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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.

Introduction
 

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

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

History
 

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

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

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

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

Addiction Potential
 

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

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

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

Frequency of Use
 

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

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

Routes of Intake
 

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

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

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

Mortality/Morbidity
 

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

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

Symptoms
 

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

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

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

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

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

Treatment of Acute Intoxication
 

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

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

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

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

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

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

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

Treatment approaches to Addiction
 

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

Pharmacological Approaches
 

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

Behavioral Interventions
 

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

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

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

Xanax is a Central Nervous System (CNA) depressant known as benzodiazepine, which is commonly prescribed by physicians to treat panic attacks, nervousness, and tension. Xanax, also known as alprazolam, is considered to be a Schedule IV controlled substance under the Controlled Substance Act (CSA). Xanax has been used as a tranquilizer since the 1960s. With strong opposition to the use of benzodiazepines in the 1970s, there was a 25 percent drop in the number of prescriptions written and today, with approximately 3 million Americans (1.6% of the adult population) having used benzodiazepine on a daily basis for at least 12 months, they are the most controversial of all psychotropic medicines.

According to the United States Department of Justice Drug Enforcement Agency (DEA) and under the CSA, all controlled substances are rated on a five-schedule system. Schedule V, the lowest, for the potential for abuse and dependency and I, the highest. Xanax is a Schedule IV. All Schedule IV controlled substances have the following attributes: a low potential for abuse, a currently accepted medical use in treatment in the United States, and if abused, may lead to limited physical dependence or psychological dependence. Other examples of drugs included in schedule IV are Darvon®, Talwin®, Equanil®, Valium®, and Xanax®.

Although there are many benefits to taking Xanax and other Schedule IV drugs, many patients are becoming addicted and therefore require an intervention and drug treatment program to overcome their addictions. The patient’s body can also build up a tolerance to the drug and require larger doses if taken for long periods of time. With these increases in Xanax use come physical and psychological dependencies. Xanax is not drug to quit cold turkey. The Journal of Postgraduate Medicine stated that up to 25 percent of patients who stop taking their medication experienced withdrawal symptoms such as: nausea, vomiting, dizziness, headache, anxiety, irritability, insomnia, chills, lethargy, fatigue, moodiness, crying, dystonia, paresthesia, tremor, vivid dreams, and myalgias.

The National Institute on Drug Abuse found during a two-year treatment outcome study that 15 percent of heroin users also used benzodiazepines daily for more than one year, and 73 percent used benzodiazepines more often than weekly. Studies also indicate that from 5 percent to as many as 90 percent of methadone users are also regular users of benzodiazepines.

With this information in mind, the Xanax abuse treatment involves careful monitoring and counseling in an in-patient or outpatient treatment facility. The American Psychiatric Association’s (APA) report on benzodiazepines revealed that 11 to 15 percent of the adult population has taken a benzodiazepine one or more times during the preceding year, but only 1 to 2 percent have taken benzodiazepines daily for 12 months or longer. However, in psychiatric treatment settings and in substance-abuse populations, the prevalence of benzodiazepine use, abuse and dependence is substantially higher than that in the general population. Treatment encompasses a patient’s thought process, behavior, and helps them to cope with everyday life. Patients suffering from Xanax addiction should be tapered off gradually. There are basic outpatient plans available for discontinuation of the drug including: gradual discontinuance over a six to 12 week schedule, monitoring and helping the patient to feel in control of their dosage, and supplying a helpline when the patient needs reassurance. Other plans include inpatient treatment centers and 12-step programs such as Narcotics Anonymous, and drug treatment exchanges such as, Clonidine, propranolol, or carbamazepine. Although these substitutes can be dangerous, an inpatient setting where dosages can be physician monitored until the patient can reach a zero dose of the benzodiazepine is recommended.

In conclusion, Xanax and other benzodiazepines can be addictive drugs that are hard to discontinue however, they are also drugs of great benefit to patients who suffer from anxiety, depression, fear of open spaces (agoraphobia), premenstrual syndrome, and panic attacks. The patient and the physician should work together to regulate long-term usage, monitoring side effects, and any signs of abuse.

InfoPackets.com — Major recovery organizations have been using the Internet to help individuals recovering from drug and alcohol addiction. An increasing number of support groups are springing up all over the web with one goal: to provide online, 24/7 assistance to people recovering from some form of substance abuse.

According to the U.S. Department of Health and Human Services, almost 2 million people this year will find themselves entering some kind of rehabilitation for abuse of various drugs or alcohol. In the past 70 years or so, these alcoholics and addicts would have left various rehabilitation institutions to then begin a lifetime of meetings in church basements with fellow addicts or alcoholics, there to find the support and encouragement to continue their life clean and sober.

Typically, the online venues focus on the 12-step recovery approach — the recovery program outlined by Bill Wilson and Bob Smith, founders of Alcoholics Anonymous. It’s a popular program and, it seems, there is now a 12-step program tied to every possible substance abuse or behavior, including Nicotine Anonymous. Instead of holding daily or weekly meetings however, more and more of these 12-step groups are turning their attention to providing online chat, web forum, and list server-based recovery groups. The Internet is being used to connect similarly afflicted individuals and groups from all over the world. Over the world wide web, recovery meetings are no longer of an hour’s duration in a church basement, groups now meet for 24 hours a day with members checking in and out at will or as needed.

Alcoholics Anonymous the oldest of the recovery groups, now offers meetings using email list servers, VoIP, and chat. AA provides online meetings in 33 different countries and hosts them in more than 10 different languages!

Narcotics Anonymous has more than 20 internationally accessible email meetings and Cocaine Anonymous offers 6 internationally accessible email meetings.

Of course, for every benefit of online meetings, there are also some risks. The use of chat protocols, for example, opens up a portal to the user’s PC that may expose them to risk of being hacked. Email-based list servers also pose the problem of how to remain anonymous when the entire virtual room can see your email address.

There are also hazards from various unscrupulous recovery organizations that prey on individuals in early recovery or their families. Over the Internet, they seem like legitimate organizations, but they are not always. As with most Internet-based activities, various fraud, email harvesting, and identity theft schemes abound. But even in those cases, Internet-based solutions emerge. One organization, All Addictions Anonymous Watch, for example, focuses on keeping a watchful eye on some of the less scrupulous efforts to exploit recovering individuals.

Exploiting Internet technology may prove to be a great boon to people trying to shake addictions. It has truly become Addiction Recovery 2.0. Nonetheless, family members and recovering individuals would be wise to stick to the best known recovery organizations (e.g AA, NA, CA) and, if they choose to participate online, they should get a Yahoo!, Gmail, or Hotmail mailbox using a pseudonym to keep themselves truly anonymous.

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.

.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

•••

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

•••

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

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

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

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

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

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

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

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

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

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

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

But not every provider takes these precautions.

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

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

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

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

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

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

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

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

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

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

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

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

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

•••

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

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

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

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

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

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

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

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