Drug addiction is a treatable disorder. Through treatment that is tailored to individual needs, patients can learn to control their condition and live normal, productive lives. Like people with diabetes or heart disease, people in treatment for drug addiction learn behavioral changes and often take medications as part of their treatment regimen.

Behavioral therapies can include counseling, psychotherapy, support groups, or family therapy. Treatment medications offer help in suppressing the withdrawal syndrome and drug craving and in blocking the effects of drugs. In addition, studies show that treatment for heroin addiction using methadone at an adequate dosage level combined with behavioral therapy reduces death rates and many health problems associated with heroin abuse.

In general, the more treatment given, the better the results. Many patients require other services as well, such as medical and mental health services and HIV prevention services. Patients who stay in treatment longer than 3 months usually have better outcomes than those who stay less time. Patients who go through medically assisted withdrawal to minimize discomfort but do not receive any further treatment, perform about the same in terms of their drug use as those who were never treated. Over the last 25 years, studies have shown that treatment works to reduce drug intake and crimes committed by drug-dependent people. Researchers also have found that drug abusers who have been through treatment are more likely to have jobs.

Types of Treatment Programs

The ultimate goal of all drug abuse treatment is to enable the patient to achieve lasting abstinence, but the immediate goals are to reduce drug use, improve the patient’s ability to function, and minimize the medical and social complications of drug abuse.

There are several types of drug abuse treatment programs. Short-term methods last less than 6 months and include residential therapy, medication therapy, and drug-free outpatient therapy. Longer term treatment may include, for example, methadone maintenance outpatient treatment for opiate addicts and residential therapeutic community treatment.

In maintenance treatment for heroin addicts, people in treatment are given an oral dose of a synthetic opiate, usually methadone hydrochloride or levo-alpha-acetyl methadol (LAAM), administered at a dosage sufficient to block the effects of heroin and yield a stable, noneuphoric state free from physiological craving for opiates. In this stable state, the patient is able to disengage from drug-seeking and related criminal behavior and, with appropriate counseling and social services, become a productive member of his or her community.

Outpatient drug-free treatment does not include medications and encompasses a wide variety of programs for patients who visit a clinic at regular intervals. Most of the programs involve individual or group counseling. Patients entering these programs are abusers of drugs other than opiates or are opiate abusers for whom maintenance therapy is not recommended, such as those who have stable, well-integrated lives and only brief histories of drug dependence.

Therapeutic communities (TCs) are highly structured programs in which patients stay at a residence, typically for 6 to 12 months. Patients in TCs include those with relatively long histories of drug dependence, involvement in serious criminal activities, and seriously impaired social functioning. The focus of the TC is on the resocialization of the patient to a drug-free, crime-free lifestyle.

Short-term residential programs, often referred to as chemical dependency units, are often based on the "Minnesota Model" of treatment for alcoholism. These programs involve a 3- to 6-week inpatient treatment phase followed by extended outpatient therapy or participation in 12-step self-help groups, such as Narcotics Anonymous or Cocaine Anonymous. Chemical dependency programs for drug abuse arose in the private sector in the mid-1980s with insured alcohol/cocaine abusers as their primary patients. Today, as private provider benefits decline, more programs are extending their services to publicly funded patients.

Methadone maintenance programs are usually more successful at retaining clients with opiate dependence than are therapeutic communities, which in turn are more successful than outpatient programs that provide psychotherapy and counseling. Within various methadone programs, those that provide higher doses of methadone (usually a minimum of 60 mg.) have better retention rates. Also, those that provide other services, such as counseling, therapy, and medical care, along with methadone generally get better results than the programs that provide minimal services.

Drug treatment programs in prisons can succeed in preventing patients’ return to criminal behavior, particularly if they are linked to community-based programs that continue treatment when the client leaves prison. Some of the more successful programs have reduced the rearrest rate by one-fourth to one-half. For example, the "Delaware Model," an ongoing study of comprehensive treatment of drug- addicted prison inmates, shows that prison-based treatment including a therapeutic community setting, a work release therapeutic community, and community-based aftercare reduces the probability of rearrest by 57 percent and reduces the likelihood of returning to drug use by 37 percent.

Drug abuse has a great economic impact on society-an estimated $67 billion per year. This figure includes costs related to crime, medical care, drug abuse treatment, social welfare programs, and time lost from work. Treatment of drug abuse can reduce those costs. Studies have shown that from $4 to $7 are saved for every dollar spent on treatment. It costs approximately $3,600 per month to leave a drug abuser untreated in the community, and incarceration costs approximately $3,300 per month. In contrast, methadone maintenance therapy costs about $290 per month.

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.

A NIDA-funded study has demonstrated that the relapse rate for heroin addicts increases with time and that the probability of long-run abstinence depends on the age of first drug use. Those who start daily heroin use at a younger age are more likely to relapse than those who start later.

The study, conducted by Dr. Marnik G. Dekimpe of the Catholic University Leuven in Belgium and his colleagues in Belgium and at the University of California, Los Angeles, examined the treatment histories of 846 patients at methadone clinics in central and southern California. The researchers looked at males and females, whites and Chicanos, most of whom started using heroin between the ages of 17 and 25. Subjects were interviewed over a 4-year period during and after treatment to determine the probability of their relapse to heroin use.

The finding that relapse is connected to time suggests the need for long-term periodic monitoring of a former heroin user’s abstinence, Dr. Dekimpe says. The researchers also found drug relapse odds were significantly different across the sociodemographic groups studied, suggesting that prevention resources could be directed to groups at higher risk. No significant differences in relapse probability were associated with either gender or education.

Education remains a key factor in fighting drug and alcohol dependencies. When people understand drug and alcohol abuse prevention becomes visible and effective. The National Institute on Drug Abuse (NIDA) notes, a tremendous opportunity exists to effectively change the ways in which the public understands drug abuse and addiction because of the wealth of scientific data NIDA has amassed. NIDA further states that overcoming misconceptions and replacing ideology with scientific knowledge is the best hope for bridging the "great disconnect" – the gap between the public perception of drug abuse and addiction and the scientific facts.
 

In the mean time, it is necessary to facilitate assistance for the current drug and alcohol abusers. There are diverse options in treatment and rehabilitation programs. Those options include: 12-step programs; 12-step alternatives; programs, wilderness camps and schools for troubled teens with addictions; inpatient residential; day treatment; outpatient treatment; faith-based facilities; and holistic treatment.
 

The 12-step program, one of the most popular rehabilitation programs, originated for Alcoholics Anonymous, but later versions were adapted for other addictions. The synopsis of the 12-step programs consists of: 1) Admit that we are powerless over drugs or alcohol and that our lives have become unmanageable. 2) Come to believe that a Power greater than ourselves can restore us to sanity. 3) Turn our will and our lives over to the care of a Higher Power. 4) Make a searching and fearless moral inventory of ourselves. 5) Admit to a Higher Power, to ourselves and to another human being the exact nature of our wrongs. 6) Be entirely ready to have a Higher Power remove all these defects of character. 7) Humbly ask a Higher Power to remove our shortcomings. Make a list of all persons we have harmed, and be willing to make amends to them all.
9) Make direct amends to such people wherever possible, except when to do so would injure them or others. 10) Continue to take personal inventory and when we are wrong promptly admit it. 11) Seek through prayer and meditation to improve our conscious contact with a Higher Power, praying only for knowledge of the Higher Power’s will for us, and the power to carry that out. 12) Having had a spiritual awakening as the result of these steps, try to carry this message to other drug addicts or alcoholics, and to practice these principles in all of our affairs.
 

The Comeback Treatment Center of California states several facts regarding drug and alcohol rehabilitation: drug addiction and alcoholism is a highly treatable disease (continued suffering is optional); no drug addict really likes the way he or she has to use drugs and alcohol; drug addiction can be outgrown in an honest, responsible, character-building environment; personal growth feels better and lasts longer than any drug; the hardest part about drug rehab recovery is getting started, the rest is reward, once earned, sobriety becomes a precious gift of spirit and mind that overcomes negative emotions and mental blocks that could keep one from continuing in a responsible direction towards self-fulfillment.
 

In conclusion, drug and alcohol abuse will be around as long as there are people, drugs and alcohol. One must make a proactive choice to educate and understand these addictions so that early intervention can be made as soon as abusers are identified. Ideally, education and training would decline the statistics on addictive behavior, but personal pleasure and the masking of personal problems through addiction remain prevalent today.

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

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

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

Effective Treatment Guidelines
 

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

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

An All Encompassing Treatment
 

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

Medications

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

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

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

Behavioral Treatments
 

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

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

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

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

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

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.

OrovilleMR.com — Addiction is the double-edged attraction of a feel-good experience that simultaneously suspends anything that is making you feel bad.

We can apply the concept of the double-edge to recovery, which includes the avoidance of a lifestyle that causes problems, and the building of a new life.

The concept of relapse prevention is valid. One needs to be aware of what triggers thoughts of using. As well it helps to have an idea about which triggers are most powerful and thus carry a greater need for avoidance.

Most agree that using buddies, be they friends, family or just using buddies, represent the biggest threat.

Preventing relapse is the first part of creating a new life.

In this phase of recovery we are considering that what went well with addiction may not be compatible with recovery. Casinos, liquor stores, and parties where people are getting intoxicated are examples of things that might not fit in the terrain of recovery.

As important as eliminating relapse hazards is, it is just the beginning of the new life vision. If all you do is remove items that were once important or enjoyable it would be like taking a child’s old toys and asking that they not consider what the new ones might be.

The new life vision must immediately expand to consider what will fill the void.

This is not a call to abandon the wisdom of relapse prevention, but to bring it along as we open the door to recovery promotion. It is helpful if this includes a door to one or more recovery fellowships where we can find the attributes of recovery.

While avoiding those relapse triggers we train ourselves to be ever on the lookout for what will trigger another day clean. We watch for the loving relationships we could not build in addiction. We see people driving legally and responsibly. We hear of children coming home, of amends being made, of self-esteem being repaired, of people getting jobs and going to school. We hear about healthy fun, vacations, sports and hobbies.

We hear it and we see it all around as we are choosing better environments and making a point to watch for those things that motivate recovery.

And as we do this we notice that our new focus is bringing the things that were once only seen and heard to our doorstep, and we become a recovery trigger for others who are seeking to change their life.

We learn again what we have always known, that the best way to lead is to follow the right path, and keep the double-edge of recovery sharp.

Des Moines Register — Monitoring your teen’s activities is an important deterrent to drug use.
 

Research shows that more teens begin using tobacco, alcohol, and marijuana between spring break and the summer months than any other time.
 

Parents can play an important role in helping their teen stay drug-free by setting clear rules, knowing who their friends are, and by having open and honest discussions about drugs.
 

Q. Why is summer a risky time for teens?
 

A. Summer is a time that often has little structure for teens. This can lead to boredom.

According to a study by the National Center on Addiction and Substance Abuse, teens who report they are "often bored" are 50 percent more likely to smoke, drink, get drunk and use illegal drugs than teens who aren’t.

Another risk factor for teens during summer is having friends who use drugs. Teens are more likely to feel pressured to experiment with drugs if their friends do.

The summer months also have more unsupervised time, which can lead to involvement in risky behavior.

Q. My teen will be unsupervised at home for most of the summer. What can I do to make sure he stays out of trouble?

A. There are steps you can take to ensure your teen stays safe and healthy.

- Lean on other responsible adults in your neighborhood. Network with other adults in your community to build a safe environment for young people.

- Use technology to your advantage. Teens these days use many forms of communication technology including e-mail, cell phones, text messaging and instant messaging, to name a few. Use these forms of technology to check in with your teen each day.

- Get to know your teen’s friends. They can be an important factor in your teen’s decisions about alcohol, tobacco and other drugs.

- Plan regular check-in times throughout the day with your teen.

- Find supervised activities in your community that your teen enjoys. Youth who are involved in constructive, supervised activities during non-school hours are less likely to use drugs. Talk with your child about what she would like to do during the summer and see if you can find a summer program in your community.

Q. How do I start the discussion about drug use with my teen?

A. Teens need to be educated by their parents about drug abuse, expectations in the home, and consequences. This can be a difficult conversation to have but the steps below can help guide you though the process.

1. Talk with your partner to agree on rules and consequences if your teen does use drugs. This information should then be shared with your teen so he knows and understands the expectations.

2. Practice ahead of time what you are going to say to your teen. Be prepared for various reactions from your teen and practice how you will react.

3. Make an agreement with yourself to not get upset or angry. Stay as calm as possible. Remember, you are the parent and you are in charge. Be kind and direct in your statements to your child. Know that you are doing the right thing.

Q. What are some signs to watch for if my teen is using drugs?

A. Look for signs of depression, withdrawal from friends and family, carelessness with grooming, or hostility. Also ask yourself, is your teen doing well in school, getting along with friends, and taking part in regular activities? Some additional signs to look for are:

- Increased secrecy about possessions or activities.

- Increase in borrowing money.

- Unexplained injuries.

- Impaired short-term memory.

- Items or money missing from home.

- Illness, shakiness, or tremors.

Q. What other resources are available?
 

A. A great resource for parents is called "The Anti-Drug," which can be found at www.theantidrug.com. This Web site has a wealth of information for parents about drug education, support from other parents striving to keep their teens drug-free, and helpful articles and advice from experts in the parenting and substance abuse prevention field.

(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.

WASHINGTON (AP) — Sure, exercise is good for your waistline, your heart, your bones — but might it also help prevent addiction to drugs or alcohol?

There are some tantalizing clues that physical activity might spur changes in the brain to do just that.

Now the government is beginning a push for hard research to prove it.

This is not about getting average people to achieve the so-called runner’s high, a feat of pretty intense athletics.

Instead, the question is just how regular physical activity of varying intensity — dancing, bicycling, swimming, tae kwan do — might affect mood, academic performance, even the very reward systems in the brain that can get hijacked by substance abuse.

What first caught the attention of National Institute on Drug Abuse chief Dr. Nora Volkow: A study found tweens and teens who reported exercising daily were half as likely to smoke as their sedentary counterparts, and 40 percent less likely to experiment with marijuana.

Volkow knows — from her own 6-mile daily runs and from her scientific experiments — that the brain literally likes physical activity. Exercise seems to invigorate neurochemicals that sense and reinforce pleasure.

"In children, it’s innate," she notes. "Children want to move."

But the nation’s children are becoming more sedentary, as illustrated by the obesity epidemic, "screen time" replacing outdoor play and a drop in school P.E. And as youngsters approach adolescence, the run around the yard that used to be fun too often becomes a chore — the dreaded jog around the school track or the nagging to get off the couch. The sedentary teen turns into the sedentary adult.

"Why do we lose the ability to experience pleasure from physical activity?" asks Volkow.

Last week she brought more than 100 specialists in exercise and neurobiology to a two-day conference to explore physical activity’s potential in fighting substance abuse, and announced $4 million in new research grants to help.

Drug treatment programs often include exercise, partly to keep people distracted from their cravings, but there’s been little formal research on the effects.

The best evidence: Brown University took smokers to the gym three times a week and found adding the exercise to a smoking-cessation program doubled women’s chances of successfully kicking the habit. The quitters who worked out got an extra benefit: They gained half as much weight as women who managed to quit without exercising, says lead researcher Dr. Bess Marcus.

She now is working with the YMCA on a larger, NIDA-funded study to prove the benefit.

Marcus cautions that people trying to kick an addiction have a powerful incentive to exercise. Could that possibly translate into prevention? Among the clues:

– Rats were less likely to ingest amphetamines if their cages had running wheels, suggesting exercise stimulated a reward pathway in the brain to leave them less vulnerable to the drug’s rush.

– In people, exercise acts as a mild antidepressant and relieves stress. Depression, anxiety and stress increase risk of alcoholism, smoking or drug abuse.

– Volkow is intrigued that attention deficit disorder and obesity both involve problems with the brain chemical dopamine, one system that drugs hijack to create addiction.

– Baby monkeys who don’t play enough in childhood have problems controlling aggression when they’re older. The most aggressive tend to have defects involving the feel-good brain chemical serotonin — and binge-drink when researchers offer them alcohol.

– Back to rats, physical activity increases production of growth factors and stem cells in key brain regions important for learning and mood; increases formation of blood vessels; and strengthens communication networks between brain cells.

Together, that’s far too little research to know if exercise really matters for substance abuse, scientists at the National Institutes of Health meeting cautioned.

But, a few studies of school-age children suggest physical activity predicts better performance on math, verbal and other tests — and better school performance in turn is linked to lower risk for substance abuse.

And getting sedentary seniors moving improves brain function — research aimed at preventing dementia, not drug abuse, although the improvement is in an area that in younger people is linked to risky decision-making.

A caveat: If your own youth includes memories of parties with beer-guzzling athletes, well, the research concurs. A major study that tracks adolescent risk behaviors found that by 12th grade, exercise offers no protection against binge-drinking.

"Now the kids who exercise the most actually drink the most," says Dr. Lloyd Johnston of the University of Michigan. It may have to do with the celebratory nature of team sports, or getting revved for college — or, other researchers suggested, even that competition is to blame.