DARE – Drug Abuse Prevention that doesn’t work

  • DARE (Drug Abuse Resistance Education) is the largest school-based drug abuse prevention program in the United States.
  • 80% of school districts across the country teach the DARE curriculum, reaching an estimated 26 million children (1).
  • Every year, over $1 billion goes into keeping the program running. A billion dollars may be a small price to pay to keep America’s children drug-free, but there is plenty of evidence to suggest that DARE isn’t doing what it’s supposed to.

What is DARE?

dareFounded in 1983, DARE began as a 17 week long course taught to 5th and 6th graders. The course is taught by a uniformed police officer who teaches the students about drug use and gang violence. The DARE curriculum includes role-playing, written assignments, presentations, and group discussions.

DARE uses a zero tolerance policy towards drug use. Students are told to adopt mottoes like “Drug free is the way to be” and “Just say no to drugs!” Pictures of blackened lungs and drunk driving accidents are methods used to discourage experimentation. The focus of the program is clearly flat out refusal. Students are not taught what to do if they are already experiencing problems with drugs.

Is DARE effective?

The effectiveness of DARE has been called into question since the early 90s. A meta-analysis of 11 studies conducted from 1991-2002 shows no significant effect of DARE in reducing drug use (1). Several studies have even reported an opposite effect, with DARE leading to higher rates of drug use later on in life. Reports from the California Department of Education, American Psychological Association, and U.S. Surgeon General all label DARE as ineffective.

The results seem clear, but statistics don’t seem to be enough to convince concerned parents and policy makers to shut down any drug abuse prevention program. With drug use on the rise, it seems that DARE is here to stay. But perhaps getting rid of DARE isn’t the best option. The framework and funding already exist for a potentially successful prevention program. Maybe all we need to do is apply some science and develop new techniques that will provide results.

*It should be noted that in 2001, DARE made substantial revisions to its program under the title “New DARE.” The effects of these revisions have yet to be measured, so we’ll wait and see.

 

Citation:

1. West, S.L., O’Neal, K.K. (2004) Project D.A.R.E. Outcome Effectiveness Revisited. American Journal of Public Health. 94(6)

Treating alcohol withdrawal with benzodiazepines – Safe if mindful

Alcohol withdrawal can lead to some pretty horrible side effects

Contributing co-author: Andrew Chen

Alcohol withdrawal can be extremely unpleasant (see here for an overview). Symptoms vary from person to person, but most people will experience some negative symptoms of alcohol withdrawal if they try to stop drinking after long term use.

Mild to moderate symptoms include headache, nausea, vomiting, insomnia, rapid heart rate, abnormal movements, anxiety, depression, and fatigue. Severe symptoms of alcohol withdrawal include hallucinations, fever, and convulsions (known as DT’s or delirium tremens). Most people undergoing alcohol detox do not require hospitalization, but in severe cases, hospitalization may be necessary (1). Since their introduction in the 1960s, benzodiazepines have been the drug of choice for treating severe cases of alcohol withdrawal.

Benzodiazepines, or benzos for short, are a class of psychoactive drugs that work to slow down the central nervous system by activating GABA receptors. This provides a variety of useful tranquilizing effects. Aside from relieving symptoms of alcohol withdrawal, benzodiazepines are also commonly prescribed to treat insomnia, muscle spasms, involuntary movement disorders, anxiety disorders, and convulsive disorders.

The most common regimen for treating alcohol withdrawal includes 3 days of long-acting benzodiazepines on a fixed schedule with additional medication available “as needed.” (2)

The two most commonly prescribed benzos are chlordiazepoxide and diazepam. Chlordiazepoxide (Librium) is preferred for its superior anticonvulsant capabilities while diazepam (Valium) is preferred for its safety against overdose with alcohol. Short-acting benzos like oxazepam and lorazepam are less frequently used for treating alcohol withdrawal (1).

Compared to other drugs, benzos are the safest and most effective method for treating difficult alcohol withdrawal. However, benzodiazepines do come with their own potential for dependence and abuse. Ironically, symptoms of benzodiazepine withdrawal are quite similar to those of alcohol withdrawal. Tapering off dosage is the best way to prevent serious withdrawal symptoms. To avoid such complications, benzodiazepines are only recommended for short-term treatment of alcohol withdrawal.

In short

Benzos can be very useful for helping long terms alcoholics deal with the difficult withdrawal symptoms that can accompany the detox period. Just be mindful so as not to find yourself right back where you started.

Citations:

1. Williams, D., McBride, A. (1998) The drug treatment of alcohol withdrawal symptoms: A systematic review. Alcohol & Alcoholism. 33(2), 103-115

2. Saitz, R., Friedmn, L. S., Mayo-Smith, M.F. (1996) Alcohol withdrawal: a nationwide survey of inpatient treatment practices. 10(9), 479-87

Saving lives made easy – Treating opiate overdose with intranasal naloxone

oxycodone-addiction-big1Contributing co-author: Andrew Chen

Imagine that you and your friend have been using heroin (or another opiate). A few hours go by and you notice your friend is progressively becoming more and more unresponsive. You check on him and find that his breathing is shallow, his skin is cold, and his pupils are constricted. You recognize these as signs of opiate overdose and call for help. Now what?

Well… If you had some naloxone around, you might be able to treat the overdose and save your friend’s life before the paramedics even arrive.

Naloxone hydrochloride (naloxone) is the standard treatment for opioid overdose. Naloxone works by blocking opioid receptors, thereby removing opioid agonists, such as heroin or oxycodone, from those same receptors. As a result, the overdose is reversed and death is prevented.

What makes naloxone great is that it has no potential for abuse. In fact, it makes the user feel pretty crappy.

Naloxone is typically delivered through an injection, which makes it pretty much useless in many situations. However, it can also be delivered using an intranasal spray device. This intranasal form of naloxone is getting lots of attention recently because it is relatively easy to administer.

In 2006, The Boston Public Health Commission (BPHC) implemented an overdose prevention program, providing training and intranasal naloxone to 385 individuals deemed likely to witness an overdose. These individuals were often family members of opiate users or drug-using partners.

15 months later, the BPHC conducted a follow-up:

  • Contact was made with 278 of the original participants.
  • 222 reported witnessing no overdoses during the 15-month span.
  • 7 had their naloxone stolen, lost, or confiscated.
  • 50 reported witnessing at least one overdose during the 15-month span. Together, these 50 individuals reported a total of 74 successful overdose reversals using intranasal naloxone!

The BPHC program is not the only example of successful use of naloxone in opiate overdose prevention programs. Similar programs have popped up in Chicago, New York, San Francisco, Baltimore, and New Mexico.

Unlike injections, using a nasal spray isn’t rocket science. All of the participants in the BPHC program were trained by non-medical public health workers, which makes the idea relatively cheap. As the data shows, the participants were able to effectively recognize an opiate overdose and administer intranasal naloxone. By targeting at-risk populations and providing proper training, distribution of intranasal naloxone can help in saving lives.

For more information, check out our post Addiction and the brain part IV – Opiates

Citation:

Doe-Simkins, M., Walley, A.Y., Epstein, A., & Moyer, P. (2009) Saved by the nose: Bystander-administered intranasal naloxone hydrochloride for opiod overdose. American Journal of Public Health. 99(5)

Convincing yourself to quit smoking – The influence of personal beliefs on smoking

no-smoking1A study published in Addictive Behaviors showed that thinking actively about quitting smoking cigarettes allows people to smoke less!!!

In the experiment, participants from one group of smokers were asked to think about reasons to quit smoking and write them down on a piece of paper. Participants from a second group of smokers were asked to read pre-written anti-smoking arguments.

Both groups of participants were then asked to wait up to 30 minutes while the experimenter prepared a task unrelated to the actual experiment. Individuals who generated their own arguments against smoking abstained from smoking cigarettes longer than those who read pre-written anti-smoking arguments.

The results of this experiment suggest that self-generated information has a greater influence on smoking behavior (at least in the short-term) than information that is simply read.

Many anti-smoking campaigns try to “educate” people out of smoking cigarettes. They provide a great deal of information on the potential health hazards of smoking and try to convince smokers to quit. This approach can be dangerous as smokers might feel as though they are being attacked and react defensively. The truth is, many smokers already understand the consequences of tobacco use. If anti-smoking campaigns could find a way to develop personal beliefs against smoking, smokers might have an easier time not lighting up.

Citation:

Müller, B., van Baaren, R.B., Ritter, S.M. (2009) Tell me why…the influence of self-involvement on short term smoking behavior, Addictive Behaviors, 34(5)

Early drug use problems: Kids, inhalants, and huffing.

Parents can save lives by educating their kids about the dangers of inhalants22.9 million Americans report trying inhalants at least once in their lives.

When it comes to drug use problems, inhalants are often the first drugs that kids decide to experiment with. The habit is often called huffing. While use of alcohol, tobacco, marijuana, cocaine, ecstasy, and other drugs peaks around the 12th grade, inhalant use peaks in the 8th grade. A study conducted by the National Institute on Drug Abuse found that 17.3% of 8th graders have abused inhalants before.

Why does kids’ drug-use start with inhalants so early in life?

Many kids start inhalant drug use by accident; they like the smell of glue, whiteout, or gasoline, take a long inhale, get high, and keep going. For others, inhalant use is introduced through friends.

Also, attaining drugs can be somewhat of a challenge when you are 13 years old. Inhalants solve this problem. Inhalants are found in a variety of household products including: spray paint, nail polish remover, whiteout, marker, gasoline, glue, keyboard cleaner, shoe polish, and aerosol sprays. These products are easy to buy and relatively inexpensive, even for young kids. They can often be found readily in the house, which also makes them easy to hide.

Inhalants, the brain, and organ damage

Inhalants can be breathed in directly or concentrated in a container such as a plastic bag or cloth and then inhaled. Most inhalants work by depressing the central nervous system. The chemicals are absorbed through the lungs and proceed into the bloodstream, where they quickly reach the brain and other organs. Inhalant intoxication looks very similar to being drunk: Slurred speech, bad coordination, euphoria, dizziness, and drowsiness are all common during inhalant drug use.

The inhalant high only lasts a few minutes, so people often use inhalants repeatedly for several hours. This can have some devastating long-term effects. Brain damage, nerve damage, and organ damage are all possible. Inhalant use can impair vision, hearing, and movement. Inhalant drug-use is also linked with a variety of mental disorders, including antisocial personality disorder and depression. In pregnant animals, inhalant use has been linked to low birth weight, skeletal abnormalities, and delayed development.

Most tragically, even a single session of inhalant use can cause heart failure and consequently, death. The National Inhalant Prevention Coalition reports 100 to 125 inhalant-related deaths per year. This is particularly sad considering the fact that many of these individuals are kids and haven’t even left middle school yet.

Dr. Jaffe talking about huffing and inhalant abuse on Fox News

Citations:

1. Seigial, J.T., Alvaro, E.M., Patel, N., Crano, W.D. (2009) “…you would probably want to do it. Cause that’s what made them popular.” Exploring Perceptions of Inhalant Utility Among Young Adolescent Nonusers and Occasional Users. Substance Use & Misuse. 44(597-615)
2. NIDA. Inhalant Abuse. 2005

Internet Porn Addiction – Why is free porn so irresistible and what can love addicts do?

online-porn101In a recent post on Internet addiction, we briefly mentioned addictions to internet pornography. There’s no doubt that the easy access, and anonymity, of online access to any and every sexual whim conceivable is at the heart of online porn’s draw. Here we will take a more in-depth look at how Internet porn addiction develops.

The internet porn addiction connection

Excessive use of online porn can be thought of as a manifestation of both Internet addiction and sex addiction. In fact, porn addiction is one of the most commonly reported sex addiction problems, especially among younger individuals and among what Dr. Carnes calls “Phase 1” sex addicts, or the lighter version of sex addiction that doesn’t involve others.

Porn addiction develops much like a drug addiction. After an initially rewarding experience with pornography (a common experience given the cycles of sex we’d mentioned in an earlier post), individuals may experience uncontrollable urges to obtain sexual satisfaction through that form of entertainment (1). The connection between internet porn and sexual gratification is positively reinforced, and the urges become more frequent and more powerful. These connections can become so strong that simply sitting down at a computer elicits a sexual response.

Like in drug addiction the problems arise when urges to view porn conflict with an individual’s daily responsibilities. Instead of leaving for work on time, the addict may decide to stay at home and watch porn – Some porn addicts report staying at home for porn sessions that can last as long as 8-10 hours. The shame and guilt that often accompany these compulsive sexual experiences are also thought to greatly affect the experience of sex addicts and to reinforce the positive experience they receive from their shameful act. Many porn addicts report that they end up in a distressing situation where their shameful sexual release is the only positive experience they get to have.

It should be noted that the majority of people who use online pornography do so recreationally, with little ill effect (2). As is the case with drug addiction, it is only a sub-group of people that become “addicted” and suffer serious consequences from their porn addiction (e.g. lost jobs, disturbed marriages).

Whether we are talking about pornography, gambling or shopping, our golden rule for diagnosing behavioral addictions has been: no impairment, no addiction.

The toll of porn addiction and the refuge of he internet

Internet Porn Addiction can also bring about a different psychological toll than the shame we discussed earlier. As tolerance develops, individuals with porn addiction may also begin to need more deviant material to achieve the same high. This is again similar to the increased quantity and variety need experienced by many drug users and it’s where rape fantasies, fetishes, and child pornography often come into play. Exposure to such material can grossly distort beliefs about human sexuality and ruin interpersonal relationships. Patients that progress in this fashion often report feeling unsatisfied with their sexual experiences and unsatisfied with their partners (2).

We noted that in addiction, shame is a major component of the addiction cycle. This is especially true for sexual addiction. Social norms tell the sex-addict that there is shame in buying an adult magazine (like playboy or hustler) and that there is shame in soliciting a prostitute. Internet porn substantially reduces the risk of getting caught, and therefore of being shamed. Many individuals who experience porn addiction are able to hide their activity from their partners and remain completely anonymous on the web. Online porn is easily accessible, it’s available all the time, and getting free porn is easy. When you add complete anonymity into the mix, you get a recipe for a potentially serious addiction (2).

Porn addiction help – Some Advice

Relapse is common during recovery as patients often experience withdrawal symptoms when their normal consumption of pornography is reduced. In this case, like in many others, relapse is to be thought of as a misstep, and not a failure. See our post on treatments for sexual addiction to see how porn addiction is usually dealt with. In addition to these standard methods, patients can often benefit from the use of Internet filters and “accountability” software that sends a report of their online activity to a partner or therapist. Again, it’s important to recognize that although porn addiction is serious, there are solutions out there and sex addiction help resources in general are growing with the recent jump in awareness brought about by high profile cases like that of Tiger Woods.

Citations:

1. Griffiths, M. (2001) Sex on the internet: Observations and implications for internet sex addiction, The Journal of Sex Research, 38(4)

2. Cline, V.B. (2002) Pornography’s Effects on Adults and Children

Actor Chris Klein in rehab – Facing jail time after second DUI

Actor Chris Klein has checked himself into rehab following his second DUI arrest that occurred on June 16. A police officer pulled him over after he was spotted swerving across the westbound 101 Freeway in Los Angeles. His blood alcohol content was nearly three times the limit of .08.

Chris Klein was previously arrested on DUI charges in 2005 and his PR rep issued the following statement:

“After recent events, Chris was forced to take a clear look at a problem he has been trying to deal with himself for years. He understands now that he can not beat this disease alone. He thanks everyone for their support as he takes all the necessary steps to deal with his addiction and asks for privacy while doing so.”

Klein is receiving treatment at the Cirque Lodge in Utah. The Cirque Lodge may sound familiar to you as Mary Kate Olson, Eva Mendes, and yes, Lindsay Lohan have received treatment there as well. Klein is enrolled in a 30-day alcohol addiction program and plans to stay longer if needed.

The L.A. City Attorney’s office says Chris Klein faces four days in jail (a slap on the wrist?) if he is convicted of his second DUI offense. In accordance with a California law for repeat DUI offenders, Klein will also have to install an interlock device in his car if he wishes to drive again. This device will require him to perform a breathalyzer test in order to start the engine.

Contributing co-author: Andrew Chen