Summer House

They don’t know each other, but they have much in common:

They’re both from small towns — Masure from St. Johnsbury, Vt., Payne from Hanover, Va. They used to steal beers from their dads before branching out into a variety of drugs.

They have been "clean" for three years, thanks in part to several 12-step program meetings each week. And they’re both preaching what they practice by working for organizations that offer support to people and families struggling with addiction.

Their stories touch upon themes made clear recently by scientists searching for answers about the genesis and treatment of addiction. The questions have plagued researchers for decades, but only in the past several years have they had the tools — such as technology that provides a real-time view of brain function — to unravel them.

The 2004 National Survey on Drug Use and Health found that of Americans 12 and older, nearly 8.4 million were addicted to alcohol and nearly 5 million were addicted to other drugs. About 1.4 million were addicted to both, according to the survey by the federal Substance Abuse and Mental Health Services Administration.

Thanks to advances in neurobiology, "we have enormous knowledge now of what’s going on" in addicts’ brains, says George Koob, professor of molecular integrative neuroscience at the Scripps Research Institute in La Jolla, Calif. Koob, who calls himself an "irrepressible optimist," says he is hopeful that new insights into the mechanisms of addiction will lead to new treatments and reduced suffering.

They might debate the terms used to describe addiction, but top scientists in the field pretty much agree on what it is.

"The inability to stop is the essence of what addiction is," says Nora Volkow, director of the National Institute of Drug Abuse, part of the National Institutes of Health. As Payne, 27, puts it, "my favorite drug was more and all."

That’s not to say that people who can’t make it through the day without latte grandes or Ghirardelli chocolate are addicts, says Volkow, a self-professed "chocoholic" who has pioneered brain-imaging studies of addiction. Caffeine does activate some of the same brain circuits as the drugs of addiction, but only very mildly, she says. Caffeine can be habit-forming, but Starbucks devotees won’t risk jail time or divorce to feed their habit.

Nor is addiction the same as dependence, although the American Psychiatric Association’s diagnostic manual says it is, says Volkow, who’s pushing to drop that wording. "Addiction is much harder to treat. Everybody given an opiate (such as morphine) will become physically dependent, but not everybody will become an addict."

They don’t know each other, but they have much in common:

They’re both from small towns — Masure from St. Johnsbury, Vt., Payne from Hanover, Va. They used to steal beers from their dads before branching out into a variety of drugs.

They have been "clean" for three years, thanks in part to several 12-step program meetings each week. And they’re both preaching what they practice by working for organizations that offer support to people and families struggling with addiction.

Their stories touch upon themes made clear recently by scientists searching for answers about the genesis and treatment of addiction. The questions have plagued researchers for decades, but only in the past several years have they had the tools — such as technology that provides a real-time view of brain function — to unravel them.

The 2004 National Survey on Drug Use and Health found that of Americans 12 and older, nearly 8.4 million were addicted to alcohol and nearly 5 million were addicted to other drugs. About 1.4 million were addicted to both, according to the survey by the federal Substance Abuse and Mental Health Services Administration.

Thanks to advances in neurobiology, "we have enormous knowledge now of what’s going on" in addicts’ brains, says George Koob, professor of molecular integrative neuroscience at the Scripps Research Institute in La Jolla, Calif. Koob, who calls himself an "irrepressible optimist," says he is hopeful that new insights into the mechanisms of addiction will lead to new treatments and reduced suffering.

USA Today — They might debate the terms used to describe addiction, but top scientists in the field pretty much agree on what it is.

"The inability to stop is the essence of what addiction is," says Nora Volkow, director of the National Institute of Drug Abuse, part of the National Institutes of Health. As Payne, 27, puts it, "my favorite drug was more and all."

That’s not to say that people who can’t make it through the day without latte grandes or Ghirardelli chocolate are addicts, says Volkow, a self-professed "chocoholic" who has pioneered brain-imaging studies of addiction. Caffeine does activate some of the same brain circuits as the drugs of addiction, but only very mildly, she says. Caffeine can be habit-forming, but Starbucks devotees won’t risk jail time or divorce to feed their habit.

Nor is addiction the same as dependence, although the American Psychiatric Association’s diagnostic manual says it is, says Volkow, who’s pushing to drop that wording. "Addiction is much harder to treat. Everybody given an opiate (such as morphine) will become physically dependent, but not everybody will become an addict."

WorldWideAddiction.com — Substance Addiction has been recognized "officially" as a disease for many years now, but there is still a great deal of ignorance on the subject -even amongst the medical profession.

Addicts/alcoholics (people tend to separate the two, but from here on in I will use the term "addict" to cover the broad range of substance abusers) are seen as weak people with no will-power.

Want to know what will-power is?

It is waking up in the morning, so nauseous that you race to the bathroom and don’t know which end to use first! After that initial wake-up purge, you then make your way shivering and shaking into the kitchen and drink an open, flat, warm beer that has a cigarette butt floating in it. Or because you are shaking so much, you drink that warm white wine that has been sitting out all night, through a straw since you can’t hold a glass! You do this, choking back the bile that is rising in your throat, because you know that the only way to begin functioning again on some sort of level is to try and build up the alcohol in your system before you take a seizure.

Do you think drinking methylated spirits at 5am in the morning is an easy thing to do?

I have known many addicts whose veins in their arms and legs are so damaged, that they inject themselves in their eyeballs. Because going without their "hit" is a far worse option.

Addicts have plenty of will-power…….

…it’s just focused in the wrong direction. Recovery teaches them us to refocus energy.

Back to the disease concept. Addiction is classified as a disease because it meets the criteria of all other terminal diseases:

- It has pattern of symptoms which are similar across all types of substance abuse

- It is a chronic condition. It doesn’t go away.

- It is progressive. Addiction only gets worse with continued use, and ends with death.

- The person is subject to relapse. In Australia, 66% of addicts who are lucky to live long enough to make it to detox will eventually die as a direct result of the disease.

- It is treatable. Here’s the good news, while substance addiction is a terminal illness, its progression can be arrested at almost any stage. But if you are seeking treatment, it is of the utmost importance that you gain medical advice. Sudden withdrawal, even from "socially acceptable" drugs such as alcohol, can cause death through seizures and coma.

It is crucial that you consult with a medical practitioner that understands addiction and withdrawal. Some well meaning, but uneducated doctors will prescribe large amounts of unsuitable medications that can lead to cross-addiction. This happened to me at one stage, and made a difficult situation worse. If you are addicted to one drug, the likelihood of becoming addicted to others is extremely high.

Wherever possible, detoxification is best carried out in a detox unit, where there is 24 hour patient care. There are a number of these units around the world, and in some cases (especially in Australia) there is no charge for this care.

When world governments begin to understand that the cost in providing this care free of charge is far outweighed by the benefits to society, we will begin to see an incredible drop in poverty, violence and divorce. The cost in providing this care will also be offset by the decrease in need of other hospitalization. 1 in 3 hospital beds in Australia are taken up by people with conditions that can be directly linked to drug abuse. At best, the world health systems overall are only currently providing band-aid solutions to one of the greatest scourges of mankind.

Are you thinking of getting help for yourself or a loved one?… do it now … for tomorrow may be too late. 

If you had terminal cancer, would you do anything about it? 

Substance addiction is a far worse disease in my opinion -it not only destroys the person, but everyone around them.

To those who helped me all those years ago -doctors, nurses, friends and strangers - even though I may not have been appreciative at the time….. my sincerest thank you. My life means something now.

Addiction is a disease, not just a state of mind.

A NIDA-funded study has demonstrated that the relapse rate for heroin addicts increases with time and that the probability of long-run abstinence depends on the age of first drug use. Those who start daily heroin use at a younger age are more likely to relapse than those who start later.

The study, conducted by Dr. Marnik G. Dekimpe of the Catholic University Leuven in Belgium and his colleagues in Belgium and at the University of California, Los Angeles, examined the treatment histories of 846 patients at methadone clinics in central and southern California. The researchers looked at males and females, whites and Chicanos, most of whom started using heroin between the ages of 17 and 25. Subjects were interviewed over a 4-year period during and after treatment to determine the probability of their relapse to heroin use.

The finding that relapse is connected to time suggests the need for long-term periodic monitoring of a former heroin user’s abstinence, Dr. Dekimpe says. The researchers also found drug relapse odds were significantly different across the sociodemographic groups studied, suggesting that prevention resources could be directed to groups at higher risk. No significant differences in relapse probability were associated with either gender or education.

Heroin is a powerful addictive drug sweeping the United States causing intense euphoria and strong physical dependence in its users. Heroin is processed from morphine; a naturally occurring substance extracted from the seedpod of certain varieties of poppy plants and appears as a white or brown powdery substance.
Heroin is highly addictive because it enters the brain rapidly and affects those regions of the brain responsible for producing physical dependence. This dangerous drug affects all decision-making, reaction time, the way one thinks, actions, and memory.
 

Heroin addicts, who use regularly, develop a tolerance. To get the same effect from the drug, the user must have higher doses, which in turn causes physical dependence and addiction. Despite the glamorization of heroin chic in films, fashion, and music, heroin use can have tragic consequences that extend far beyond its users. Fetal effects, HIV/AIDS, tuberculosis, violence, and crime are all linked to its use. Long-term effects of heroin use are also devastating to the body and mind.
 

The affect of heroin on the body is dependent on the method of administration. Heroin can be taken orally, which is metabolized into morphine before crossing the blood-brain barrier; snorted, which results in onset within 10 to 15 minutes; smoked, which has immediate effects; intravenously injected, which results in rush and euphoria within 7 to 8 seconds; and, intramuscularly injected which takes longer but results in onset within 5 to 8 minutes. Finally, heroin can kill. Of all reported drug abuse deaths, heroin is one of the top two most frequent. As with any drug addiction and physical dependency, withdrawal symptoms occur if use is reduced or stopped.
 

Withdrawal can occur anywhere from a few hours to 72 hours after the last dose and symptoms can include: drug craving, restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, and kicking movements. For the user trying to quit, medications and behavior therapies are the most common treatment options.
 

First, the medications Methadone and Buprenorphine have proven to be successful in treating heroin addiction. Methadone, a synthetic opiate, blocks the effects of heroin for about 24 hours. Buprenorphine is the most recent addition to the array of medications available for treating addiction to heroin and other opiates. This medication is different from methadone in that it offers less risk of addiction and can be dispensed in the privacy of a doctor’s office. Other medications include naloxone and naltrexone, both of which block the effects of morphine, heroin, and other opiates.6 In addition; there are many effective behavioral treatments available for heroin addiction. These can include residential and outpatient approaches. Contingency management therapy uses a voucher-based system, where patients earn "points" based on negative drug tests, which they can exchange for items that encourage healthful living. Cognitive-behavioral interventions are designed to help modify the patient’s thinking, expectancies, and behaviors and to increase skills in coping with various life stressors. Treatment can and should be integrated with support services to enable the heroin user to return to a stable and productive life.
 

In conclusion, heroin addiction is a terrible way of life but can be overcome with hard work, a support group, a drug rehabilitation program or center and pure determination.

Maryland — The lifestyles of Jean Duley’s clients run the gamut: long-time street drug users, those who were prescribed powerful painkillers after an injury or operation and are now addicted, and middle-class housewives who abuse prescriptions, to name a few.

"Prescription drug abuse is the biggest kept secret," said Duley, program director at Comprehensive Counseling Associates in Frederick. "It’s a lot more prevalent than people can imagine."

In December, Comprehensive Counseling became one of three practices in Frederick County to prescribe suboxone, which Duley calls a "miracle drug" for those addicted to pain medication. The center now prescribes suboxone to about 50 clients.

Suboxone is a partial opioid agonist, containing enough buprenorphine (an opioid) to eliminate cravings and symptoms of withdrawal. The pill also contains naloxone, an opioid antagonist, which blocks the user’s ability to get high on any other drug, Duley said.

Clients usually come to the center for suboxone in the midst of withdrawal, and with regular treatment, clients have gone from "living a nightmare, to feeling like they have a brain for the first time in a long time," said Dr. Allan Levy, a psychiatrist at Comprehensive Counseling.

Duley said while some people lie about the severity of their pain to acquire their abused prescriptions legally, physicians themselves can fuel prescription addiction. Some prescribe increasing strengths of painkillers and then abruptly stop after patients have already become dependent, forcing them to get their fixes from either prescriptions sold on the street or illegal drugs like heroin.

Others prescribe painkillers too loosely. Duley said some of the center’s suboxone clients have Percocet "handed to them like candy for every little ache and pain — it’s a culture of doctors not paying attention. The worst is OxyContin. That drug — is so highly addictive, it’s so difficult to come off of."

Some people can stop taking suboxone after a few months, but most continue for as much as a year before weaning themselves off, Levy said. For others, it becomes a lifelong maintenance drug.

While suboxone addresses the neurological aspect of addiction, Duley said giving medication without regular therapy defeats the drug’s purpose. She facilitates a support group at the center three times a week, and suboxone users are asked to attend at least once a week.

"They usually have all kinds of issues going on at the same time (as the addiction)," Duley said, including problems with employment, family and mental health. "You have to address the whole piece. The drug alone doesn’t work by itself."

And all addiction treatments should revolve around the key factor — a person’s health, Duley said.

"(Beating addiction) is a complicated issue, but it’s very doable," she said. "It’s not a moral issue, it’s not a criminal issue, it’s a health issue."

ABC NEWS — A study at the University of Western Australia has found that heroin addicts with naltrexone implants are far less likely to return to heroin use than those taking oral tablets.

But critics are sceptical about the study and say that naltrexone is still a risky option for drug users trying to kick the habit.

Naltrexone is a drug which blocks the effects of heroin on the brain. It is usually taken as a tablet, but if heroin users stop taking the pill they often fall back into drug use.

That is why scientists have been working on an implant which automatically releases naltrexone into the body.

Gary Hulse from the University Of Western Australia is confident about the naltrexone’s success.

"It means that you’ve got a a one-stop shop. People can come in, they receive their treatment or implant and for five months or six months, they carry that treatment with them," he said.

The six-month trial involved 69 heroin users. Fifty-four completed the trial. Of the 28 participants who received a naltrexone tablet, 15 returned to regular heroin use. Of the 26 people who received a naltrexone implant, just two returned to heroin use.

Researchers like Mr Hulse say it is a good result for naltrexone implants.

"This is a relatively safe and a treatment which has good clinical outcomes," he said.

The study is yet to be published in a peer-reviewed medical journal, but the team at the University of Western Australia are confident the research will be well received.

"I’m not only confident that it’ll be published in a peer review but I would be surprised if this wasn’t accepted by one of the extremely high rating journals," said Mr Hulse.

But critics like Dr Alex Wodak, from the Alcohol And Drug Services at Vincents Hospital in Sydney, have little time for the new study.

"The paper hasn’t been published yet in a scientific journal and so therefore, it’s the equivalent of hearsay in a court of law. That is, it’s not really evidence," he said.

Naltrexone is a controversial drug. The implants are yet to be approved by Australia’s Therapeutic Goods Administration (TGA) and there have been mixed results for heroin users.

Some patients have stopped using heroin after receiving an implant. But others have cut them out of their body or suffered serious side effects.

"The implants, I know for a fact, were at one stage required by the therapeutic goods administration to be stamped, not for use in human subjects, and the authors have conceded that to me in writing," said Dr Wodak.

But researchers such as Moira Sim from the Naltrexone Trial Independent Monitoring Committee say the implants used in the Perth trial were approved by the TGA.

"The committee reviewed all the processes that the trial went through and we are confident that they followed the correct processes that the data was collected properly, and therefore I’m very confident in the results of the trial," she said.

The researchers say the next step will be to conduct a trial comparing naltrexone implants with methadone and other drugs used to control heroin addiction.