Teens and drugs: Drug use statistics and treatment that works

Here are some drug use statistics:

  • Over 80% of teens engage in some form of deviant behavior (1).
  • Over 50% of high-school seniors admit to having used drugs (2).
  • Only 10%-15% of the population develop drug addiction problems related to their drug use (1).

The question is:

If the majority of teens experiment with drug use, and so few eventually develop drug addiction problems, should we be focusing on something other than stopping kids from trying drugs? Continue reading “Teens and drugs: Drug use statistics and treatment that works”

Biology, environment, or psychology? Which is most important in addiction?

I get asked this question a lot, both by people who are fully committed to the biological (or brain) model of addiction and ones who thinks it’s crap and that it’s all about psychology, experience, and motivation.

The thing is that it is absolutely impossible to separate the influence of the brain, environment, and psychology since they all intertwine and interact to deliver the final condition… I was reading an article about marketing in the new Internet age yesterday and it included a joke that I thought was relevant, so I’ll steal it. Instead of focusing on addiction, this joke centered on the question of which part of the body is most important? Maybe it’ll do a good job of explaining why asking the question of which of the above is most important is to some extent useless.

So – The brain, blood, lungs, and Legs were all fighting each other on the question of which of them was most important in the human body. Along came the anus and argued for its own place as The King of all that is human. The first four all laughed in its face, thinking the idea that the anus is King a funny joke. In protest, the anus shut down, a little upset at being made fun of. Three days later the rest of the body sent a notice that the anus has won the debate and begged it to get back to business.

You see, the brain runs the body, upon which it relies for everything and together those two interact with the environment in ways that alter them both. Then you place thousands and millions of people together in the environment and they interact to create a psychological reality that affects everything else that’s already there. It’s completely impossible to separate the parts sice they all rely on each other and are affected by the others.

This is why behavioral interventions, medical interventions, and environmental conditions have all been shown to affect the probability of addiction developing and of addiction ceasing. They all contribute so they all have the power to affect it, though the mix is probably different in different people based on their own experiences, biology, etc…

Make sense?

About Addiction: Prescription drugs, Alcohol prices, and prevention among teens

You know you care about addiction, and you know you love reading addiction news and research – A3 does it all for you and gathers things up in a nice little package we call our weekly “about addiction” post. It’s the fastest way to get the information you want, even if you didn’t know it was out there!

Prescription Drugs, drug safety, and sales

Reuters– Walgreen’s offers its customers a convenient way of disposing of their prescription drugs. This allows individuals to safely dispose of unwanted or expired drugs. The way that the program works is to place the unwanted prescription drugs in an envelope and send it to a medication incinerator. Controlled substances however are excluded from the program, I guess they’re afraid of bags of heroin and cocaine showing up at Walgreen offices?

Wales online– After being bugged to see if a man was in possession of illegal drugs, a number of men were sentenced to 48 years in jail for selling heroin. This undercover investigation lasted for six months, revealing a magnificent economy of drug use, abuse and profit.

Discovery News– Authorities discovered that eight illicit drugs, including cocaine, ecstasy, and methamphetamines, were detectable in the waterways of a Spanish national park. They’re worried about the threat of the drugs’ side effects to animals, but I have to say it makes me wonder why so many drug addicts are dumping their drugs there…

Alcohol Prices

Telegraph (U.K.)– A “price fixing”  system for alcohol prices has been suggested in the U.K., which is supposed to help reduce binge drinking encouraged by bottom priced alcohol. Economics experts in England suggest that all the policy will likely do will be increase profits for store that sell cheap alcohol. If our work here is any indication though, driving alcohol price up (as much as 100% in some stores) will certainly have an effect on some drinkers.

Health DayTax increases in alcohol prices may aid in alleviating alcohol problems. A study was conducted which showed that increasing the alcohol prices will result in significant reductions in many of the undesirable outcomes associated with drinking. So next time you go to buy alcohol and the price is too high just think of all the help you’re providing the community.

Addiction interventions and addiction treatment of teens

Time to act!- Perhaps one of the most important ways to prevent an addiction from happening is to catch it in its early stages and prevent it from ever developing. This website promotes primary prevention of as a means of addiction intervention and urges parents to act as soon as possible if you think your child is using drugs or alcohol.

DBtechno– Children who have regular meals are less likely to drink (read our coverage of teen drinking). This was attributed to parents having better, more consistent, interactions with their children at the dinner table. Kids who did not eat regular meals were twice as likely to drink and use cigarettes. Talk about a great way at starting on an addiction intervention early on in life – a nice relaxing dinner, and maybe some dessert…

ABC News– This article tells of the ill effects that alcohol can have to a child when alcohol is consumed during pregnancy. It tells the story of one family who could not stand their child’s “out of control behavior” likely brought on by FAS (Fetal Alcohol Syndrome). Read All About Addiction’s coverage of drinking during pregnancy.

Addiction Inbox– A great article using Dock Ellis’ perspective on LSD. Ellis is now speaking to inmates in correctional facilities, telling his story of how he was addicted to drugs and alcohol while playing baseball.

Oxycontin and Gambling Addiction on A&E’s Intervention

On last week’s episode of A&E’s Intervention, we were able to see how a prescription drug abuse problem can devastate the lives of addicts and their families. As we’ve already mentioned on A3, prescription drug abuse is the fastest growing drug problem in the U.S. at the moment having gone up more than 400% in only a few years.

Prescription Drug Abuse on A&E’s Intervention

Andrew, a 21-year-old, had been terribly addicted to OxyContin for the past 4 years. Because of his addiction, his father and two brothers were on the brink of homelessness as they watched Andrew snort his father’s last 40 dollars. This now made them unable to pay for the motel they had been staying in and all knew it was only a matter of time before they would be asked to leave.

Andrew’s journey with addiction began at 13 when he started experimenting with alcohol and marijuana. By 14, Andrew was using cocaine, crack, and ecstacy. He had also dropped out of school. By 17 he had a baby on the way and had begun his love affair with OxyContin. Though OxyContin is a prescription painkiller, it is attributed to a growing number of debilitating addictions and deaths every year. As the U.S. Drug Enforcement Administration warns, “OxyContin abuse can lead to weakened skeletal muscle, heart and respiratory failure and death”.

Oxycontin – the other heroin addiction

OxyContin is the brand name of the drug Oxycodone and is also known as “hillbilly heroin”. Many who abuse OxyContin crush the pills and then either snort or inject them, giving them a very similar high to that of heroin. Research has shown that when adolescent mice are exposed to OxyContin, lifelong and permanent changes to the brain’s reward system result. OxyContin is highly addictive and withdrawal symptoms are severe. OxyContin related deaths are usually linked to ingestion of the drug in combination with some other depressant of the central nervous system such as alcohol or barbiturates. Prescription drug abuse is a growing problem in the U.S. and according to recent government data, conducted between 1998 and 2008, there has been a 400 percent increase in substance abuse treatment admissions for people abusing prescription drugs.

Like the many others who abuse OxyContin, the drug had taken a fatal grip on Andrew’s life. He now found himself selling drugs to support his habit, stealing from his family and in debt to many drug dealers. In the past 2 years, he had stolen more than $4,000 from his grandmother and in the past year had been in over a dozen drug-related fights. As the dealers were hunting for him, Andrew began to fear for his life.

Gambling addiction can ruin lives

His family’s situation was even worse. His father had lost his car and home and could no longer feed Andrew’s two younger brothers. They often did not eat for days. Andrew’s violent behavior when he did not have the OxyContin made matters worse. Within 2 years, they had been evicted from 7 apartments because of the destruction Andrew caused to them when in a rage. As the situation worsened, Andrew’s father, Dan, was fired from his job of 19 years because he was caught stealing. But just as we begin to blame Andrew for the devastating situation he has placed his family in, the producers of A&E’s intervention revealed that there may be more than one addiction contributing to this family’s pain.

Over the past 9 years, Andrew’s father, Dan, had lost over $80,000 dollars through gambling and had taken more than $100,000 from his mother to support his gambling addiction. Dan had been able to mask his habit by focusing attention on Andrew’s oxycontin addiction. However, once their extended family saw an opportunity for Dan to get help, they came forward, hoping he too would seek treatment.

According to the Illinois Institute for Addiction Recovery, recent evidence indicated that pathological gambling is an addiction similar to chemical addiction. It has been observed that some pathological gamblers have lower levels of norepinephrine than normal gamblers. Norepinephrine is secreted under stress, arousal or thrill so pathological gamblers make up for their deficiency by gambling despite the negative consequences to their lives and the lives of those around them. Brain activation in gambling addict’s brains while receiving a monetary reward has also been linked to the brain activation of a cocaine addict when receiving cocaine. All of this makes gambling addiction difficult to treat and often requires the help of a treatment center or group therapy, like that of drug addiction.

Fortunately, after Andrew agreed to go to a 90-day treatment program, Dan did as well. Andrew has been sober since February 4, 2010 and Dan has not gambled since being featured on A&E’s Intervention. In the future, we’re going to follow up some of our favorite personalities from the show and see how they’re doing now.

A&E’s Intervention – Joey, the middle class, heroin addiction, and hepatitis C

A&E’s Intervention built quite an initial popular following for itself by choosing subjects with disarmingly unique stories and addictions. However, as the show has progressed, it has found strength in an ability to show America the true face of addiction: the so-called normal, everyday people battling their demons in private.

Heroin addiction doesn’t understand “class”

Joey, a 25-year old father from Pennsylvania, stands as a prime example, a young male who grew up with a supportive family in a comfortable suburb and nevertheless found himself in the grip of heroin addiction. By his own account on Intervention, Joey began experimenting with drugs at the age of 13, and by 15 was regularly smoking marijuana. By 17, he was using ecstasy, LSD and had developed a heroin addiction, which several trips through a 12-step rehab program did little to slow. As his tolerance for heroin built, Joey found himself shooting heroin at the rate of up to 7 bags a day to maintain his high. Despite steady work as a tattoo artist, his money was increasingly feeding his heroin addiction, preventing him from even making his child support payments. Sharing dirty needles had also most likely been the cause of his recent contraction of Hepatitis C, an infection that now shows up in a staggering 80% of all regular injection drug users.

A&E’s intervention – A glimpse into the face of addiction

As per the show’s format, this episode revolved around a forthcoming intervention planned by Joey’s family, who were growing more and more desperate as his heroin addiction continued to eat away at his life. In accordance with the Johnson Model, the classic standard of addiction intervention, the family resolved to present Joey with an ultimatum- either he could voluntarily enter rehab treatment, or he faced losing contact with all of his family members, losing any rights to his young daughter, and could even face jail time for violation of his probation.

Even with the gravity of the consequences facing him, Joey’s heroin addiction was such that he still could not come to terms with his situation. Anticipating the intervention, he ran, going into hiding for two days while his family camped outside of his home, his job, and the homes of his friends, waiting for the chance to confront him with reality. Ultimately, they spread the word that they were prepared to have him arrested. With nowhere left to turn, Joey finally resolved himself to rehab, though not without one final fix.

Difficult recovery and relapse

Though the treatment originally seemed to take well, giving Joey 9 months of sobriety, he was depicted on the program suffering a late relapse. This time, he willingly returned to treatment. According to A&E’s Intervention, he has now been sober since April 25, 2010.

Joey’s story resonates because of how tragically common his themes are: the complete loss of personal wealth, the hardship that the addict’s behavior has on family and friends, and the willingness to put oneself in extremely dangerous situations for the chance to use just one more time. Time and again, Joey demonstrated an extreme lack of caution as he shot up heroin with dirty needles, putting himself at risk for Hepatitis, HIV, and any other number of serious diseases. This brings up the issue of so-called “harm reduction” programs designed not to prevent injection drug users from using, but rather to provide them with clean needles and education in order to minimize the threat to public health and guide, not force, the addict towards potential treatment. The long-standing counterargument to such programs has been that they implicitly condone drug abuse, but research has shown that needle exchange programs do not increase drug abuse but merely decrease disease and dirty needle use. In this way, it is increasingly becoming regarded as analogous to sex education and the distribution of birth control, another common-sense public service that has too often fallen victim to the agendas of culture warriors.

Though for some a lurid escape, it has become increasingly clear to us at A3 that A&E’s Intervention, by presenting a straightforward view of the true complexity of modern drug use and addiction, has become an invaluable tool for those attempting to understand the face of this issue. As is usually the case with television content though, it pays to go a little deeper, and hopefully the show motivates people do just that.

A&E’s Intervention: The Johnson Model, Motivational Interviewing, and more

A&E’s “Intervention” is a reality series that follows one individual struggling with addiction per episode.  Family and friends gather with an interventionist toward the end of the episode and an intervention is planned.  The addict is then given a choice between leaving immediately for rehab or risk losing contact, financial support or some other privileges from their family and friends.

All interventions are not the same

This style of intervention used in A&E’s “Intervention” is known as The Johnson Model (JM), as thought up by Dr. Vernon Johnson in the 1960s. This intervention model has, because of the show, become the most recognizable version of addiction intervention.  An interventionist using this style aims to abruptly break the denial that is harbored by the chemically independent individual.  By assembling loved ones and presenting an ultimatum, the addict is forced to hit “bottom”, in hopes of pushing them toward recovery and avoiding further destruction.

There are alternative intervention approaches, including Motivational Interviewing (MI), and CRAFT (Community reinforcement and family training).  These relatively more recent and less confrontational approaches also employ professional counselors or interventionists who seeks to move the addict into a state in which they themselves are motivated to change their behavior (MI) or who focus on teaching behavior change skills to use at home (CRAFT).

By using common psychological techniques such as mirroring and reflecting, MI practitioners gradually make the client face the consequences of their action, taking the burden of motivation away from loved ones. CRAFT practitioners, on the other hand, use a manual-drive method to improve the addict’s awareness of negative consequences, reinforce non-drinking behavior, and improve communication skills and participation in competing activities. Both methods also prepare family members (or friends) to initiate treatment, if necessary, when the patient was ready. Though far less dramatic and “TV worthy,” MI has been shown in research to be very effective at increasing clients’ motivation to change in many different setting including addiction. It’s also my favorite technique because it allows for amazing, non-confrontational, change.

Some of the reasons to question the confrontational Johnson Model used in A&E’s “Intervention” have to do with the fact that although they’ve been shown to increase treatment entry rates once a successful intervention has been performed, they haven’t been shown to do much for treatment completion rates. Even more important is the fact that multiple studies have found that a small percentage of those who seek consultation in this method actually go through with the family confrontation portion. Instead, the more collaborative and supportive MI and CRAFT methods have greater participation and have been shown to provide even better treatment entry as well as improvement in communication and overall relationship satisfaction between the families and the addicts (which JM interventions provide as well). Additionally, a significant portion of individuals who enter treatment after a JM intervention end up leaving treatment early or relapsing quickly since they themselves have not yet internalized the motivation to quit.

Pressure and shame can backfire

This phenomenon can be seen in Corinne’s episode of A&E’s Intervention.  Addicted to heroin and crystal meth, Corinne had lost control of her life and her family was desperate to save her.  Corinne is a diabetic and had not been taking her insulin for years, using her needles to shoot-up instead. When Corinne overdosed nine months prior to taping, Corinne’s family knew they needed to intervene.  During taping, an interventionist was brought in to meet with the family.  She helped them to plan out how they will address Corinne.  She started by emphasizing how desperate the situation has become and encouraged them to be forceful with Corinne. She explained that this is a life or death situation and that if Corinne refuses treatment, they might consider turning her in to be arrested.  As Corinne arrives, she reacts harshly and explains that she is not “ready” for treatment.  She flees the room for a short time only to return and agree to go into rehabilitation as they had requested.

As is too often the case, Corinne struggles at the first treatment center and is quickly transferred. Eventually after getting clean, her family is overjoyed.  Unfortunately this is short lived when three weeks after taping, she relapses several times. As usual, I think it’s important to know every tool available when considering how to help an addict – that’s why I believe that knowing about MI and CRAFT (as well as other intervention methods) in case the more popular Johnson Model Intervention doesn’t work is crucial. It’s a matter of life and death.

Citation:

Miller, W.R., Meyers, R.J., and Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems: Comparison of three strategies for intervention through family members. Journal of Consulting and Clinical Psychology, 67, 688-697.

Rollnick, S., Allison, J. (2003) Motivational Interviewing, in The Essential Handbook Of Treatment and Prevention of Alcohol Problems (2003)

Women, Trauma and HIV Transmission

Co-authored by Jamie Felzer

Just how much can the events of a traumatic childhood affect the likelihood of contracting HIV or other serious diseases in later life? Unfortunately, recent research shows that the effect can be profound, especially for women.The silver lining may be in our ability to reduce later HIV transmission by providing better intervention services post-trauma.

Childhood Trauma, Women and HIV/AIDS

In ways both surprising and predictable, it seems that even very early childhood trauma can be firmly linked to high risk behaviors and a higher risk of contracting HIV. And with AIDS now reported by the US Department of Heath & Human Services as the leading cause of death for African-American women between the ages of 25-34 (and the perhaps even more sobering H&HS assessment that African-American women are a staggering 21 times more likely to die from AIDS compared to non-Hispanic white women), this crisis has a particular impact on women of color.

The obvious conclusion is that those subjected to childhood trauma are more likely to engage in risky behavior in an attempt to relieve some of the chronic stress that often accompanies such experiences. Drug use, unprotected sex, heavy drinking and other accompanying behaviors can all seem like appropriate responses to mental and emotional stress, but that stress can also inhibit one’s ability to make safe choices in this context. This naturally leads to an increased risk for contracting sexually transmitted diseases and blood-borne pathogens. Factor in the simple biological reasons why women may be at an elevated risk of contracting HIV through any one encounter, and it becomes clear that many at-risk young women are not receiving adequate education on how to protect themselves against this threat.

Many young women with a history of trauma and elevated lifetime stress from sexual assault, violence or any of the myriad stressors that accompany low socioeconomic status may be inadvertently putting themselves at greater risk for contracting HIV and AIDS. As mentioned, these risks can commonly come from unsafe sex and the abuse of unknown drugs, potentially with non-sterile needles. Without a strong support system to help them adequately process the short and long-term effects of trauma, many young women end up developing symptoms of chronic anxiety and depression, conditions that can alter behavior and even ultimately lead to demonstrated higher rates of mortality. That these conditions also often co-exist with other health issues linked to lower socioeconomic status such as obesity and heart disease serves to further compound this risk. Stress has even been shown to speed the progression of the AIDS virus, making the disease itself more deadly.

And with a full 1/3 of the female population having reported some form of sexual assault or similar violent trauma, the sad reality is that the risks for contracting HIV among young women are, if anything, growing. It seems that one way to attack the HIV pandemic is by improving prevention, as well as intervention, services, for women affected by such early trauma. It might be a way to kill two, or even more, birds with one stone.