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  • Bath Salts – Pressing the Issue

    Q &A – Dr. Adi Jaffe PhD Interviewed By Tony O’Neil of The Fix

    “A man was attacked on the side of the highway, authorities find the attacker eating a the victims face, and only after multiple bullet wounds is the attacker stopped.” This Zombie-like behavior is common in Hollywood scary movies, but as of late the new “Bath Salt” epidemic has turned places is like Miami into a real life Zombieland, or at least that’s what we have been told.

    UPDATE: We now know that the assailant in this case (Rudy Eugene) had only traces of marijuana in his blood and no evidence of bath salts use. However he was previously diagnosed as schizophrenic and we know that especially for those at risk, marijuana use is associated with psychotic breaks.

    What are “Bath Salts”?

    Bath Salts are a street name given to a number of meth like drugs, so we’re not talking about your everyday Epson salt here. Although drugs like MDPV have just been made illegal, most of these substances seem to be cathinone derivatives and are central nervous system stimulants that act through interruption of dopamine, norepinephrine and to a more limited extent serotonin function.

    It’s very important to note that research on this is still in its early stages and so reports are limited. However, it seems that at low to moderate doses the most common effects for MDPV can be thought of as either meth-like or like very strong adderall or ritalin – so users experience stimulation, euphoria, and alertness. Mephedrone seems to act more like MDMA (ecstasy) than meth, at least in early animal research with these drugs. At high doses however, and obviously there is no one regulating the dose since these drugs are sold as if not for human consumption, the effects can look like psychosis. These are not necessarily very different from meth induced psychosis which can include panic attacks, severe paranoia, self-mutilation, and violence.

    There are several confirmed research reports (individuals who had only MDPV in their system) of people injecting or snorting MDPV and developing severe psychosis, “running wildly throughout the local neighborhood,” foaming at the mouth and being combative when approached. Worse still, these individuals can develop severe organ failure, require intubation (breathing tube insertion through throat), and at times die even in the face of extreme medical intervention.

    How do Bath Salts affect the nervous system?

    These drugs tend to be sympathomemetic, which means they induce sympathetic nervous system activation – the increased heart rate, temperature, etc. This is also where they can be most dangerous even when people don’t develop the possible psychotic effects (due to organ failure from the hyper activation).

    Can one become addicted to Bath Salts?

    I think that there’s no question that this stuff can cause physical dependence. I personally know of a client at matrix here in west la who came in specifically for “over the counter stimulant addiction” to drugs like these. He was snorting, then injecting them and stayed up for days. Eventually he was hospitalized with severe agitation and mild psychosis. These high doses are almost certainly, based on what we know with meth and MDMA, also causing neurotoxicity (some of the effects irreversible).

    What Harm Reduction model should be used for Bath Salts?

    It seems that MDPV and mephedrone are indeed drugs worth worrying about, at least in so much as they are completely unregulated when sold “not for human consumption.” While their effects at low/moderate doses are not severe are can be thought of as related to those of other stimulants, at high doses they can be lethal and can certainly bring about serious negative psychological effects. I always think that there is some room for harm reduction when trying to get some control over abuse of such drugs. In this case, while it’s probably best to stay away completely, I would urge people who are going to use to be careful and not to use large amounts of this stuff before seeing how they react. The neurotoxicity and cardiac effects can be too extreme and may lead to severe irreversible consequences at high doses.

    How can the media help resolve this epidemic?

    Press coverage always makes more people aware of an issue than they were before the topic was covered. In this case, especially if we can sneak in some of the above harm-reduction messages along with the overall “don’t use this stuff” text we normally see, we might be able to use the opportunity to save some lives. I think, as I’ve said before, that people (especially kids) are going to be on the lookout for ways to change their experience no matter what. The question is how we react when they do things we don’t like and how does our reaction affect their future behavior.

    I think that we can use the real information – possible death and psychosis, especially when snorted or injected – to alter the ways people use Bath Salts, allowing for a campaign that isn’t only looking to stop the use of the drug but that is focused on minimizing consequences. However it seems that the press isn’t covering the range of possible effects but is choosing instead to focus on the most outrageous. These types of scare tactics haven’t worked too well in the past for curving drug use, but it doesn’t hurt TV ratings so I don’t expect it to stop.

    Will banning bath salts help?

    I believe that in this case, as we can already see, we are once again going to be playing a cat and mouse game that congress seems happy to play. They’ll outlaw more components of Bath Salts (MDPV, mephedrone, and methylone apparently already are controlled) but new ones will continue to come out. To me, the question is whether we believe we will one day ban all psychoactive substances we have issue with or whether we will be successful in developing a strategy for dealing with their abuse in a way that helps recognize and intervene early.

    I think that the banning approach makes it less likely that people with abuse problems, or even acute medical problems, will contact authorities for help. Worse yet, it makes it nearly impossible for us to get a handle on safer use practices for a specific drug as they all get replaced by new variations – often ones that are even more dangerous.

    Although the press has made the Bath Salt epidemic much more like a Hollywood production than reality, there are issues that need to be addressed. I just don’t believe in scaring the public into action, I’d prefer if popular media were just honest with the public about these drugs so that people can draw their own conclusions.

  • About Addiction: food, treatment, babies and teens

    Our weekly About Addiction summaries are back! Make sure to tune in for the latest in research and news coverage of the drug abuse and drug addiction landscape. This time we’re talking about the food and drug addiction connection, drug using baby boomers, accidents, addicted babies, and drug using teens during summer breaks. If you

    Food or drugs? A new study suggests a path for choice – A recent study Yale School of Medicine professors has found that neurons associated with overeating are also linked to non-food associated behaviors such as drug addiction. However, their discovery points to a relationship different than the contemporary view; they found an inverse relationship between eating and drug addiction that shows people who lack a desire for food have a higher predisposition towards drug addiction. According to their findings, it seems that the drive for food and the drive for drugs compete with one another!

    Obamacare’s effect on addiction treatment – The recent ruling by the Supreme Court to uphold the Affordable Care Act was a huge moment in our country for many reasons. In the world of addiction, it has a great impact as well! By making sure all citizens have health insurance, it gives those seeking treatment a huge advantage: choice. In the past, those seeking addiction treatment could be limited by their insurance situation. Now, those seeking help will be able to get the treatment that is right for them, not just what is available to them. Also, substance abuse treatment will be able to have a more wide-reaching effect as treatment can be provided earlier as well as a preventative measure.

    The dangers of driving high – According to a recent study done at Dalhousie University, marijuana use has a severe adverse effect on safe driving. This may not be new information, however this paper was the first to separate driving under the influence of marijuana from the influence of other drugs and alcohol. They looked at nine smaller studies including 49,411 people in order to calculate their results: finding that cannabis use nearly doubles the likelihood of a motor collision as compared to an uninhibited driver. With marijuana being the most widely used illicit substance in the world, with its usage rate still rising, it is important to separate the truths and myths about its effects.

    Babies born addicted – This Thursday’s episode of Rock Center With Brian Williams featured a story on babies born with withdrawal symptoms from prescription painkillers. This is an epidemic in America, and the symptoms are heartbreaking to watch: the babies have tremors, digestive problems and cry inconsolably. There’s little doctors and nurses can do to comfort them as they slowly wean them off of the drugs. On this Thursday’s new Rock Center, Kate Snow reports on the shocking increase in the number of babies born addicted.

    A Teenagers’ Summer: No school, less supervision, more drugs? – A new study released by SAMHSA (Substance Abuse and Mental Health Services Administration) reports that 671,000 teens aged twelve to seventeen will try alcohol for the first time this June and July alone; 305,000 teens will try cigarettes for the first time during these months, while 274,500 will have their first experience with marijuana. These numbers are an increase from the rest of the year, likely due to an increase in free time and decrease in adult supervision. While a large proportion of these individuals will never end up developing an addiction or substance abuse problems, this study makes it clear that the summertime may be a good time to talk to your kids about the risks and effects of these substances.

    Spankings leading to drug abuse? New research reveals it may not be as far-fetched as you may think – The American Academy of Pediatrics (AAP) has released research that reveals strong links between corporal punishment in childhood and mood disorders, personality disorders, and addiction and drug abuse later in life. Specifically, according to the study, spankings raise the risk of alcohol and drug abuse by 59 percent. With a reported 94 percent of three- and four-year-olds receiving a spanking at least once in the last year, this has a widespread effect on the entire population. While one spanking does not lead to abuse, the research points to physical punishment as a regular means of discipline having adverse effects on mental health later in life.

    Is grandpa getting high? More and more often the answer is becoming yes! – Drug use and drug abuse are often thought of in connection with young people, however the Baby Boomers are proving it can affect older people just the same. Last year alone an estimated 4.8 million adults aged 50 and above used an illicit drug. The risk is not just with illegal drugs, but also the misuse of prescription drugs. With the average 50-year-old-man using four different prescription drugs per day, the risk of becoming addicted to any one of them is substantial.

    Seeing addiction as a disease, not a moral failing – In an interview with MSNBC’s Andrea Mitchell, director of the National Institute of Drug Abuse Nora Volkow explains how addiction and drug use affect the brain and why it should be considered a disease, not a moral failing. Check out this link to see the whole interview.

  • A3 Academy Intro Workshop – Level 1&2

    Here at All About Addiction (A3), we take the issue of compulsive behaviors – addiction, anxiety, eating, sex, gambling, working, and more – very seriously. We believe that they are all related to one another and we’ve developed a treatment system that aims to quickly introduce clients to a number of tools that can help them make a difference in their lives quickly.

    We’re going to hold an introductory workshop, one that addresses the issues, introduces everyone to the A3 Academy system, and takes you through levels 1-2 (of our 10-level system) all in a five hour workshop. See here for tickets – A3 Academy Tickets – for now, only those of you in Los Angeles will be able to attend, but in the future, to make sure we can help addicts everywhere, we’ll bring live streams back.

    We’re going to keep the groups small, no more than 10 people per session, and there’s no long term commitment unlike with other treatment options. Anyone can attend this workshop – people struggling with compulsive behavior or addiction themselves, family members of loved ones who are struggling, or even those of you who are just interested and want to hear more.

    We won’t make you label yourself (addict, ex-addict, whatever) and we won’t be asking you to commit to anything more than those 5 precious Saturday hours. We’re so sure that people will enjoy the workshop that we’ll offer you a money back guarantee – attend and feel like you got nothing? We’ll refund your money, no questions asked.

    We’re looking forward to seeing you and helping you become the best you possible.

  • How to Give Up Giving Up – The Lexicon of success

    When I was facing eighteen years in prison for a string of felonies long enough to make an organized crime boss proud, I made a decision that would alter the course of my life forever: I was going to change.

    It’s not that I had a problem making decisions for myself before that time. I had begun my drug dealing career so I could get, and do, what I wanted: play music, party with beautiful women, get high, and have enough money to get my parents off my back. It worked, too. For a 23-year-old, I was hugely successful–as long as you only measure success by glitter and gold. I had the Teflon invincibility of a rock star, and the ego to go with it.  Until the day the cops busted down my door and took me to jail.

    It wasn’t automatic, but after speaking with my attorney and weighing our options, it was clear that I needed to go to rehab. Not only had I been addicted to crystal meth for over three years, but my attorney was sure that if I didn’t base my defense on my drug addiction, I’d be braiding someone’s hair in prison well into my thirties.

    People think drug addicts are weak,  but maintaining an addiction is hard!  Addicts have powerful wills and incredible problem-solving skills: drop an addict in the middle of lonely road in Montana and that addict will find his drugs faster than you can find your car keys.  I just needed to channel my abilities into something that wouldn’t kill me or confine me to a life behind bars.

    So I did the thing that seemed to be in my best interest, not because I admitted failure or powerlessness, but because I decided to exercise my power in a new way.  Yes, I had to change course dramatically and leave the world I had built behind, but I knew that I wasn’t about to give up on life.

    It was made obvious to me, as it eventually is to most addicts, that the path I was on was no longer going to take me where I wanted. So I changed direction. Now, don’t get me wrong: powerlessness came into play quite a few times during the process of shifting course, most notably when I got kicked out of my first rehab for using. But powerlessness is not a new concept and it is not at all unique to addicts–we are all powerless over some events in life; we have all confronted moments of profound hopelessness and despair.  All we can do, no matter the situation, is make the best choice we see at the time and go with it. We won’t always get it right.  We will make mistakes.

    The question, however, is how we deal with outcomes that don’t suit us–how we respond to the inevitable “failures” that are the near-universal stepping stones to success. Life is less about never making a mistake or never walking down a wrong path; it’s about what you do when those things happen. Because they will, and they have–in every success story there ever was.

    We’ve all heard these stories–Abraham Lincoln continued to run for office after losing five political races in a row.  Thomas Edison conducted over 6000 experiments in two years before he developed a reliable light bulb.  J.K Rowling was rejected by twelve different publishers before finally finding a home for the Harry Potter books and a level of success beyond her wildest imaginings.

    As Edison put it: “If I find 10,000 ways something won’t work, I haven’t failed. I am not discouraged, because every wrong attempt discarded is another step forward.”

    This simple mindset makes all the difference.  For those who will succeed, failure is not an option; it’s not part of their vocabulary.

    So how can we mere mortals adopt this sort of thinking, this lexicon of success? How can we develop an unfailing belief in our ability and allow that belief to drive us forward no matter what?  Simply put, we must change our definition of failure and, in doing so, change our relationship with our struggles, our world, and ourselves.

    You see, psychologists have long known that the best functioning individuals–those who seem happy and well-adjusted–don’t actually view the world realistically. They consistently overestimate their chances of success and their own performance. You might be thinking to yourself, “Shouldn’t I be striving for as objective a view of reality as I can muster?” Apparently not–not if you want a formula for success.  It may be counter-intuitive, but if the old ways haven’t worked, we don’t have much to lose in trying something different.

    It’s hard to imagine a realist continuing his work after 100, 200, 500 failed attempts at creating an electric light bulb. Now imagine Edison’s 6000 such attempts and see: anyone objective would have quit, realizing that the likelihood of success seemed low. What about being defeated in five consecutive races for elected office? Would a realist muster up the courage to do all that work again, knowing the odds of failure? Imagine what our world would look like if Abraham Lincoln had believed in his defeats more than his vision and himself–we may never have seen Barack Obama take his oath.  Forget the “facts”–nobody has ever changed himself or the world by believing that what he’s seen before is as good as it’s going to get.

    Successful people know there’s a chance of success, however distant or small, and they know they won’t quit until that success is in their hands.  Period.  So if true failure is really just giving up trying, there’s no way to fail if you simply keep going.  Seems like a winning recipe to me.

    After I got out of jail and completed rehab, people often told me how amazed they were at my transformation.  I always told them, “I didn’t have a choice.”  But even though I believed it at the time, it wasn’t true – I had many specific behaviors to choose from: keep dealing, keep using, move, stay, get a job, go to school, and more.  And beneath those options, there was another, truly essential choice to make: to give up or not.  Not giving up meant a lot of work, a lot of struggle, and many possible “failures”.  But the alternative was simply not an option.

    My first choice was to get a job, but after being rejected for a number of them, including one at a mall Apple store, due to my criminal record, I decided to go back to school.  It’s not that a Masters degree seemed more likely than a job at the mall; it’s just that I wasn’t going to take no for an answer.  I was not going to let my past mistakes determine what was possible for my future.  As we’ve seen, success doesn’t work that way.

    Eleven years later, I’m sitting here writing this piece for Psychology Today, holding a Ph.D. in my hand (not literally, that would be weird), and helping others overcome. So screw Apple, screw the mall–screw all the messages we hear and the messages we give ourselves about what we can and cannot do.

    Whether your struggle is depression, addiction, a personality disorder, or a difficult marriage, just remember that part of the equation of powerlessness has to do with the way you see the world. With the idea of failure removed, each setback is only a wrong turn, a corrective lesson for a fresh attempt–and not a sign of falling skies. So let yourself feel sad or disappointed if you hit a rough patch on your way, but don’t believe for a second you’re hopeless. Don’t let failure be part of your vocabulary. If we could predict success by track record, we’d all still be reading by candlelight.

  • 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)

  • Is opiate pain medication safe for addicts? Part II

    In our previous article on pain medication and addicts we looked at how common opiate prescriptions are among people who are, or ever have been, identified as having substance abuse issues. We saw that although clinicians are often aware of the problem of possible prescription addiction developing, the issue of managing pain often results in the eventual prescription of opiate medications for chronic pain even in this population.

    This time we’re going to explore whether these prescriptions end up resulting in benefits to the patients. We are going to look both at opiate and non-opiate pain relief as it applies to addicts or past addicts with chronic pain.

    Pain medication benefits among addicts

    Stimulant users (cocaine, amphetamines, and methamphetamine) are not expected to experience many physical or chemical (neurophysiological or neuropharmacological) changes in their brain and nervous system that would interfere with opioid medication therapy. Additionally, their use of meth, cocaine, and similar drugs is not expected to increase their experience of pain unless they’ve been injured while using those drugs. That by no way means that their drug abuse prevents them from experiencing pain, but it less of a direct influence on the future likelihood that they’ll suffer with chronic pain.

    But those who do, or have, abused alcohol, benzodiazepines, and obviously opiates (heroin, morphine, oxycontin, etc.) are much more likely to be differentially affected by these medications. Physicians know this well, and in preparation for serious medical procedures specifically ask about such drug use to properly manage patients during surgery (don’t want someone waking up in the middle).

    One of the most obvious factors has to do with the high tolerance opiate abusers and users build up to these drugs. For this reason, the doses often needed to help long-term opiate abusers with chronic paid using opiate pain medications can be so extreme that they would easily kill an inexperienced opiate user. We’ve talked about tolerance many times on A3, so I’ll just summarize by saying that the body and brain of opiate addicts will have a much reduced response to opiate medications because their bodies have become less sensitive to the substances in response to the extended high dose use they have put it through. This can happen through reduction in available opiate receptors as well as increased responsiveness in other regulatory systems meant to counteract the opiates (the opponent process theory).

    In short, since pain perception and experience is so dependent on the body’s natural opiate response, people addicted to opiate drugs (heroin, morphine, oxycontin, vicodin) have essentially neutralized their natural pain machinery and are more likely to feel pain for an extended period after they quit. By super-activating their pain-blocking response using drugs they have weakened the body’s natural pain-response and are more likely to experience pain when they stop.

    These factors are also important when considering pain medication for people in addiction treatment. Indeed, research (1) has found that patients in Methadone Maintenance programs, who are maintained on long-term opiate therapy, are more likely to experience severe pain and more likely to get opiate pain medication prescriptions for it when compared with people in drug-free residential treatment. However, the patients in the drug-free environments were more likely to have used alcohol or benzodiazepines to deal with their chronic pain, so it seems like a bit of a case of choosing between the better of two evils.

    The specific medications for opiate-experience patients can also be different, and using more long-release or extended release formulations of these drugs can reduce the abuse liability of the medication itself while also offering better outcomes. I have to say though that the results differ when looking at different populations and it’s always important to consult, and be very honest and clear, with your doctor.

    Overall, research suggests that opiate pain medications are as effective for patients who have a history of substance abuse as hey are in the general population (but our Part I article suggests that effectiveness is itself limited). One issue, especially for heroin addicts (or people addicted to other opiates) who are in recovery or active use is balancing pain management with potential abuse problems. Unfortunately, it is true that the medications most effective in treating the pain are also the ones most likely to be abused (2). Our next article is going to cover the issues of prescription abuse in this population but I think it’s important to point out that chronic pain can be debilitating in itself and that it is likely not useful to withhold medication from someone because of the possibility that they will abuse it if the medication itself will help them.

    There are certainly approaches to pain-management that do not use medication (exercises, meditation, cognitive behavioral approaches, and more) and an initial recommendation can be that those be tried first, followed by non-opiate pain-relief and then the opiates. However, other options do not manage to deliver results, opiate pain medication can be effective in managing pain symptoms, especially if physicians are aware of methods to spot abuse and control it.

    Next up – how to identify prescription abuse in patients, what does it mean, and what should we do about it?

    Citations:

    1. Rosenblum, Joseph, Fong, Kipnis, Cleland, and Portenoy (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. The Journal of the American Medical Association, 289, 2370-2378.

    2. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.

  • Is opiate pain medication safe for addicts? Part I

    A recent user question on VYou (see my response here) addressed the issue of prescribing addicts with opioid pain medication. Since prescription medication abuse and addiction is on the rise and getting more and more attention in the media every year, the question of whether addicts in recovery, or people who have dealt with substance abuse and addiction problems in the past, should be prescribed these medications is a very relevant one.

    Chronic pain affects a substantial portion of the population worldwide (as many as 30%, see here). Opiate medications are one of the most commonly used approaches to treating such pain, which if untreated can cause serious disruptions to sufferers’ lives. Even when treated, chronic pain can be pretty debilitating. Some research (1) brings up good questions about the true effectiveness of opiate therapy for chronic pain, especially among long-term opiate users (like heroin and prescription pain medication addicts) but also among other drug using populations.

    So how common is the practice? What sort of results do drug addicts usually get from these opiate therapies? And finally, how many of the addicts or drug abusers who receive these therapies end up abusing them and can we identify those people early so we can stop prescribing to them? In this three-part series of articles we’re going to cover these questions in-depth.

    Prescription pain medication use in addict populations

    Clinicians treating chronic back pain choose from a range of options, including opioid medications, exercise therapy, nonsteroidal anti-inflammatory medications, tricyclic antidepressants, acupuncture, and electrical stimulation. One study (1)  found wide variability in the percent of chronic pain patients prescribed opioids (from 3%-66%) although the studies varied widely in their size and population served – some even looks at general back pain and not chronic pain alone (they tended to have much lower opioid prescription percentages). Among chronic pain clinic patients, chronic opioid pain medication use was estimated at 19% (2).

    Among addicted populations, concerns about tolerance, withdrawal, and abuse tend to cut prescription rates for opioid pain medications. However, past drug abuse can exacerbate pain issues, especially for people who abuse, or have abused, opiates in the past. For this reason, it can sometimes be difficult to properly manage pain in people with a history of addiction. One study (3) found that as many as 67% of patients in a Methadone Maintenance Program and 52% of patients in short term residential treatment programs were being prescribed opiates for pain. It’s important to note that these numbers are higher than those reported in other studies but that populations in treatment do generally show prescription rates higher than the general population. A study in Finland (a country that has great medical record data) found that opiate prescription rates in substance abuse populations were equivalent (not higher or lower) to those in the general population. The College of Problems on Drug Dependence itself had released an official statement noting that a balance must be reached between fear of opioid prescriptions for pain and the usefulness of opioid pain medication for chronic and severe pain (4).

    Interestingly, it seems that of all opioid pain medication prescriptions, the largest increases in troubling use has been around oxycodone (Oxycontin), which gets mentioned as often in emergency departments (ED) around the country even though it is prescribed about one-third as often as hydrocodone (Vicodin). This is less surprising when you consider the fact that many addicts report using oxycontin in different ways including smoking, snorting, and injecting the stuff, which is stronger and does not have the same amount of fillers as most hydrocodone preparations. The fact that oxycodone is stronger also means it is more effective for pain relief through higher activation of the opioid system that is relevant for addiction.

    In our next piece we are going to explore whether opiate pain medication is helpful in controlling pain among addicts and substance abusers, see you then!

    Citations:

    1. Martell, O’Connor, Kerns, Becker, Morales, Kosten, Fiellin. (2007). Systematic Review: Opioid Treatment for Chronic Back Pain: Prevalence, Efficacy, and Association with Addiction. Annals of Internal Medicine, 146, 116-127.

    2. Chabal, Erjavec, Jacobson, Mariano, Chaney (1997). Prescription Opiate Abuse in Chronic Pain Patients: Clinical Criteria, Incidence, and Predictors. Clinical Journal of Pain, 13, 150-155.

    3. Rosenblum, Joseph, Fong, Kipnis, Cleland, and Portenoy (2003). Prevalence and characteristics of chronic pain among chemically dependent patients in methadone maintenance and residential treatment facilities. The Journal of the American Medical Association, 289, 2370-2378.

    4. College on Problems of Drug Dependence taskforce on prescription opioid non-medical use and abuse: position statement.

  • WCSAD – Addiction and treatment education conference is back

    Our readers may remember us highlighting the West Cost Symposium on Addictive Disorders conference, which took place at the La Quinta Resort and Club in La Quinta, California, last year. Well, the conference was so amazing and well planned that we wanted to make sure you heard about it again this year.

    The West Coast Symposium on Addictive Disorders (WCSAD) is a three-day conference that provides attendees with the opportunity to learn and network at the same time while getting to hear presentations on some of the most important, relevant, and current topics in addiction and addiction treatment. And the topics this year cover essentially every aspect of addiction including:

    Keynote Speakers for 2012

    • Raul Rodriquez, MD – CEO and Medical Director of the Delray Center for healing
    • Brad Lamm, BR-1- Founder and president of Intervention specialist
    • William G. Borcher – Screenwriter and author, known for his work on the film “My name Is Bill W.”
    • Robert Weiss, LCSW,  CSAT-S – Founding Director of The Sexual Recovery Institute (SRI)
    • Mel Pohl, MD, FASAM- Family Practitioner and Medical Director of Las Vegas Recovery Center
    • Garret O’ Conner, MD- Professor of Psychiatry at UCLA

    In addition to the enlightening talks mentioned above, WCSAD will also feature other events that will allow attendees to have some fun:

    • WCSAD Golf Tournament at PGA West
    • Fun Run/Walk Sponsored by Runwell
    • Treatment Professionals Alum
    • Discounted Spa for WCSAD Registrants

    At the end of the three days you will better educated on addiction in general and on any specific topic you feel really passionate about or interested in. You can also earn Continuing Education credits and come by and meet us at our booth too!

    If you want to register, make sure to use our special VIP code – AAAVIP – it’ll get you in to the pre-conference for free AND save you $50 off the registration fee. If you have any questions you can feel free to email me or Dee McGraw at deemcgraw@ameritech.net, or visit www.wcsad.com for details.

    Hope to see you at La Quinta!!!

  • Brain and relaxation drinks – the new fad

    You’ve seen them advertised an on store shelves – drinks with names like Neuro, IDrink, and Dreamwater promise that their combinations of hormones, neurotransmitters, and related amino-acids will keep you relaxed, focused, happy, and improve your sex life. We’ve seen these sorts of promises before from unregulated dietary supplements.

    The problem is that, since these sort of relaxation or brain drinks aren’t tightly controlled by the FDA like most medicines, little is known about what is actually in them let alone the sources for those ingredients, their safety, or often the dose. While it is true that many of these over the counter drinks purport to offer the sort of benefits or effects usually associated with the substances they are supposed to contain. But what doses are proper and what combinations are safe? Fortunately for the makers of these drinks, those questions don’t have to be answered by dietary supplement makers. Lucky for them.

    This sort of drink fad reminds many of us in the scientific community of the issues raised when energy drinks like RedBull, Monster, Rockstar, and others showed up – pushing as much caffeine into users as 4-5 or more cups of strong coffee in one can. Things got worse when those drinks were mixed with alcohol, finally culminating in their mixing right in the can! Lots of caffeine and alcohol?! Sure, here you go! Too bad drinking these in massive quantities sent dozens, if not hundreds, of young people across the United States to hospitals for cardiac problems, blackouts caused by excessive drinking masked by the caffeine, and near death from alcohol poisoning.

    The question is – what may we find out about these new relaxation and brain drinks containing unspecified amounts of GABA, melatonin, 5-HTP, and other chemicals that are important for brain function. Will they help, hurt, or cause irreparable damage? Since we don’t have years of data and multiple studies assessing their use, that’s a question that’s going to take a while to answer – until then, sip carefully and be sure to take marketing slogans with a grain of salt.

  • The best addiction treatment option

    I get asked which addiction treatment option is the best all the time. The short answer? Whichever one ends up working for the client.

    I don’t like being stuck in the corner, having to pick a “best of” option just because I’m asked. For some clients Moderation Management will work, others need intense day-treatment or an in-hospital residential treatment program before moving into a more traditional residential place for a year or more. Some clients feel suffocated by such a structured environment and can’t manage it – outpatient treatment options can be a better fit there.

    Sometimes we ask ourselves questions in a way that forces us to make bad choices: Which is better, chocolate or vanilla ice-cream? I reject the premise.

    It’s about time we all faced the fact that only rare occasions allow for two-word answers that are absolutely true. The world is full of nuance and if we don’t start allowing some gray into our conceptualization of questions and answers we are going to keep repeating the past mistakes of polarized opposition to a small number of camps that are all equally wrong.

    Brain research supports the notion that they way in which questions are posed can affect the sort of answers we look for – our brain pays attention to the stimuli it expects to find. So if you think that all you have to pick from are two or three options, your brain will calculate costs and benefits and spit out an answer – 42. It’s what happens when you ask the wrong question – you get a nonsensical answer.

    So I don’t answer question like “which treatment is best?” or “which is more important, biology, the environment, or personality?” The way I see it the pieces are all so interconnected that the separation is false. The question is moot. And that’s true whether you’re picking addiction treatment or a your favorite cone.