January 2008 Archives

There's a small voice nagging inside the heads of most alcoholics, it's the voice of addiction, and it tells us what we need to hear to keep on pouring in the booze.

• It tells us (in whatever words we like to hear) that alcohol isn’t the problem, the job-wife-neighbors-whatever are the problem, and that good old alcohol is the only real solution.
• It tells us that we don’t have a problem we can’t handle, and if we wanted to quit we could, and that maybe we will someday, but not quite yet, anyway.
• It also reminds us that until we shoot down stiff drink or two, we're just not that interesting. Alcohol, it tells us, makes us funnier, better looking – just plain-old more fun to be around.

Of course, it doesn't, none of this is true - but that's what we believe. Maybe it did help to some degree once. Maybe a couple of drinks at that party loosened us up enough to relax, to crack a few jokes, to flirt shamelessly – to be the center of attention. Maybe it did, once, have some effects we liked. But we cling to these memories as if they were fact, all the while not noticing that now, we're not funny…we're sloppy. Not noticing that now the only people that really enjoy spending time with us when we're loaded – are just as loaded as we are, and somehow overlooking what alcohol has been doing to our appearance. I quit drinking, and now, for the most part, I cringe to remember the ass I made of myself, on so so many occasions. I can tell you that a lot of those people observing the spectacle that was me weren't thinking about how debonair and charming I was! Oddly, it wasn't till after I quit drinking that I made this realization. If you’re an alcoholic, you would be funnier, better company, and surely better looking if you stopped. That voice inside your head – it's lying.

• How can you control cravings at the subconscious level?

• How can you avoid cues that lead to cravings when these cues get processed unconsciously, and it all happens so quickly that you may start craving drugs, with no idea of why?
• How can you control cravings that stimulate a system of the mind responsible for self preservations acts such as sex and eating, cravings that provoke this system strongly enough to override all other impulses (including towards food or sex)?

Well the answer is that you can, but it's really really hard. A study released today in PLoS One, funded by NIDA and the National Institute of Health, reveals that cocaine addicts can experience cravings after being shown pictures of drugs for only 33 milliseconds – so fast that the cocaine patients were not even aware of having seen them, but were aware of all of a sudden wanting cocaine! Study authors Dr. Anna Rose Childress and Dr. Charles O'Brien, at the University of Pennsylvania used MRI imaging to observe brain response after cocaine patients were presented with pictures of crack, or a crack pipe, pictures flashing by so fast, that patients were not consciously aware of them. The brain however does see, even when we are not aware of it, and after each provocative stimulus, researchers saw a dramatic response in the limbic system of the brain. The limbic system is responsible for reward and pleasure, and is known to be involved with addiction. Cocaine addicts can see things in their environment, not even realize that they see them, and start feeling strong urgings to use cocaine. When a major strategy for early relapse avoidance involves minimizing these types of cravings provoking stimuli, this is obviously very problematic. Researchers claim that greater understandings of the neurological underpinnings of addiction and craving takes them closer to medications that may work to minimize this effect in the limbic systems, and give cocaine addicts (and likely all addicts) a much better chance at quitting. Willpower is essential for recovery, yet willpower has nothing to do with addiction. We cannot call addicts who relapse weak for failing to manage impulses they can’t control. Willpower keeps addicts in treatment, fighting, but willpower alone is just not enough.

Dealing with substance abuse in the home, and worrying about the safety and welfare of grandchildren should never be thrust upon grandparents wanting only to enjoy and spoil their young grandkids. But with so many kids growing up in abusive homes, too many grandparents either assume the role of primary caregiver, or worry constantly about the safety of the kids. There a number of proactive steps grandparents can take to improve the situation.

Grandparents want to play with, enjoy and spoil their young grandkids, and they never want to be concerned about the stability of the home environment or worried about the safety of their young grandchildren. But with so many kids growing up in homes with alcoholic or drug abusing parents, too many kids, and by extension grandparents, have a lot more than normal to worry about.

About a million and a half kids in America are being raised by grandparents…and substance abuse and addiction is a major casual factor for grandparents assuming the role of primary caregiver; and while grandparents surely never wished for the responsibility of parenting again, the stress and concern of leaving kids in questionable or dangerous environments can be even worse.

The pains of addiction resonate through the family, and extend beyond the borders of the immediate family home, and nothing is worse than a feeling of impotence to effect change for the better and constant worry for the welfare of beloved grandchildren.

Getting help

The obvious solution to the problem is to convince abusing parents of the need to change behaviors, and to attend needed drug or alcohol treatments; if only for the good of the children. An organized family intervention with pre arranged and ready treatment can be extremely effective at convincing even unwilling and denying addicts of the need to concede to treatment. Nagging, shaming and lecturing don’t work, and can even exacerbate the level of abuse; and neither does pretending that all is well do anything to improve the situation. Proactive and constructive actions are needed, and an intervention is a great place to start.

If an intervention does not convince of a need for treatment, grandparents need to take other proactive steps to ensure the safety of the children in the home. The behaviors of addiction can be painful to bear, and although taking extreme measures to protect the children is never easy, acting out of concern for the welfare of the children is always appropriate, no matter how emotionally complex and difficult the decision to intervene may be.

According to the National Association for Children of Alcoholics, there are three concrete things that grandparents need to do when children remain in an abusive household.

1 Get informed

To really affect daily realities, grandparents need to understand the nature of addiction and abuse, and understand the real risks to the children in the home. Information can be sourced from print and web resources, from professional organizations, and through peer support groups such as al anon, or other grandparents groups.

2 Know your options

No grandparent ever wants to call child protection services on their children, but if the situation becomes desperate enough, it may be required. Grandparents need to get educated as to the legal and community organizations offering support, and know what their legal and community options are in case of extreme eventualities.

3 Be a source of stability and comfort

Children of alcoholics or drug abusers crave stability and comfort, and grandparents can offer sanctuary and a needed place of emotional and physical escape to children suffering in abusive homes. Grandparents can be sure that children understand that addiction is a disease, and that the behaviors of addiction are all a part of the disease; and make sure especially that children understand that they are in no way at fault, that they didn’t cause the situation, and they are not responsible to change it.

Kids always want to love their parents, so grandparents should also strive to accentuate anything positive about the parent child relationship, and never to needlessly degrade the abusing parent.

Grandparents can do a lot to help kids in homes with substance abuse

Grandparents should never need to worry about the safety of their grandchildren, but too many kids are growing up in very negative environments and suffering the alcohol or drug abuse of one or both parents. Grandparents can help, and they need to get involved, try to enact change, look out for the safety and well being of their grandkids, and always be ready to offer needed comfort and stability.

Tens of thousands of children are born each year in America alone with either fetal alcohol syndrome of fetal alcohol effects, and these children will suffer physical, emotional and developmental problems for life. Completely preventable and tragic, fetal alcohol syndrome is the leading cause of mental retardation in America today. The term fetal alcohol syndrome (FAS) is an umbrella term describing the facial and physical deformities, the cerebral deficits and the emotional and behavioral legacy of children born to women who drank during pregnancy. A less severe syndrome know as fetal alcohol effects (FAE), affects many thousands more children each year; and because at birth the characteristic facial deformities are not always recognizable, experts estimate that the prevalence rate of FAS and FAE is actually far greater then reported. Between 4000 and 12000 children are born each year with FAS, and FAE effects tens of thousands more. The disorder plagues the development and potential of children for life, and although the facial characteristics of the disorder may become reduced in severity after puberty, the emotional, cognitive and behavioral deficits actually become more pronounced with adulthood. There is no uniform set of symptoms associated with the disorder, but very often FAS will cause characteristic facial structure deformities, including a smaller than normal head and a flattened mid face, cognitive and developmental delays or retardation and life long behavioral and emotional adaptation issues. Un coordination, impulsivity and speech and hearing impairments also characterize symptoms of the disorder. A late 90's study of alcohol consumption during pregnancy reports that almost 20% of women continue to drink some amount of alcohol during pregnancy, heedless of warnings to the contrary; and women with lower incomes and with less prenatal care are far more likely to drink heavily while pregnant. The Surgeon General recommends complete abstainment from alcohol during pregnancy, as no one is sure at what level alcohol consumption may be safe. If pregnant women drink very heavily, especially during the last trimester, newborn infants may endure dangerous alcohol withdrawal symptoms such as tremens, abnormal muscular activity, an inability to sleep and extreme and inconsolable crying. The societal economic costs of FAS and FAE run into the billions each year, but the individual and life long costs are far more tragic than any increased bill to the State. And all of this devastation is completely and 100% preventable. If a woman does not drink during pregnancy, there is no possibility of FAS or FAE. While all involved despair over the tragedy of FAS, there is little consensus about what proactive steps should be taken to reduce the incidence rate. Some States aim to protect unborn children by enforcing treatment on pregnant women who exhibit signs of substance abuse and others argue that by essentially criminalizing the issue, you deter far more women from treatment than you help. Another problem is that alcoholic women wishing to curtail their drinking during pregnancy often have a hard time finding a treatment facility capable of admitting a pregnant woman, and also offering needed prenatal care. Every dollar spent towards substance abuse prevention and treatment yields a massive dividend in societal savings, and surely this is also the case with FAS. If FAS cost's billions in increased health care, education and eventual incarceration costs each year, perhaps we should spend bit more now in the hopes of reducing the FAS societal bill down the road. More spent on education and prenatal outreach, more spent on subsidized treatment beds for pregnant women wanting to change, and more spent on awareness campaigns…there will always be some who ignore all the warnings and attempts to help, but every person saved would be a huge and celebratory victory.

About two thirds of all binge drinks consumed are beer, and the people most at risk to drive drunk, get hurt or get violent have more than likely gotten drunk on beer. Beer enjoys a strong and favorable misperception of its inherent dangers, and also enjoys very favorable legislation governing its taxation, marketing practices and lack of sales restrictions. Governmental policies that favor the sale of beer over other types of alcohol do not make any sense from a public health viewpoint.

A lot of people don’t consider that drinking beer is as serious or as harmful as drinking hard liquor, and this perception in reinforced by governmental legislation that allows for more intensive marketing of beer, for favorable taxation and for less regulation over its sale.

Of course beer is simply alcohol just like any other form of alcohol, and if you drink 7 beers, or have 7 cocktails…you will be just as drunk; and if you drink a number of beers with regularity, you are just as at risk for addiction as you would be if you drank only bourbon or vodka.

In fact, studies of binge drinking in America show that beer is the favored binge drink of choice, and because binge drinking creates such societal problems (drunk driving, violence, domestic abuse) and because binge drinking is a necessary stepping stone to dependency, it seems that beer is in fact the most dangerous alcoholic beverage consumed in America today.

The breakdown of binge drinking has beer accounting for 67% of all binge drinks consumed, with liquor a very distant second at 22%. The survey study, conducted by the National center for Disease Control and Prevention, illustrates how dichotomous liquor/beer laws are confusing the drinking public about the relative safety of beer drinking, and researchers conclude that preferential laws favoring beer make absolutely no sense from a public health viewpoint.

Researchers call for tougher beer control laws and increased taxation. They call for a limit on points of sale, and a reduction in marketing…particularly marketing directed at younger people.

I was a beer drunk, and I know first hand that the damage done by a case of beer sure seems a lot like the damage down by a bottle of whiskey; and it's too bad that a lingering misperception of the dangers of beer remains a part of out National consciousness.

Beer is alcohol, and it needs to be regulated in a similar manner to all other forms of alcohol. Why can we buy beer at a convenience store but not whiskey, when studies show that the people most likely to drink to excess, drive drunk, and have problems with the law or most probably going to have been drinking beer?

Why can Budweiser sponsor a Super Bowl halftime show, when a great many football fans watching the game are very likely drinking beer, and when Super Bowl game day is one of the riskiest days of the year for alcohol fueled domestic assault?

Prohibition is never the answer, and I don’t think that we can or even should deny responsible adults the right to purchase and consume beer or any other alcohol in a moderate and reasonable manner. But giving preferential legislative treatment to beer simply because it enjoys a misperception of safety (huge lobbying dollars???) is damaging and nonsensical.

While far from perfect, and only to be used as a part of a more comprehensive drug treatment program, acamprosate or a combination of acamprosate and naltrexone offers some protection against relapse through a reduction in experienced cravings, and a reduction in withdrawal symptoms during the first few months of sobriety.

There are few things as poorly understood as the remarkable complexity of the human brain, and addiction as a function of the brain is only very minimally understood at the neuronal level. Thankfully continuing research initiatives continue to uncover ever increasing pieces of this complicated puzzle, but for now, existing pharmacological interventions for addictions recovery remain imperfect.

Three of the most commonly used medications in the treatment of alcohol addiction, are disulfiram, naltrexone, and the newest medication, acamprosate.

Disulfiram works by making recovering alcoholics very ill if they consume alcohol concurrently with the medication, and naltrexone works by reducing the pleasurable rewards of drinking. Acamprosate works by stabilizing brain activity altered by abuse, and reducing the compulsions to abuse.

Acamprosate has its mechanism of action within the GABA neurotransmitter systems of the brain, and it is this damaged GABA system that results in dangerous tremors or convulsions during acute alcohol withdrawal, and also seems to continue to influence cravings to abuse. Alcohol is a natural GABA inhibitor and acamprosate also inhibits the neurotransmitter, allowing brain activity levels to stabilize naturally and slowly over time, with less experienced discomfort, or cravings back to abuse.

Acamprosate is no magic solution, and a significant percentage of people treated with acamprosate during the initial months of alcohol recovery will relapse back to drinking, but it does work significantly better than nothing, and some research indicates that when the drugs acamprosate and naltrexone are combined, the greatest possible efficacy is achieved.

Acamprosate can reduce some of the anxiety associated with the initial period of abstinence, and also seems to help people sleep better during initial recovery, which is important as insomnia during initial recovery is a significant predictor of relapse and further abuse. Acamprosate also seems to diminish the strength of cravings, at least in the very initial few months of recovery; allowing recovering alcoholics enough time of sobriety to regulate brain activity naturally, and develop natural motivations and strategies to continued relapse avoidance.

Acamprosate also gives addictions professionals another drug in the arsenal against relapse, particularly for alcoholics suffering liver damage, as since it is not significantly metabolized in the liver; it is safe even for cirrhotic patients.

The drug seems to be very well tolerated, and side effects most commonly experienced are headache or nausea. The drug is not intended to be used as a stand alone treatment to alcoholism, but as a part of a comprehensive drug treatment program, including significant psychosocial and behavioral components.

This is a prescription medication, and there some people who cannot take it. As with any prescription drug, you should only take the medication on a doctor's advice, and under professional care and supervision.

Although acamprosate doesn’t cure alcoholism, it does offer some efficacy during the very tough initial few months of sobriety, and can make those few months just a little more comfortable for people suffering from a legacy of addiction, and resultant brain deficits. The risks of use seem very low when compared with the possible benefits; and when acamprosate is combined therapeutically with naltrexone, it seems to offer significant protection against relapse.

Alcoholism is a serious, stubborn and lasting disease, and while acamprosate certainly won't cure it; anything that helps to improve the odds of recovery is to my mind a very good thing. If you are struggling with sobriety, speak with your doctor about the risks and benefits of adding acamprosate, or acamprosate and naltrexone, to your medication regimen.

We need to use everything at our disposal to give people the best chance of beating addictions, and living better lives of sobriety.

Women are at a greater risk to develop addictions, to succumb to acute alcohol poisoning, and to develop a host of physical and mental deficits. Women are more likely to die from cirrhosis, and more likely to get certain cancers and more likely to experience alcohol induced cardiac disease. All people abusing alcohol need treatment help, but women abusers seem especially needy of timely intervention and treatment.

It's well known that because of a reduced body weight and a reduced volume of water in the body to dilute the concentration of alcohol, women get drunk quicker than men, and are more at risk for the acute effects of binge drinking, including the risk of fatal overdose; but the dangers to women drinkers a not only acute in nature, and alcoholic women are at greater risk for a number of health disorders than are alcoholic men.

Heavy drinking women are more susceptible to developing addictions, and they also seem predisposed to start feeling the negative effects of chronic alcohol abuse faster than men.

A greater percentage of alcoholic women than alcoholic men will develop often fatal cirrhosis of the liver, and women are also more at risk for malnutrition, anemia and high blood pressure, particularly during very heavy drinking. Women alcoholics also suffer more cardiac damage than do men with equivalent drinking histories.

Women alcoholics suffer proportionally more brain damage and memory loss as a result of drinking behaviors as well, and a recent study comparing men and women with similar histories and durations of use saw women exhibit 11% more "brain shrinkage" (a sign of brain cell death) than men.

Heavy drinking greatly increases the gastro intestinal cancer risk in both men and women, but alcoholic women also suffer a hugely elevated risk for breast cancer; and Women who drink heavily are almost 50% more likely to get breast cancer.

The likelihood of developing alcohol related problems increases later in life, and more women develop drinking problems in late adulthood than do men, at a time when they are a greatest risk to suffer the consequences of their dependency.

Alcohol is physically devastating to all, but women are unfairly susceptible to some of its most dangerous effects; and any woman struggling with alcohol use and dependency needs to consider professional treatment help to lessen the risks of a great many serious and possibly fatal disorders.

Our sisters our mothers and our friends need and deserve intervention and treatment, and because each continuing day of abuse increases the risks of so many serious or even lethal disorders, intervention needs to occur as soon as is possible.

Government can't seem to reduce the flow of prescription drugs for abuse; and in those areas where they have had some success, all they've accomplished by reducing the supply is increasing local rates of heroin addiction. We need to stop thinking about this as a criminal justice issue, and start dealing with the problem as a health challenge. We need to stop addicting ever increasing generations with easy access to prescribed medications, and we need to give the already addicted the drugs they need, while also trying to effect some therapeutic change for the better.

The National Drug Intelligence Center, in its 2007 drug threat assessment on the abuse of prescription drugs, reported a number of findings…and none of them can be considered positive.

Firstly, the organization asses that the availability and supply of illegitimate (not taken or acquired in a medically prescribed manner) prescription pharmaceuticals is high and increasing.

Secondly, the organization asserts that demand and use has remained stable over the last year despite law enforcement efforts at reducing supply.

Thirdly, the organization reports that in some States, where strict pharmaceutical chain of custody regulations have diminished the availability of diverted pharmaceuticals for illegitimate usage, there has been a significant increase in heroin usage.

So there are lots of drugs around, the numbers of people using them has not decreased despite the best efforts of law enforcement, and in those areas where stringent regulations have limited local supply, addicts have been forced into even more damaging and dangerous practices such as heroin usage…hardly good news all around.

The challenges of regulating a product that does have a legitimate purpose, but that can so easily be abused, and that can be easily purchased through any of thousands of out of country illegal on line pharmacies is enormous; and increasing availability throughout most of the country indicates that law enforcement has so far been unable to really effect change. But when we consider that in those few areas where regulations have limited access, all that has occurred is a migration to even more dangerous and socially destructive usage of heroin or other illicit drugs, maybe we should question the philosophical motivation behind attempting to reduce the flow.

Enforcement and prohibition of psychotropic substance has an abysmal track record throughout recorded history, and the desperate realities of opiate addiction means that people will do whatever it takes to avoid the pains of opiate withdrawal. You cannot simply solve the problem by decreasing the supply, and when you consider the increased infectious disease rates, overdose risks, and criminal issues associated with the use of illicit drugs such as heroin, nor should we be striving to push people into even greater desperation.

My opinions are a bit contradictory in nature, and I feel that we need to both loosen availability as we tighten access???

We firstly need to stop creating ever increasing generations of addicts, and prescribing practices within the health care community need to change to reflect the dangers these drugs present to society. Extremely potent medicines, these drugs do serve a needed therapeutic function for some, but we as a nation consume far too many, and doctor's need to prescribe these dangerous drugs with greater judiciousness. We should also continue with legislations that have proven effective at limiting the supply of diverted pharmaceuticals into the community.

Secondly, we need to give those people that have developed addictions the drugs that they need. You can’t stop an opiate addict from taking drugs, and they will do whatever it takes to get a substance that both makes them feel good, and keeps away a very uncomfortable and scary period of detox sickness. Instead of making these people acquire the drugs illegitimately, or even worse, forcing them onto the even greater dangers of illicit drugs such as heroin; we should open clinics akin to methadone clinics, where addicts can get the drugs they need, safely, and without undue hassle.

Addicts participating in these subsidized programs would only be given enough for a day's usage and they would be required to pay for them at standard market prices. Governmental subsidies would fund corresponding and mandatory therapeutic involvement that would be a prerequisite to access into the program.

We can’t stop it, and we can’t even seem to control the flow of drugs, so instead of increasingly criminalizing the issue, why don’t we control the administration of drugs to those that need them, and while we're at it try to effect change through offered therapies, medical care and treatment.

Drug abuse is a disease and health care issue, and any attempts at criminal justice control always prove ineffective.

One drug is legal, one drug is not, and as a result one very very old man is now behind bars, and two very young and very rich women, not only using but also using and driving while intoxicated, are free to drink and drive again.

Durham North Carolina police got a dangerous offender off the streets this week…93 year old William C. Tinnen, arrested on cocaine trafficking charges, and held under $200 000 bond in jail awaiting trial. Also this week, repeat drunken driving stars Lindsay Lohan and Nicole Ritchie served a collective one day and 86 minutes in jail for a total of four DUI arrests.

What is going on???

Firstly, in defense of the justice system, the 93 year old arrestee did also have firearms in the house, and he may well have been the meanest predator in the neighborhood, I just don’t know; and secondly, although people have been quick to blast prosecutors for preferential treatment in the DUI offences of the young Hollywood starlets, legal professionals assure the public that the sentences as issued were very much in line with customary sentencing for DUI's within the county's overworked justice system.

Both the police and the courts have by all accounts acted within the confines of the laws and the realities of the overcrowded jail and justice system, and you can't fault them for following the laws they’re sworn to uphold; but when you compare the punishments meted out, it seems as though those at greatest risk to do harm to others are free, and the man hard to see as a threat lingers behind bars.

I've known a lot of drug dealers in my time, and these guys were all small time, dealing primarily as a means to support their own habits…not a great risk to anyone but themselves; and arresting and locking up these small fry dealers certainly does nothing to curtail the flow of drugs into the community. I've also seen first hand the devastation and despair of a drunken driving accident fatality, and I can tell you in no uncertain terms that the pain of that DUI far eclipsed the combined efforts of all the drug dealers I've ever known.

Why is a 93 year old man living in a slum and dealing cocaine? Doesn’t sound like he was saving up for a mansion on the hill or a new yacht; and shouldn't we take a better look at how we in the richest nation in the world can allow for environments that force a very desperate very senior citizen to sell drugs, and to now reside behind bars where any sentence is almost certainly a life sentence?

Drug enforcement is an abysmal failure by any measures of social betterment, and all we seem to be doing is enriching rarely arrested criminal leaders, fueling inner city violence, and imprisoning those lowly and desperate souls all to often suffering the dual despair of addiction themselves.

Take every dollar away from enforcement and imprisonment of non violent drug offenders and build hundreds of rehab facilities. Get those people that need it help, and send those people who repeatedly break DUI laws to 90 day or greater rehabs (not Hollywood resort facilities…real honest rehabs).

Change the climate that allows 93 year old seniors to remain behind bars and drunken repeat offenders loosed to endanger the streets again.

For any number of reasons, the vast majority of alcoholics and drug addicts never get help for their disease, and one reason given (with some regularity) for not getting treatment, is an inability to pay for it. Treatment costs can be high – many thousands of dollars for residential care, and sure, a lot of people can honestly say that they don’t have the money. At least, they don’t have it just sitting around. And there may be some people that, no matter what they tried, couldn’t come up with a few thousand dollars - but most of us, if we are completely honest with ourselves, could. Take 2 hypothetical situations as examples Scenario 1 I say to you – if you can give me $5000 in 30 days, I'll give you 1 million back. You'd say it was a scam, of course, but just imagine it's a real offer and you would get the reward. Could you scrape together $5000 to earn a million? Could you sell a car, or another prized possession? Could you borrow the money from friends, family, a credit card or a personal or home loan? Could you work for at least part of it? If you really believed that a million was coming; you'd get the $5000, one way or another. You would. Scenario 2 I say to you – if you don’t give me $5000 in 30 days, you will die on that 31^st day. Assuming again that you believe this to be true – could you get the money? More than likely, you could. So, if you could answer yes in either of the above scenarios, you must admit that you could, if the stakes were high enough, compile a few thousand dollars in a relatively short period of time. You might need to make some sacrifices, but you could do it; yet when considering money for treatment, most people don’t seem willing to make these self same sacrifices. People say they can't pay for rehab even with an expensive car (or 2 or 3) sitting in the driveway. When people say they can’t afford drug treatment, what a lot of people are truly saying is that they can’t pay for drug treatment without making any sacrifices. Now, the two scenarios outlined above are a bit extreme. No one is going to give you a million dollars for going to rehab, and you're probably not going to die if you don't get help this month. BUT No one that quits drinking or drugging suffers financially for it. In 5 years, if you can get clean and sober, you will have more money. You will likely live in a nicer house (this has been studied – it's true) and drive a nicer car. You won’t be spending all your money on intoxication, you'll perform far better at work and you'll have fewer healthcare expenses. Money is not a great reason to get sober, but when you look at the big financial picture, getting sober always pays off. Addiction is a disease. It's progressive, and without treatment, it's ultimately fatal. You probably won’t die this month or the next, but if you can’t stop using drugs or drinking, you will die from it eventually. Getting together some money for treatment could save your life. Invest in yourself. Make some sacrifices to get the medical care you need. You probably can afford rehab; you're just not trying hard enough.

Barack Obama has used drugs - he has broken the law. He admits to experimenting with cocaine and marijuana while a young men, and although his candor is refreshing, his drug use has complicated his political aspirations, and political opponents from within his own party have been casting subtle digs about his past. We expect leadership and moral correctness from our elected officials, and when yet another politician falls from grace, caught in lies about past or present acts, we bemoan the low ethical standards seemingly so prevalent among the Washington elite. Yet why, when we ask the impossible - perfection – are we surprised when imperfect humans (as we all are) prove themselves so? Looking at the 2007 NIDA released statistics on drug use amongst high school seniors; we can see that although drugs may be illegal, more people than not in our society will try them, at least once. About half of all high school seniors will have used illegal drugs by graduation, and three out of four will have drunk alcohol, under age. The democratic foundations of this country call for a person of the people, representative of the people, to serve in the best interests of all the people. In reality, we ask for a person who exhibits an impossible perfection of character and even of youthful judgment – a person very unlike most of us! Some may argue that Obama's youthful indiscretion is not an issue of drugs, but rather of lawfulness; and that whether you can forgive him for his drug use, he did knowingly and willfully break the law. But once again, we all break the law! We are all essentially guided by two often complimentary laws of action – our moral compass and the statutes of law. We do (mostly) what we perceive to be ethically right based on what we believe, and we follow laws of the state out of a fear of legal repercussions. And as such, when we do not perceive an act to be morally wrong, and when we feel that we are unlikely to face legal sanctions for engaging in it (getting caught) we are somewhat likely to break a law of the state barring this action. Running a red light on a deserted country road at 3am is against the law, but as we perceive no moral need to stop, and feel we are unlikely to get caught, most of us will at some point creep through an intersection, without waiting for a green. Taking drugs, as an individual act, is illegal, but it is not immoral - the act of using alone harms no one but the user. It may show poor judgment, but as teens, who amongst us can boast of uniformly good judgment? Obama took drugs, like well more than half of us have. He does not take drugs now, and he has not for decades. Obama broke the law, like all of us have; he did not break any moral laws. What about all the politicians who claim never to have used drugs? Seems unlikely, based on the statistics. Obama has told the truth. He is human. We should laud him for his courage. He may or may not be the right choice for president, but his past use of drugs should have no bearing on his legitimacy as a candidate today.

We are told, berated even, to stop our enabling behaviors when living and dealing with a still using alcoholic or drug addict. It's hard to do, but it all makes sense, and we for the most part can accept the need for it. Some of us even do it - some of us do too much. Curtailing enabling behaviors does not require complete inaction on our part. We often confuse doing anything for enabling, while what enabling covers are only those actions of ours that make it easier for an alcoholic or addict to continue using. We do not enable when we take steps towards getting someone into treatment. Running an intervention is not enabling, it is a proactive and positive step towards a solution. We are told that the alcoholic needs to come to terms with their own addiction, needs to decide for themselves when and where to turn for help. Baloney! Waiting for an addict to decide for themselves to get help is nothing more than inactive enabling. The addict wants to be left alone to drink or drug, they want nothing more than that! Which would be fine, of course, if that was their decision alone, if we didn’t care for them, and if their actions did not have profound and negative implications for our own quality of life. But we do love them, we live with them, and when they abuse drugs or alcohol, even if they consider it a matter of personal choice, they harm those that must live with them in deep and sometimes lasting ways. Does an alcoholic have the right to subject children in a household to drunkenness, poor role modeling, drunk driving, abuse etc.? Does their personal decision to drink affect them alone? Family has a right to get involved, inaction is enabling.

Why can’t they see what their drinking or drugging is doing to them, and to us? For family, few things frustrate like the seeming inability of the addict or alcoholic to recognize the extent of their self destructive behaviors. What seems so obvious to us seems not to register with them, and if losing a job, career, family or health won't convince a using addict to change their ways – what possibly can? Addiction changes the mind, it is complex and pervasive, and no single phenomenon fully explains the influence it exerts over thoughts and behaviors; but understanding confirmation bias takes us a step closer to understanding the realities of addicted thinking. Confirmation bias refers to a cognitive process in which we selectively and unconsciously assign more weight to stimuli, information or events that seem to confirm our preconceptions or world-view. We all unconsciously use confirmation bias; it is simply a psychological streamlining for informational processing. When we read a political editorial that matches our world-view, it resonates more profoundly and influentially than when we read an editorial that opposes our notion of the world – even if both are factually accurate. We are the choir – and we like to be preached to! Addicts unconsciously use conformational bias as a way to preserve activities (drinking or drugging) that are important to them. It is conformational bias that allows addicts to disregard or minimize negative information that might force them to question their behaviors, and over-emphasize positive information that convinces them to continue their use behaviors. An addict or alcoholic might process information on a night's events such as this: Pros: HAD A GREAT TIME LAUGHING WITH BUDDIES GOT A PHONE NUMBER FROM THAT CUTE/HANDSOME BARTENDER Cons: Vomited in the bar bathroom Was asked to leave Performed badly at work the next day, and was noticed for being hung-over Alcoholic thinking=A good night's fun. Most of us would call such an evening a lesson against excessive drinking, but an alcoholic will assign much more weight to the positive parts of the evening, and gloss over any negative aspects that don't align with alcoholic thinking. Alcoholics maintain denial through unconscious conformation bias internalization; thinking that keeps them sure that although drinking may cause a few minor headaches…on the whole it brings more happiness than pain. Addicts are not purposefully obtuse when they fail to recognize how much their use hurts them, it's a psychological process, and one an addiction hijacked brain makes full use of in defense of its consumptions. Eventually, if it gets bad enough, most alcoholics and addicts will concede that they have a problem – but it can take a long while and some pretty overwhelming (and often tragic) evidence. Understanding why addicts and alcoholics continue to drink or drug even as things get bad helps family and friends to enact better and more successful interventions - Helps them to realize that just letting an addict see the problems abuse causes won’t necessarily be enough to induce change. Rock bottom can motivate, but rock bottom is sad; and there is no need for it. Although an addict may not come to an internal conclusion of a need for change, family and friends can help them along, and can help to change their thinking. Interventions work, and they can get some pretty reluctant addicts into treatment. You can wait for an addict to see it on their own, but with conformational bias…it may take a long, long time.

Anyone who quits drinking or drugging, no matter who they are or how determined they are, comes to a point in recovery when the cravings to use or drink just seem overwhelming. And a lot of people (when they hit this point) do take a drink, or ten or 50 - For a lot of people, this is the end. The urge to drink or use drugs can consume us, and when it gets bad, we can think of little else. It feels like these urges will never end. We doubt we'll have the strength to fight them for long, and since we feel like we'll never succeed in the end, we can think of nothing else but using and we feel a craving so strong it's almost physical – a lot of us just give in to what feels inevitable anyway. One of the hardest things about overcoming an addiction is dealing with the weight of a lifetime of sobriety. Forever feels like a long time, and when things are hard, forever feels way too long. And it is for this reason, that there is real truth and strength in the AA mantra of one day at a time. Forget about staying sober for life, juts worry about today. Stay sober for today, and that's good enough – and the great thing is, add enough of those "today's" together, and it just gets easier after a while. When relapse threatens, when you’re having a really tough time, and when you're two seconds away from taking that drink…even staying sober for the rest of the day can seem an impossible goal. Break it down! You don’t need to worry about staying sober for the rest of the say – just think about staying sober for the next 10 minutes! Anyone can delay a drink for five minutes. Distract yourself, make yourself a sandwich, walk around the block once, do ANYTHING BUT DRINK. Urges, even the strongest of urges, are transitory things, and they will pass. There may be another one coming down the pipes, but deal with it when it comes, just as you dealt with the last. If you can wait 10 minutes, you will find that more often than not, the urge subsides, and things seem a little less crazy. Things get easier in time, and we all go through a rough patch every now and again. Don’t worry about tomorrow; think only of the here and now. It seems too easy, but it works!

Seems sort of like the Holy Grail to many of us. We drink at a level that causes us (and those around us) real problems; and we watch with envy how others seem to be able to enjoy the pleasures of alcohol without feeling the pains. Could we learn to be like them?!? Firstly, we, most of us anyways, like to drink. That's why we got into trouble in the first place. Few of us quit drinking because we all of a sudden stopped enjoying feeling high - we stopped (or are thinking about stopping) because the negatives associated with our drinking have escalated to a point that makes continuing to drink heavily a very bad idea. But what if we could somehow learn to drink in moderation? Learn how to stop after a drink or two, drink only in social situations, and never again need to experience serious problems from our use. For many of us, this would be ideal. I have just finished reading Dr. Michael S. Levy's (Cambridge Medical & Harvard Medical School) book "Control Your Drinking and You Might Not Need to Quit". Dr. Levy is a clinical psychologist with more than 20 years of clinical experience counseling people with alcohol problems, and a pioneer in the field of moderation for substance abusers. A very interesting book…and a book that rang very true with me. I am not one of those people that can achieve stable moderate drinking. I know this, and I have no desire to change a course away from the abstinence that has been working so well for me. Substance abuse and addiction remains somewhat poorly understood. We do not yet have all the answers, and although terms like alcoholism do seem to have a basis in fact, they remain somewhat abstract, and it can be tough to diagnose someone with certainty as an alcoholic. Alcoholics, so the story goes, can never learn to drink moderately, and the only course for them is to abstain for life. Alcoholics can rarely quit on their own, we are also told. Problematically, research shows that many people who would almost certainly be classified as "alcoholics" tend to do both of those things, and in fairly large numbers as well. More people with drinking problems quit on their own without any outside help than by any other method, and a lot of these people who have managed to quit drinking, and often for many years, do manage later in life to drink with moderation, and keep it in moderation. Alcoholism is clearly not a one size fits all moniker for the problem (and problems caused) by drinking too much. Also problematic is that the vast majority of those people classified as alcohol abusers or alcohol addicts never get any help for their drinking, and many never change their ways. There are of course many reasons why someone might choose not to get help or make an effort at quitting, but when alcoholics are polled, the single biggest reason for not stopping is simply not being ready to give up alcohol! People like drinking, and it can be hard for a lot of people to even imagine a life without drinking, forever. Moderate Drinking – The Advantages Moderate drinking, as a therapeutic solution to alcohol abuse and alcohol addiction, is not going to work for everyone. Some people, with lengthy histories of abuse, with severe addictions, or with co-occurring mental health challenges or very weak social support, are unlikely going to have much luck with anything other than abstinence. But it doesn’t matter! Firstly, beginning a program of moderate and controlled drinking sure sounds a lot more inviting and a whole lot less scary than beginning that long journey of abstinence. Many people, who might not consider quitting completely, may find the idea of learning how to drink responsibly very attractive, and if having a more flexible approach to the problem gets more people thinking about and working on their drinking, this is surely a very positive thing. Secondly, there is real value in even trying to adhere to a structured program of moderate drinking (the key word is structured…more later) and value even in failing at it. Those people who make an honest and structured attempt to limit their alcohol consumption, and fail, have at least begun a journey towards recovery, and gained self awareness about what they need to do, no doubt about it, if they want their lives to get better. How does it work? For moderate drinking to work, it has to be very structured. Informally just trying to drink less will not work. There is a distinction made between a social drinker, and a moderate drinker. A social drinker does not have an issue with alcohol, and doesn't need to think about it much - it's just never a problem. A moderate drinker is not a social drinker. A moderate drinker does have to work at it, and although the goal is to mimic the ways a social drinker might drink, it has to be conscious, controlled and planned. Here are the steps of the program as outlined by Dr. Levy. The point is to take a shot at this thing, and it might just work. It's quite important to stick to the plan absolutely. No bending of the rules, ever, and if you can't seem to do this, moderate drinking is not going to work for you. 1…Think about the problems alcohol is causing in your life, and think about how your life will improve if you didn't have a problem with alcohol. Write these things down – be thorough and be honest. 2…Take a couple of weeks off from alcohol, completely. 3…Draw up a contract for your moderate drinking. The rules are: *Never more than 3 drinks (2 drinks for women) per day. *Never drink more than 4 days per week. What days will they be? *Never drink in situations that you know are problematic for you…better to avoid these situations completely. You need to plan exactly what situations you will allow yourself to drink in, and what situations you won't. If you tend to drink too much watching sports on TV, you cannot allow yourself to drink at all in these situations. *Never drink a form of alcohol that you have a problem with. If you're a whiskey drinker, switch to wine or beer, it will make things easier. 4…Follow your contract to the letter for at least three months. If you can't, and find yourselves consistently breaking or even bending the rules, moderate drinking is not going to work, and over time, you will be back where you started. 5…After a few months, you may be able to make some small changes, but only small increases, and you must always stick to the rules. 6…A drinking contract is forever. You will never again be able to drink healthily, without thought and planning. Moderate Drinking Can Work – Sometimes For some people, people serious about making a change and willing to work at moderate drinking as the most important thing in life…it works. Some people, even those people able to follow the plan, find the whole thing so stressful and miserable, that abstinence is surely the better choice. Now, if you are already sober, and happy, and it's working, YOU WOULD BE CRAZY to read this and think about beginning a program of moderate drinking. Don’t risk your hard earned sobriety for the few pleasures found in a bottle. If you are reading this, and think that although you need to make a change and that your drinking is getting out of control, you just can’t consider giving up alcohol entirely; maybe moderate drinking is a good place to start your road to recovery. We're all different, what works for one won’t work for another, and there are no clear and universal solutions to the societal and personal tragedies of alcoholism and addiction. Drinking less is better than drinking more. It might work for you.

Remembering the good times… We all do it, when we look back, we always seem to remember the good times; and those tough times (although remembered) don’t seem as vivid as those happy memories and good experiences. Parents remember those first few toddling steps with greater intensity than those sleepless nights, and we remember the friends and excitement of high school more than we do the social insecurity. It's human nature, and for the most part, it's a good thing. But for recovering addicts or alcoholics, this kind of nostalgic thinking gets us into trouble. Relapse can happen for any number of reasons, but at the root of a lot of slips are a combination of overconfidence ("I've got this thing beaten now…a few drinks won’t hurt me anymore") and reminiscent thinking. Remembering all of the good times we had while drinking, all of the fun and laughs, and minimizing the negatives. Truly a dangerous mental combination for anyone in recovery! If you quit drinking or drugging, you did it for a reason, probably a pretty good one. People don’t, as a rule, quit drinking or drugging until the negatives start to outweigh the positives, and outweigh them by a lot. And while it's true that getting drunk or high with friends, hitting the club or a sharing a bottle of good wine with dinner were sometimes very enjoyable, for those of us with substance abuse problems, there were terrors lurking beneath the surface, and we do well to remember these. Most of us don’t quit until we feel the pains of our addiction. We all have our personal reasons for making a change and change isn’t easy, it usually takes some pretty strong motivation to overcome our using inertia. What made you stop? Now write it down. Seriously, if you are in recovery, write down what made you decide you needed to stop. Make a list of the harms that your drinking or drugging was causing, the things that finally forced you to concede of a need for abstinence. And whenever the past starts calling, whenever those good times start to outweigh the pains in your mind's eye, take a look at your list - and remember. Here's my list: 1…People were obviously losing respect for me, to my face, and that was very painful - especially painful because I knew that they were right to think less of me. 2…I was 60 pounds overweight, looked 10 years older than I was and every day I endured a terrible hangover. I was on pace for an early grave. 3…I was useless for my family; too hung-over in the day to play with my kids, to busy getting drunk at night to help out. 4…My business was suffering. I didn’t have the energy to make it better. 5…My kids were starting to notice what their dad was. And there's more of course, but that's enough for me. I've got it written down, and whenever I start thinking of the past through rose colored glasses, I just have a quick read of my list (I've got it in my wallet!) and I remember. It's uplifting too! Remembering the truth about how bad things were makes me truly grateful for how things are now – and it keeps me very motivated to never go back to what I was, and what I did. Don’t fall into the trap. Make a list (and check it twice!) - You are better off now than you were when you were drinking or drugging. Don't get fooled - stay sober, and stay happy.