Summer House

A Review of What Works

Introduction

Alcoholism affects millions of people in the United States alone. According to the National Institute of Alcohol Abuse (NIAA), a division of the National Institutes of Health in Bethesda, Maryland USA, at least 700,000 Americans receive treatment for this disease every day. Some kinds of treatment, such as Alcoholics Anonymous (AA) have been around for many years while others are relatively new. Clinical research to determine the effectiveness of these various treatments has resulted in some important findings.

In October 2000 the NIAA released a summary of its conclusions based on fifteen years of research on alcohol treatments. According to the NIAA, self-help programs such as AA, psychotherapy and pharmacotherapy, either alone or in combination, are in fact effective and do reduce the use of alcohol.

Alcoholics Anonymous

Of all the treatments for alcohol misuse, Alcoholics Anonymous (AA) is probably the most well known. In AA, a form of "self-help" treatment, participants take part in a series of mental, written and verbal activities that can lead to recovery and abstinence. In one study, alcoholic patients who received inpatient and outpatient psychotherapy, as well as AA, had better outcomes than those patients who attended only one kind of treatment.

It is thought that AA helps people because it provides a new social network that replaces the alcohol abuser’s usual group of friends who drink with him or her, and provides a fellowship that inspires motivation and lends support toward the goal of reaching and maintaining abstinence. AA also teaches a set of coping skills so that, when stressed, the alcohol abuser has more constructive ways of coping, and does not need to turn to alcohol to escape his or her problems.

Another study, conducted at a Department of Veteran Affairs hospital, indicated that those alcoholic patients who underwent either cognitive-behavioral therapy (CBT) or a 12-step program in combination with CBT did better, over the long run, than those who participated in the 12-step program alone. (CBT entails learning coping skills, new ways of interpreting and reacting to stressful situations, and changing one’s destructive or maladaptive behavior patterns.) The patients who received the combination treatment stayed sober longer and were able to hold down a job for longer periods than those patients who received only CBT.

Both of these studies seem to show that a combination of some kind of psychotherapy and a 12-step program such as AA produces the most beneficial results for patients who use alcohol in excess.

Other beneficial treatments

Other promising treatments of alcohol abuse that are being studied include Motivational Enhancement Therapy (MET); couples therapy; Brief Intervention Therapy; dual-addiction treatment; and pharmacotherapy.

Motivational Enhancement Therapy: The key component of MET is an interviewing technique conducted by a trained psycho-therapist. The goal of this method is to increase an individual’s degree of motivation to stop drinking and to maintain abstinence. This is accomplished by the therapist gauging the individual’s readiness to change and then adjusting feedback accordingly. An intensive, individualized interviewing strategy, MET was demonstrated to overcome many patients’ disinclination to address their alcohol problem in treatment and increase their willingness to change.
Couples Therapy: Patients who include their non-alcohol abusing partners in their psychotherapy are more apt to attend therapy, and more likely to alter their unhealthy drinking habits. In one model of couples therapy known as Behavioral-Marital Therapy (BMT), communication and conflict-resolution skills are taught. When a relapse-prevention plan was added to this model, alcohol abstinence rates were even higher.

Brief Intervention Therapy: This treatment method usually takes place when alcohol users visit their primary care physicians. It typically entails the imparting of information about the negative consequences of drinking to excess, as well as supportive programs in the community. Two studies, carried out in the United States and Canada, showed that patients did reduce their alcohol consumption as a result of these interventions. This treatment seems to work best with those individuals who are at-risk for alcohol abuse. Those who are already dependent are better off being referred to specialized treatment programs.

Dual-addiction treatment: This method attempts to target both cigarette (nicotine) and alcohol dependencies at once. The use of one of these substances seems to make an individual more susceptible to dependence on the other. The rationale behind dual-addiction treatment is that reducing dependence on one may help a person reduce his or her reliance on the other. Although this is a newer approach to treatment, a recent study seems to suggest that this is indeed the case.
Pharmacotherapy: Finally, if taken on a regular basis, the drug naltrexone, approved by the U.S. Food and Drug Administration in 1995, can be a valuable aid in preventing relapse among recovering alcoholics receiving psychotherapy. Another medication, acamprosate, proved helpful in several European trials. (Editor’s note: It is now undergoing clinical trials in the United States.) Zofran, a medication usually used to prevent nausea during chemotherapy for cancer, was beneficial in the treatment of early-onset (i.e. those who started drinking heavily before age 25) alcoholism. Sertraline (Zoloft), an anti-depressant, was found to be helpful in reducing drinking in those with late-onset alcoholism.

Summary

Using proven methods of evaluating medical therapies, recent research reveals that many effective treatments exist to help people to stop drinking and maintain abstinence. These treatments include self-help groups such as AA, psychosocial approaches and medications.

Continued research in the field of alcoholism is likely to produce highly specific medications that will reduce the craving for alcohol. It will also yield an even broader range of therapies, including those mentioned here, that will improve the alcohol abusing person’s chance for recovery.

Over time, those who suffer from alcohol abuse and/or dependence will have even more and possibly better options for successful treatment. In the meantime, effective treatments already being offered by mental health professionals and community groups have been demonstrated to reduce alcohol use and promise a better life for people who make use of them.

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.

Cocaine and methamphetamine are two drugs that are often linked together because they produce similar effects and because they belong to the same class of drugs called psychostimulants. In addition, they both have the potential for causing dependence and abuse which further strengthens the bond associate between them. Though there are many similarities, a fair number of differences do also exist, which will be discussed here.
 

Where Do They Come From?
 

Methamphetamine is man made, while cocaine is derived from the coca plant.
 

Is There A Difference in the Way They Are Used?
 

Both can be smoked, injected intravenously or snorted. The difference being that methamphetamine can be taken in pill form. In addition, cocaine can be used medically as an anesthetic and as an appetite stimulant while methamphetamine has no proven medical use.

Where and By Whom Are the Drugs Used?
 

Out of the two drugs, Methamphetamine has a much more defined area of use as well as stereotype of user. Statistics show that use of methamphetamine is highest in western areas of California, Honolulu, Hawaii, and western areas of the continental United States. Urban areas of California, Oregon, Arizona, Colorado and Washington, show increased use of methamphetamines. In recent years however, use of methamphetamine has increased in rural and urban areas of the South and Midwest.
 

Cocaine use varies so there is no geographic pattern that clearly delineates where the drugs are used. Cocaine use however, is usually significantly higher in large cities and metropolitan areas as opposed to non-metropolitan areas.
 

A possible reason for the difference between cocaine and methamphetamine addiction by area is that in rural areas, cocaine is not as easily accessible. Methamphetamine however, can be made in a garage or basement with household products, making it quite easy for individuals to make their own high.
 

Do They Produce The Same Effects?
 

* Perhaps the reason why cocaine and methamphetamines are confused is because both produce a very well received rush almost immediately. This is followed by feelings of extreme happiness or euphoria which is referred to as a rush.
 

* Methamphetamine’s high can last from eight to twenty four hours and fifty percent of the drug is removed from the body in twelve hours. Cocaine’s high on the other hand, lasts from twenty to thirty minutes and fifty percent of the drug is removed from the body in one hour.
 

* Both cocaine and methamphetamine, when injected intravenously or smoked, can cause an almost immediate rush which is followed by a high.
 

* When ingested nasally, which is referred to as snorting, neither methamphetamine nor cocaine cause a rush or a high. A similar effect is produced when methamphetamine is ingested orally.

Are the Physiological Effects Similar?
 

* Both methamphetamine and cocaine can cause immediate effects of irritability, anxiety, increased heart rate, blood pressure, body temperature and possible death. Methamphetamine’s and cocaine’s short-term effects also can include increased activity, respiration, and wakefulness, and decreased appetite.
 

* Chronic use of cocaine or methamphetamine can cause dependence and possibly stroke.
 

* In either case, cocaine or methamphetamine can lead to psychotic behavior. These behaviors are characterized by hallucinations, paranoia, violence, and mood disturbance.
 

* Some data suggests that violence is more common among methamphetamine users than among cocaine users. Drug craving, paranoia, and depression can occur in addicted individuals who try to stop using either methamphetamine or cocaine.
Is there a difference in neurotoxicity?
 

* Neurotoxicity refers to the toxic damage these drugs can incur on the brain, specifically on neuron transmission. Neurons are responsible for the processing and transferring of information. Methamphetamine can be neurotoxic in animal species ranging from mice to monkeys. Methamphetamine specifically damages neurons that produce serotonin and dopamine. Since the usual doses taken by humans are comparable to the doses causing neurotoxicity in animals, it is reasonable to believe that this also causes the same effect in humans.
 

* On the other hand, cocaine does not cause neurotoxic damage to dopamine and serotonin neurons.
 

Transmission of HIV/AIDS
 

Whether discussing methamphetamine or cocaine, a risk for HIV/AIDS still exists and must be considered when engaging in any type of sexual behavior.

Washington Post Magazine — When her friend drove up to her house drunk that night, the girl was annoyed but not alarmed. Even after the friend polished off what was left of a pint of Absolut Citron and could not walk without falling down, the girl still thought, as teenagers do, that she could handle the situation.

"It was a burden being her friend, and that night it became painfully obvious," the girl, a Montgomery County high school senior, would later write in a college application essay. "She was far too drunk to accomplish anything on her own. …" After going to a party, "at one point in the evening I was tempted to take her to the hospital to get her stomach pumped. However, I decided that, since she was conscious, we would take care of her." So she brought the friend back to her house to sleep it off on the couch.

"Later that evening, she vomited everywhere and nearly choked herself to death. Luckily, my friends and I were there, and we were able to prop her up sideways and watch her … but I have never been as embarrassed and as scared as I was that night," wrote the girl, who doesn’t want herself or her friend identified. She learned two things: that she liked helping people, but that some people refuse to be helped.

Her mother learned something as well. She was home upstairs that Friday night, and when she saw the friend asleep on the couch late the next day she assumed it was nothing more than the unshakable sleep legendary to teenagers. She didn’t realize that the girl on her couch could have died there – not until months later, when she read her daughter’s essay.

Unless they get a phone call from an emergency room or the police, most parents never do learn how much their children drink or how close they have come to disaster. It’s a point worth remembering at prom time and throughout the summer – prime teenage drinking season.

The news in the ’90s is not that American teenagers drink in high school. The real news is that they drink in middle school or younger, and that both binge drinking and frequent drinking are increasing. It’s also no longer a matter of boys will be boys. The girls are catching up.

Fewer high school seniors last year reported using alcohol to the University of Michigan’s annual Monitoring the Future survey than in the early ’80s. Still, almost one-third of high school seniors reported bingeing – which the survey defines as downing five or more drinks at one time – within the previous two weeks. So did one-quarter of 10th graders and more than 15 percent of eighth graders.

But focusing on which numbers are going up or down misses the most important point: The use of alcohol by American teenagers long before they leave home continues to be "very high," in the words of the survey.

"Fewer are drinking but those who drink, drink more. That concerns me – it’s the institutionalizing of a behavior. The pattern is tougher to break," says George Mason University associate professor of public health David Anderson, an expert on youth drinking.

When college binge drinking repeatedly made headlines, a cluster of alcohol-related deaths led Virginia to establish a task force on the problem. At the time last fall, then-state Attorney General Richard Cullen noted that colleges are inheriting freshmen who are already "professional drinkers."

Buried in annual news reports about the War on Drugs is the fact that alcohol, not cocaine or marijuana, remains the drug of choice for kids ages 12 to 17. At the same time, mounting scientific evidence has found a correlation not just between alcohol and automobile accidents, but between alcohol and violence, alcohol and sexual assault, alcohol and adolescent drownings, alcohol and teenage suicide, alcohol and unprotected sex, and between drinking in the teen years and later alcoholism.

A study by the National Institute on Alcohol Abuse and Alcoholism, published in January, found that young people who began drinking before age 15 were twice as likely to abuse alcohol later in life than those who began at 21, and four times as likely to become alcoholics. The study also found that a 13-year-old who has started drinking has a 44 percent chance of becoming an alcoholic whether or not there is a family history of substance abuse.

Parents, of course, are aware that teens drink; what they may not understand is how much. Nancy Rea, coordinator of a publicly funded coalition in Montgomery County called Drawing the Line on Under 21 Alcohol Use, says those who imagine that their children simply sip a beer or two to relax at a party have the wrong picture entirely. Drinking isn’t part of the party; it is the party.

"The activity is to get as drunk as possible," says Rea. Kids put tubes or funnels down their throats for chugging. "They put their mouth right under the spigot of a keg in a contest to see who can drink the fastest. All of these behaviors start before college: drinking fast, drinking excessive quantities, drinking until they throw up."

Yet, David Anderson says, "most communities are not aggressively addressing this issue." Neither are parents, many of whom, he says, are "just happy their children are not doing drugs."

But in Montgomery County – which in recent years has witnessed the consequences of teen alcohol abuse – parents, teachers, school officials, police and students themselves are aggressively addressing underage drinking. In the process, as I found out, they’ve learned a lot about something parents rarely see – how their kids drink.

The wreck has passed into Montgomery County mythology so completely that it is simply referred to as "River Road."

On Labor Day weekend 1994, a Walt Whitman High School junior who had received her driver’s license just three weeks earlier drove her BMW into a tree in Bethesda, splitting the car in half. The driver, Elizabeth Clark, and a passenger, Katherine Zirkle, died; two other passengers were critically injured. Afterward, friends described how the 16-year-old driver and some companions had purchased cases of beer without difficulty and drunk steadily at three houses and a hotel before she climbed behind the wheel a final time.

It was Drawing the Line and Trina Leonard who made sure the community drew a moral from the story. As teenagers turned the crash site into a shrine with flowers and poems, Drawing the Line held a press conference and announced that River Road was not some isolated or romantic tragedy, but the outcome of bad decisions made by kids. The deaths helped mobilize the community into embracing a new approach to teen drinking. "That crash was pivotal," says Leonard.

Leonard had launched Drawing the Line 18 months earlier as an aide for Montgomery County Council member Gail Ewing, who made teenage drinking a point of emphasis in her election campaign. The idea was not to teach kids moderation, but to establish zero tolerance for underage drinking through a combination of enforcement, education, treatment and recreation. The group’s ambitious goal, in Leonard’s words, was nothing less than "to change the environment in which children grow up."

Before Drawing the Line began, police would bust a party, send the kids home and pour the liquor down the drain. The kids would simply move on somewhere else. There were huge field parties in the summer, drawing two or three hundred teenagers in their cars by word of mouth. Prom seasons had brought at least one alcohol-related death every year for the past five years. Stings of area stores and restaurants showed that the majority were selling beer and wine to underage customers. Even if retailers got caught, the penalties weren’t severe. Adults who served alcohol in their houses to other people’s children could not be held responsible.

When Leonard talked to parents about zero tolerance she would see their eyes glaze over. Many were still focused on cocaine as the number one substance abuse problem following University of Maryland basketball star Len Bias’s death in 1986, she says. "At that point I literally heard parents say, ‘Oh, thank God, it’s only alcohol.’ " They would tell her that drinking was a rite of passage and that nothing could be done to change it.

At Churchill High School, the principal required families who wanted graduation tickets to first attend a meeting and listen to Leonard and a Montgomery County police officer. Leonard remembers only a few adults paid attention when she talked about drunk driving, since they assumed their children would not drink and drive. But they began to take more notice when she mentioned that alcohol has been implicated in up to two-thirds of cases of date rape and sexual assault among young people. "Parents need to view illegal underage drinking as a truck coming at your child," Leonard says.

And they really focused when the police officer told them, "I know a lot of your kids. You may not realize it, but I may have been to your house. I spend more time with your kids on weekends than you do." Then he would pull out about 60 fake IDs and say, "Have you seen these around your house?"

These days Drawing the Line numbers 30 to 40 community groups in its coalition and is involved in nearly 50 projects designed to help curb teen drinking – ranging from toughening the laws to sponsoring alcohol-free events like after-prom parties and establishing committees at every high school and middle school to alert parents about students in need of treatment. There’s a hot line people can call to report teen drinking parties and a tracking system to collect data. Last November the group published its first data report, including a police log of underage drinking parties. A sample:

12/28/96 12000 block Cook Court. Parents away. 1 passed out. Kennedy, Wheaton, Springbrook High Schools.

1/97 9100 block Bobwhite Circle. 2 hospitalized (overdose). 1 adult furnishing; ½ day of school, Gaithersburg.

5/23/97 12300 block Chagall Dr. North Potomac. Drug paraphernalia. Kids hid in attic. Officer fell through ceiling. Quince Orchard, Watkins Mill High Schools.

7/19/97 19500 block Olney Mill Rd. Coach bought keg. Quince Orchard, Wootton, Damascus, Seneca Valley High Schools.

Last July 26 happened to be an unusually busy day: Party in Bethesda, two kegs, marijuana, Sidwell Friends School. Party in North Potomac, one assault on an officer, Gaithersburg, Quince Orchard, Wootton High Schools. Party in Darnestown, one juvenile arrested for disorderly conduct, resisting arrest, Quince Orchard High School.

This summer’s police log may not be any less full. But it won’t be for lack of trying. Long before the prime-time drinking season begins, Montgomery’s police are out working the one place where teens can’t evade them and their message: the classroom.

Officer Dana Way’s job is to convince teenagers who drink that they’ll get caught. Addressing a 10th-grade class at Bethesda’s Walter Johnson High School, Way makes sure the students know that Maryland recognizes no safe alcohol level in the blood for anyone under 21. Even if they’re not driving, if they’re under 18 and caught drinking in Montgomery County they could lose their driver’s license, be fined $500 the first time and be screened to determine whether they need treatment. He warns them that cinnamon gum on their breath makes him more, not less, suspicious, and that, contrary to adolescent folklore, putting a penny in their mouths won’t work either.

The 10th graders laugh nervously.

Way is a member of the alcohol enforcement unit, another Montgomery County innovation. Its purpose is to break up drinking parties, to police stores and restaurants so they don’t sell alcohol to minors, and, two days each week, to talk to 10th-grade health classes. Today it’s Walter Johnson – which rarely makes the party raid list – where Way and a fellow officer have been detailed to convince students that the penalties are too high to risk drinking or even risk being around drinking.

Some things about high school never change; the officers are interrupted when someone pulls the fire alarm as a prank. On the other hand, some things do, like the posters on the wall that warn about AIDS and date rape. Officer Way’s job is to tell the students what else has changed since he was in high school, when he drank beer with his buddies every weekend.

Way describes a St. Patrick’s Day party he helped bust this year, knocking on a door that was opened by a teenager who didn’t want to let him in. "I said where’s the host? Not here? Well, where’s the owner? Not here? Well, now we have a burglary." That got him inside, and upstairs he found the teenage hostess "passed out – they were doing vodka shots."

The message is that it’s better to cooperate with the police. Don’t run away, he advises, and end up with a criminal record "that can be with you forever. … We’ve had kids who have jumped out of windows, broken legs."

Way admits that he drank at their age. "I did it in high school, everyone did it. But when I was in high school the penalties weren’t as large as there are now."

Adolescents come with built-in hypocrisy meters, and so someone immediately asks why the penalties are higher.

"In the last few years you have kids showing up at parties and they’re not wanted," Way replies. "They’re rivals, and they go to the car and pull out a gun. There’s more violence, sexual assault, destruction and vandalism and theft."

Way recalls a party he busted last prom season in Rockville, where he found a 14-year-old girl passed out on a bed, wearing a bra and blue jeans pulled down to about her thighs, with four or five boys sitting around her trying to look angelic. He didn’t even realize the girl was there, under a pile of pillows and blankets, until everyone else had been cleared out of the basement and he heard her throwing up. She was so out of it she couldn’t even give officers her name and address.

He winds up by warning the Walter Johnson students that even if they drive sober, the sound of someone vomiting in their precious car might make them crash into a tree.

When lunch time comes, a trail of students make their way to nearby Georgetown Square, where many of them go to buy food at the Giant or just hang out. I pick two girls who have stopped to light up cigarettes. They’re ninth graders – too young to have taken the health class that Dana Way just addressed.

But they do like to party, which they define as "chillin’ with your friends and drinking." They do it once a week or twice a month, they tell me. Soon they’ve called over some boys who describe their drinks of choice – "40s," or 40-ounce bottles, of malt liquor like St. Ides or Olde English, which they consider a single serving. A 40 is the equivalent in volume of 3½ beers, and some brands have twice the alcohol content. They also like "vodka OJ," which is popular because vodka leaves less telltale odor.

The boys soon take over the conversation. They say they know plenty of people with fake IDs, courtesy of desktop publishing and the photocopying machine, but they don’t usually need to take the risk. Most often, they "give money to bums" to buy booze for them, or get it from older friends or siblings. Several say they steal from their parents’ liquor cabinets, and one boy claims he drinks every day when his parents aren’t home. "My parents work late, they’re workaholics," he says.

When I ask if anyone here has ever passed out, one of the boys points to a girl with strawberry blond hair who has been standing around quietly. "She passed out last weekend," he shouts. "We had to carry her away." He laughs as she shakes her head and slips away from the crowd.

One of the cigarette-smoking ninth graders admits she has passed out "a couple of times." Does that worry her? "A little," she says. Her round face still maintains a look of childhood sweetness, even a little surprise at the things she’s tried just since she graduated from middle school last year. "My mom knows I drink," she says. "She’s an alcoholic. Your parents can’t really stop you."

But what if one of your friends were passing out every weekend?

The girl answers, "I’d talk to them. You shouldn’t pass out every weekend if you get drunk. You should get drunk to have fun."

Still, it happens. "When kids drink, they drink pretty much to get drunk," admits the second girl. The previous weekend, she drank and fell asleep in a boy’s lap. Her parents don’t know she drinks. "My mom’s in denial. She doesn’t want to know what I do. She’s naive and they want to believe they’re good parents. She makes it her business not to know." This girl thinks maybe kids get drunk when they get their hands on alcohol because they can’t get it all the time.

"No, it’s the fun of it, because you know that you’re not supposed to be doing it," says the first girl, who didn’t party with the others last weekend because she was away on a church retreat. "And it makes you feel good." Her boyfriend joins her, puts his arms around her, and says he gets drunk every weekend – sometimes on beer and vodka, but mostly by downing three 40s at a time. The boyfriend – who says that his mother works full time and his father could care less about him – spontaneously adds, "I never drink and drive."

The group starts to break up as kids return to class, and only those willing to risk being late remain, including the original two girls. They’re both 14.

Now the second girl comes up with another reason why she drinks: "It gives you something to remember, to talk about." One of the things she remembers is the time "my friend broke a toilet bowl with her head. I was holding her head while she was puking," but the hair slipped out of her hand and the friend pitched forward.

With most of the crowd gone, the quiet strawberry blonde reappears. When I ask her how often she drinks, she answers, "Whenever possible." Then she amends that to "every other weekend." She began in sixth grade. Now she’s in ninth. Was last weekend the first time she passed out? "No," she answers, and the others laugh knowingly. How much did she drink? She thinks it was more than half a bottle of vodka and about six beers, starting at around 7:30 p.m. She got sick around 10. "I was throwing up for two hours. Everyone just left me."

The house where they partied belonged to a student whose parents were away for the weekend but whose older brother came home and broke things up. After all the vomiting, the girl could barely walk, so "these two guys carried me to a friend’s house to pass out." At that house the mother was upstairs, already asleep.

"It was a little scary," she admits. "I didn’t know where I was going. There was a guy on each side." She got home about 5 the next afternoon and told her mother only that she’d been at a friend’s house.

Do these kids ever do anything drunk that they later regret?

"Definitely," the first girl responds softly and slowly. "I sometimes get a little out of control with guys when I’m drunk. I have sex. I know about it. I mean, I consent, but I wouldn’t have done it if I wasn’t drunk, and I feel kind of bad about it afterwards."

Her boyfriend still has his arms around her, and he’s smiling. She insists that even drunk she always makes the boys use a condom.

I ask how it feels to run into the boys the next morning at school. She shrugs and doesn’t answer. Finally, her friend intervenes.

"It’s not a big deal afterwards. It’s just that you were drunk and everyone knows you were drunk, so it doesn’t matter."

It might be easy to dismiss the kids at Georgetown Square as extreme. But there is plenty of evidence to suggest that they are not unique in either the amounts they drink or the reasons why.

Montgomery County instituted a new program in January to evaluate every teen who is cited on alcohol charges. In the first three months, the program screened 191 kids, two-thirds of them boys, almost all of them ages 15 to 18, and determined that 84 percent needed either mental health or substance abuse treatment or both.

The mental health workers who do the screening use various questions to distinguish teenagers who are abusing alcohol from those just checking out the party scene with friends. John Dunn looks for "a kid who’s struggling in school. If the kid smokes marijuana, too, I’m much more likely to think there’s a serious relationship to chemicals." They look for kids who have dropped their extracurricular activities. They look for a family history of alcoholism, for signs of abuse, for whether the parents and the child are able to talk to each other.

They see plenty of "good" kids, "getting very good grades, not low-functioning, hurting kids," Dunn says. The binge drinkers who do well in school and sports are the hardest ones to spot. "I ask kids how many times they’ve thrown up. Is it once every two weeks? If a kid’s thrown up more than once and didn’t learn, if he tells me he’s getting drunk once a month, that’s serious." The kids, of course, never think they have a problem. "They all say, ‘I don’t drive.’ "

Some of these teenagers drink for the same reasons teenagers always have. To dull pain or handle stress or find a social niche or gain popularity. Others are typical adolescents, just taking risks. "We see a lot of obviously popular, attractive, sophisticated, nice kids who are just rolling the dice and hoping that snake eyes doesn’t come up," says Dunn.

But kids are left on their own more than ever to take the gamble. In many ways what’s new is the world adults have made for them.

It’s a world full of baby boomer parents who don’t like to lay down rules, says Mitzi Ross, who runs the screening program. Boomers who dabbled in drugs and alcohol themselves as teens feel hypocritical dictating to their children. Ross, a boomer herself, says that often it’s a case of "parents being afraid of saying no to their kids, that their kids won’t like them." Those parents who do want to exercise some control find it difficult when they’re surrounded by other parents who don’t even try. And there is always some place kids can go where there are no adults, since this is also increasingly a culture where there is a single parent or both parents are working. Ross notes that the Maryland Adolescent Survey – the State Department of Education’s biennial study – shows a jump in drinking among kids between sixth and eighth grade. That’s about the age when parents begin to relax about leaving their children alone after school.

The other big jump in alcohol use occurs at the beginning of high school. The screeners wonder about the role of huge schools, leaving students to their own devices, with open campuses at lunch and little after-school recreation. "So many of the kids start their serious pattern of use in ninth grade," says Dunn. "You’re going to a big city every day. You’re barely out of puberty, still look like a kid, you’re out at 2:30 and running around with seniors. It’s a mess."

"Karen, at most of the parties you go to, is there drinking?" Sylvia Fubini calls into the den where her daughter, a ninth grader at Bethesda-Chevy Chase High School, curls up under a blanket on the couch, watching television on a Sunday evening.

Karen chooses her reply carefully. "Lauren says every party has drinking after 10th grade," she says, referring to her older sister, who lives with her father and isn’t here right now. Lauren later confirms that there’s alcohol at every party she knows of – and that there are parties every weekend.

Earlier in the year, Fubini, who is divorced and runs her own business writing a health industry newsletter, got phone calls from families in her pleasant Bethesda neighborhood warning that their kids had come home from her house intoxicated. "My child swore nothing happened. Parents started to try to keep in touch. We even talked about getting a group together." Nothing happened, but one set of concerned parents told their son he is not supposed to be at the Fubini house unless there’s an adult there.

We’re sitting in her brightly lit kitchen, which faces onto a deck and a green yard from which three cats and a dog come and go. Sylvia Fubini is a pretty, petite woman with lively blue eyes and lots of energy. "I tend to be the house where the kids congregate," she says, especially in the afternoons when she’s away at her office. Coming home, "I’ve found pot in the garage, beer in the garage, the brandy gone." Not a parent who hesitates to put a direct question to her children, she says she and both her daughters "have talked at length." Her older daughter "will tell me she’s drinking and that my younger one’s drinking," although Fubini doesn’t know how much.

A few years ago, she went away for the weekend, leaving an au pair who went out on Saturday night. "The kids just all started to congregate here. They will just learn where the parents are absent. There was beer. … My daughter didn’t want them here. Kids showed up unannounced, uninvited, it just blows my mind." When the au pair returned at 11 p.m., she was unable to break up the party. Lauren, then a sophomore, called a college-age male friend to come help clear out the house. Fubini realized that "every time I left the house overnight I had the potential for this to happen."

But Fubini worries that if she forbids the kids to hang out at her home, they’ll just go somewhere else. Once adolescents drive, much of the control seems to drive away with them. She knows some teenagers rent hotel rooms to drink. At least in her home, she can lay down some rules. "I will not tolerate drinking or pot because it’s illegal," she repeatedly tells her daughters – but "I might as well be talking to blank walls."

She calls again to Karen to try to get her to join the discussion, but Karen has selected the safe course and fallen asleep in front of the television.

"They are doing everything much faster than we did," says Fubini. "They have cars, we give them everything, and they think they can handle it. There’s a lot more overt dysfunction in families."

Parents are always told to make sure their children go to a party only where an adult is present. But during one of their talks, Lauren described a party she went to as a sophomore at a house in which the parents were there. "They were drunk upstairs and the kids drunk downstairs."

Even responsible parents are unsure what to do. On New Year’s Eve, a neighbor sent Karen and her friends home from his house when he found bottles some of the boys had swiped from their parents’ liquor cabinets. Another neighbor told Sylvia, "Kids are going to drink. Now what you’ve got to teach kids is how to do it in moderation." She thinks she agrees with that. On the other hand, she wonders out loud if she’s naive about what goes on, even when she’s home.

"Karen, is there much drinking among your friends?" she asks as her daughter finally emerges from the den in search of a bowl of cereal. Karen shrugs and names one boy who has a problem, but says she herself doesn’t. Her mother asks if all the kids on New Year’s Eve had been planning to drink.

"I know I wasn’t," Karen answers firmly and exits with her cereal.

Fubini sighs. "I’ve asked my kids not to lie to me. The problem is, if you pull your head out of the sand and really see it as a serious problem, what do you do? What do you do?"

Some of the things you do, according to material from Drawing the Line, include setting curfews; staying up until your child gets home; being alert for the smell of alcohol or the coverup signs of mints and toothpaste; establishing rules and consequences. But in Montgomery County, they don’t just leave enforcement to parents.

As Officer William Morrison starts his 5 p.m. to 3 a.m. shift, the whiteboard in the alcohol enforcement unit’s headquarters lists "Restaurant Hot Spots" that police want to monitor for possibly selling liquor to minors. Also listed are three stores they want to stake out for the same reason. Sometime in the evening the six officers on duty will probably be called on to break up a party, since it’s a Friday night, but it’s pouring outside, which might put a damper on things even for teenagers.

Morrison thinks this is the night he might arrest a father who let his son have a 20th-birthday party with alcohol a couple of weeks ago on the condition that all the guests turn in their car keys. But one 18-year-old high school student retrieved his, left around midnight and wrapped his car around a telephone pole on Arcola Avenue in Wheaton. He’s in a coma and on life support. Morrison would like to cite the father for "adult responsibility" and furnishing alcohol to a minor, but he needs to get hold of the last two young witnesses and they’re not home.

Hey, it’s Friday night.

Morrison has a fringe of sandy hair, blue eyes and the air of a crusader. As the police department’s first officer trained in drug recognition, he developed the alcohol enforcement unit with another officer about four years ago. Morrison believes it was unique in its mission – not just to look for drunk drivers on prom nights and holidays, but to combine education with deterrence and enforcement. And he coined the nickname, the Whiskey Units.

The Whiskey Units have developed a policy called "controlled dispersal," which means that instead of just busting up a party, they stake it out until they see evidence that kids are drinking. Then they block off the road so no one can drive away, surround the house and knock on the door. They give Breathalyzer tests to the kids and citations to those who test positive. Then they call all the parents to come, and they don’t clean anything up first.

"When we first started it, we would hear the parents say, ‘You should be out arresting burglars, murderers, drug dealers. These kids are only having a couple of beers,’ " Morrison says. He’s in his patrol car – Whiskey 17 – headed to stake out a store that’s on the Hot Spots list. But when parents began to come to the party scenes, "they would see cases of beer, their feet would stick to the floor, they’d look at the damage that was done to the house. … They might see 50 kids inside one motel room, or see a kid hanging over a toilet throwing up." Within three months, he says, he began to hear the attitudes of adults change.

"Most of the parents now are very upset. We’ve actually had to pull parents off the host."

Before the unit’s reputation was established, it was not uncommon for parties to grow from a few dozen friends to a few hundred uninvited guests when Mom and Dad left town. Now, he says, it’s hard to find a party with 100 kids, although there are still plenty of gatherings with up to 50.

At a party of Quince Orchard High School students in Gaithersburg in March, teenagers tried to play possum, refusing to open the door, turning out the lights and lying down on the floor out of sight. Morrison went to the back of the house. "They began throwing beer cans out the window," he says. One person jumped off the balcony. As the officers were planning to back out and block off the road, the parents suddenly came home. "The parents had no idea this was an ongoing thing," he says.

The Whiskey Units found beer, vodka and wine. "There’s beer in the bathroom closet, under the bed, in the washing machine." They found several class officers who were designated drivers and had abstained from drinking, but cited them anyway for "constructive possession" – being in the presence of alcohol. "They were charged because there was so much alcohol and we were there an hour," he says, still sounding annoyed. "They chose to hide with the rest of the kids. Their parents were so upset: How could we charge them?"

Some police officials believe that with all the other demands on resources, alcohol enforcement has received too much emphasis, and some parents contend the officers of the Whiskey Units are overzealous. Last December, the units busted a large afternoon party following a half-day at Damascus High School, where school authorities had gotten wind of what the students were planning and alerted police. Thirty-one students were cited for drinking. Those involved with sports teams were barred for the remainder of the season; a student body officer was impeached, and others were banned from their extracurricular activities. But the action split the community because the school, which had allowed a teacher and its own security personnel to go along on the raid, had chosen to notify police rather than call the parents to prevent the gathering. And because the partying – and drinking – went on for several hours before police got there.

Ellen Pickett, the Clarksburg mother whose house was raided, fired off an angry letter to the Damascus Gazette, saying that she felt "used and violated." She and her husband, who both work full time, "are 100 percent against underage drinking," Pickett wrote, and would have stopped their son from throwing the party if they’d been informed. They were outraged by the police raid and the teacher’s "sneaky" invasion of their home. "I suggest the two-hour delay was a deliberate plan to allow time for the house to fill up with teenagers and time for their blood alcohol levels to rise to measurable levels. That would grab headlines. … The motive for headline-grabbing is obvious. There is talk in the county government of disbanding the police unit assigned to breaking up such parties."

Morrison responds that police were late getting there because the party occurred on one of the days they spend teaching in the schools, and that they didn’t inform the parents because they feared the party would just be moved elsewhere. But it’s true about disbanding the unit. Police Chief Carol A. Mehrling announced in November that the department planned to break up several special units, including the one devoted to alcohol enforcement, to make better use of limited manpower. County Executive Doug Duncan, who received community protests against the plan, announced he would not let that happen until the department came up with a plan to continue enforcing underage drinking laws. As of July, Morrison and the others will be reassigned to various district stations to advise regular beat officers, although how that will work is not yet clear.

Morrison believes breaking up the unit is a mistake. "If we shut down a party with 50 kids, that’s 50 less people that are drinking and driving down the road," he says. If they convince one kid in a health class that the chances and consequences of getting caught are too high, that’s one kid they might have stopped from drinking. They’re getting almost complete compliance now from local beer and wine stores, he says, although he’s beginning to see more alcohol drifting in across the county line from D.C. Still, he believes the unit has had a positive impact, even though "we can’t see how much good we’re actually doing."

The question could be asked of all Montgomery County’s efforts – how much good are they actually doing?

Drawing the Line cites a list of achievements. The top three are: that no alcohol-related deaths have occurred during prom season since the program began, that the rate of binge drinking among 10th graders dropped from 33.5 percent to 29 percent between 1992 and 1996, and that more than three-fourths of Montgomery County residents are aware of county efforts to reduce underage drinking.

Still, it takes time to change the environment in which kids grow up, argues Trina Leonard, who no longer works for the county but is setting up similar programs in five communities around the country for the National Highway Traffic Safety Administration. "You’re not going to walk into a high school where you’ve got 90 percent of the kids drinking and give ‘em a presentation and they’ll say, ‘Well, we’re never doing that again.’ … You think of the whole culture they’re exposed to about alcohol."

Nancy Rea of Drawing the Line believes ours is a culture that bombards kids with mixed messages about drinking and then blames the problem on peer pressure. "I think the problem is a bigger problem than peer pressure. It’s not that somebody says, ‘Why don’t you drink?’ Nobody says anything to you, you just kind of feel out of place." If you drink, "on Monday morning you can say, ‘I had such a great time; Friday night I got so plastered, buzzed, wasted.’ Can you say, ‘Friday night I had such a good time – I stayed sober’? It doesn’t come off quite the same way."

Pit one county’s efforts against that whole culture and Trina Leonard’s modest expectations make sense: "There’s a certain number of kids that probably will drink, there’s some who wouldn’t drink even if you put a bottle in their hand – [and] then there’s this really big swing group," she says. The theory is that if you give that swing group other ways to have fun, if you make it hard enough for them to get hold of alcohol, if they see their older siblings getting caught and punished, maybe they’ll decide to wait until they’re 21 and legal.

At least that’s the theory.

By late Friday night the rain is pouring down in sheets. Whiskey 17 parks a few blocks away from a Bethesda address that’s been phoned in to police by a man complaining that teenagers are drinking noisily next door. The other Whiskey Units roll in one by one, all careful not to be seen in their police cruisers. They sit in the dark, which is punctuated by thunder and lightning, like troops massed on the border, waiting for "the Bomber" – a junky, unmarked car – to scope things out more closely. When he finally arrives, the driver of the Bomber takes a look around, even peers into the windows of the suspected party site, then radios back: "There ain’t jack going on over here, not a creature stirring, no music, no noise."

Just before midnight another call comes in, from Norwood. The dispatcher says a teenage party seems to be getting out of hand and that "they might be about to fight." Almost immediately, another police unit radios that it has intercepted 15 of the party-goers in a van. Some of the kids are trying to run away. Morrison swings Whiskey 17 around, flips on the overhead flashing lights and accelerates. But before he gets there, the radio squawks that the occupants of the van are under control.

The Whiskey Units converge on a cul-de-sac near the Norwood house. The house appears to be quiet, although paper cups are scattered on the lawn. The other units leave, but Morrison decides to ring the bell. A harried-looking woman answers and tells him that she had given her daughter permission to have some friends over from Sherwood High School but then "all these other kids showed up" from another high school and "it got out of hand." That’s when she called the police. "I’m the only adult here," she says, a young son peering out from behind her.

Morrison informs her that the police got the kids who left the party.

"All of them?" her teenager calls out from the living room in disbelief. "You got all of them?"

Its very simple, substance abuse effects body functioning. Drug use can lead to long term physiological effects that can not only be acutely harmful, but can also result in chronic problems. The use of drugs is not the only issue. It is all the harmful behaviors that come along with substance abuse that tend to make matters worse.
 

Substance abuse harms the body in two distinct ways: via the effect of the substance itself and via negative lifestyle changes, such as irregular eating habits and poor dietary intake. For example, infants who were exposed to alcohol while in the womb often have physical defects and mental disabilities. In this case, the growing fetus has deficits both directly caused by the substance crossing the placenta and indirectly due to inadequate nutrition of the mother while she was drinking.
 

Recovery from substance abuse involves many different components, including proper organ functioning, assuring mental well being and proper metabolism. A huge factor in the healing process is proper nutrient supply. Nutrients are essential for not only for energy, but also to keep the immune system strong which helps to fight off infection and keep one strong.
 

Though it is clear that substance use in general is not healthy, like anything else, different substances have different effects on the body. In this article we will discuss a few of the more popular drug categories and how they each can affect body functioning.

Opiates

Which Drugs Are Opiates?
 

This category includes: codeine, morphine, and heroin. All of these affect the gastrointestinal system. One of the main symptoms associated with opiate use is constipation. When one withdraws from opiates classic symptoms of withdrawal include: diarrhea, vomiting, and nausea. The danger here lies primarily in a depletion of valuable nutrients and electrolytes. This includes imbalance in the amount of potassium, sodium, chloride, and calcium. Electrolytes are important for a variety of things, including proper cardiac, or heart, functioning.
 

To combat the severity of these symptoms, one should eat meals that are balanced (i.e. proper amounts of vegetables, grains, fats, and proteins). A high fiber diet with things such as whole grains, beans, peas and vegetables is advisable due to constipation associated with opiate use.
 

Alcohol
 

Out of all the drugs utilized in the US, alcohol is the major cause of nutritional deficiencies. The most prominent deficiencies include the following:
 

* Pyridoxine or Vitamin B-6
* Thiamine
* Folic Acid
 

An individual lacking in these nutrients may develop anemia which is a low blood count, for women a deficiency in folic acid can cause poor pregnancies, and B vitamin deficiency can also cause neurological problems. Lack of thiamine (B1) in particular, can lead to Korsakoff’s syndrome. It is important to understand that it is not necessarily the alcohol that cause the disorder, but the effect of alcohol of the absorption of nutrients that is damaging.
 

Alcohol damages the liver and pancreas in particular. These two organs are necessary for detoxification and processing (liver) and the pancreas effects blood sugar and absorption of fat. If these two organs are not working properly, one can have an imbalance of fluids, calories and electrolytes.
 

Permanent damage can take place in the form of cirrhosis which is liver damage, diabetes, seizures and malnutrition. Liver damage can also result in decreased clotting factors, which means an individual has the chance of bleeding unnecessarily. Women also have an increased risk for osteoporosis and may require calcium supplementation.
 

Stimulants

What is a stimulant?
 

This includes cocaine, methamphetamine and cocaine. Use of these drugs can lead to a decrease in appetite and weight loss which will eventually lead to malnutrition. As the name implies, stimulants stimulate the body thereby causing many users to stay awake for unhealthy periods of time. This can range from one night of missed sleep, to being awake for days at a time. This may result in dehydration and subsequent electrolyte imbalance. One should return to a normal, balance diet which may be difficult given the abuse the body has suffered especially if there has been severe weight loss.
 

The Marijuana Munchies
 

Marijuana can increase appetite, which, in chronic users can lead to being overweight. For these individuals it is probably best to cut back on sugar, fat and overall caloric intake.
 

Nutrition and psychological aspects of substance abuse
When people feel better, they are less likely to relapse. Since balanced nutrition helps improve mood and health, it is important to encourage an improved diet in people recovering from alcohol and other drug problems. Individuals recovering from substance abuse have just given up a huge part of their life and for this reason, it is better for these individuals to focus on not using again as opposed to putting all their energy into a drastic diet change.

How to Incorporate a Healthy Diet into Recovery
 

Perhaps the most important thing for prior substance abusers to remember is routine. For instance, regular meals throughout the day are recommended. An increase in proteins, complex carbohydrates and dietary fiber are highly recommended. Due to the irregularity of diet that tends to accompany substance abuse, most individuals will needs to supplement diet with vitamins and minerals. As every individual is different, it is recommended that recovering addicts meet with a dietician. A trained professional can then develop a plan that is specific to the person’s needs. The vitamins that are most often lacking include zinc, vitamins A and C and most of the B vitamins.
 

Keeping Your Sugar Steady Can Decrease Cravings
 

As many drug addicts do not eat regularly, they may forget what it feels like to really be hungry. Not eating steadily can cause a fluctuation in blood sugar levels which can lead to feelings of unsteadiness throughout the day. For a recovering addict, these feelings may be interpreted as drug cravings which could lead to one using. This is yet another reason to keep a steady and healthy intake of food.
 

The Importance of Water
 

Dehydration is common for substance users and it is very important to emphasize the need for fluids during and in between meals. As appetite can return during recovery, it is important to emphasize fluid intake as well as proper food consumption. For all the reasons discussed prior, it would be detrimental to recovery for an individual to begin eating the high calorie foods with little to no nutritional value due to all the abuse the body has already endured. Drinking water will help the body to absorb nutrients which is something most of these individuals are lacking.

Substance abuse recovery is a difficult road to follow. Good nutrition is something that can help to make that road a little easier to walk down. Encouraging healthy eating and a healthy lifestyle, is something concerned loved one can do to help ensure the people in their lives stay clean.

Individuals, who engage in substance abuse use, are often facing more than one issue. Research literature has shown, time and time again, that there is a stereotypical personality that accompanies the addict, rightly named, the ‘addictive personality’. Some characteristics that accompany said individual are as follows:
 

* Impulsivity
* Difficulty in delaying gratification, sensation seeking
* Nonconformity combined with a weak commitment to the goals for achievement valued by the society.
* Social alienation and a general tolerance for deviance.
* Poor tolerance for stress, increased sensation of distress
 

This is being outlined, to assist the lay person in understanding why addicts cannot just stop using drugs. Substance use is not just an action it is in effect a lifestyle. This implies that in order for an individual to stop utilizing drugs, he or she must not only actually stop using but must change aspects of personality that may lead him or her in that unhealthy direction. Once this has been outlined and agreed, the individual next needs to decide a plan of action. It is unadvisable for an individual to attempt to stop using drugs on his or her own. Breaking such habits is difficult for anyone with the assistance of others let alone as a solitary mission.
 

So, now the question comes, inpatient or outpatient?
 

Research conducted over the last few decades indicates that longer treatment periods are associated with more positive outcomes. On average, a treatment period of three months was correlated with more positive results. In the case of substance abuse treatment, this is to mean less incidence of relapse. Patients expressed more positive feelings towards more intense treatment plans. So, those individuals who were in residential treatment and received one on one consistent attention were more likely to indicate a better sense of overall satisfaction in regards to treatment. However, there is little statistically significant difference between outpatient and inpatient long term treatment recidivism. Meaning, long term effects of staying clean do not differ.
 

In order to understand the above findings, one must integrate the information previously presented. In order for substance use to cease permanently, an individual must totally change his or her behavior and surroundings. Going into a residential facility assists in removing one from his or her life. This cuts out locations and individuals that probably assisted in facilitating drug use. One is also in the presence of others with a similar goal. All of these factors are positive and if one can integrate them into his or her psyche, inpatient treatment can longitudinally provide the basis for healthy living. The one factor that proves to sabotage all this is properly presented in one question often asked by residents of treatment programs:
 

What Happens When I Get Out?
 

It is a valid question. In a controlled environment anything is possible. If temptation is outlawed, the individual does not have to utilize his or her decision making skills because in effect, the decisions are made for them. Substance users in this context can be thought of as a child. As children, our parents monitor our behaviors and our actions often giving us the proverbial slap on the wrist if we reach too close to the fire. As adults, we must utilize our decision making skills or else we have the potential to be severely burned. For this reason, substance abuse recovery must take place in small steps with much reinforcement utilized.
 

The main variable shown to influence whether treatment programs work or not is continued monitoring. One study that analyzed outcomes of parolees who participated in treatment communities (TC), either outpatient or inpatient, found that the outcome variable: return to prison, was correlated with longer participation in ‘aftercare’ treatment programs. Thus, those individuals who left prison and had some level of reinforcement, was more likely to stay clean and not return to incarceration.
 

McLellan (2004), a researcher out of the University of Pennsylvania, compares substance abuse treatment to treatment for any other chronic illness. Mclellan point out, that what will make treatment effective is the three following variables noted:
 

* Making treatment options attractive
* Offer options/alternatives
* Constant and continued monitoring of the individual
 

It is no shocker that most people are more inclined to do something they view as positive or attractive. So, first things first, treatment options should be something that the individual in fact beckons to the individuals tastes. Varying options in the form of treatment (i.e group versus individual therapy for instance) keep treatment ‘entertaining’ if you will, thereby making continued treatment as an option. Finally, when an individual leaves treatment he or she needs to continue with what we will call ‘stabilization’. Whether that means switching from residential to outpatient treatment or joining a group like alcoholics anonymous or narcotics anonymous after intense treatment depends on the individual and the program from which he or she graduated.
 

No one program will fit every individual as every person is different. Residential treatment may very well be the best option for some and not for others. It is up to the individual to decide what will suit him or her better. Having said that, when considering substance abuse treatment one must remember that treatment consists of a plan that must unfold longitudinally. Changing one’s behaviors and in effect, one’s personality is a long process which, with proper guidance and support can occur. Like any task worth undertaking it takes time, perseverance and most importantly assistance from those who can help to attain a life free of drug use.