Summer House

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.

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.

Introduction
 

Cocaine is a intensely powerful addictive stimulant that acts directly on the brain. Cocaine was first extracted from the leaf of the Erythroxylon coca bush, which is endemic in South America, West Indies and Indonesia. Cocaine is one of the most commonly abused drugs and the majority of the individuals who use cocaine are also users of other drugs. The drug can generate a feeling of euphoria, hyperactivity and mental alertness. It can be rapidly highly addictive leading to relentless mental and physical problems.

The neuro-stimulating properties of the coca leaves are thought to have played some role in the development of the Inca People. Soon, the Spanish invaders quickly discovered the euphoric effects of the coca plant and introduced the plant to the Europeans, who also developed a great liking for the plant and its stimulating effects.
 

History
 

The plant was used for medicinal purposes as early as the 15th Century in Europe. In the 18th Century, concentrated forms of cocaine became available and it was soon discovered that the plant extract had some medical benefits. The drug was then widely used as a topical local anesthetic and because of its mental stimulating properties, was also used to treat depression. The use of cocaine in tonics and elixirs became widespread and it was also added to coca cola.
 

However, soon it was soon observed that drug was addictive and had profound effect on the psyche of the individual. Because of cocaine’s potent side effects, in the early part of the 20th Century, the Pure Food and Drug Act was introduced, which required that all cocaine be labeled in all medical products. However, this did not limit the use of cocaine and addiction to cocaine reached endemic proportions. In 1914, the Harrison Narcotics Act was introduced and banned the nonprescription use of cocaine products and labeled cocaine as a narcotic.
 

The Harrison Narcotics Act did nothing to diminish the use of cocaine and over the next 50 years, cocaine became the number one illicit drug used in North America. In the 70s and 80s, a new cheaper formulation of cocaine became available on the market and it has today become the favorite drug among teenagers and socially deprived individuals. By the mid-1980s, the emergency rooms were again becoming full with individuals with cocaine-related problems. Physicians again re-affirmed the abuse potential of cocaine.
 

Today, cocaine is classified as a Schedule II drug — it has towering potential for abuse and can only be administered by a doctor for legitimate medical uses. Today, the medical use of cocaine is limited to topical anesthesia of the upper respiratory tract and eye because the vasoconstrictive properties of cocaine are desirable during these procedures. However, it is not available in majority of the hospitals in North America, because safer and better agents are available.
 

Addiction Potential
 

Cocaine is an addictive psycho-stimulant with euphoric effects. The addictive properties of cocaine are thought to be due to brain dopamine D2-receptor stimulation. Dopamine is released as part of the brain’s reward system and is implicated in the high that is typical of cocaine consumption. Patient dependence depends on a number of different factors, including genetics, social and environmental factors, preexisting medical and mental conditions.

There are two fundamental forms of cocaine: powdered and "freebase." The powdered form easily dissolves in water whereas freebase is a mixture that has not been neutralized by an acid. The freebase form is usually smoked or snorted.
Warning signs of cocaine use include a change in behavior, acting isolated, careless about personal appearance, loss of interest in school, family, friends and frequently needing money. Physical exam may reveal red eyes, runny nose, frequent sniffing, change in eating and sleeping patterns and a change in friends

Cocaine induces an artificial “high” that gives its user a feeling of limitless ability and energy. When users come down, they are usually depressed, nervous, and crave for more. Todate, it has been impossible to predict who will become addicted and when the fatality will occur.
 

Frequency of Use
 

In the US, as of 2005, according to the Office of National Drug Control Policy, more than 3 million people in the United States are considered long-term cocaine users. Cocaine abuse is also widespread universally and has become a major public health issue in North America. Data suggest that the prevalence of cocaine use in the world is approximately 13 million people, or 0.23% of the global population. Cocaine use is also increasing in a number of Latin American countries, including the countries that are the main producers of cocaine.
 

All races and both genders are known to use cocaine. Individuals between the ages of 18-30 are the most frequent users. Men not only are more heavy users but also account for more overdose and toxicity from cocaine.
 

Routes of Intake
 

Cocaine may be inhaled (snorting), injected or smoked. Irrespective of the method of intake, cocaine is still a potentially deadly agent. Most individuals report that the psychotic features and habituation are more rapid and pronounced after smoking cocaine, compared to other methods. The “high” generated with smoking is instant but of a shorter duration, but the addiction potential is the same by all routes. Like all illicit drugs, injection of drugs carries with it the potential for transmission of HIV/AIDs. This becomes of more concern when the needles and other injection paraphernalia are shared.
 

A common route of transportation of cocaine is by swallowing cocaine packed in condoms. Body stuffers usually hide packages of cocaine in the rectum, vagina or mouth. These individuals usually get away until the packages rupture and cocaine intoxication becomes obvious.
 

Street cocaine is often accidentally/intentionally contaminated during the preparation process in order to dilute the cocaine used and increase profits. Commonly used cocaine adulterants may include local anesthetics, phenytoin, sugars, amphetamines, phencyclidine, phenylpropanolamine, quinine, talc, and others.
 

Mortality/Morbidity
 

Data from the Drug Abuse Warning Network (DAWN) indicate that there are about 4-5000 cocaine related deaths annually in the US. Cocaine-related deaths are rare and not always due to high dose intoxication. The lethal dose of cocaine remains unknown. Fatalities are multifactorial, and, often the cause remains unknown. Occasionally, massive exposure of cocaine occurs in body packers and results in rapid death.
 

However, the majority of cocaine users are prone to serious long term medical complications. These complications may include seizures, abnormal heart rhythms, heart attacks, stroke, blindness, liver and kidney failure, lung fibrosis and heart failure.
 

Symptoms
 

Cocaine has numerous physiological and psychological side effects. The adverse effects of cocaine’s appear almost immediately after a single dose, and fade away within a few minutes or hours. Cocaine can cause intense vasospasm of blood vessels, dilate pupils, increase the heart rate and blood pressure and can also generate a febrile response.
 

The psychological effects include euphoria, decreased fatigue, extreme hyperactivity and mental lucidity. The sense of sight, sound and touch are over amplified. During the cocaine euphoria, the need for food, sleep and personal hygiene are significantly absent. The majority of individuals report that cocaine aids them completing simple chores swiftly, whereas others experience mental confusion and are unable to carry out any tasks

The quicker the cocaine is absorbed, the more intense is the “high”, however, the duration of action is short lived. The euphoria from snorting may last 15-30 minutes, while that from smoking may last 5-10 minutes. Increased utilization can diminish the period of stimulation due to development of tolerance. High doses of cocaine and/or extended use can generate an aggressive paranoid behavior, tremors, vertigo, muscle twitches, extreme restlessness and auditory hallucinations.
 

When addicted individuals discontinue using cocaine, they frequently become depressed. This may lead to additional cocaine use to lessen the depression. Extensive cocaine snorting is known to cause ulceration of the nasal mucous membrane and even perforate the nasal septum. Cocaine-related deaths are often a consequence of cardiac arrest or seizures followed by respiratory arrest.
 

When both cocaine and alcohol are consumed, the adverse risks are increased by several folds. Combination of cocaine and alcohol in the liver is known to generate a substance called cocaethylene, which is known to potentiate cocaine’s euphoric effects and also increasing the danger of sudden death.
 

Treatment of Acute Intoxication
 

Patients with cocaine poisoning may exhibit severe CNS and cardiovascular dysfunction, leading to a loss of airway protective reflexes, cardiovascular collapse, and mortality. The goals of pharmacotherapy are to neutralize toxicity, reduce morbidity, and prevent complications.
 

The immediate control of mental agitation is critical in preventing the mortality associated with cocaine overdose. Benzodiazepines are the mainstay of therapy and may be used generously until sedation is accomplished. Avoid physical restraints in patients with psychomotor agitation because they may interfere with heat dissipation. Seizures should be aggressively treated because they may worsen hyperthermia, rhabdomyolysis, hypoxia, and acidosis. In some cases, ventilatory support and neuromuscular blockade may be required

Body packers and body stuffers may require critical care monitoring. The body packers pack their gastrointestinal tract with bags of cocaine. However, occasionally the cocaine-containing package ruptures or the packages may cause gastrointestinal obstruction.
 

All symptomatic body packers and body stuffers require intensive therapy. Charcoal may have to be introduced in the stomach to bind the cocaine and prevent absorption and surgery may be required to remove the packages.
 

Asymptomatic patients may be treated with laxatives and bowel irrigation to remove the cocaine bags. Surgical removal may also be indicated in patients with bowel obstruction.
 

Some individuals may suffer a Cocaine washout syndrome (cocaine crash syndrome) which is characterized by sudden and severe exhaustion with mental slowness, depression, suicidal ideation, anxiety and increased appetite, lasting as long as 18 hours after the last consumption. Cocaine washout syndrome is usually self-limited, and only requires supportive therapy.

Once the acute phase is stabilized, patients may require further therapy to treat the complications of cocaine. It is highly recommended that these individuals enter into a rehabilitation therapy program.
 

Treatment approaches to Addiction
 

Treatment of cocaine addicts is a multi million dollar business. Treatment programs are available throughout North America. The treatment is complex and involves changing the mind as well as altering the psychological, social, familial and environmental factors
 

Pharmacological Approaches
 

There are no approved medications currently available to specifically treat cocaine addiction. Few emerging compounds currently being investigated to assess their safety and efficacy in treating cocaine addiction include disulfiram, terguride, topiramate and modafanil. Additionally, baclofen, a GABA-B agonist, has shown promise in a few individuals who use excessive cocaine. The use of anti depressant drugs has been recommended during the early phase of cocaine abstinence, because of the moderate depression that occurs.
 

Behavioral Interventions
 

Many types of behavior therapies have been used to treat cocaine addiction, and involve both residential and outpatient approaches. Behavioral therapies are frequently the only available effective treatment for cocaine addiction. However, amalgamation of both medical and behavior treatments are more effective in the treatment of cocaine addiction.
 

Behavior therapy which has been shown to be beneficial includes vocational rehabilitation, career counseling, contingency administration and cognitive-behavioral treatment. Therapeutic communities (TCs), or residential programs with intended lengths of stay of 6 to 12 months, present another option to those in need of treatment for cocaine addiction. TCs concentrate on remobilization of the individual to society, and can incorporate on-site vocational rehabilitation and other helpful services.

Enrollment in deterrence programs, such as Narcotics Anonymous, may be of benefit for some patients.

Addiction to drugs and alcohol encompasses more than a behavioral intervention. The reason for this is drug addiction is a complex disease, however, it is treatable. Like chronic illnesses such as hypertension and asthma, relapse can occur with drug addiction even after extended periods of continued abstinence. For this reason, repeated treatments may be necessary. Treatments should be tailored to the individual in order to be more effective and long lasting, therefore allowing people to live long and productive lives.
 

In a study conducted in 2004, 22.5 million American needed treatment for substance abuse. Out of this large number, only 3.8 million received help (NSDUH2004).Leaving substance abuse and addiction cases untreated, though in the short-term can save money, in the long-term can lead to many extraneous costs to society. Some of these things include: court and criminal costs, emergency room visits, prison costs, child abuse and neglect, foster care, welfare costs, healthcare utilization, reduced productivity and unemployment.
 

For every dollar spent on addiction treatment, there is a four to seven dollar reduction in the cost of crimes related to drugs. In 2002, it was estimated that $181 billion dollars was the cost to society for drug use. Over $500 billion was spent when including tobacco and alcohol costs. This includes lost productivity, healthcare and criminal justice costs. Substance abuse programs that are run successfully and efficiently can help society in more than one way. Not only can they assist the person in need, they can also help reduce the amount of sexually transmitted disease that are spread such as HIV/AIDS and Hepatitis. In addition, crime and costs to society can also be reduced. So, the question comes, how can one develop an effective treatment program?
 

Effective Treatment Guidelines
 

Research has been conducted since the 1970s shows that treatment can help people avoid relapse, change destructive behaviors, and take them out of a life of substance abuse and addiction. Treatment tends to be a long term process and can require several episodes of treatment. This research has helped lay down the structure on which effective treatment programs should be based.
 

• Treatment does not need to be voluntary to be effective.
• For certain types of disorders, medications are an important element of treatment, especially when combined with counseling and other behavioral therapies.
• No single treatment is appropriate for all individuals.
• Treatment needs to be readily available.
• Effective treatment attends to multiple needs of the individual, not just his or her drug addiction.
• Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
• Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
• An individual’s treatment and services plan must be assessed often and modified to meet the person’s changing needs.
• Medical management of withdrawal syndrome is only the first stage of addiction treatment and by itself does little to change long-term drug use.
• Possible drug use during treatment must be monitored continuously.
• Counseling and other behavioral therapies are critical components of virtually all effective treatments for addiction.
• Treatment programs should provide assessment for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases, and should provide counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
• As is the case with other chronic, relapsing diseases, recovery from drug addiction can be a long-term process and typically requires multiple episodes of treatment, including "booster" sessions and other forms of continuing care.
 

An All Encompassing Treatment
 

When treating an individual for addiction treatment, it is important for the individual as a whole to be looked at. Usually, treatment begins with detoxification which is followed by treatment and relapse prevention. Initially, in order to ease the individual into treatment, medications may be needed in order to control symptoms of withdrawal. All encompassing care includes mental health services, medical care and of course aftercare. In order to make sure that someone in recovery continues to stay there is to make sure all bases have been covered. Follow up options such as community or family based recovery support systems can be essential to acquiring and maintaining a life that is free of drug use and abuse.
 

Medications

Medications can help in various different fashions. In some cases, coming off of a substance can be life threatening and medication is necessary. Often times, the symptoms of withdrawal can be so severe that medication is necessary. This is not considered treatment; it is however, the first step in the process of recovery. Going through withdrawal treatment is not sufficient. If one does not receive further treatment, it is like not receiving treatment at all.
 

Using chemical substances can help to establish brain functioning that may have gone awry. At present medications are available to help reestablish pathways for addiction related to heroin, morphine (opioid) and nicotine (tobacco). Other medications are currently being developed for treatment of cocaine and methamphetamines (stimulants) and marijuana (cannabis) addictions.
 

Methadone and buprenorphine act as antagonists on brain receptors which means that they block the pathways which opiates like heroin take. This helps to block the drugs effects, suppresses symptoms of withdrawal and can even reduce the incidence of cravings. Ideally, this helps patients to stop drug seeking behaviors and activities that may be criminally related. Thereby, patients should be more focused on treatment having reduced many outside stimuli.
 

Behavioral Treatments
 

This is a very important part of effective therapeutic treatment. Stopping substance abuse habits is only effective if behaviors change, therefore, attitudes have to be changed so that a healthy lifestyle is maintained. Life skills need to be altered, unhealthy patterns need to be changed. In addition, medication effectiveness is usually better, and this can help people stay in treatment longer which will hopefully improve the likelihood of the individual staying clean.
 

Outpatient behavioral treatment can include a wide variety of programs. Most include group or individual counseling. Some of the more popular forms of treatment include the following behavioral treatment programs:
 

• Motivational Incentives (contingency management), which uses positive reinforcement to encourage abstinence from drugs.
• Cognitive Behavioral Therapy, which seeks to help patients recognize, avoid, and cope with the situations in which they are most likely to abuse drugs.
• Motivational Interviewing, which capitalizes on the readiness of individuals to change their behavior and enter treatment.
• Multidimensional Family Therapy, which addresses a range of influences on the drug abuse patterns of adolescents and is designed for them and their families.
 

Residential treatment can be very helpful, even more so for individuals with severe problems. Therapeutic communities are structured programs in which patients remain for half a year to twelve months. Those in treatment usually have long histories of drug addiction, have often been involved in criminal activity and may have reduced social functioning. Treatment communities have become so evolved that they may also be structured to accommodate women who are pregnant or have children. The purpose of treatment communities is to help the individual learn how to behave in society without drugs.
 

In conclusion, with the proper mix of effort on the part of the individual, the proper care by practitioners, medications and community, a formula for success on the part of the substance user can be acquired. With that formula put in motion, an addict can become a former one and go on to live a happy and fulfilling life.

The body’s reaction to the removal of a substance it has become dependent on is called withdrawal. Withdrawal causes craving for more of the substance being removed. The period of time when the body is trying to overcome its addiction is called detoxifica-tion (detox). Detox is the first step in overcoming a substance addiction such as drugs or alcohol. Detox is a pertinent step for the patient is to be successfully rehabilitated.
 

Opiate drugs such as heroin and methadone, and prescription medications including Hydrocodone, Oxycontin, Xanax, Vicodin and Lortab, require medical detox supervision. There are however, other illegal drugs such as marijuana, crystal methamphetamine, and cocaine that do not require medical detox. Since there is psychological dependence associated with these drugs, it would be wise to complete a period of stabilization. The process of drug detox requires the patient to be closely monitored by keeping vital signs, giving support and administering medications if needed. There are numerous withdrawal symptoms or side effects when a patient stops or dramatically reduces drugs after heavy or prolonged use. Those side effects include: sweating, shaking, headaches, drug cravings, nausea, vomiting, abdominal cramps, diarrhea, sleeplessness, confusion, agitation, depression, anxiety, and other behavioral changes.
There are two commonly used drugs to enable the patient to feel relief from these symptoms. First, Klonepin, which reduces physical symptoms, and Buprenophex, which is an anticonvulsant. These drugs must also be monitored as cessation produces withdrawal symptoms. Generally, the time period for drug detox is three to seven days under medically monitored supervision.
 

Alcohol detox, like drug detox, is usually accomplished in an inpatient medical facility. Duncan Raistrick identifies the key to a successful, planned detoxification is preparation. Raistrick goes further to detail that the first job of therapy is to bring the patient to a point of readiness to change their drinking behavior. Second, patients need to be given accurate information about what to expect during detoxification.
 

There are two withdrawal categories: minor, meaning early withdrawal and major, meaning late. The severity of withdrawal depends greatly on the duration of alcohol used. Alcohol Withdrawal Syndrome (AWS) falls into three main categories: central nervous system (CNS) excitation, excessive function of the autonomic nervous system (ANS), and cognitive dysfunction.5 Richard Saitz, M.D., M.P.H., states, since alcohol enhances gamma-aminobutyric acid’s (GABA) inhibitory effects on signal-receiving neurons, neuronal activity is lowered. This lowering leads to an increase in excitatory glutamate receptors. Tolerance occurs as GABA receptors become less responsive to neurotransmitters, which in turn requires more alcohol to produce the same inhibitory effect. During detox, the GABA is ineffective and unable to suppress the excitatory glutamate receptors. Detox is intended to relieve physical symptoms such as: shaking or tremors, headaches, vomiting, sweating, restlessness, loss of appetite, sleeplessness, Delirium Tremens (DT’s), hyperactivity, and convulsions. Alcohol detox medications are similar to drug detox medications: Buprenophex, certain benzodiazepines and anticonvulsant medications. Alcohol detox completion can take from three to fourteen days.
 

Norman S. Miller notes that medical management of alcohol and drug withdrawal during detoxification often is not sufficient to produce sustained abstinence from recurrent use. Therefore, further addiction treatments are needed to prevent relapse to alcohol and drug use following treatment of withdrawal.
 

In conclusion, drug and alcohol detoxification can effectively prepare the addicted abuser for rehabilitation and treatment.
 

Some physicians believe the withdrawal phase is related closely to the drug addiction – the worse the withdrawal, the more likely the continued use of the chemical to prevent withdrawal. Several factors are key to successful detoxification.
 

1. Acknowledge that there is a problem and decide to do something about it.
2. Get rid of all the drugs and paraphernalia.
3. Drop friends and associates that are tied to our drug problem.
4. Seek and accept spousal support, or support from friends, or relatives.
5. Prepare for symptoms with the support of a professional.
6. If tranquilizer drugs are needed for a few days or longer, they must be handled sensitively, as one addiction can easily replace another.

Miami Herald — Most everybody in this neighborhood coffee haunt has been hooked on something. The high school dropout with beauty-pageant looks has been fending off a heroin habit for two decades. The former football player says he is clean now after years of popping pain pills. Santa Claus succumbed to alcohol.

Nineteen of the fallen are here tonight for therapy and healing, for a second — or a third or fourth — chance, hoping to reclaim a piece of their lives. They form a circle in the pebble garden behind KoffeeOkee, which is owned by Harold and Dawn Jonas, former users who now help others kick drug and alcohol habits and answer the question: What now?

A resort on the Atlantic in Palm Beach County, Delray Beach has another, less obvious civic profile: Florida’s sobriety capital. Like Hazelden in Minnesota and Utah’s Cirque Lodge and the communities that surround them, it is a place to dry out, clean up. Its recovery community is spirited and multilayered, a dense mesh of dozens of treatment facilities, counseling centers and residential housing that gives addicts a wide-reaching chance for recovery and permanent lifestyle change.

This is where people start over. And sometimes stay.

”You want to be here if you are struggling with an addiction,” says Anna O’Connell, 43, who has been in and out of detox for crack cocaine, heroin and alcohol over the past 20 years and attends therapy sessions at KoffeeOkee. “This is the closest thing to family; this is where you feel safe.”

Treatment for addictions that the medical community now accepts as chronic diseases ranges from private $10,000-a-month treatment centers to free coffee, counseling and karaoke at java houses such as this one, which hosts formal therapy sessions twice a week and informal gatherings even more often.

MANY, FROM ALL OVER

The size of South Florida’s recovery community is difficult to estimate because only one layer — facilities with residential treatment beds — is licensed by the state. Delray Beach alone offers more than 1,200 beds in transitional houses — a second layer — according to the South County Recovery Residence Association in Delray, which monitors halfway residences.

Every week in Delray, about 5,000 addicts attend 12-step meetings that stretch from 7 a.m. to 11 p.m. At Crossroads Club, a squat stucco complex off Lake Ida Road, about 700 people walk through the doors every day to attend 120 meetings aimed at a swath of needs, from treatment for cocaine addiction to obsessive cluttering, says Susan Miller, executive director, a recovering alcoholic.

Addicts arrive from as far away as Oregon and Rhode Island and from as nearby as South Beach. They face daunting odds: Relapse rates range from 40 to 90 percent, depending on the client’s dedication and will power, sustained treatment, and follow-up care, according to the National Institute on Drug Abuse.

”My parents sent me here to try to turn my life around,” Rani Canosa, 21, a pretty, petite college dropout offers one Monday night at KoffeeOkee. “Alcohol made me feel good. I would be really, really happy, then really, really sad, then just miserable.”

Canosa, from a Baltimore suburb, started drinking seriously as an 18-year-old freshman in college. Soon she could consume a 12-pack of beer and a half-bottle of vodka in a two-hour stretch.

She had tried treatment centers in Maryland and Pennsylvania but returned home only to relapse once she was back among friends and familiar haunts.

Canosa has been in Delray Beach since Aug. 29, out of treatment at the Wellness Resource Center in nearby Boca Raton since Feb. 5. She lives in a halfway house and works as a barista at KoffeeOkee.

”The truth is, if I was home, I would be drunk or looking to get drunk,” she says softly, never making eye contact. “I actually want to be here.”

COLLECTIVE STRUGGLE

But what distinguishes this vibrant recovery community from similar places elsewhere, is a growing sober social infrastructure, an informal network of places for people to mingle without the colossal temptations of drugs and alcohol.

”Delray Beach is a microcosm of the various layers of the recovery process,” says Howard Lerner, clinical director of the Addiction Treatment Program at South Miami Hospital. “Those struggling belong to a fraternity.”

Here, even in the midst of fighting for sobriety, addicts can go dancing at popular clubs that hold sober nights, sing karaoke at a sober coffee house, listen to live music at a sober juke joint, call in to recovery radio shows, roar into the sunset with a sober motorcycle club and pray at a Bible study just for them.

”The struggle with an addiction can be forever,” says Harold Jonas, a mental health counselor. “So all we really want is for people to be healthy and to laugh and have hope and be part of the world, not just the recovery community.”

The collective sobriety struggle here is no longer anonymous. Recovering addicts live among ”normies” and often work on Atlantic Avenue, the city’s glittering ribbon of sidewalk cafes and boutiques and galleries.

”When you are on this journey, it’s incredibly important to feel like you are not alone, to see and be around people just like you,” says nattily-dressed Jonah Yolman, now 22 months on the clean side of a wicked crack-cocaine addiction.

Yolman, 29, sitting in a Starbucks on Atlantic Avenue, quietly acknowledges two people ordering coffee who are in one of the dozens of 12-step anonymous programs. He talks casually about the familiar identifying signs of people in recovery: the relentless smoking and coffee drinking, the trails of cigarette butts and empty coffee cups and candy wrappers. And the most obvious sign: people tightly clutching books with dark covers, their 12-step guides.

”We are everywhere, living and working in this city,” says Yolman, a counselor at a local treatment facility who promotes two sober nights at area clubs. He and a partner are also launching a similar sober club night in August at a South Beach club (sobernightlife.com).

“People come here and enjoy the weather, the beaches, low-key atmosphere and try to start over.”

NATIONAL REPUTATION

In some ways, Delray’s recovery community draws its inspiration from a small, rural town in Minnesota that over the years became a magnet for recovering addicts, from marquee rock stars like Eric Clapton to the anonymous souls who came looking for peace and order.

Since 1949, addicts have famously flocked to Hazelden, which started as a farmhouse retreat in Center City for men working their way through programs based on the 12-step principles.

Over the years, teams of doctors, counselors and chaplains developed a holistic approach to rehab now emulated worldwide.

More than three decades ago, Delray’s first sober houses opened for people making the transition from residential care to independent living. The houses — a yellow clapboard with a sweeping porch on one street, a peach bungalow with a white-picket fence on another — are sprinkled within neighborhoods, around public squares, near churches.

Rents range from $125 to $175 weekly for a room and access to kitchens and family areas. Most landlords require random drug tests, and some perform bed checks or monitor whether their clients have reported to work.

Two years ago, Crossroads Centre in Antigua, a drug-treatment program founded by Eric Clapton, opened in the city. And in February, Lecreshia Hall, a Boca Raton psychiatrist, started Hallway of Life Recovery Center, a faith-based, 28-bed transitional facility for women, on a quiet residential street near downtown.

”When I did the research to find the best place to open, Delray Beach kept coming up,” says Hall, who leads Bible study on Tuesdays. “The idea of our center is to teach our clients how they can use the Bible to help in recovery.”

But Delray Beach’s national reputation as a recovery community has been unsettling for some residents.

”We don’t mind taking care of the people living here, but we don’t particularly like people coming from all over the country or the world to recover,” says City Manager David Harden. “But it’s a fact of life, and so we have tried to be supportive of the community.”

Harden says Delray Beach gives money each year to the Drug Abuse Foundation of Palm Beach County, the county’s oldest chemical-dependency treatment and prevention center. The Commission also sold city property to Crossroads Club several years ago, allowing the center to expand.

Over the years, residents have complained to city officials about the lack of security and control at some sober houses. Owners need only a landlord permit to run them, a reality that makes strict regulation difficult.

Jonas, who heads the South County association and runs the coffee shop, says problems stem mostly from unscrupulous landlords who hope to turn quick profits at the expense of fragile tenants and the surrounding neighborhood.

”You got some of these operators who don’t manage the property or the tenants, then they put the people out and leave them homeless,” Jonas says. “There are some operators we would all be better off without.”

FINDING SOLACE

Jonas came to Florida 20 years ago full of reasons to give up. But with the help of his father, who put him in a West Palm Beach treatment center, he cleaned up and stayed put.

A slight guy with a thick mustache and a thicker Philadelphia accent, Jonas sits in the lounge of his coffee shop one afternoon rattling off his story with sobriety’s detachment and confidence.

Pot by 13. Then acid and speed and cocaine. Graduation to alcohol. Bottomed out in the injection world of cocaine and heroin.

Jonas entered rehab in 1987. He married Dawn, a recovering cocaine addict (they met in a 12-step group), and went back to school, earning an online master’s degree in counseling psychology from Antioch University and a doctorate in addiction studies from International University in St. Kitts.

”You come out of a situation like that broken and with very little to hold on to,” Jonas says. ‘You come out of treatment and you say, `Now what?’ ”

So Jonas and his wife — who recently celebrated her 22nd clean year — began working to answer this huge question, working to help define what life after treatment really means.

In 2000, they launched sober.com, a Web clearinghouse for 30,000 recovery programs nationwide. And for 10 years, he operated a recovery residence in Delray Beach. She runs a home for women in recovery.

Two years ago, they opened KoffeeOkee, in many ways ground zero for the recovery community. Inside is a cozy mix of velvet wingback chairs and bistro tables and a small cafe offering every coffee, tea and juice imaginable but absolutely no alcohol. The walls are covered with bulletin boards offering testimonials, treatment and housing ads, and calendars outlining the month’s sober activities.

A piano sits in the corner with a dried white rose on top, a delicate memorial to Valerie, a drug counselor who died a year ago.

Of an overdose.