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

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

Want to know what will-power is?

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

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

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

Addicts have plenty of will-power…….

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Review of What Works

Introduction

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

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

Alcoholics Anonymous

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

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

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

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

Other beneficial treatments

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

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

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

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

Summary

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The 10th graders laugh nervously.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hey, it’s Friday night.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

At least that’s the theory.

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

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

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

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

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

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

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

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

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

Opiates

Which Drugs Are Opiates?
 

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

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

Alcohol
 

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

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

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

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

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

Stimulants

What is a stimulant?
 

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

The Marijuana Munchies
 

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

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

How to Incorporate a Healthy Diet into Recovery
 

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

Keeping Your Sugar Steady Can Decrease Cravings
 

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

The Importance of Water
 

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

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

12 (Twelve) Step Programs: Alcoholics Anonymous, Narcotics Anonymous, etc..What Are They?
Nobody wants to be judged; especially when they’ve done something they aren’t proud of. That is the beauty of the twelve step program. These programs are based on the idea that their only purpose is to work on personal recovery. The most famous of the twelve-step programs include Alcoholics Anonymous, which is basically a recovery guide from alcoholism. Since the onset of A.A., there have been many different groups that have used the AA principles for recovery. A few examples are: Narcotics Anonymous, Crystal Meth Anonymous, Co-Dependents Anonymous, and Overeaters Anonymous.
 

As the name implies, there are twelve steps or principles by which the program is run. They are as follows:
 

1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood Him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed, and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them or others.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His Will for us and the power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

How are these principles used to recover?
 

Being involved in the twelve step program involves working the steps. Working the Twelve Steps involves: admitting to having a serious problem, recognizing there is an outside power that could help, consciously relying upon that power, admitting and listing character defects, seeking deliverance from defects, apologizing to those individuals one has harmed and helping others with the same problem.
 

How did the other programs develop from Alcoholics Anonymous?
As said prior, the original twelve step program began with alcoholics Anonymous. It was found, that when an individual did adhere to the principles of the twelve step program quality of life improved within the family unit. This resulted in approximately fifty different twelve step program groups. The reason for this is simple. The beauty of A.A., why it works so well, is that the people involved in the program have themselves gone through recovery and understand the problems current participants are experiencing. For this reason, groups for different substances arose. In addition, other groups that deal specifically with behavioral problems sprouted up as well. The twelve steps are used to work out problems like: sexual compulsion, gambling and even dealing with debts.
 

How did the twelve step program begin?
 

The first program was Alcoholics Anonymous and began in 1935 in Akron, Ohio by Bill Wilson and Dr. Bob Smith. Most of the ideas of the twelve step program were derived from the Christian Endeavor Movement as well as ideas about abstinence, conversion, elimination of sin, obedience to God, and growth in Fellowship through Bible study and prayer and religious literature.
 

From the twelve steps, arose what is called The Twelve Traditions, a set of guidelines for running groups. In effect, The Twelve Traditions is the establishment or constituition of the Twelve Step programs.
 

What are the Twelve Traditions?
 

They are as follows:
 

1. Our common welfare should come first; personal recovery depends upon A.A. unity.
2. For our group purpose there is but one ultimate authority — a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.
3. The only requirement for A.A. membership is a desire to stop drinking.
4. Each group should be autonomous except in matters affecting other groups or A.A. as a whole.
5. Each group has but one primary purpose to carry its message to the alcoholic who still suffers.
6. An A.A. group ought never endorse, finance, or lend the A.A. name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.
7. Every A.A. group ought to be fully self-supporting, declining outside contributions.
8. Alcoholics Anonymous should remain forever non-professional, but our service centers may employ special workers.
9. A.A., as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.
10. Alcoholics Anonymous has no opinion on outside issues; hence the A.A. name ought never be drawn into public controversy.
11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.
12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.
 

How Does the Meeting Process Work?
 

"Hi, I’m Eric and I’m an alcoholic.” At these meetings it is recognized that one must recognize that they have a problem, so many members open by actively admitting they have a problem. One is supposed to share experiences with the group whether they be good or bad and the group is to provide peer support. There is some controversy because twelve steps are associated with religion, which not everyone adheres to.

How Does Sponsorship Work?
 

A sponsor is an individual who is more experienced then the sponsee in following the twelve steps. In fact, individuals new to the program are encouraged to form a relationship with a sponsor right away. Sponsorship is important not only for the sponsee, but also for the sponsor. By helping the new individual, the sponsor themselves continues to work on themselves. Therefore, the benefits of this program works two fold.
 

What is Acceptance of a Higher Power?
 

For most afflicted persons, holding on to willful self-reliance, instead of relinquishing control can work against them. Therefore, one of the main characteristics of the twelve step program is to start relying on “God” or another Higher Power—whatever that is to that person. Even for agnostics and atheists, if they can identify a power larger than themselves, thereby admitting their powerlessness, they can recover.

What is the success rate of Twelve-Step Programs?

Twelve step programs have a reputation for working well. Of course, everyone is different, and often time addicts use more methodology than just the twelve steps. Going to rehabilitative therapy may also accompany utilizing the twelve steps for a more secure recovery.

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.

(HealthDay News) — Drinking and alcohol dependence has increased substantially among women, particularly white and Hispanic women born since 1945, new study finds.

Alcohol use and dependency appeared to remain stable for men, while young Americans report having more lifetime alcohol problems than older Americans, despite having had less time to develop issues with drinking.

The findings were published in the May issue of Alcoholism: Clinical and Experimental Research.

"We found that for women born after World War II, there are lower levels of abstaining from alcohol, and higher levels of alcohol dependence, even when looking only at women who drank," the study’s corresponding author, Richard A. Grucza, an epidemiologist at Washington University School of Medicine, said in a prepared statement. "However, we didn’t see any significant tendency for more recently born men to have lower levels of abstention or higher levels of alcohol dependence."

The researchers’ findings came from analyzing two large, national surveys conducted 10 years apart (1991-1992 and 2001-2002). The polls compared lifetime alcohol-use rates from the same age groups and demographics.

The "closing gender-gap in alcoholism" may be due to higher levels of problems facing women, while men have been more or less steady in their levels of dependence, he said.

"Clearly, there were many changes in the cultural environment for women born in the ’40s, ’50s and ’60s compared to women born earlier," Grucza said. "Women entered the work force, were more likely to go to college, were less hampered by gender stereotypes, and had more purchasing power. They were freer to engage in a range of behaviors that were culturally or practically off-limits, and these behaviors probably would have included excessive drinking and alcohol problems."

Shelly F. Greenfield, associate clinical director of the Alcohol and Drug Abuse Treatment Program at McLean Hospital, added to Grucza’s assessment.

"One possible explanation is that between 1934 and 1964, the social acceptability of women’s drinking increased. As it was more socially acceptable for women to drink, a greater number of them became drinkers. Because women have a heightened vulnerability to the effects of alcohol — that is, greater blood alcohol levels at similar doses of alcohol — we may therefore see a concomitant rise in alcohol dependence among those who ever drank."

Another potential factor: immigrants arriving to America from cultures with more conservative values about drinking tend to stick with their native cultural norms, but their children are more likely to follow comparatively lax U.S. norms regarding alcohol.

"We can think of U.S. culture as having been traditionally dominated by white men," added Grucza. "As women have immigrated into this culture, they have become acculturated with regard to alcohol use."

He said the added barrier of race may be what is keeping black women, who still have the lowest rates of drinking among the demographic groups looked at, from adopting the alcohol-use standards of the dominant U.S. culture.

Greenfield suggested that targeting females with gender-specific prevention programs might lower drinking rates or delay when drinking begins, which could help prevent later alcohol problems.

"It would also be helpful to educate women about the gender differences in metabolism of alcohol, and the associated heightened female vulnerability to alcohol’s adverse health consequences at lower doses than men," she said.

Marin Independent Journal — THE OLD JOKE in medical school was that you weren’t an alcoholic unless you drank more than your physician. Come to think of it, that wasn’t funny then, and it isn’t funny now.

Lately, a number of people have been telling me about friends or family members who may have a drinking problem, and they ask me, "Is he an alcoholic?" Sometimes they’ll tell me: "Well, she may have a drinking problem, but at least she isn’t an alcoholic."

Although we have all grown up knowing the word "alcoholic," this term is very nonspecific and means something very different to each of us.

In the medical profession, we do not use this term because it is so vague. Instead, we describe the illnesses, collectively known as substance-related disorders, in several categories based on specific criteria, as defined in a text known as the DSM IV R, which defines criteria for all psychiatric and behavioral disorders. The advantage of this specificity, instead of using the term "alcoholic," is that it helps guide treatment as well.

One diagnosis within the category of substance-related disorders is "Alcohol Abuse," which is coded in the text as DSM 305. To be diagnosed with alcohol abuse, a person must show "a destructive pattern of alcohol abuse, leading to significant social, occupational or medical impairment, as manifested by at least one of the following within a 12 month period:

- Recurrent substance use resulting in failure to fulfill major obligations.

- Recurrent substance use in situations in which it is physically hazardous.

- Recurrent substance-related legal problems.

- Continued substance use despite persistent or recurrent social or interpersonal problems related to alcohol.

For example, two traffic violations for DUI (driving under the influence) within one year would meet the criteria. If one is repeatedly late for work, or coming to work "hung over," this would also meet these criteria.

Another diagnosis is Alcohol Dependence, coded as DSM 303.9. The criteria for this diagnosis reflect that the patient is physiologically dependent upon alcohol, and would suffer alcohol withdrawal symptoms when he stops drinking. To be diagnosed with Alcohol Dependence, one must meet three of the following criteria:

- Alcohol withdrawal symptoms, such as rapid heartbeat, sweating or confusion.

- Alcohol tolerance – need for increased amounts, or diminished effect.

- Alcohol taken in larger amounts over a longer period than intended.

- Persistent desire or unsuccessful effort to cut down on alcohol consumption.

- Increased time spent attempting to obtain alcohol.

Many people who are alcohol dependent try to hide their alcohol consumption from friends or family. They travel out of town to purchase alcohol. Some try to stop, or at least verbalize that they wish to stop, but cannot.

Alcohol withdrawal is more than just the "shakes." It is a true cardiovascular emergency, with rapid heartbeat (tachycardia), fever and very high blood pressure, which occurs as the autonomic nervous system, which has become accustomed to a certain level of alcohol in the body, now tries to adapt to its absence.

Alcohol-related disorders are rampant, as are substance disorders related to other drugs, such as narcotics, cocaine and crystal meth. People who suffer these disorders hide them well, rarely exhibiting the stereotypic behaviors that we all describe as those of an "alcoholic."

I remember one family member whom everyone decided was not an alcoholic because they never saw him drunk. He was generally jovial and charming, and was the center of attention at a party, although he could be withdrawn on occasion. He drank a minimum of five mixed drinks every day, starting around noon.

If you are wondering if a person might be an "alcoholic," or if you find yourself questioning a loved one’s consumption, please put the term "alcoholic" out of your mind. It will lead you astray. Instead, contact your physician and describe the behaviors that you have witnessed.

Please act before it is too late.

.

(HealthDay News) – Sticking to a regimen of prescribed medications is the most effective way to reduce withdrawal symptoms and urges to drink alcohol in those being treated for alcohol dependence, according to a U.S. study.

The study compared two medications (naltrexone and acamprosate) used in combination with two behavioral treatments — low-intensity medical management (MM) and moderately intensive combined behavioral intervention (CBI).

The researchers analyzed data from 846 males and 380 females who took part in the National Institute of Alcohol Abuse and Alcoholism’s Combine study, a large-scale, multi-site, combined medication and behavioral treatment study.

The participants were randomly assigned to one of eight different combination treatments involving naltrexone, acamprosate, a placebo, MM, and CBI. After 16 weeks of treatment, the patients’ primary outcomes — including percent days abstinent and time to first heavy drinking — were compared.

"First, high medication adherents fared better than low medication adherents across all combinations of behavioral and pharmacological treatment conditions," Allen Zweben, associate dean for academic affairs and research in Columbia University’s school of social work, said in a prepared statement.

"Second, CBI — a specialty alcohol treatment — surprisingly had a beneficial impact on nonadherents receiving the placebo. This raises the issue of whether or not CBI may serve as a cushion or have a protective function for these patients," said Zweben, the corresponding author for the study.

"Conversely, CBI did not provide similar benefits for naltrexone-treated patients; their relapse rates appeared to be more a function of inadequate exposure to naltrexone and less influenced by CBI," he added.

Overall, specialized CBI did not perform better than the more primary-care MM.

"Both of these behavioral treatments performed equally as well with regard to treatment adherence and medication adherence rates," Zweben said.

The findings show that combing MM and naltrexone could benefit a large percentage of alcohol-dependent patients.

"Alcohol-dependent patients could be managed in nonspecialized or general health care settings, which, in turn, could broaden the treatment options for individuals diagnosed as alcohol-dependent," Zweben said. "We will need to adapt these findings to ‘real world’ medical settings and follow the results."

The study was released online by the journal Alcoholism: Clinical and Experimental Research and was to be published in the September print issue.