Summer House

Times Union — Tatum O’Neal, the Oscar-winning actress, took a plea deal last week stemming from her June 1 arrest while supposedly trying to score some crack cocaine on the Lower East Side of Manhattan. She was initially charged with possession of a controlled substance and faced a year in prison if convicted. The court allowed her to plead out to a disorderly conduct charge and ordered her to attend two half-day drug treatment sessions. If she follows the court’s orders, the cocaine possession charges will be dismissed.

O’Neal has been open about her history of heroin addiction as outlined in her memoir, "A Paper Life." When she was arrested by undercover officers, they searched her and found two bags of cocaine along with an unused crack pipe. She had initially told police she was doing research for an acting role. Then she changed her story and told them that the death of her 16-year-old dog nearly triggered her into relapse.

Some say O’Neal was treated with a slap on the wrist. Others say she did not deserve to do any jail time because of her addiction. This raises a critical question that we as a society need to address. Should we treat drug addiction as a criminal matter, or as a medical problem?

For most people, treatment is a much more effective approach than imprisonment for successfully breaking their addictions, yet our prisons are full of individuals whose only crime is their drug addiction.

According to Justice Department statistics, the United States has more prisoners than any country in the world, 2.5 million and rising. In 2006, the Justice Department recorded the largest increase since 2000 in the number of people in prisons and jails. Criminal justice experts attribute the exploding prison population to harsh sentencing laws and record numbers of drug law violators entering the system, many of whom have substance abuse problems.

Nonviolent drug offenders like Tatum O’Neal should be given an opportunity to receive treatment, not jail time, for their drug use. This would be a more effective (not to mention much more affordable) solution for both the individual and the community. Prosecutors in many states, most notably New York, have leeway to recommend a defendant to treatment instead of incarceration. More than likely, however, they will not do it. This is because it would not be considered a victory for them. The system does not reward prosecutors for doing the compassionate thing.

O’Neal can be an example for millions of young people. One can only hope that her experiences with addiction and the realities of the drug war will encourage her to join the movement to reform U.S. drug policy. If she decides to take up the cause of treatment, she could help change laws across the country. After all, if treatment instead of jail is good enough for her as she struggles with her addiction, surely it is good enough for the thousands of others just like her who struggle with their own substance abuse problems.

Like depression, addiction affects tens of millions of Americans. How best to treat it is a serious a question we need to explore. Rich or poor, young or old, addiction has no boundaries. But the drug war does. Our long war on drugs has stifled the open debate society should be having about the nature of addiction and how best to deal with it. It is time to treat addiction for what it is — a medical problem, not a criminal one.

Problems associated with an individual’s drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.

A variety of scientifically based approaches to drug addiction treatment exists. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person’s drug-related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients. The best programs provide a combination of therapies and other services to meet the needs of the individual patient, which are shaped by such issues as age, race, culture, sexual orientation, gender, pregnancy, parenting, housing, and employment, as well as physical and sexual abuse.

Medications, such as antidepressants, mood stabilizers, or neuroleptics, may be critical for addiction treatment success when patients have co-occurring mental disorders, such as depression, anxiety disorder, bipolar disorder, or psychosis.

Treatment can occur in a variety of settings, in many different forms, and for different lengths of time. Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment often is not sufficient. For many, addiction treatment is a long-term process that involves multiple interventions and attempts at abstinence.

Why can’t drug addicts quit on their own?

Nearly all addicted individuals believe in the beginning that they can stop using drugs on their own, and most try to stop without treatment. However, most of these attempts result in failure to achieve long-term abstinence. Research has shown that long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs. These drug-induced changes in brain function may have many behavioral consequences, including the compulsion to use drugs despite adverse consequences the defining characteristic of addiction. Long-term drug use results in significant changes in brain function that persist long after the individual stops using drugs.

Understanding that addiction has such an important biological component may help explain an individual’s difficulty in achieving and maintaining abstinence without treatment. Psychological stress from work or family problems, social cues (such as meeting individuals from one’s drug-using past), or the environment (such as encountering streets, objects, or even smells associated with drug use) can interact with biological factors to hinder attainment of sustained abstinence and make relapse more likely. Research studies indicate that even the most severely addicted individuals can participate actively in treatment and that active participation is essential to good outcomes.

About 1 in 20 high school seniors now acknowledges taking OxyContin, a prescription drug for managing severe pain that, when abused, can be powerfully addictive. In its annual survey of teen drug use, the National Institute on Drug Abuse reports that OxyContin use by 12th graders is up 40 percent nationwide in just three years. Five times as many 12th graders report using OxyContin than report using methamphetamine. The results have been tragic.

Fast-Forming Addiction

Prescription drugs are the second-most used drugs among teens, behind marijuana. Teens are doing stimulants, barbiturates and painkillers. Many don’t realize how highly addictive and dangerous some of these pills can be — OxyContin in particular.

“I was sick as a dog and I was in bed and I couldn’t believe it. I was actually scared,” recalls 17-year-old Ryan, a high school senior from Tewksbury, Mass.

Ryan, who asked that NPR use only his first name, is enrolled at a drug-treatment clinic at Children’s Hospital in Boston. He says he first tried OxyContin at a party when he was 16. Kids crush up the 12-hour time release pills and snort them, so they get hit with all the opiate at once. Ryan says pot made him feel “weirded out.” OxyContin just made him feel good — warm and relaxed. And it’s easy to get.

“There’s always someone who has it,” he says. “There’s kids selling it. I know alone, like, 10 kids selling it themselves.”

But just a week after he started using OxyContin, Ryan realized that if he didn’t get a pill every day or two, he’d start to feel sick. So he kept using it. He says he had no idea how bad he was hooked until the next time he tried to stop.

“It was like somebody was inside of your head with a hammer,” Ryan recalls. “You feel like you’re going to die. Just laying there in the bed, sweat pouring off of you… Then five minutes later, you’re freezing… then you’d be throwing up.”

A Pricey Habit

OxyContin is very expensive on the street: $80 for one pill. To pay for his habit, Ryan says he cashed $7,000 in savings bonds his aunts had given him on birthdays. He sold his PlayStation, leather jackets, cell phone — everything he had — just to stay high and keep from getting sick. He finally broke down and asked his parents for help. Looking back on it, Ryan says he didn’t think using OxyContin would be that dangerous because it was a prescription pill — that made it seem safe. Many different kids at his high school were playing around with it, he says: “People from every sort of group — the burnouts, athletic kids, the geniuses and, like, girls playing wicked-good softball [who were] offered scholarships to places — they would be using it.”

That sentiment is echoed by 18-year-old Mike, a recovering OxyContin addict in Winthrop, Mass. Mike says he was always an athlete and played football. Until his sophomore year in high school, he attended a prep school with wealthier students; he later transferred to the local public school. He says that, if anything, he saw more OxyContin at the prep school.

“All the popular kids — that was the cool thing to do,” Mike says. “It seemed like it was cool because it was so expensive, this big rich drug. And a lot of rich kids were doing it because the poor kids couldn’t afford it.”

OxyContin is so expensive that many teens turn to stealing to support their habit.

“I stole so much money from my parents,” says Katie, 18, who is also a recovering OxyContin habit. She says she and a friend both stole their parents’ ATM cards to support their habits. “I stole $5,000 from my parents in two months.”

Katie also wrote checks from her mother’s checkbook. Katie’s parents say she and her friends stole cameras and jewelry from their house. Somebody stole her father’s wedding ring out of his top drawer.

“It’s like someone just punched you in the stomach,” Katie’s father said in an interview with NPR. “You know you’re never going to get it back. And what did it get used for? The addiction.”

Gateway to Heroin

Katie’s parents say they feel lucky to still have their daughter. More than a year has passed since they enrolled her into a treatment program. She’s relapsed twice. Doctors say OxyContin addiction can plague people for years. And some users move on to heroin. It is much cheaper than OxyContin, and it satisfies the same craving. Instead of $80 a pill, heroin costs about $5 a bag around Boston. One night when Katie was getting sick and desperate, she called a women she’d used OxyContin with before whom she knew also used heroin.

“I didn’t think if she had heroin I would do it,” Katie recalls, “but then when I had that option — to be sick or do this — I did that.”

Deadly Consequences

All the teens interviewed for this story said they knew at least one young person who had overdosed and died recently either on OxyContin or on heroin after first getting hooked on OxyContin. Cheryl Oates of the middle-class suburb of Burlington, Mass., knows the deadly repercussions of OxyContin addiction all too well. Two months ago, her 19-year-old son, Christopher, died of a heroin overdose.

Oates says her son was not the kind of teen one would expect to become a drug addict. He was a captain of his football and wrestling teams at Burlington High School and popular among his teammates. He got good grades and didn’t have behavior problems, Oates says.

“He was the kind of kid who would walk through the mall with me and hold my hand,” Oates says. “He didn’t care what other people thought and said. Christopher was just his own person.”

But by his junior year, Christopher was experimenting with Percocet, another opioid painkiller. It had been prescribed to him for a football injury. By his senior year, he and some friends were using OxyContin; they got hooked. Soon after he graduated, he started using heroin, too.

“The night before Christopher overdosed, we sat in the kitchen and we talked until three in the morning,” Oates says. “And he said he knew he needed help. He was such a good kid and he loved so much. And he got grabbed by something that was greater than him.”

Oates says she’d tell other parents to keep all prescription medications in a locked cabinet, just to make it harder for teens to start experimenting with them. She says it is frightening that more than 5 percent of high school seniors nationally now report using OxyContin in the past year.

Meditation can be a powerful tool in relapse prevention and can become what one therapist called a “positive addiction” that provides a healthy alternative to addictive behaviors. People also report that meditation leads to new insights about the source of their cravings and helps to dissolve them.

In their book, Mindful Recovery: A Spiritual Path to Healing from Addiction, Drs. Bein and Bien offer ten “doorways” to recovery, from journaling to meditation, and they present dozens of specific meditation exercises based on their experience as therapists and meditators. Their book says: “People use addictive behaviors to avoid facing what hurts them. The Buddhist mindfulness practice offers a gentle way to begin facing pain and working with it to establish a new relationship to life. Mindfulness helps in two ways: first, by becoming aware of yourself and your environment, you understand what hurts you, what ‘triggers’ you, and second, by befriending your triggers, you can disarm them. Mindfulness provides a larger purpose, a broader context in which to see a problem. And then things fall into place more gently. If you are awake and relaxed and enjoying your life, there is less need and desire for your addictions.”

Kevin Griffin writes about Buddhism and the Twelve Steps saying this: “Buddha said that the cause of suffering is desire, and the Twelve Steps try to heal people from desire gone mad: addiction. Both systems ask you to look at the painful realities of life, to understand them, and to use this understanding as the foundation for developing peace, wisdom, faith, and compassion. The practical aspects of Buddhism is one of its main corollaries to the Steps.” His book, One Breath at a Time, is an exploration of how the two systems can work together, and he offers meditation techniques based on Vipassana and Metta practices.

“Zen is the ultimate and original recovery program,” says author Mel Ash in his book, The Zen of Recovery. “It exposes our denial of true self and shows us how all our other diseases and discontentments flow from our fundamental denial of unity with each other and the universe.”

Sogyal Rinpoche writes: “All we need to do to receive direct help is to ask. Didn’t Christ also say: ”Ask, and it shall be given you; seek and ye shall find; knock and it shall be opened unto you. Everyone that asketh, receiveth; and he that seeketh, findeth”? And yet asking is what we find hardest. Many of us, I feel, hardly know how to ask. Sometimes it is because we are arrogant, sometimes because we are unwilling to seek help, sometimes because we are lazy, sometimes our minds are so busy with questions, distractions, and confusion that the simplicity of asking does not occur to us. The turning point in any healing of alcoholics or drug addicts is when they admit their illness and ask for aid. In one way or another, we are all addicts of samsara; the moment when help can come for us is when we admit our addiction and simply ask.”

An evaluation of alcoholism treatment suggests more ways to define success than strictly total abstinence. The method may help provide some changes to traditional approaches, the results of a case study suggest. "It may be argued that subjects who remain abstinent [from alcohol] during treatment are the most successful because psychosocial functioning and physical health depend on sobriety," say study authors Sue-Jane Wang, Ph.D., and Celia Winchell, M.D., and colleagues from the U.S. Food and Drug Administration in Rockville, Md. "However, other patterns of drinking are very common during treatment and many analytic approaches fail to make a distinction among the patterns." "For example, traditional research methods often don’t distinguish between a person who drinks only once a week during a 12-week trial and one who abstains for the first 10 weeks but spends the last two weeks intoxicated, according to the study.

These summary measures fail to capture the full complexity of the drinking pattern over time," the researchers say. The authors said, "There has been a great deal of contention on whether the effects of alcoholism treatment should be evaluated solely against the criterion of abstinence. The clinical community is still searching for a better description of what constitutes effectiveness in alcoholism treatment trials. More informative statistical analysis methods are necessary to arrive at meaningful evidence."

According to a Center for the Advancement of Health report, "Wang and colleagues tested a research tool called the ‘multiple failure time’ approach that asks more nuanced questions than traditional approaches, including: ‘Does the treatment reduce the rate of relapse to heavy drinking?’ They used this approach to re-examine a study that found weakly statistically significant evidence that an alcoholism treatment drug called naltrexone was effective." By taking into account both the time and the frequency of the study participants’ drinking episodes, the researchers noted two things that were overlooked in the first analysis: The risk of having any drinking episodes and any heavy drinking episodes was significantly lower in the group treated with naltrexone rather than a placebo, the report said. Source: The study results were published in the March 2003 journal Alcoholism: Clinical and Experimental Research.