Summer House

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.

BBC News — Twin research projects have offered both present and future hope to people suffering from alcohol addiction.

US researchers say that epilepsy drug topiramate boosts general health as well as cutting the craving for drink.

A UK specialist said the potential side-effects of topiramate still merited caution.

A separate project showed that a single injection of a protein into the brains of rats almost immediately stopped them wanting alcohol.

Topiramate is not licensed in the UK for the treatment of alcohol addiction, although doctors are allowed to prescribe it if they wish, and occasionally do.

The latest study results, published in the journal Archives of Internal Medicine, could increase the number of doctors willing to do this.

Researchers from the University of Virginia analysed the results of the US-wide trial, which took 371 people with a heavy drinking problem, and gave them either topiramate or a placebo "dummy" drug.

They found, that over 14 weeks, those taking topiramate not only had fewer obsessive thoughts and compulsions about using alcohol, but had generally improving health.

Their weight, cholesterol and blood pressure dropped, and levels of liver enzymes linked to "fatty liver" disease, the forerunner of cirrhosis, also fell away.

Lead researcher Professor Bankole Johnson said: "What we’ve found is that topiramate treats the alcohol addiction, not just the ’symptom’ of drinking."

Side effects

Dr Jonathan Chick, a specialist in the psychiatry of addiction, welcomed the results, particularly the figures which proved better health, rather than relying on an estimate of reduced drinking levels, which could prove misleading.

He said: "There are other drugs which were originally developed to prevent epileptic seizures, which have also shown promise in reducing relapse in alcoholism, but topiramate is so far the most convincing."

However, he said that his own limited use of topiramate had been very carefully monitored to minimise the powerful side-effects of the drug.

In the other study, the Proceedings of the National Academy of Sciences Journal reported on a study in rats carried out at the University of California at San Francisco.

The scientists injected a brain protein called GDNF directly into a part of the brain called the ventral tegmental area, which is thought to be heavily involved in "drug-seeking" behaviour.

The rats were placed in an environment designed to mimic human social drinking, with a lever that could be pushed to deliver an alcoholic drink.

Rat rehab

The protein began working almost immediately, with effects noticed within 10 minutes.

The research also suggested that other cravings were unaffected, as the rats’ desire for their supply of sugary water continued unabated.

In addition, once treated with GDNF, rats seemed to be less likely to "relapse" to alcoholism after a "rehab" situation, in which the alcohol supply was cut off for a period of time, then reintroduced.

"Our findings open the door to a promising new strategy to combat alcohol abuse, addiction and especially relapse," said lead author Dr Dorit Ron.

Dr Chick said that there had been various attempts to interfere directly with the brain systems controlling alcohol cravings, although these had only achieved "mixed success" when transferred from experimental animals to humans.

Fox News — The U.S. leads the world in marijuana and cocaine experimentation, as well as in lifetime tobacco use, according to a survey released this week by the World Health Organization.

For the survey, which was partially funded by a division of the U.S. National Institutes of Health, researchers at the University of New South Wales in Sydney, Australia looked at drug, alcohol and tobacco use in 17 countries throughout North and South America, Europe, Asia, the Middle East, Africa and Oceania. More than 54,000 people participated in the survey.

"The United States, which has been driving much of the world’s drug research and drug policy agenda, stands out with higher levels of use of alcohol, cocaine, and cannabis, despite punitive illegal drug policies, as well as (in many U.S. states), a higher minimum legal alcohol drinking age than many comparable developed countries," the authors wrote in the study, which was published in the July 1 issue of the journal PLoS Medicine.

"The Netherlands, with a less criminally punitive approach to cannabis use than the U.S., has experienced lower levels of use, particularly among younger adults," they added.

The U.S. had the highest percentage of respondents admitting to lifetime tobacco use at 74 percent, followed by Lebanon at 67 percent, and Mexico and the Ukraine at 60 percent, according to the study.

The lowest percentages of lifetime tobacco use were found in the African countries of South Africa with 32 percent and Nigeria with 17 percent.

More U.S. respondents said they used marijuana at 42.4 percent, followed by New Zealand at 41.9 percent. Lifetime marijuana use was virtually non-existent in Asian countries, however.

Sixteen percent of U.S. survey participants said they used cocaine at least once, followed by Colombia, Mexico, Spain and New Zealand where between 4 and 4.3 percent of respondents admitted to use.

The only area where U.S. respondents trailed was in alcohol use. Almost 92 percent of U.S. respondents said they used alcohol, compared to 97 percent of Ukrainians and 95.3 percent of Germans. Just 40 percent of South African respondents used alcohol.