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

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

Want to know what will-power is?

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

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

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

Addicts have plenty of will-power…….

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

WorldWideAddiction.com — "The road is long, with many a winding turn………"

Never have truer words been spoken – especially when it comes to substance addiction recovery.

When we first decide to crawl out of the darkness and take our tentative steps in the light of sobriety, it’s an amazing experience. We begin to feel stronger and our reasoning abilities become a lot clearer.

……then the emotional crash, the "honeymoon" period is over.

Perhaps you have experienced this and know what I mean. The "high" of making the decision to clean up and detoxing has gone. You are now back in the community and facing it on it’s terms, learning to cope.

You may be alone, isolated in your pain that "normal" people can never understand. You grieve for your lost "friend", even though that friend was actually your worst enemy. You become irritable, uninterested, depressed -perhaps even suicidal. This can lead to a "bust", a bust you may never recover from -remember, that if we are addicted we cannot control our substance intake. The "just one more time" may seal your fate. And as we all know, there are worse things in life than death -the insanity of addiction. You may not be lucky enough to die the next time.

Many of us have experienced this phase, the "emotional roller coaster". For me, it was as though all the colours of the world were washed away. There was no point to anything, my mind constantly went back to the dark days. I was guilt ridden, self-pitying and unmotivated. I was very hard to be around. While others who knew me congratulated me on my efforts, I saw only failure as I didn’t feel "right". I felt the same way I did at the age of 13 when my hell really began.

There is a reason for this – in a lot of ways, I was still 13. When I began abusing substances, a great deal of my emotional growth stopped, the substance was my coping mechanism. At the age of 24, it began again. There was a steep learning curve ahead.

But don’t worry, this phase does not last forever. For me it was one year. For you it may be a few weeks. It depends greatly on your network of support and more so, yourself.

-If you are experiencing this, it is imperative that you build a network of people around you that understand what you are feeling. These people are the recovered addicts. They will know when to hug you and tell you that everything will be OK, and they also know when to kick your butt and tell you to "get over it"….tough love, but necessary.

-If the environment you are in threatens your sobriety, leave it. I am serious…whatever it takes, get the hell out of there! You may be saying to yourself "I can’t leave, I can’t afford to" or "People are relying on me to be around". It doesn’t matter – remember where you have just come from. If you finish up back there again, you may never re-emerge.

-You may have friends who are still practising addicts/alcoholics. Stay away from them if they do not respect what you are doing to improve yourself. It is in the nature of people who have the disease of addiction and are still practising to influence you in subtle ways. In a great deal of cases, it is not on purpose, but more a subconscious thing.

-Start putting routine into your day. I’m not suggesting too much, too soon but keeping busy is a great way of keeping your mind off things. As you become more productive, your self-esteem increases.

-Re-establish a sleeping pattern. Your body has been through hell and back. It needs rest, and your brain needs to sort things out on many levels. Be prepared for nightmares involving the past and use of the substance. Even though you may have no apparent cravings, your subconscious yearns for another hit and expresses this in your dreams. The nightmares are alarming at first. There were many times that I woke up in a pool of sweat. Even seven years down the track I still have them, but I accept them for what they are.

-Eat regular meals. I am a fine example of a toxic waste dump when it comes to things of a dietary nature, but I learnt early in my recovery that cravings could be lessened through eating something. The advice given to cigarette smokers about eating healthily when quitting is sound and good, but it is my experience that when withdrawing from other substances it is wiser to satisfy your food cravings with what it wants, including fatty and sugary foods. Alcoholics will probably find that they will develop a sweet tooth because their bodies are used to high amounts of sugar. So, if you wake up at 3 in the morning and eat a quart of double chocolate chip ice cream smothered in fudge, don’t feel guilty! It’s better that than what you were using before!

-If you find yourself feeling angry a great deal, this is also normal. It is important to examine the anger and not just lash out using whatever situation you are in as a scapegoat. Whatever is going on, it will pass. Breathe deeply and think.

Some of the points above may seem fairly drastic and harsh, but this is a life and death situation. And unlike some other terminal illnesses, addiction destroys everything in it’s path as it destroys you – your family, your friends and anyone you come into prolonged contact with.

The advice above is not mine; it was given to me and I now pass it on to you. The easy way to remember the points is the HALT statement

The 4 Don’ts:

H-ungry
A-ngry
L-onely
T-ired

Good luck to you in your recovery, there are people out there who care about you, even if you don’t know them….

"You alone can do it, but you cannot do it alone"

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.

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.

Since the 1960s, many addicts have reported that even a single dose of ibogaine, a hallucinogenic alkaloid extracted from the root of an African shrub, helps them kick their habit by reducing their cravings for drugs. And there is hard evidence to back these claims, as well. Ibogaine was first introduced as a potential treatment for opiate addiction by Howard Lotsof, who took the drug in 1962 looking for a psychedelic experience, and awoke 30 hours later with no cravings and no withdrawal symptoms, despite being a heavy heroin user at the time. Lotsof was able to develop and follow an ibogaine maintenance program, which he then followed for three years while remaining opiate free. In 1986, Lotsof opened a company by the name of NDA International to advocate for the use and research of ibogaine and its active constituents as anti-addictive compounds.

Since ibogaine aides in the cessation of addiction, it started to be used to deal with opiates and other substance addictions. Ibogaine has only been introduced to Western scientific medicine but has documented use by the Bwiti tribe in Central Africa for centuries. At lower doses ibogaine has the ability to increase energy and mental alertness and appears to decrease the desire for food and drink. Higher doses (20+ mg/kg) of ibogaine have a larger psychoactive property, and is used ritualistically in initiation rites for its potent hallucinogenic properties.
 

Barbara E. Judd, CSW did a study on ibogaine and stated that the most difficult aspects of treatment are getting the patient to enter treatment.  She notes that the three major obstacles are the fear of detoxification lack of insight, and the inability of patients to control their urges to use drugs. It was in these three areas where she felt the benefits of ibogaine treatment far outweighed those of traditional methods. Judd further states that psychological fear of pain and withdrawal prevents many addicts from even attempting detox. Addicts feared having to deal with the emotions that lead them to use in the first place. Judd adds that when patients learn the benefits of ibogaine they are more willing to try it.
 

Like all forms of detox, ibogaine is not without risks and side effects. At therapeutic doses, ibogaine has an active window of 24 to 48 hours, is often physically and mentally exhausting and produces ataxia for as long as twelve hours. Nausea that may lead to vomiting is not uncommon throughout the experience. These side effects reduce the attractiveness of ibogaine as a recreational drug at therapeutic doses, however, at lower doses ibogaine is known to have stimulant effects. It is still a controversial and experimental drug and there are some cases of fatal cardiac arrhythmias.
 

There are two types of ibogaine treatment. The first type of treatment is oriented toward addiction, most commonly heroin dependence, and typically involves dosages in the range of 15 to 25 mg/ kg .5-8 The second type of treatment, also know as “initiatory," involves a dosage on the order of 8 to 12 mg/kg, or about half of the dose used for addiction and is used for spiritual insight and facilitating psychotherapy.  In addition to reducing craving, ibogaine often promotes a sense of wellbeing that can last from weeks to months. As the studies into the nature of ibogaine progress, scientists have discovered that ibogaine’s anti-additive properties are actually two-fold. First, when the substance is consumed, the body produces a chemical called noribogaine. Noribogaine blocks the brain’s receptors that control cravings. Noribogaine also increases dopamine and serotonin levels, which elevate feelings of wellbeing.

So while ibogaine is not a substitute for drugs, and is not addictive, ibogaine is a chemical dependence disruption and a chance for patients to get a head start on recovery. Ibogaine enables the patient to focus on the underlying causes of addiction without going through the intense withdrawal symptoms that accompany most types of detoxification. And, even if there are some remaining symptoms after ibogaine detox they are more tolerable than other detox approaches. Studies show that ibogaine has the ability to drastically attenuate drug withdrawal in all patients and, in 90 percent of treated patients during one case study, to interrupt the patient’s craving to continue drug use for periods of time ranging from as short as two days to as long as two and a half years from a single treatment.

Currently opiate dependence treatments like methadone can be dispensed only in a few centers that focus in addiction treatment. There are not enough addiction treatment clinics to assist all patients seeking treatment. Suboxone is the first narcotic drug available under the Drug Abuse Treatment Act (DATA) of 2000 for the treatment of opiate dependence that can be prescribed by a physician. Hopefully, this advance in therapeutics will provide more patients the opportunity to access treatment.

Suboxone (buprenorphine with naloxone) is currently available for the maintenance treatment of opioid addiction. The intention of adding naloxone to the formulation is to deter intravenous misuse and reduce the symptoms of opiate dependence. Suboxone treatment is intended for use in adults and adolescents more than 16 years of age who have agreed to be treated for addiction.
 

Once detoxification of the individual is completed, Suboxone is used during the maintenance phase of treatment. Suboxone has recently become the drug of choice instead of methadone in the treatment of opiate addiction. Suboxone use is less rigidly controlled than methadone because it has a lower potential for abuse and is less dangerous in an overdose. As patients progress on therapy, the physician may write a prescription for a take-home supply of the medication.
 

Suboxone Prescription
 

Only those physicians who have approval from the Drug Enforcement Agency (DEA) are able to start in-office treatment and provide prescriptions for ongoing medication. The Center for Substance Abuse Treatment (CSAT) maintains an active database to help patients locate qualified doctors.
 

Route of Administration
 

Suboxone is available as a tablet which is always administered sublingually. The pill is placed underneath the tongue until it is fully dissolved. Swallowing or sucking on the pill does not offer any therapeutic benefit. When placed underneath the tongue, the pill dissolves and is absorbed in 10 -20 minutes.
 

Suboxone treatment is generally done under medical supervision. During the induction phase, one is taught how to properly take the medications and dose adjustments are done during the phase. One is usually started on the smallest dose until the best therapeutic effect is obtained. Once the ideal dose is obtained, the individual is seen once in a while and prescriptions can generally be available from the same physician.
 

Suboxone is available as 2 and 8 mg tablets. Most anecdotal reports indicate that the response to the 2 mg dose is suboptimal. The majority of individuals report benefit at higher doses of 8-16 mg. The aim of the maintenance treatment is to rid the drug craving and decrease the anxiety. The dose is usually adjusted until the drug craving features are diminished.
 

Since Buprenorphine is a Schedule III drug, the physician is only allowed to prescribe 5 refills in 6 months.
 

Maintenance therapy
 

Although Suboxone can be used for detoxification, its intended use is for maintenance. The ideal candidate for maintenance therapy with Suboxone is an older individual who has previously been on drugs but now has a job and wants a stable lifestyle. The individual previously has failed detoxification and wants to live a simple life without the daily cravings of his previous addiction. The majority of past drug users immediately adjust to Suboxone as the cravings disappear immediately and a smoother life style are accessible.
 

Suboxone Control
 

Because of the great potential for abuse, FDA works closely with the drug manufacturer, Reckitt-Benckiser, and other agencies to develop an in-depth risk-management plan. The FDA receives quarterly reports from the manufacturer and pharmacies and maintains a comprehensive surveillance program. This monitoring allows for early detection of abuse of the drug. The major components of the risk-management program are preventive measures and surveillance. Preventive measures instituted include drug education, tailored distribution, Schedule III control under the Controlled Substances Act (CSA), child resistant packaging and supervised dose induction. The program regularly monitors local pharmacies and web sites. Numerous other agencies also monitor the abuse of Suboxone and these include:
 

-Drug Abuse Warning Network (DAWN). This agency run by the Substance Abuse and Mental Health Services Administration (SAMHSA) gathers data from emergency rooms related to the illicit use of drugs or non-medical use of a legal drug.
 

-Community Epidemiology Working Group (CEWG). This agency monitors the use of buprenorphine.
 

-National Institute of Drug Abuse (NIDA). NIDA frequently sends newsletters to physicians about the addictive drugs and to report it if necessary.
 

Side Effects
 

The most common reported side effect of Suboxone includes:
 

- Cold or flu-like symptoms
- Headaches
- sweating
- insomnia
- Nausea
- Mood swings
- Pain
- restlessness

Like other opioids, Suboxone have been associated with respiratory depression (difficulty breathing) especially when combined with other depressants.
 

Cautions
 

Intravenous use of Suboxone usually in combination with benzodiazepines or other CNS depressants has been associated with significant respiratory depression and death. Suboxone has the potential for abuse and produces dependence of the opioid type with a milder withdrawal syndrome than full agonists. There are no adequate and well-controlled studies of Suboxone use in pregnancy. Due caution should be exercised when driving cars or operating machinery.

Close to a million Americans are treated for alcoholism on a daily basis. For the past 3 decades, the majority of treatments have been empirical and the success of the treatments has never been verified by clinical trials. The numerous methods developed in the treatment of alcohol addiction include the use of medications, psychological, social, behavioral methods and self help groups- all designed to help achieve abstinence from alcohol.

The initial approaches to alcohol treatment were all based on self help and over the years the 12-step self help program has become the gold standard. Other treatments include brief interventions by visiting the primary care physician or trained nurses. Behavioral and psychosocial support therapies have evolved over years and generally involve long term therapy. Over the last 2 decades, motivational enhancement therapy and involvement of the non-drinking spouse have evolved and produced good results.
Of course, over the past 4 decades, pharmacological approaches to alcoholism treatment have made some progress, but the ideal drug still remains to be discovered.

Alcoholism Treatment

The majority of individuals with alcohol dependence initially always deny that they have a problem and are reluctant to undergo therapy. Agreeing to undergo alcohol treatment usually occurs after the individual encounters health, family, employment or legal problems. Depending on the situation of the individual, various treatments are available to help with alcohol dependence. The initial part of the treatment involves evaluation, a brief intervention and either an in/outpatient program or counseling.

Principles of Alcohol Dependence Treatment

Before alcohol treatment can begin, one has to determine if the individual is alcohol dependent. For some who drink socially and are in control over their drinking, treatment may simply require reduction of drinking<. For those who have no control over their drinking, the best treatment is abstinence.

To maintain abstinence, the best approach is to be included with alcohol abuse therapists. These specialists can help develop specific-tailor made treatment plans, which may include objectives, behavioral modification skills, use of self-help manuals, counseling and follow-up care at a treatment center.

Non Drug Residential treatment programs

There are numerous non-drug residential alcoholism treatment institutions and include therapy to maintain abstinence, individual and group therapy, participation in alcoholism support groups (such as Alcoholics Anonymous), educational seminars, spousal involvement, work assignments, physical and non physical activity therapy. Most of these residential programs have professional counselors and staff involved in the treatment of alcohol dependence.

All individuals undergo a complete physical and medical assessment prior to therapy. The essence of all residential programs is to commence detoxification and treatment of withdrawal symptoms that may occur. Hard-hitting psychological counseling and psychiatric treatment is offered to individuals, couples and their families. The principal emphasis of all residential programs is on recognition of the problem and motivation for abstinence. Individuals who are unable to fulfill this basic criteria usually do not succeed with therapy.

Psychological, Behavioural and Social therapy

Numerous behavioral approaches to alcohol dependence treatment include psychological therapy. The primary component of these therapies is motivational enhancement therapy. This therapy is designed to help the individual become more responsible and develop a change in his lifestyle.

Various forms of counseling are available and may involve cognitive behavior therapy to help cope with distorted/abnormal thoughts and help develop a sense of control over these thoughts and feelings.

The majority of pychological therapies often involve the non-alcoholic spouse as most studies show that couple participation increases the likelihood of abstinence from alcohol. Behavioral –marital therapy is a combination of an approach to drinking treatment while strengthening the marital relationship through sharing, teaching and communication skills

Self-Help Programs

The most common self help group in the treatment of alcohol dependence is Alcoholics Anonymous (AA). This is one of the most common and easily available group in any community.

Alcoholics usually get involved with AA before seeking professional help, as a part of it, or as aftercare following professional treatment. Although anecdotal data on the success of AA are plentiful, results indicate that inpatient treatment, a combination of professional treatment and AA, will achieve better results for more people than AA alone. The reason why AA has been beneficial as a treatment for alcohol addiction includes isolating the individual from his social network of alcoholic friends, providing psychological/social support, teaching coping skills and structured behavior treatment.

Physician intervention

Some indivuals receive counseling from primary care physicians and trained nursing professionals. This consists of numerous office visits and counseling. The majority of these brief interventions help those with acute alcoholic crises. Following the brief intervention, all individuals are recommended to enter specialized treatment programs if the alcohol consumption continues.

Drug Treatments

Disulfiram (Antabuse) is an alcohol-sensitizing drug which has been around for at least 40 years. It was the first drug used for aversion therapy. It provides a strong deterrent to alcohol. It is not a cure and does not decrease the craving for alcohol. If taken before an alcoholic drink, it causes a severe reaction that includes nausea, vomiting, facial flushing and headaches. The drug is rarely used today as the severe reaction is not tolerated and most alcoholics are reluctant to take it.

Naltrexone (ReVia), is an antagonist of morphine and has been found to decrease the urge to drink. As is the case with all addiction disorders, however, naltrexone is only effective if taken on a regular basis.

Acamprosate (Campral) is a drug that decreases alcohol cravings and helps maintain abstinence from alcohol. Unlike disulfiram, naltrexone and acamprosate have fewer side effects and do not produce serious nausea and vomiting if alcohol is consumed.

Recently, the Food and Drug Administration (FDA) approved the first injectable drug to treat alcohol dependence. Vivitrol, a drug similar to naltrexone is administered by an intramuscular injection in the buttocks monthly. It has been shown to decrease the urge to drink by blocking neuro receptors/transmitters that may be coupled with alcohol dependence. Vivitrol has no effect on the withdrawal symptoms due to alcohol. The drug is recommended for use by alcoholics who are undergoing psychosocial therapy and have not consumed any alcohol in the recent past. The drug is also available as a pill, but it has been found that the injectable formulation is easier for individuals recovering from alcohol dependence and only has to be administered once a month.

Even though some drugs may reduce alcohol drinking, it is highly recommended that individuals enter in aftercare programs and prop up groups to help prevent relapse and encourage motivational behavioral and life style changes.

Conclusion

Research supports the idea of using drugs as an adjunct to the psychosocial/behavioral therapy for alcohol abuse and dependence. However, additional clinical trials are needed to identify those patients who will most likely benefit from such an approach, to determine the most appropriate medications for different individuals, to develop optimal dosing formulas, and to develop strategies for improving patient compliance with medication protocols.

With continued research on the effect of alcohol on the brain and behavior, hopefully this will lead to the magic pill. Drugs to decrease alcohol craving are around but specific medications are still missing. In the meantime, the combination of drug therapy and the use of behavioral therapies are the best hope for recovery of the individual -and the lives of loved ones-who suffer from alcohol abuse and dependence.

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.

Las Vegas Sun — Nevadans consume about twice the national average of several prescription painkillers, making us among the most narcotic-addled populations in the United States, a Sun analysis has found.

The consequences are deadly. More people in Clark County die of prescription narcotics overdoses than of overdoses of illicit drugs or from vehicle accidents. In 2006, Nevadans were the No. 1 users per capita of hydrocodone — better-known by the brand names Vicodin or Lortab. 

We took enough of the drug to equal 48 Vicodin pills for every man, woman and child in the state for a year.

And the numbers are climbing. From 1997 to 2006, the most recent year for which data are available, the per capita rate of hydrocodone used in Nevada jumped by 273 percent.

Nevadans are turning to other narcotic painkillers at an even faster rate.

The per capita use of oxycodone, best-known by the brand name OxyContin, climbed sevenfold from 1997 to 2006, while methadone use jumped 12-fold.

Nevada is ranked fourth in the nation for methadone, morphine and oxycodone use per person, the Sun analysis found.

Following crack cocaine in the 1980s and methamphetamine in the past decade, prescription narcotics are “the next big drug epidemic,” said Matt Alberto, deputy chief of investigations for the Nevada Public Safety Department, the lead prescription drug policing agency in the state.

Emergency room physician Dr. Edwin “Flip” Homansky, medical director of the Valley Health System and a member of the Nevada State Board of Health, said the dramatic rise in prescription narcotic use should be examined.

“When you see increases like that, it’s a warning sign to all of us,” he said, referring to the Sun’s analysis.

The Sun reached its findings after analyzing several thousand pages of Drug Enforcement Administration reports on the state-by-state distribution of controlled substances to pharmacies and health care practitioners. (The DEA monitors the production and distribution of prescription narcotics, which fall into the highest category of regulation for prescription drugs.) After breaking down the data by state populations to reach per capita figures, the Sun determined the highest per person consumption of each prescription narcotic, as well as how consumption has changed over time.

Nevada leads a national trend in the growing use of narcotic painkillers. The National Institute on Drug Abuse reports the number of opiate prescriptions escalated from about 40 million in 1991 to 180 million in 2007 — a 350 percent increase at a time when the nation’s population increased by 19 percent.

A few doctors are doing most of the prescribing. A Sun analysis of a Nevada Pharmacy Board database that tracked all the prescriptions for controlled substances in the state, not just narcotics, showed that in 2007, 1 percent of medical practitioners in the database prescribed 51 percent of controlled substances in the database, and 5 percent of them prescribed 88 percent of the drugs.

No identifying information was made available to the Sun, but experts presume that the heaviest prescribers are pain management and cancer specialists.

Although analyzing individual prescribing habits could hint at who might be overprescribing narcotic painkillers, scrutinizing the database with that intent is banned by statute. Pharmacy board officials said that’s to allow doctors to make judgments and prescribe medicine without fear, which could compromise patient care. The database can be examined by police as part of an active investigation, but authorities can’t use it to go fishing for doctors who can be criminally prosecuted for overprescribing narcotic painkillers.

Assemblywoman Sheila Leslie, D-Reno, said it’s important to understand the factors surrounding the rise in prescription narcotic use and abuse, so legislators may need to “take a closer look” at the law that prevents analyzing the state’s highest prescribers.

Narcotic painkillers are derived from opium, a drug made from poppies that has been used medicinally for thousands of years. Opiate use was common in the United States in the 19th century, and by the early 1900s, when it was recognized that doctors were overprescribing opiates and addiction was a problem, their use was regulated and the drugs fell out of favor. They were mainly prescribed to cancer or terminal patients until the 1990s, when their use was expanded to people with chronic pain. Now we’re in a prescription narcotics boom.

The increasing use of prescription narcotic painkillers in America illustrates the evolving understanding and treatment of pain.

Among the chief challenges to doctors who prescribe potentially addictive painkillers is that pain can be described only subjectively, by the patient. It can’t be measured clinically, like blood pressure or pulse rate.

As a result, pain treatment is both an art and a science. Is the doctor to believe the patient is in pain, or is the doctor being conned by an addict or a drug dealer on the hunt for painkillers? Even the best pain management specialist will say he can’t always tell the difference.

The lines separating prescription narcotic dependence, abuse and addiction are blurry, making it difficult to say whether the skyrocketing drug use is a welcome relief, an epidemic, or something in between.

And experts disagree on how to interpret the growing use of narcotic painkillers. Law enforcement complains about the illegal activity, addiction specialists decry that more people are becoming hooked on drugs, and pain management specialists talk about the benefits of narcotics.

Research on narcotics’ effectiveness in treating pain is inconclusive. In fact, there’s some evidence they can increase pain.

Alarmed experts from all fields agree the rising rate of prescription narcotic use shows no sign of abating.

•••

The use of narcotics to treat pain got a tremendous boost in 1995 from the American Pain Society. Its corporate members include the pharmaceutical companies Purdue, maker of OxyContin; Abbott, maker of Vicodin and UCB, and Watson, maker of the hydrocodone drugs Lortab and Norco.

The society set guidelines saying proper pain management includes urging patients to report unrelieved pain. At the time studies had shown that cancer patients were suffering needlessly because they were not being given enough painkillers.

In January 1999, the Veterans Affairs Department, citing the American Pain Society’s statement that pain is one of the main reasons people consult a doctor, launched a campaign known as “Pain is the Fifth Vital Sign.”

The initiative encouraged health care providers to monitor a patient’s reported level of pain — a subjective symptom — as they did the four measurable vital signs: blood pressure, breathing rate, pulse and temperature. Health care providers asked patients to rank pain on a scale of 1 to 10, and were then urged to treat it.

Dr. Mel Pohl, a Las Vegas addiction recovery specialist, criticizes the pharmaceutical industry’s role in making pain the fifth vital sign.

“The rationale was that we don’t want people to suffer,” Pohl said. “In the best case that’s what it was about. In the worst case, somebody was working this out with the (financial) bottom line in mind. Probably both factors are part of it.”

Soon after, the methods advocated by Veterans Affairs were endorsed by the Joint Commission, the agency that monitors and regulates hospitals. Every hospital is now expected to measure pain in a similar manner.

Dr. Jim Marx, a Las Vegas addiction medicine and pain management specialist, praised the advances, saying doctors now realize they can safely treat patients for pain. This allows patients such as blue-collar workers in Las Vegas to continue in their jobs, he said.

The advent of direct-to-consumer marketing by pharmaceutical companies has also contributed to the rise of prescription narcotics. In 1997, the Food and Drug Administration allowed drug companies to hype their brand-name medicines directly to consumers, which has helped remove any stigma attached to their use. Doctors say patients are now demanding drugs by name.

Homansky, the emergency room doctor, recalled the case of a tourist who said she’d left her bottle of hydrocodone pills at home and needed more. After Homansky recommended a nonnarcotic treatment, she stormed out of the hospital, cursing the staff along the way.

“We’ve had people who get physically abusive, verbally abusive and expect that we’re just there to provide them whatever they want,” Homansky said.

The pharmaceutical companies also market their narcotic painkillers by unleashing cadres of sales representatives on doctors and hosting dinners where physicians offer testimonials about the companies’ medicines.

“There’s a lot of money in the drug industry and they push really hard,” one pain doctor said.

No one can say with certainty why so many narcotic painkillers are used in Nevada, but experts make several educated guesses. The lifestyle of night life and partying leads to more drug-seeking and abuse, doctors said. Also, pain is a complicated symptom of multiple diseases that’s intensified by psychological distress. Las Vegas is a transient place where many people are without social and family support and where the nation’s highest rate of suicide shows a population with mental health problems, doctors said.

The city’s physician shortage also likely plays a role, several experts said. Doctors stressed for time may treat the symptomatic pain rather than explore the problem that’s causing the pain. And once the treatment begins it may continue under the logic that it’s what the patient is accustomed to.

Doctors may further be predisposed to cave in to patients’ requests for narcotics because of how they are reimbursed by insurance companies: by the number of patients they see, not the time spent with each. This may lead providers to take the path of least resistance by writing a prescription. Pohl, the addiction recovery specialist, said it takes doctors “five minutes to say yes and 45 minutes to say no” to a patient’s demand for drugs.

•••

Larry Pinson was browsing in a shop recently when a greeting card caught his eye: “The best part of getting sick is Vicodin,” the card read. “So make sure you save me some, and don’t tell your doctor!”

When greeting cards joke about illegal narcotic abuse, Pinson said, “We’ve got a problem.”

The United States makes up less than 5 percent of the world’s population, but is supplied 99 percent of its hydrocodone and 71 percent of its oxycodone, according to the National Institute on Drug Abuse.

As executive director of the Nevada Pharmacy Board, Pinson presides over the licensing of thousands of pharmacists, pharmacies, technicians and wholesalers, plus about 7,000 doctors, nurse practitioners and dentists who prescribe the drugs and about 180 drug distributors.

About a decade ago the board became aware of the emerging practice of “doctor shopping,” the illegal practice of conniving patients’ visiting multiple providers to get drugs, either to feed an addiction or to sell.

So the Nevada Pharmacy Board created a database that would list every prescription written in the state for certain controlled substances, with the name of the provider and the patient, and the date of the transaction. The monitoring program would help catch patients who might be “doctor shopping.” Regulators from about three dozen other states have followed Nevada’s lead.

A growing number of health care practitioners are using the online database to track their patients’ use of prescriptions. In 1997, the first year of its existence, the database was used 480 times. The number grew exponentially to 65,372 reports in 2007, nearly double from the previous year.

The database flags patients who make a certain number of visits to doctors within an allotted time frame, though officials will not say exactly what type of patient behavior triggers the system, for fear addicts will adjust their behavior accordingly. The database then alerts the doctors to patients who may be shopping for drugs.

Pain management specialists in Las Vegas say the prescription monitoring program is one of many safeguards they use to ensure patients are not abusing painkillers.

“Our attitude is that when a patient leaves our office with a month’s worth of medication, it’s the equivalent of leaving the office with a loaded gun,” said Dr. Michael McKenna, a Harvard- and Stanford-trained pain specialist in Las Vegas.

Among the precautions pain specialists can take to guard against abuse are requiring contracts with patients that discourage doctor shopping, urine tests to verify drug use and monthly visits to track prescriptions and lessen the number of pills a patient has at a given time.

But not every provider takes these precautions.

Jennifer Hilton says that after she had a tooth filled, her dentist handed her a prescription for Vicodin even though she was not complaining about pain. She bristled at the unsolicited prescription because she’s a program coordinator for an inpatient drug addiction program for adolescent girls that’s run by Westcare, a Las Vegas nonprofit that specializes in substance abuse treatment.

Hilton admonished her dentist to ask whether his patients have addiction problems before handing them Vicodin prescriptions.

She said the dentist replied that patients should inform him if they have a drug problem.

“I’m sure some of my clients would have loved to have him as a dentist,” Hilton said, incredulous.

Las Vegas medical professionals repeatedly fail to take addiction seriously, Hilton said. On every clinic visit her teenage drug addicts hand doctors a medical feedback sheet that says: “This person is in a residential treatment facility. Please do not prescribe them anything of a narcotic or addictive nature.”

Still, about one in three kids returns with a narcotic painkiller prescription.

Las Vegas doctors say they are aware of physicians who prescribe whatever drug patients desire, so they will return. It’s good for business.

One drug addict told the Sun addicts share information about the doctors who are quick to write prescriptions.

“If you want (the drugs), you know where to go,” the woman said.

She said a few doctors ran her name through the Nevada Pharmacy Board’s database, recognized her as a doctor shopper and refused to give her drugs. But they never helped her or talked to her about treatment options, she said. Instead they sent her on her way.

The woman, who did not want to be identified, said she is trying to quit drugs and is detoxifying at home. Her only hope is her own motivation to get clean. Her only support is from fellow addicts in her 12-step program.

“I could go to the doctor tomorrow and mess it all up,” she said.

Dr. Jerry Jones, a Las Vegas obstetrician-gynecologist who is president of the Clark County Medical Society, said there may be a few unethical doctors who are overprescribing narcotics. “Most primary care doctors are extremely cautious and conservative about their narcotics prescriptions,” Jones said.

•••

Experts struggle to explain the notably high use of narcotic painkillers in Nevada. Two popular explanations are based on myths or outdated assumptions propagated in the medical community.

Every medical professional interviewed by the Sun cited what each said was Nevada’s aging population — assuming older people need more drugs because they suffer from more cancer or painful chronic conditions.

But U.S. Census figures show that Nevada is actually the 11th-youngest state in the country.

National experts said the same thing, and indeed the median U.S. age — reflecting aging Baby Boomers — rose from 35 in 1997 to 37 in 2007, according to Census figures. But the population aged 65 and older decreased in the same time frame from 12.6 percent to 12.4 percent.

The other common explanation for the high rate of narcotic use was that pain is undertreated in the United States and that Nevada doctors are prescribing more, as they should. But data suggesting the undertreatment of pain are dated and don’t reflect the exponential growth of prescription narcotic use in the past decade.

James Zacny, a psychopharmacologist at the University of Chicago who studies opiates, said the undertreatment of pain is no longer a concern for most patient populations. “I’ve heard the pendulum has swung the other way,” he said. “Now there’s some concern about overprescribing.”

The tragic irony is that painkillers may not work as well as people think. Many doctors say they’re not ideal for long-term use for chronic pain. And some studies show, paradoxically, that they can increase pain. McKenna said the research is relatively new, but shows that some patients actually improve when the medication is withdrawn.

“Pain is very complicated,” McKenna said. “But throwing opiates alone at pain is probably not the best approach.”