November 2007 Archives

Treatment works, incarceration alone clearly doesn't, and although the knee jerk reaction in this country is still too often a crime and punishment based approach to drug offenses, an innovative program in Delaware is gaining impressive results using a more therapeutic approach. The vast majority of drug offenders incarcerated…and there are millions, receive either no drug therapy, or minimal prison based treatment, and these two approaches have not historically shown much effectiveness in reducing recidivism either to drug abuse or to re-offending. A NIDA funded program in Delaware prisons looked to explore a different matrix of treatment, using a three stage approach to therapy prior to complete release. Inmates begin in the general prison population, proceed then to a structured prison based drug treatment program, and finished their sentence in a community based drug treatment facility. The results demonstrate quite clearly that a progressive and lengthy model of correctional treatment shows far greater efficacy, and ultimately saves a great deal of money. Of prisoners who proceeded through the three stage program, 77% had not re-offended after 18 months, compared to only 43% of prisoners having participated in prison only drug and alcohol treatment programs. Demonstrating yet again that incarceration alone for drug offenses does not solve the problem, and that every dollar spent on treatment as versus incarceration yields an incredible societal dividend. Let's follow the lead of Delaware, and give sick people treatment, instead of just locking them away.

Recent research from the University of McMaster in Ontario Canada adds to the body of data indicating that the age of first use of illicit drugs, tobacco and alcohol is strongly correlated with later in life problems with drug addiction and alcoholism.

The study authors completed a long term data analysis of almost 5000 youths starting from the early 1990's, and have examined specifically the age of first experimentation with different substances, and the prevalence of continuing substance use later in life.

The results are unsurprising, and confirm other research done on adolescent drug abuse.

Some of the findings include:

Sixty percent of teens who start using marijuana before the age of 15 will still be using the drug 8 years later. Only 20% of teens who start after the age of 19 will continue to use 8 years later.

Boys start using drugs earlier, and with more frequency, and are less likely to stop.

The study authors conclude that early in life prevention programs are of paramount importance, and that waiting until kids are in junior high may well be waiting too late. They note that a significant number of kids are trying alcohol at ages of 10 and 11 and that these kids may never, at this age, have been exposed to any drug or alcohol information. They suggest late elementary school grades as a better time to start drug and alcohol educational programming.

The study results also underscore the importance of drug and alcohol education in the family, and starting from a young age. Our kids are starting to experiment earlier than we realize, yet if we can keep them from this early experimentation, they stand a much better chance to avoid the pains of later in life addiction or alcoholism.

Lord help me be the kind of person my dog thinks I am Ran across this quote the other day, and I can't think of a better ambition for life than that! My dog thinks I'm kind, generous (except with the doggie treats, which he must think I hoard miserably) wise and a whole lot of fun to be with. I can’t think of anyone else in this world who thinks quite as highly of me as my dog. I gotta admit my inspiration is coming from some odd sources these days, but hey, I'll take it where I can get it…(God works in mysterious ways?). So for today, I'm going to try to live up to these lofty doggy ideals of perceived conduct. I'm going to try to be as kind and wonderful to all as he thinks I am. I'm going to try on wisdom for a change by talking half as much and listening a whole lot more, and when I have something negative to say, I won't. I'm not going to drink too -he honestly doesn’t have strong feelings on this one - but I'm going to add it on the list. I'll try it on for today, and see how it fits, and maybe tomorrow too. I won't be what he thinks I am, but if I can get halfway there, I'd be twice what I am now!

Don’t want your teen to drink, smoke or do drugs? Well, there's no easy one answer, but one easy step in the right direction is as simple as sitting down at the dinner table together, as a family, 5 or more times a week. Research by the National Center on Addiction and Substance abuse compared the drug and alcohol consumption patterns of teens that ate family dinners 5 or more times per week, with those that ate them 2 or less times per week, and the difference revealed is dramatic. Families that don’t often eat together have teen children that are: 300% more likely to smoke marijuana 250% more likely to smoke cigarettes 150% more likely to drink alcohol Wow! What an easy way to make a real difference, in your teen's life, and for the family as a whole. The study authors state that although the simple act of eating together as a family seems most important, the experience can be enhanced with conversation and by ensuring the TV is turned off throughout the meal. Research continually demonstrates the influence of family and parental involvement on the likelihood of teens avoiding the troubles of drugs and alcohol. And this recent study shows just how easily parents can ensure they exert that influence. Make it fun for all, order a pizza if that’s what it takes, and sit down as a family, at the table. It's worth it.

OK, here's a secret, a secret that people in the recovery business don’t necessarily want you to know. Getting over addiction doesn’t guarantee happiness. It probably means a lot less pain when you can leave abuse behind, but a lack of pain does not necessarily equate to happiness, and deep down, bottom line and big picture, that's the only thing that's really important. Now, that doesn’t mean that you are not going to be happy after you quit drinking or drugging, it's just not a guarantee. Christian Recovery Now if you don't believe in God, Christian recovery doesn’t offer you much, obviously. If you do believe in God though, the Christian method of recovery may have some advantages over secular forms of treatment. I'm not sure that long term success rates are all that different between Christian recovery and secular recovery, but if you change things around a bit, and define success as happiness, I think Christians in recovery win hands down. Some people can stay sober through sheer determination - through grit - and some of these people can even stay sober like this for ever. But man oh man…this takes work! It wears you down, and maintaining such constant vigilance drains the life out of you and it's pretty hard to be truly happy when you’re just so tired. Now by contrast, in Christian recovery, one of the fundamental principles to grasp is that you don’t have the strength alone to get better, only God does. Let go and let God! Once you can trust in God, feel His grace and believe that He will show you the path, you no longer have to worry every minute of the day about staying sober…God's on the job! And this letting go, this makes it a whole lot easier to start really enjoying your life of sobriety. That's not all too. Christian recovery is an exercise in humility, real humility before Christ. Although going through addiction is a pretty tough way to find humility, let me tell you that once you do, and once you feel your relationship with Christ flourish through your newfound humility…whatever you went through before was worth it! We also relearn the power and beauty of prayer through recovery, and that feels pretty good too. No recovery is easy, but once you can put your trust in Christ, you'll feel better, you'll feel His Grace and His strength, and it won’t feel so hard anymore. You may be able to recover through a secular rehab, but if you want Christian happiness, walk the Christian 12 steps, and rediscover how sweet life can be.

A new study conducted throughout New England health care clinics that was looking to evaluate teenage substance use prevalence brings us some astonishing…and worrisome, results. Teens visiting the doctor throughout New England were given a confidential questionnaire to fill out surveying their alcohol and drug use behaviors. Now we know that a lot of teens are using drugs and alcohol, and we know that about 80% of teens will have done so by the time they finish senior year in high school, but we didn’t know that so many of these teens that are experimenting with drugs and alcohol are consuming these substances at such a significant rate. Fifteen percent of teens screened in New England self reported substance use behaviors that met the criteria for substance abuse. Not substance use, substance abuse. We know that the earlier teens start taking drugs and alcohol in quantity the more likely they are to become addicted and also to experience psychiatric illness. We also know that early intervention and preventative screenings that unearth problematic use behaviors can make a real difference. Sometimes all it takes is a few words from a doctor or a school counselor, in private, about use behaviors and the risks of those behaviors to make a real behavioral difference. The study leaders call for an increase in substance abuse screenings and preventative interventions nation-wide. Let's hope they get heard by those that can enact such changes, and let's hope that we can stop a lot of these preventable tragedies…before abuse becomes addiction and pain.

Kids aren’t dumb, they may not know much, but they have a funny way habit of learning stuff, and they also seem to remember what we tell them. So why do we lie to them? We teach them in drug education classes about the harms of drugs and alcohol, and the pains that these can bring to those that would abuse them. We teach them these things because we love them and we worry for them and we know the perils they face as they proceed through the turbulent years of adolescence. Our intentions are good, and all we wish to do is to spare them pain; but we almost always take things too far. We scaremonger; we say all drugs are bad…equally bad, and we present worse case scenarios as commonplace occurrences. And it works fine for a while, and they believe us…for a while. But then they get a little bit older, and they see that some people that smoke marijuana don’t seem to be experiencing all of those drastic consequences that we foretold of. They get a bit older, and they learn a bit more and they start to realize that they were lied to! They learn that not everyone that smokes a joint becomes a junky; in fact mostly they seem to do just fine. And then we wonder why they don’t believe us when we warn them of the dangers of meth…but why should they, we can’t be trusted. We need to start teaching kids the truth about drugs so that they can be informed about the real risks and consequences of their actions. We need to teach them that marijuana is not as harmful as a lot of other drugs and that most people that use it will not become raving lunatic drug addicts. We need to teach them that there are a lot of legitimate risks associated with today's marijuana, but we need to stay real about it, and tell them the truth. They'll learn it for themselves eventually anyways. And maybe if we tell them the truth about marijuana, maybe they'll smoke it or maybe they won’t (it's pretty unlikely that more will smoke it than do know!) but at least they will know that they have been treated with respect, told the truth and educated to make their own decisions; and maybe then they will believe us when we warn them of the real dangers of a lot of other life-destroying drugs floating about out there. Kids aren’t dumb, they'll learn the truth, and they will remember being lied to.

Addiction is a medical disease, and is recognized as such by the AMA and virtually all public health groups, including the government. The more research that comes out, the more we know that addiction creates fundamental changes in the way our brains' operate; and the more we understand that without treatment, few addicts have much chance of leaving the harms of drugs or alcohol behind them. So it strikes me…and a lot of other people…as kind of funny that although we know that addiction is a disease--and it's recognized as such by all public health organizations--that our insurance companies can somehow opt out of paying for treatment when we need it? Thankfully, it strikes a lot of lawmakers as a bit funny too, and over the last ten years or so federal and (to varying degrees) state legislatures have been increasingly demanding parity for mental health and substance abuse treatment needs. What parity means is essentially equality. That mental health and substance abuse treatment is considered to carry equal weight, and warrant equal types of coverage to physical conditions like cancer or arthritis or what have you. Now, we can be fairly certain that without mandated legislation our friendly neighborhood insurance providers are not just going to start increasing our coverage, and although the federal government does put forth some pretty strong recommendations for mandatory parity, state insurance law superseded these federal guidelines. An awful lot of people in need of mental health or substance abuse services just have the misfortune to live in one of the many states yet to adopt full parity legislation, and to put it bluntly…are getting the short end of the stick on this one. No Parity Legislation: Alabama

Alaska

D.C.

Florida

Kansas

Michigan

Mississippi

North Dakota

Pennsylvania

Wisconsin

Wyoming

Great Parity Legislation

Connecticut

Maryland

Minnesota

Vermont

Oregon

And every other state just sort of falls in between, offering some parity coverage, but nowhere near inclusive access to all in need.

So although state insurance parity legislation debate sounds pretty dull, it is relevant, it could have a major impact on your life, and if you happen to live in one of the many states yet to adopt full party legislation, you might want to let your lawmakers know how you feel about this.

Mental health and substance abuse treatments are not superficial, not cosmetic and not extravagances; they save lives, better families and improve our communities. The sick have rights, they pay for insurance coverage like the rest of us, and when they do get ill, whether with a physical or mental heath condition, they deserve to be taken care of. They deserve the treatment that's going to get them better.

I'm not talking about, why would anyone use methadone instead of cold turkey detox, I'm talking about why would anyone in their right mind use methadone instead of buprenorphine? Really…I want to know, so if you’ve chosen methadone over buprenorphine or suboxone…why??? Firstly, I should say that I never used either in my battles with opiate type pain pills, but I understand and respect the use of opiate substitution as a valid and respectable choice in a recovery program. But I just don’t get what's better about methadone. The drug is more easily abused You have to go to a clinic to take it It is very addictive The eventual detox off of methadone is terrible So why, when buprenorphine has little potential for abuse, and can be prescribed in a month' supply, when it's far less addictive than methadone and when the eventual withdrawal and detox pains are nowhere near as bad as for methadone…why? I know that there are some problems with finding a doctor capable of prescribing the drug in some parts of the country, and I also know that it is more expensive, but when you consider the cost benefit ration and weigh the options, buprenorphine just seem to me to come up a clear winner. So if any one can answer me this question, I would love to know why so many people still choose methadone.

Recovery statistics are always of questionable merit, and when so many are in a position to profit from impressive statistics of result and recovery, you have to wonder just how these stats are collected and to what extent they accurately reflect reality. Intervention stats are different though, and addictions professionals universally recognize that an intervention is the absolute best way to convince a reluctant and still using addict of the need for treatment. Interventions will work the vast majority of the time, conservatively with an 80% or better success rate. What is an Intervention? During an intervention, all family and close friends (and any other people of influence in the addict's life) will joint together to confront the addict in a unified and structured manner. Denial is a hallmark of addiction, and to overwhelm this harmful defense mechanism there needs to be a concerted, united and intense front of opposition. Basically, when everyone the person cares about tells them in one session how much damage the drinking or drugging is doing, it can be hard for them to maintain this wall of denial. During an intervention, every person will participate with a prepared statement concerning how the drinking or drug use is harming the addict and by extension how it harms them. They will have prepared specific examples of when the addict's intoxication did them personal harm. The addict needs to realize and accept that their drinking or drug taking does not exist in a vacuum, and that when they abuse themselves they also do harm to others that they care about. The goal of every intervention is to have the addict admit to the real extent of the problem, admit that they do need some help and to proceed immediately to treatment that has been prearranged for them. How to Run a Successful Intervention The behaviors of addiction often create negative emotions that ripple deep throughout the family, and although all still love and worry about the health and wellbeing of the using addict, intermingled with concern there are often contradictory emotions of anger, of guilt and of shame; and as such an intervention can be a very complex emotional event. You have to do it, but you have to ensure that you do it well. A poorly run, chaotic and emotionally confrontational intervention can do more harm than good, and derail an excellent opportunity for change. Here are some tips to make sure that you get it right the first time, and that you get that person into the treatment help that they so desperately need. 1) Practice Practice Practice You don’t want to go into an intervention blind. It's not something that many people will have participated in before, most won’t understand completely how it should run or what they are supposed to do and some may be feeling apprehensive about confronting the addict. For the best chance of success, you need to get everyone together and have at least one real serious rehearsal. Before the rehearsal, contact all participants, explain what is expected of them and ask them to prepare a written statement that includes how the drinking or drug taking has harmed them personally, how it has harmed their relationship with the addict, and how they've seen the addict change over time. Make sure that they include specific examples if possible, as examples lessen the ability of the addict to deny the truth of what is said. You should also ask them whether they are comfortable including an ultimatum. The best interventions combine both the carrot and the stick. Through your loving and concerned meeting of intervention, and through the obvious trouble you have gone through to arrange the event and arrange for treatment, you show your love and concern. The stick part comes in the form of consequences. "Accept our offered treatment, or suffer this consequence from me…" 2) Don’t Get Angry The addict may have done some terrible things, and a lot of the people participating in the intervention may legitimately feel owed an apology and may feel justifiable anger over past behaviors of intoxication. Remember though, the intervention is not about you and the day of the intervention is a day during which the focus needs to remain firmly on the addict, and not on your personal grievances. If the tone of the intervention becomes negative, angry or overly confrontational, the message can get lost within a defensive and equally emotional response. You sit the addict down and you force him or her to listen to what you want to say. Make sure that your message gets through. When you maintain a tone of concern and of love, the addict cannot react defensively and they must listen and receive what is offered in the spirit in which it is given. For the best chance at success, everyone needs to keep their cool, say what needs to be said, but say it with love. 3) Everyone Needs to Participate Since denial is such a hallmark of addiction, for the best chance at success, all meaningful people in the addict's life need to participate. If there are many significant absences, the addict might continue to rationalize their behaviors. They may say, well, Uncle Bob and Aunt Jean obviously don’t feel the same way that you do, or they'd be sitting here too. The more people get involved, the more powerful the event. Don’t disclude the very young or the very old either. Sometimes the most powerful testimony comes from children, and since they are affected by the behaviors of addiction, they have a right to contribute as well. Those people who cannot be physically present can contribute through phone calls, internet conferencing or through written messages read to the addict during the intervention. 4) Get Professional Help Hiring a professional interventionist is about the surest step towards running an effective intervention. They will organize fragmented family into a coherent tool towards recovery, they know how to diagnose the extent of the problem and they will ensure that the intervention proceeds as it should and that nothing derails the ultimate goal of getting an addict into treatment. But they are expensive. If you can't afford the fee, which can be several thousands of dollars for a top interventionist, you can do it on your own and you can, with a little planning and consideration, run an effective intervention without outside assistance. If you do have the money though, hiring a professional is about the best thing you can do to increase the odds of success. 5) Don’t Delay…Get Them into Treatment Right Away At best, the bags are packed, responsibilities arranged for and the car full of gas. You don’t want to allow for any barriers to an immediate transition into recovery. There is a real and sometimes brief window of opportunity after the addict agrees to accept help and you want to make sure that you get them into treatment before they change their mind. If they agree to treatment, even if they don’t agree that they need it, they should go. They may well change their tune with a few days of sobriety and therapy. Get them into prearranged treatment as soon as is humanly possible. A Well Run Intervention is Always Worthwhile Even if you fail to get the addict to accept of a need for treatment right away, they may in time contemplate the weight of the offered testimonies and decide that they do need help after all. However, even if the addict never gets the help they need, interventions empower the family. Nothing will ever be the same again after it's all laid out on the table…and this is a very positive step towards family healing. Getting things out into the open reduces harmful internalizing and misdirection of blame and guilt. It leads the family back towards cohesive health, and it never again allows for a minimization of the extent of the problem. At worst, you may need to decide how you can live in peace with a still using addict, and draw your own personal and familial boundaries to ensure lasting harmony. You can't do it for them, and if they refuse to go even after a well run, concerned and loving intervention; then at least you know that you've done all that you can…thankfully, most of the time it does work.