prescription Drug User Fee Act, which will expand the F.D.A.’s post-marketing drug surveillance, though I think it did not go far enough in mandating the use of powerful epidemiological strategies to monitor drugs over the long term.

Beyond these concerns, there are other important issues to consider in long-term use of antidepressants, especially in young people. One patient, a woman in her mid-20s, told me that she felt pressured by her boyfriend to have sex more often than she wanted. “I’ve always had a low sex drive,” she said.

For the past eight years she had been taking Zoloft, which like all the antidepressants in its class is known to lower libido and to interfere with sexual performance. She had understandably mistaken the side effect of the drug for her “normal” sexual desire and was shocked when I explained it: “And I thought it was just me!”

This just underscores how tricky it can be to use psychotropic drugs during adolescence — when the brain is still developing, when one’s identity is still work in progress.

The drugs save lives, and we often have no choice but to use them — even if we have questions about their long-term use. But the questions are big ones, and we owe it to our patients to try to answer them.

Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.
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Monday, April 21, 2008

A Grim Tradition, and a Long Struggle to End It

Published: April 2, 2008

ESPAÑOLA, N.M. — Eric Lucero has been addicted to heroin for three decades and says he has known at least 100 people in this pastoral county who died from overdoses, some in his presence.

But Mr. Lucero has recently become a popular — and, he would argue, safer — injection buddy. Seven times, he says, he has revived companions by using an anti-overdose drug, Narcan, which the state now hands out to addicts and their relatives as part of its effort to reduce the toll of one of the country’s most pervasive epidemics of narcotics use.

Mr. Lucero, 48, said, “People know I’m good at saving them.”

Rio Arriba County, just north of Santa Fe, is a Georgia O’Keeffe landscape of juniper-dotted desert and mountain valleys populated mostly by Hispanics who proudly trace their lineage to settlers of the 1600s — and who, a decade ago, discovered that their county had the nation’s highest per capita rate of deaths from overdoses. Hundreds of families are struggling to live with a multigenerational plague of narcotics; Mr. Lucero’s own son is addicted.

Federal data released in March showed that the county ranked first in drug fatalities for 2001 to 2005, with a death rate of 42.5 per 100,000, compared with a national average of 7.3.

Heroin use in the county jumped in the 1970s, as world production soared and some Vietnam veterans returned as addicts. It zoomed in popularity in the 1980s and ’90s, abetted, surprisingly, by the tradition of close-knit extended families. “We start our addiction getting high with our uncles, then we turn on our own nephews,” said Manuel Anaya, who was an addict for 26 years and now runs a drug counseling program for Hoy, the county’s largest treatment group.

Intensified law enforcement and a flurry of new treatment programs have failed to stem the use of narcotics here. So New Mexico has adopted the country’s most sweeping effort at “harm reduction,” a strategy to eradicate disease, suffering and death among addicts that includes exchanging used needles for clean ones and dispensing Narcan. Last year, the state adopted the country’s only law limiting the ability of the police to arrest users who call 911 to save an overdosing companion.

There has been no evidence yet of a decline in addictions, perhaps because of a scarcity of treatment facilities. And the seemingly contradictory impulses to stamp out drug use and safeguard addicts can lead to difficult situations for relatives.

In Cordova, a valley hamlet with peach and apricot orchards, Dolores S. emerged from her adobe house to greet the state’s needle-exchange van. A nonuser who lives with seven relatives, four of whom are addicts, she said trading hundreds of used syringes each week for fresh ones “makes me uncomfortable.”

Her face tightened as she admitted to giving money for heroin to her addicted son, slouched nearby, who is in his 20s. “I’d rather give him money than see him panhandle or steal,” said the woman, who does housework for a living and spoke on the condition that her last name not be used, to protect her family. “A lot of mothers here are in the same situation.”

Needle exchanges and Narcan distribution are opposed by federal officials, who say they amount to endorsing addiction. Bertha K. Madras, a deputy director at the White House Office of National Drug Control Policy, has said that Narcan, the trade name for naloxone, should be administered only by medical professionals and that it could make addicts feel safer and less likely to seek care.

But Bernard Lieving, director of the harm reduction program at the New Mexico Department of Health, said, “These programs have just the opposite result.” Mr. Lieving said studies elsewhere had shown that needle exchanges greatly increased the chances that users would enter recovery programs.

“Unfortunately,” he said, “it’s very difficult to get people into residential treatment immediately, right when they express interest, because there aren’t enough beds in the state.” But field workers provide counseling, acupuncture therapy and social services to addicts who say they are ready, which Mr. Lieving called important first steps.

Addicts remain a small minority of the population, and drug use remains largely hidden behind the closed doors of trailers and small metal-roofed homes. But nearly everyone here seems to have friends or relatives who died from drug use or are addicted to cheap Mexican heroin, cocaine, prescription painkillers or, increasingly, combinations of the above, often mixed with heavy alcohol use.

Peggy Ulibarri, a state health official who distributes Narcan in Rio Arriba County, said clients had told her of using the antidote hundreds of times. Without Narcan, Ms. Ulibarri and others say, the number of deaths would certainly be higher. Instead, recorded deaths have been steady, around 20 a year in a county of 41,000. Meanwhile, the health department trades about 12,000 clean syringes for used ones in the county each week.

Dealers are arrested, but users found with syringes now flash a card showing enrollment in the needle exchange program and are often let go.

Proximo Martinez, 35, of Chimayo, counts 38 drug-related deaths in his extended family, including his brother and sister, and is a vocal crusader against drug abuse. Yet he recently collected syringes from the van — sterile needles to protect his brother-in-law and other relatives — as well as kits with a new form of Narcan that is sprayed in the nose rather than injected.

Mr. Martinez said he had administered Narcan about 20 times. “But some can’t be revived,” he said. “People have died in my house.”

Many in the fight against drugs, including Ben Tafoya, the director of Hoy, believe the heavy use of drugs and alcohol is rooted in a shared sense of loss, starting when the United States refused to recognize many Spanish land grants in the mid-19th century and building more recently as struggling families, accustomed to farming and ranching, became dispirited as they had to sell land.

An obvious factor is poverty — more than one in five residents is below the federal poverty line and far more are just above it. Yet many working-class people are users, too.

The family role is sometimes a sad reversal of expectations. “Addiction can become a source of bonding between parents and their children,” said Angela Garcia, an anthropologist who was born in Rio Arriba County and studied drug use here.

The Rev. Julio Gonzalez, the pastor at the Holy Family Roman Catholic parish in Chimayo since 2001, said he had buried overdose victims “of all ages, including people you’d think were pillars of the community.”

“It’s not just the youth, it’s all generations here,” Father Gonzalez said.

James Garcia, who is now clean, used and sold heroin and cocaine in Española until 11 months ago and said he had encountered at least a dozen families in which grandparents, parents and children all injected drugs, with some working and others selling drugs or stealing to sustain habits that can cost $40 to $100 or more each day.

Lawrence N., an Española man in his early 50s, said he had been addicted to heroin, pills and cocaine since 1970, including during 18 years in prison.

The man, who would not allow his surname to be used, is disappointed that his two sons, in their 20s, use heroin, too. “I had them deliver to me in jail,” he said. “Maybe that had something to do with it.”

Dr. Fernando Bayardo, director of the Española Hospital emergency room, called overdoses “only a small fraction of the deaths and disease caused by substance abuse,” which include liver disease and blood infections as well as car accidents, marked by omnipresent roadside crosses bedecked with plastic flowers. The county has been spared a major epidemic of AIDS, but testing in drug clinics indicates that a majority of needle users here are infected with hepatitis C.

The county built a residence that now houses about 25 patients and has a program to counsel youths at high risk, said Lauren Reichelt, the county’s director of Health and Human Services. But there is no county center for medically supervised detoxification, and the wait list for the one in Albuquerque is long.

The most successful treatment, used on 75 patients at the community health clinic, is the opiate replacement bupenorphrine, which can be dispensed at doctors’ offices and is rapidly catching on around the country despite costing up to $450 a month.

In the backyard of the house he shares with his elderly, ailing mother, Mr. Lucero, the 30-year addict, raises chickens and pigeons, saying, “This is what keeps me sane.”

He survived five overdoses, he said, turning apologetically to his mother. “She would find me in the yard with a needle in my arm, all purple, or lying on the floor in the kitchen.”

He has been more careful, or luckier, in the last several years. But just in case, his mother took a quick lesson in Narcan administration the other day. She and her son watch over each other, she said. Every night, before going to bed, she checks to make sure he is breathing.


Saturday, April 19, 2008

Prescription Drug Abuse

Prescription drug addiction is major problem affecting millions of individuals in North America growing the demandfor drug rehab, but there is not much awareness about the magnitude of the problem. Because the nation has a major problem with other illicit drugs (like cocaine, marijuana, crack), prescription drug abuse has not been a major priority for both the health and legal professionals.

The non-medical use or abuse of prescription drugs is an escalating and has become a major public health issue. Every single day, there are reports of deaths being reported from accidental overdose of prescription drugs. In most cases, the individual was abusing multiple prescription drugs.

Even though many of these prescription drugs have beneficial uses in clinical medicine, for some unknown reason(s), the abuse of a wide variety of prescription drugs will soon surpass smoking as the number one health problem in America. Hundreds of internet sites sell these drugs without a prescription. These drugs may relieve anxiety and pain, but when abused they can be lethal and just as addictive as other illicit drugs like cocaine.

The abuse of prescription drugs has increased exponentially over the past 2 decades and is just below marijuana, which is the most abused substance in North America. The prescription drug abuse has created problems at all levels of society and presents a major challenge to law enforcement, health professionals and families of those involved. Today there needs to be a legitimate strong willed approach to control the abuse of these drugs, because the problem will soon be out of control with devastating consequences to society.

Extent of Use

Data from the National Drug Threat Survey organization reveals that prescription drugs are illegally diverted and heavily abused in most states.

Data from the pharmaceutical agencies indicate that at least 50 million Americans report the use of at least one psychotherapeutic drug (tranquilizer, sedative, pain killer, stimulants) at some point in their lifetimes. Approximately 7 million Americans over the age of 12 report recent (past month) use of psychotherapeutic drugs for non-medical purposes.

Drug Availability

Obtaining prescription drugs for abuse is not difficult and there are various means of obtaining the drugs. This includes:

- multiple Doctor shopping
- forged prescriptions
- via Illegal online pharmacies
- Theft and burglary (from hospitals, residences, pharmacies)
- obtaining prescription from family and friends
- Over prescribing by physicians
- Unscrupulous physicians selling drugs

Prescription drug abuse is occurring at epidemic proportions in almost every state. Numerous government studies reveal that the majority of internet sites selling prescription drugs do not even require a formal doctor’s prescription. The drugs are bought directly from the pharmacy and there are never any questions asked and no IDs are required for purchase.

Commonly Abused Drugs

The four classes of prescription drugs that are most commonly abused are

- Opioids -prescribed to treat pain,—(codeine, oxycodone, oxycontin, Percocet, morphine, Lortab, Vicodin

- central nervous system (CNS) depressants -used to treat anxiety and sleep disorders—(barbiturates, Valium, Xanax, clonazepam)

- CNS stimulants- treat the sleep disorder narcolepsy, attention-deficit hyperactivity disorder (ADHD), and obesity—(dextroamphetamine, Ritalin, Phentermine).

- Non opioid pain killers (vioxx, oxycodone, oxycontin, Lortab, Vicodin

Abusers of prescription drugs tend to combine other prescription drugs for abuse. This leads to more adverse effects and the risk of overdose is common.

Symptoms of Drug Use

Because there are numerous prescription drugs that are abused, it is impossible to mention all the symptoms, but some features are common to all prescription drugs. These features include:

- alterations in mood
- erratic behavior
- mental cloudiness
- confusion
- inability/excess sleep
- anxiety
- hyperactive, increased alertness
- suicidal tendencies
- alterations in physical outlook

Medical Problem

Just like illicit drugs, prescription drugs also have numerous side effects and toxicity from these drugs is common. On a daily basis, individuals are admitted to the Emergency Rooms with overdose from the drugs, some of these overdoses are intentional, some not.

The majority of medical emergencies are related more to overdose. Once managed in the hospital, these individuals are stabilized and treated but the addiction problem is not catered to.

Like all individuals who abuse illicit drugs, individuals who abuse prescription drugs also deny that they have a problem. The majority of these individuals have premorbid conditions which are obvious but the prescription drug problem is hidden. The majority of these individuals may have social, emotional problems, stress, depression, anxiety, financial woes or familial problems.

A gradual change in these individuals may give a hint to their problem of prescription drug abuse. These changes include:

- a change in friends
- declining interest in health
- decreased interest in school
- isolation from family and old friends
- repeated lies, stealing
- withdraws from social activities

Health Effects

The health risks associated with prescription drug abuse vary depending on the agent. Each class of drugs has its own particular set of side effects but in general the majority of prescription drugs can cause the following side effects:

- opioids (respiratory depression, low BP, nausea, vomiting)

- Benzodiazepines (sedation, coma, decreased respiration, lethargy, mental confusion)

- Stimulants (fever, fast heart rate, increased BP, seizures)

Reports from emergency rooms across the nation reveal that individuals abusing prescription drugs are increasing in numbers in the hospital. Accidental overdoes and adverse reactions to the drugs have accounted for the majority of these cases. In many instance, it was discovered that the individuals have been abusing multiple drugs of different classes, thus compounding the toxicity and increasing the chance of an adverse reactions.

Prescription Drug Addiction Treatment

The major dilemma is treating prescription drug addiction is that it is a hidden disorder. No one admits to using drugs. Because the problem is not recognized by the individual, helping the person is difficult. It is essential to see a physician as a first step in the management of the disorder. After this step the primary care physicians may help with getting aid from organizations which can help with detoxification. The physician can also refer to a drug rehabilitation center; many government institutions offer free medical help to treat the addiction.

There is no single type of treatment that is appropriate for all individuals addicted to prescription drugs. Treatment takes into account the type of drug used and the needs of the individual. Successful treatment may incorporate several components, including detoxification, counseling, behavior management and the use of pharmacological therapies. Multiple sessions of treatment may be needed for the patient to make a full recovery.
Narcotics Anonymous is a great source for helping people fight their addiction.

Most individuals have to be realistic and realize that the treatment is time dependent and takes time. Relapse is common and it is essential to have the support of the family and friends through the recovery phase.

Legal Problems

In the last few years, the DEA has become more aware of prescription drug fraud and new regulations and bills have been passed to prosecute doctors, pharmacists and others who deal in the selling of these drugs without proper authority. Almost all the states have addressed the prescription drug abuse by

- keeping a check on the pharmacists and record of all drug prescription
- keeping a track of all patients who require prescription drugs
- employ tamper resistant prescription pads
- maintain records of all electronically prescribed drugs
- target internet pharmacies and doctors who work for them

Most states have developed strict prescription monitoring programs, which can help prevent and detect the diversion and abuse of pharmaceutical controlled substances. Recent bills have made funds available to develop and enhance the strict enforcement of drug regulation in each state.

The proliferation of internet pharmacies has also been noticed by the Federal agencies who have now become very involved with prescription drug diversion. Both the DEA and FDA work together on criminal investigations involving the illegal sale, use, and diversion of controlled substances, including illegal sales over the Internet. Additionally, the FDA and U.S. Customs and Border Protection inspect all parcels being shipped to US customers. In the last 2 years, many pharmacies, doctors and others have been criminally prosecuted for the illegally distribution of these drugs.

Thursday, April 17, 2008

Words of Encouragement

When we feel discouraged, it’s usual to try to find some external source which will give encouragement. We think that we can find a way to increase our motivation by finding someone who can give us a pep talk, or by reading a motivating book or a piece of motivational writing—much like this one.

It’s true that these things, especially people with a bright outlook on life, can give us encouragement and motivation. People with a positive outlook can do wonders for our own mental outlook. But sometimes that doesn’t work. No matter how much we’re around positive people, the great outlook just doesn’t seem to rub off.

So what do we do when we have no motivation and can’t be bothered?

What do we do when we want to feel positive but can’t help feeling negative? Being in a positive situation, with positive people can help us to be encouraged, but we need something more.

And paradoxically—as always—what can be good for us is the exact opposite of what we think. Being around positive people can be good because they encourage us, but it doesn’t follow that they are positive and so are good at giving encouragement. It can be that they are good at giving encouragement, and so therefore have a positive outlook. What you give out, you get back.

What may be needed then, when we feel a lack of motivation and feel discouraged with our progress and life in general, is not encouragement or to be around positive people. What may be needed is for us to be around people who need encouragement and motivation and for us to give it to them. We then find that what we give out—encouragement—comes back to us.
If you look back on times when you have encouraged someone to make an effort, you usually find that your own outlook improved dramatically.
This paradox is encapsulated in one of the many Zen sayings which relate to our outlook on life. One day a Zen student went to his master feeling that he wasn’t progressing in his training. The conversation went like this…

Zen student: “Master, I am very discouraged.”
Master: “Encourage others.”

The next time you find yourself feeling discouraged look at how you could give encouragement to someone else. The encouragement you give out will come right back to you in the form of encouragement for yourself.
Source: The Sober Village

Thursday, April 10, 2008

Alcohol Addiction

What does addiction mean?
When a person has lost control over the drug or drinks he or she uses, then it is called as addiction. Besides alcohol or some illegal drugs, people get addicted to cigarettes, medications and even glue. Addiction can often be psychological, physical or both. The need to have the specific substance or drug is the most significant sign of an addiction.

Addiction to Alcohol – Alcoholism
The persistent use of alcoholic beverages despite health problems and negative effects is generally known as alcoholism. Medically, alcoholism can be described as a disease that results in continued use of alcohol despite negative consequences. It is basically the inability to understand the negative consequences of alcohol consumption. Alcoholism, as per the American Medical Association is the primary chronic disease that is characterized by loss of control over drinking, use of alcohol despite negative effects and even distortions in thinking.
What are the primary and secondary effects of alcoholism?

It induces the sufferer to drink at times and in damaging amounts. This is perhaps the primary effect of alcoholism. The impaired ability to have control over drinking is the secondary damage due to alcoholism.
Even after the health problems start, it is common for an alcohol addict to drink well. The health problems that are related to excessive alcohol consumption are pancreatitis, increased chance of cancer, liver cirrhosis, polyneuropathy, heart diseases epilepsy, alcoholic dementia, sexual dysfunction, nutritional deficiencies and also death from all kind of sources.
How does alcoholism affect socially?
The consumption of alcohol during duty hours can lead to loss of employment and thus creating financial problems. The intake of alcohol at inappropriate times can cause legal consequences, which includes criminal charges for tortuous behavior, public disorder, and drunk driving. The behavior due to reduced judgment of a drunken person can lead to the imposition of civil penalties on that person. The impact caused by an alcoholic’s behavior can be significant. The mental impairment of a drunken person due to increased consumption of alcohol can affect the surrounding family and friends. This could lead to domestic violence, divorce and marital conflict. As a result, the emotional development of the alcoholic’s children can be drastically affected.

What are the issues related to alcohol withdrawal?
When an alcohol addict stops drinking, he may find very difficult without alcohol. The person may feel very uneasy. This is known as withdrawal. The withdrawal from alcohol differs very much from that of other types of drugs due to the fact that it could be fatal directly. If mismanaged, a healthy alcoholic could die due to the direct withdrawal effects. The production of a neuroinhibitor known as GABA could be very much reduced due to heavy consumption of alcohol. When the consumption of alcohol is stopped abruptly, it leads to a condition where both GABA and alcohol to be in inadequate quantities in the system as a result causes the firing of the synapses in uncontrolled manner. This manifests as convulsions, hallucinations, seizures, shakes and even heart failure. These are together referred as delirium tremens. A medically directed detox can be used to control all these withdrawal problems.

What impact does alcoholism have on society?
The general perception of the health problems related to long-term alcoholism is that it is detrimental to the society. The most important factor for causing vehicle accidents, head injuries, assaults and violence is the use of alcohol. It causes pain induces suffering and causes money problems to alcoholic affected and others around the person. Fetal alcohol syndrome is an incurable condition caused by consumption of alcohol by a pregnant woman. Due to its wide impact on the society parliaments and governments have formulated alcohol policies to control the problems of alcoholism.

How to treat Alcoholism?
Since there are many perspectives for alcoholism, treating an alcohol addict is quite varied. Persons approaching alcoholism as a disease or medical condition suggest differing treatments than those who approach it as one of social option. The main focus of treatment is on aiding people to stop their alcohol consumption. It is then followed up with life training and social supporting so as to help them withstand a return to use of alcohol. Alcoholism treatment should prevent a relapse since alcoholism encourages a person to continue consumption of alcoholism. Detoxification is an example of this kind of treatment. It is then followed by combination of providing support through introducing to the self-help groups. The treatment to alcoholism is based on zero tolerance approach and harm reduction approach.

How effective is the treatments?
As far as the effectiveness of the treatment is concerned, it varies widely. When the effectiveness of alcoholism treatment is taken into account, the rate of success should be based on those who enter the program, but not on those who complete the program. Qualification of success is the completion of the program. So the success rate among the persons who complete the program is nearly 100%. It is vital to consider not just the success rate, but also the relapsing rate. A year after the completion of the rehabilitation program the results show that roughly a third of the alcohol addicts are sober, 40% of alcoholics have improved substantially but still consume occasionally, and a quarter of the persons have totally relapsed.

Rehabilitation Program – A Good Treatment
The integral part of the rehabilitation program is the detoxification, which is abrupt stopping of alcohol consumption coupled with replacing drugs having same effects in order to prevent alcohol withdrawal. The detoxification is followed by group therapy and psychotherapy. Detoxification treats physical effects and psychotherapy deals with psychological issues related addiction to alcohol. The next step is rationing and moderation programs. Then, providing the medication, which is the vital part of the rehabilitation program. It is considered as part of the treatment for alcoholism. The medication includes medications for withdrawal and detoxification known as Delirium treatments, and medications for long – term usage.

Tuesday, April 8, 2008

Link Between Insomnia And Depression In Young Adults - New Study In The Journal SLEEP

A study published in the April 1 issue of the journal SLEEP confirms the persistent nature of insomnia and the increased risk of subsequent depression among individuals with insomnia.

The study, conducted by Jules Angst, MD, of Zurich University Psychiatric Hospital in Switzerland, focused on 591 young adults, whose psychiatric, physical, and sleep symptoms were assessed with six interviews spanning 20 years. Four duration-based subtypes of insomnia were distinguished: one-month insomnia associated with significant distress, two-to-three-week insomnia, recurrent brief insomnia, and occasional brief insomnia.

According to the results, the annual prevalence of one-month insomnia increased gradually over time, with a cumulative prevalence rate of 20 percent and a greater than two-fold risk among women. In 40 percent of subjects, insomnia developed into more chronic forms over time. Insomnia either with or without comorbid depression was highly stable over time. Insomnia lasting two weeks or longer predicted major depressive episodes and major depressive disorder at subsequent interviews. Seventeen to 50 percent of subjects with insomnia lasting two weeks or longer developed a major depressive episode in a later interview. "Pure" insomnia and "pure" depression were not longitudinally related to each other, whereas insomnia comorbid with depression was longitudinally related to both.

"We used to think that insomnia was most often just a symptom of depression. However, a growing body of evidence suggests that insomnia is not just a symptom of depression, but that it may actually precede depression. In other words, people who have insomnia but no depression are at increased risk for later developing depression. This study adds to our knowledge by including a much longer follow-up period than most previous studies," said Daniel J. Buysse, MD, of the University of Pittsburgh, lead author of the paper. "We were also able to look separately at insomnia alone, depression alone, and combined insomnia-depression. The results show that insomnia seems to be followed by depression more consistently than the other way around. In addition, we found that insomnia tended to be a chronic problem that gets more persistent over time, whereas depression was a more intermittent problem."

Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. It is the most commonly reported sleep disorder. About 30 percent of adults have symptoms of insomnia. It is more common among elderly people and women.

It is recommended that adults get between seven and eight hours of nightly sleep.

The American Academy of Sleep Medicine (AASM) offers the following tips on how to get a good night's sleep:

- Follow a consistent bedtime routine.
- Establish a relaxing setting at bedtime.
- Get a full night's sleep every night.
- Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
- Do not bring your worries to bed with you.
- Do not go to bed hungry, but don't eat a big meal before bedtime either.
- Avoid any rigorous exercise within six hours of your bedtime.
- Make your bedroom quiet, dark and a little bit cool.
- Get up at the same time every morning.

Those who suspect that they might be suffering from insomnia, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist.

More information about insomnia is available from the AASM at http://www.SleepEducation.com/Disorder.aspx?id=6.

SLEEP is the official journal of the Associated Professional Sleep Societies, LLC, a joint venture of the AASM and the Sleep Research Society.

Sunday, April 6, 2008

Problem Gamblers

Problem Gamblers Want To Stop Their Gambling Addiction
By: howard keith

Problem gamblers from all walks of life want to stop their addiction to gambling, but seem to fall short of reaching their expectations. This seems to be a similar pattern among those who have a gambling addiction. Research in this area seems to dictate to compulsive gambler that the odds of achieving success are very limited. This statement may have been true in the past, but with all the new alternative stop gambling recovery programs, gamblers can be the odds and live a normal healthy life.

The key to any successful program is the willingness of the compulsive gambler at the time they enter a treatment program. There are so many compulsive gamblers today that it amazes me that there aren't more programs available. However on the bright side, there are a few programs that have been successful. These programs are drastically different but share a common bond. They all have been created to help those that are suffering from the negative affects of gambling addiction.

A compulsive gambler and their family members have searched endlessly to find the right program with very little success. However now with the world at their finger tips though the internet all new doors are starting to open. The amount of information now available has enabled them to head in the right direction.

There are programs that offer daily meetings, weekly meetings, private chat rooms open seven days twenty four hours and self help books.

Through new innovative programs those who suffer from gambling addiction now have hope to recover. Gambling addiction is just as serious an addiction as alcohol, tobacco and drug addiction. Our society needs to wake up and take responsibility and help those that continue to suffer.

The pain, anguish and self destructive behavior are apparent as the addiction gets out of control. Our society seems to look the other way. For example in New York City there are those that live on the streets in card board boxes. Each and every day those riding the subway walk over and even around these individuals. They do not think twice to help them. The police take notice and all they do is ask them to move to a more private area of the city. This is same at all local gambling establishments. They do nothing to help those that are addicted. They have no problem taking their money until there is no money to take. At that point they throw them out into a world where they have lost respect from friends and loved ones. They know that a large percentage of their profits come from those that are addicted. They do nothing. It is up to you and me to make that difference. By helping the compulsive gamblers to stop their addition we no longer feed the gambling establishments.

Gambling establishments should be legally responsible for the continual destruction of the people in our society. The day will come where politicians and lawmakers will open their eyes and put an end to the abuse brought on by the gambling establishments. Until then we need to take care of our own. Through proper education we need to help the compulsive gambler and family member to recover and move forward.

Problem gamblers do not have to suffer any longer. The stop gambling addiction resources available can put them and their family in the right direction. Look for well established websites that are at least two years old and find the answers to all of your questions. These websites will help you to move in the right direction. Take the time and before you know it, your lives will be a lot healthier and a lot more rewarding.

As a former compulsive gambler, I found it easy to take one day at a time as I faced my gambling addiction head on.

Article Source: http://article2008.com

Thursday, April 3, 2008

Maternal Cocaine Use Affects Long-Term Health Of Offspring

study published in the open-access journal PLoS ONE reports that maternal cocaine use results in lasting neurochemical and functional changes in the offspring. Dr. Ashiwel Undieh, PhD (Professor and Chair of the Department of Pharmaceutical Sciences at Thomas Jefferson University's Jefferson School of Pharmacy) and colleagues came to these conclusions while investigating how maternal cocaine use affects the long-term health of the child.

It is known from previous studies that cocaine exposed mothers tend to have offspring that demonstrate significant behavioral changes. Undieh and colleagues added to these findings by investigating the alterations in fetal epigenetic machinery of mothers exposed to cocaine.

Epigenetic refers to biological features such as DNA modifications that are stable over rounds of cell division and do not involve changing the underlying DNA sequence of the organism.

This current study uses mice to conclude that if mothers are exposed to cocaine during the last two trimesters of gestation, the result is potentially profound structural and functional changes in the epigenomic programs of neonatal and prepubertal offspring. The results suggest s strong link between maternal cocaine exposure and alterations in global DNA methylation, in CGI-specific methylation, and in the transcriptional processes of many genes that are responsible for coding proteins involved in critical neural functions.

Since cocaine is one of the most abused drugs in the Western hemisphere, the conclusions of this study are important for human mothers and children. It is widely known that when mothers abuse cocaine, there is an increase in the likelihood of both immediate and long-term harmful effects on both the mother and the child. Though there is not complete consensus on the effects of cocaine use by expectant mothers, animal studies have shown significant damage to nervous system structure and function in offspring.

Maternal Cocaine Administration in Mice Alters DNA Methylation and Gene Expression in Hippocampal Neurons of Neonatal and Prepubertal Offspring
Novikova SI, He F, Bai J, Cutrufello NJ, Lidow MS, et al.
PLoS ONE (2008). 3(4): e1919.
Click Here to View Article

About PLoS ONE

PLoS ONE is the first journal of primary research from all areas of science to employ both pre- and post-publication peer review to maximize the impact of every report it publishes. PLoS ONE is published by the Public Library of Science (PLoS), the Open-access publisher whose goal is to make the world's scientific and medical literature a public resource.

About the Public Library of Science

The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org

Written by: Peter M Crosta
Copyright: Medical News Today

Tuesday, April 1, 2008

Editorial: Evidence Disparities in the Drug War

A legislative battle currently underway in Idaho illustrates an "evidence disparity" at work in US drug policy. The state's legislature, conservative but starting to favor different approaches to substance abuse, recently approved $16.8 million of funding for treatment programs, but Gov. Butch Otter vetoed it. Not that Otter opposes such programs in principle -- he says Idaho should have them -- but he wants to "ensure that taxpayer dollars are used carefully, responsibly and to the best possible advantage" in that context, according to reporting by the Boise paper New West.

I don't know enough about the details of Idaho's drug treatment programs to say whether they're well-designed or not. Odds are they are needed. But I wish such care would be put into the criminal justice side of drug policy. Is arresting, prosecuting and incarcerating drug law violators in large number a "careful" or advantageous use of tax monies? (Hint: Look at the availability of drugs and their prices, which have plummeted over these last most serious decades of the drug war. That means the answer is "NO.") Otter could at least claim consistency if he were also calling for an end to the drug war's imprisonment program, or even just scaling it back. But if he's doing so I've not heard that.

In this week, as in most other weeks I remember, the actions of governments all over exhibit this evidence disparity:

* In Mexico, dramatic evidence in the form of nationwide, gruesome violence shows that prohibition is dangerous and that enforcing it is futile. But Mexico continues to fight the drug war and suffer that cost.
* In California, the feds have garnered five year sentences against a couple who provided marijuana to patients, despite evidence that marijuana is helpful to patients.
* Alaska politicians are trying hard to overturn the state's constitutional protection of private marijuana possession, despite a lack of evidence demonstrating that marijuana is any threat.
* In states around the country, moves are afoot to ban the hallucinogenic plant salvia divinorum, despite a lack of evidence for danger or widespread use. One legislator wants to "help" salvia users by giving them five-year prison terms! Where's the evidence supporting that?

I support having policies that are based on evidence. But let's put all of the evidence, and all of the policies, on an equal footing. The drug warriors who are putting people in prison should bear the burden of proof for their policies, a burden under which their philosophy will undoubtedly collapse. Because it is the truth that is disparate -- the case for legalization is overwhelming -- and if measured evenly, that truth will indict the drug war beyond any and all reasonable doubts. Prohibition is indefensible, and the drug war is a failure and travesty. So let's really talk about the evidence, and do it right. The day on which happens will be ours.
Politics & Advocacy The Drug Debate
from Drug War Chronicle, Issue #529, 3/28/08