Why Prevent Drug Abuse?

 

WHY INVEST MORE MONEY IN DRUG ABUSE PREVENTION?
AFTER ALL, IT WON'T FIX THE PROBLEM, WILL IT?

"Prevention programs are not vaccinations

that inoculate children against substance abuse. 

Sadly, significant numbers of young people 

who participate in the best programs 

will go on to use drugs."

("Preventing Drug Abuse," Office of National Drug Control Policy, 1999)

We all know the reality of drug abuse prevention. No knowledgeable person would claim that prevention programs alone will stop the nationwide epidemic of drug abuse by American youth. Despite our best efforts to educate children about the dangers of abuse, many will choose to experiment with substances and take active roles in the drug culture.

Let's not kid ourselves about the massive changes in society 

that must be initiated to stop the deadly consequences of drug dependency. 

Children can be negatively influenced by 

their families, 

their schools, 

their neighborhoods, 

and popular culture – especially the media.

HOWEVER

Preventing drug abuse is one of the best investments we can make in our country's future. Doing so is preferable to dealing with the consequences of drug abuse through law enforcement or drug treatment.

The "no-use" message must be reinforced consistently by parents, teachers, clergy, coaches, mentors, and other care givers.

AND, EVIDENCE SHOWS 

PREVENTION DOES WORK

A. Studies indicate that students' attitudes, beliefs, and skills that counter or resist substance abuse and other kinds of delinquent or violent behavior can be enhanced by instructional approaches combining social and thinking skills with resistance skills.

(Botvin, Baker, Dusenbury, et al. 1995; Greenberg, Kusche, Cook, and Quamma, 1995; Caplan, Weissberg, Grober, et al. 1992; and Bry, 1982).

Evidence supports that students in strong prevention programs can learn the following:

* Empathy and perspective-taking, which demonstrates that people can have different views of the same situation.

* Social problem-solving, which allows students to solve social problems with a series of steps that involve setting pro-social goals, generating alternative solutions. anticipating the consequences of actions, choosing the best course of action, and successfully executing the solution.

* Anger management or impulse control, which helps students understand how anger escalates and teaches personal techniques for controlling it.

* Communication skills, which involve students’ active listening, understanding of nonverbal communication, and ways to express their thoughts and feelings in a non-inflammatory manner.

* Stress management or coping skills, which provide adaptive strategies for dealing with or relieving stress or anxiety.

* Media literacy skills that help students recognize and resist media influences that glorify violence or substance abuse.

* Assertiveness skills that provide students with methods of working toward their goals without provoking others.

* Character/belief development that helps students understand how the content of their beliefs affects the decisions they make. Teaching these skills is sometimes referred to as character education or normative education.

* Resistance skill training that helps students rebuff peer pressure toward substance abuse and violence.

B. Good junior high school interventions affect knowledge and attitudes about drugs, use of cigarettes and marijuana, and persist into the twelfth grade.  

(Botvin, G. J., Baker, E.,Dusenbury, L., Botvin, E.M., and Diaz, T. "Long-Term Follow-Up Results of a Randomized Drug Abuse Prevention Trial in a White Middle-Class Population," Journal of the American Medical Association, Vol. 273, (1995), pp. 1106-1112.)

C. A Cornell University study of six thousand students in New York state found that the odds of drinking, smoking, and using marijuana were 40 percent lower among students who participated in a school-based substance-abuse program in grades seven through nine than among their counterparts who did not. Similarly, an assessment of Project STAR found that forty-two participating schools in Kansas City, Missouri reported less student use of alcohol, tobacco, and marijuana than control sites.  

(Information about prevention findings at Cornell University, Project STAR and other CSAP grantee programs can be obtained online, January 29, 1999.)

D. Since rates of drug use seem to spread in a manner similar to an epidemic, prevention will be more effective when undertaken EARLY in the cycle when use is proliferating with existing users introducing others to drugs.

"At this time, enabling  

ONE PERSON TO ABSTAIN CAN PREVENT OTHER INITIATIONS.

Rather than be reactive,  

prevention programs should be proactive 

and reach each rising cohort."

The NIDA pamphlet Preventing Drug Use Among Children an Adolescents: A Research-Based Guide. (Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse,March 1997, reprinted November 1997, January 29, 1999) 

 RISK FACTORS AND 

PROTECTIVE FACTORS

Research over the past two decades has tried to determine how drug abuse begins and how it progresses. Many factors can add to a person’s risk for drug abuse. Risk factors can increase a person’s chances for drug abuse, while protective factors can reduce the risk. Please note, however, that most individuals at risk for drug abuse do not start using drugs or become addicted. Also, a risk factor for one person may not be for another.

"Risk and protective factors can affect children 

at different stages of their lives. 
At each stage, risks occur 
that can be changed through 
prevention intervention."

("Preventing Drug Abuse Among Children and Adolescents," National Institute On Drug Abuse, U.S. Department of Health and Human Services, 2011)

Thinking Like a Teen

 

"Truth is, the teenage brain is like a Ferrari: 

It's sleek, shiny, sexy, and fast, 

and it corners really well. 

But it also has really crappy brakes."

 (Judith Newman, "Inside the Teenage Brain," Parade, November 28 2010)

It is a very common misconception to view teenagers as adults. And, no wonder -- so many young people today look mature, handle tough schedules, successfully multitask activities, ace difficult courses in high school (and college), and exhibit many other characteristics associated with adults. HOWEVER, TEENS ARE STILL DEVELOPING, EXPERIMENTING, AND LEARNING. To assume they need less guidance and less structure than younger children can lead to some dreadful consequences.

Does this scenario sound familiar?

"Your teenage daughter gets top marks in school, captains the debate team, and volunteers at a shelter for homeless people. But while driving the family car, she text-messages her best friend and rear-ends another vehicle.

"How can teens be so clever, accomplished, and responsible—and reckless at the same time? Easily, according to two physicians at Children’s Hospital Boston and Harvard Medical School (HMS) who have been exploring the unique structure and chemistry of the adolescent brain. 'The teenage brain is not just an adult brain with fewer miles on it,' says Frances E. Jensen, a professor of neurology. 'It’s a paradoxical time of development. These are people with very sharp brains, but they’re not quite sure what to do with them.'

"Research during the past 10 years, powered by technology such as functional magnetic resonance imaging, has revealed that young brains have both fast-growing synapses and sections that remain unconnected. This leaves teens easily influenced by their environment and more prone to impulsive behavior, even without the impact of souped-up hormones and any genetic or family predispositions." (Debra Bradley Ruder, "The Teen Brain," Harvard Magazine, September-October 2008)

Human and animal studies have shown that the brain grows and changes continually in young people—and that it is only about 80 percent developed in adolescents. The largest part, the cortex, is divided into lobes that mature from back to front. The last section to connect is the frontal lobe, responsible for cognitive processes such as reasoning, planning, and judgment. Normally this mental merger is not completed until somewhere between ages 25 and 30.

A Few Findings About the Teen Brain

1. Teen brains are more susceptible to external stressors and alcohol or drug induced toxicity than their adult counterparts. (Debra Bradley Ruder, "The Teen Brain," Harvard Magazine, September-October 2008).

3. With the tremendous amount of cognitive input that’s coming at teens, they need practical strategies for making in-the-moment decisions, rather than mere lecture teens about behaviors themselves. (Have you ever met a pregnant teenager who didn’t know biologically how this transpired?)

4. Cognitive control over high-risk behaviors is still maturing during adolescence, making teens more apt to engage in risky behaviors. Teens are at risk for addiction vulnerability, and mental illness, as different parts of the brain mature at different rates. ("The Adolescent Brain," Brain Briefings, Society For Neuroscience, January 2007)

5. Since teens' prefrontal cortex is still developing, they are prone to have trouble organizing plans and ideas, forming strategies, and controlling impulses.

6. Amy R. Wolfson, PhD, of the College of the Holy Cross, and Mary A. Carskadon, PhD, of Brown University Medical School, found that beginning in puberty and continuing into the early 20s, adolescents need from 8.4 to 9.2 hours of sleep on average a night, compared with 7.5 to 8 hours for adults. (Siri Carpenter, "Sleep Deprivation May Be Undermining Teen Health," American Psychological Association Monitor, October 2001)

What Is a Parent To Do?

Here are some questions parents may want to consider concerning their children's risky teen years. Thanks to Denise Witmer ("Top Ten Things You Can Do To Prevent Your Teen From Taking Drugs," About.com Guide) for the advice. Aren't these practical suggestions considering the state of the teenage brain?


1. Will your teen CALL YOU if the party he/she attends makes drugs available?

2. Do you know your TEEN'S FRIENDS AND THEIR PARENTS on a FIRST NAME BASIS?

3. If you can't be home with your teen, do you CALL and LEAVE NOTES while ESTABLISHING A ROUTINE to keep him/her busy?

4. Do you TALK OFTEN with your teen about drugs?

5. Do you encourage your teen TO GET INVOLVED in positive extra-curricular sports, clubs, and community organizations and LIMIT TIME HE/SHE SPENDS JUST HANGING OUT?

6. Do you ASK QUESTIONS when your teen makes plans to go out such as -- Who with? Where going? What doing? -- AND CALL OTHER PARENTS to check up?

7. Do YOU EVER USE ILLEGAL DRUGS or ABUSE LEGAL DRUGS (Including alcohol)?

8. Do you use strong family beliefs to UNITE YOUR FAMILY with healthy ways to enjoy life AND FIX PROBLEMS INSTEAD OF PROVIDING A MEANS OF ESCAPE?

9. Do you DO THINGS TOGETHER as a family, even as simple as EATING FAMILY MEALS TOGETHER?

10. Do you drop any baggage you carry and NOT ALLOW MISTAKES YOU MADE AS A TEENAGER TO INFLUENCE YOUR TEEN IN A NEGATIVE WAY?

Children and Safety

The best approach 

to reducing the tremendous toll 

substance abuse exacts from individuals, families, and communities 

is to 

prevent the damage before it occurs. 

("Drug Abuse is a Preventable Behavior," A Research Update 

from the National Institute on Drug Abuse, March 2007)

Here are some key findings from prevention research:

Addiction is a complex disease. No single factor can predict who will become addicted to drugs. Addiction is influenced by a tangle of factors involving genes, environment, and age of first use. Recent advances in genetic research have enabled researchers to begin to uncover which genes make a person more vulnerable, which protect a person against addiction, and how genes and environment interact.

Addiction is a developmental disease. It usually begins in adolescence or even childhood when the brain continues to undergo changes. The prefrontal cortex– located just behind the forehead– governs judgment and decision-making functions and is the last part of the brain to develop. This may help explain why teens are prone to risk-taking, are particularly vulnerable to drug abuse, and why exposure to drugs at this critical time may affect propensity for future addiction.

Prevention and early intervention work best. The developmental years might also present opportunities for resiliency and for receptivity to intervention that can alter the course of addiction. We already know many of the risk factors that lead to drug abuse and addiction– mental illness, physical or sexual abuse, aggressive behavior, academic problems, poor social skills, and poor parent-child relations. This knowledge, combined with better understanding of the motivational processes at work in the young brain, can be applied to prevent drug abuse from starting or to intervene early to stop it when warning signs emerge.

Effective prevention principles can be applied. Youth prevention programs must be specifically designed to "speak to the audience." Research has demonstrated that research-based drug abuse prevention programs are cost-effective. Each dollar invested in prevention achieves a savings of up to $7 in areas such as substance abuse treatment and criminal justice system costs, not to mention their wider impact on the trajectory of young lives and their families.

Consider just some of the many areas of concern for children:

1. Anabolic steroids,

2. Hard drugs such as cocaine and heroin,

3. Ecstasy (MDMA),

4. Inhalants,

5. Marijuana,

6. Prescription drugs,

7. Stimulants,

8. Tobacco,

9. Alcohol,

10. Meth,

11. Bath salts and other "designer drugs,"

12. HIV, AIDS, and their association with drug abuse,

13. Teen pregnancy related to drug abuse,

14. Depression and other mental illnesses related to drug abuse,

15. Large numbers of co-existing health problems related to drug abuse.

16. Criminal behavior related to drug abuse,

17. Suicide,

18. Addiction.

Consider just some of the tremendous pressures on children:

1. The pressure to be successful,

2. The pressure to fit in,

3. The pressure to be sexually active,

4. The pressure to pick on others.

Think of the amount of concentrated education required for safely operating a motor vehicle. The State and parents emphatically preach the tremendous responsibilities of teens climbing "behind the wheel." They require effective training, up-to-date knowledge, and graduated hands-on experience to ensure the safety of teen drivers. Every parent fears the consequences of too little driving education.

Solo driving by teens is regarded as very serious business because the automobile is a potentially deadly weapon, and parents know their teenagers are prone to make some mistakes. No parent wants a poorly educated son or daughter driving.

Drug abuse is the #1 cause of accidental death among young people.

How about drug education? How much time and effort are currently spent educating youth about the dangers of drug abuse? Not enough -- certainly not as much time and effort as are spent educating teen drivers. Is it any wonder the problem has escalated to epidemic proportions. America must make prevention and early intervention the highest priority in school-age health education. Failure to do so is unacceptable. Citizens all must rise to their duty, make commitments to support prevention, and help protect the safety of all.

Do you expect the children you love to solo in a world of escalating drug abuse with insufficient education?

You Must Invest More 

To Reap Maximum Benefits 

And Prevent Disastrous Consequences!

Money Well Spent: Prevention

 Why Must We Spend More To Save Our Kids?

"Ohio's spending on substance abuse's consequences totaled $4.9 billion,

roughly 12% of state spending in 2005, 

while spending on prevention, treatment and research

only accounted for 0.3% of the overall state budget."

For every dollar spent on substance abuse, 

1 cent went to prevention, 

1 cent to treatment, 

7 cents to regulation and compliance, and 

90 cents to cover the associated burden on public services. 

This report: "Shoveling Up II: The Impact of Substance Abuse on Federal, State and Local Budgets" by the National Center on Addiction and Substance Abuse at Columbia University is the result of a three-year study to assess the costs of tobacco, alcohol and illegal and prescription drug abuse at all levels of government.

When considering Federal, State and local budgets combined, the report put spending related to substance abuse in Ohio at nearly $5.4 billion, or nearly $469 per capita. ("Substance Abuse Costs States, U.S.," The Business Journal of Youngstown Ohio, June 10 2009)

This report clearly illustrates the astounding impact untreated substance abuse and addiction has on our state's bottom line, said Angela Cornelius Dawson, director of the Ohio Department of Alcohol and Drug Addiction Services. While the economic forces that are driving budget decisions are out of our control, it is imperative that we focus our efforts on strategic investments that can save our state money. Alcohol and drug addiction services are one such investment that continues to demonstrate a positive return.

In fact, the Ohio Department of Alcohol and Drug Addiction Services 

and the National Institute on Drug Abuse both estimate that 

every dollar spent on prevention 
saves $7 in related expenses.

How Our Spending Can Save Lives and Money

The ADAMHS (Alcohol Drug and Mental Health Services) board is proposing a $1 million levy for 5 years to be put on the November 8th ballot. The levy will generate $950,000 per year for prevention education in all of Scioto County.

Sounds great. After all, currently there is less that $3.00 per child available in Scioto County for prevention education in the schools. 

 BUT... 

I know: What about

THE COST?

How can we afford to spend more in these times of economic hardships? The levy will cost a property owner 10 cents per $100.00 of property value/$1.00 per $1000.00. $4.17 per month for the owner of a home valued at $50,000.

The truth is...

HOW CAN WE NOT AFFORD 

THE COST?

Scioto County is the epicenter for prescription drug abuse. It is the #1 cause of accidental death among our young people. We may not like it, but we cannot ignore the facts. The last couple years, we have made great strides to improve conditions; however, more emphasis on prevention is desperately needed.

Consider the continuing risk of drug abuse among Scioto youth. Drug abusing youth have powerful influence over others. Negative peer pressure and social influences related to drugs have had devastating effects on countless youth and their families. Now, we have the obligation to assure that all Scioto County youth receive the best educational program to protect themselves (and all of us) from the ravages of abuse.

It is time we face a sobering reality: our children are not receiving the tools they need to fight the many pressures of living in our drug-riddled communities. Prevention education must start at a young age and must continue throughout school years. We can't afford to allow ignorance and indifference to weaken our resolve to fight abuse.

Our children are our greatest resource and our promise for a brighter future. Well-educated children can make sound decisions that will lead to healthy, happy lives. The implementation of evidence-based curriculum will provide prevention education to sow the seeds of knowledge in our youth essential to fostering their lifelong positive growth. 

Prevention education will pay huge dividends. It will do the following:

1. Reduce the rise of drug experimentation,

2. Reduce drug overdose,

3. Reduce academic and behavioral problems,

4. Reduce crime and incarceration,

5. Reduce the costs of long term health care of drug dependent individuals,

6. Reduce the number of babies born addicted,

7. Reduce the number of those who seek addiction treatment, and

8. Reduce other costs associated with drug abuse including lost wages.

The children in our community must learn about the dangers of drug abuse at an early age, and everyone needs to support these youth in their most formative years. The Scioto County Coalition of Drug Prevention wants to Save Our Kids through prevention education. Join the cause.The expense will save both money and the lives of our precious children.

Younger Risks

Looking back to the high energy, fun-seeking days of my youth, I realize that I, like most American teens, once possessed a high propensity to engage in risky behavior. In my younger days, I felt seeking what we then called carefree "kicks" was perfectly natural and 100% safe. This unconstrained, bulletproof attitude even served to build my "rep" and bolster the "tuff" image that spurred my popularity.

Seeking novel experiences, I yearned for adventures that would bring me ever closer to crossing lines of safety and reason. Venturing into uncharted territories, I tested the limits of my ever-expanding freedom and blindly trusted luck during my many risky excursions. I found rushes of excitation to be irresistible. After all, cool people "did things" while the squares just thought about "doing them."

This is not to say that I didn't calculate my movements and consider the consequences of my behavior. My conscience always begged me to exercise constraint, but I had a brain full of morals and values and a body full of adrenaline and testosterone. Needless to say, I made more than my share of bad decisions that resulted in disasters. Now, I consider myself very lucky to have survived the falls of youth with minimal permanent damage.

Why did I ever flirt with dangers that might have taken the ultimate toll? I've thought about this, and I've come up with some answers.

When I was young, I was...

1. Easily bored,
2. Overly curious,
3. Significantly insecure,
4. Subject to peer pressure,
5. Fun-loving,
6. Longing to prove maturity,
7. Prone to seek attention,
8. Easily impressionable,
9. Drawn toward rebellion,
10. Blind to reality.

Now that I'm an old geezer -- the one with the permanently flashing turn signal driving  45 MPH on the freeway -- I've learned that a slower, more deliberate lifestyle will likely buy me some more precious time. I know now that thinking I'm cool by doing things that can potentially damage my health and the health of others is stupid and selfish.

I still like to have fun; however, I understand that I can be very happy by eliminating risks and walking the line.
In fact, I admire most those who find joy in the good, small things life has to offer. I see that adventurous complications often draw me away from my best interests.

And, I understand that the best peers are those who do not pressure me, but, who, instead, take me for the person I am (with all of my hangups and faults). These friends stand the tests of trials and time.

Most of all, I have learned to hate -- to hate all of those excesses that have robbed me of good friendships formed in my youth:

the speeding car;
the ever-flowing alcohol;
the cancerous drug addiction;
the violent, spur-of-the-moment emotion;
the life-choking cigarette,
the unrelenting mental illness.

Gone is my high propensity to engage in risky behaviors. I see these thoughtless actions end the lives of too many much too soon.

Ohio and Heroin

News: Heroin Revival in Ohio

The heroin revival, 

said Drug Enforcement Agent agent Anthony Marotta of Detroit,

"is being driven by prescription pills." 

With oxycontin or "OC" pills fetching $80 apiece on the black market,

"people can't afford $300 a day so they're paying $15 to $20 bucks a balloon [of heroin]." 

(Paul Solman & Kelly Chen & Sarah Svoboda, 

"Getting High For Less: Easier Access to Better, Cheaper Heroin Cripples Small Towns," www.pbs.org/newshour, August 18 2011)

Cheaper Than Rx

As agent Marotta points out, for just $15 to $20, users can purchase a small "balloon-full" of approximately a tenth of a gram of Mexican black tar heroin to get a high equivalent to half an 80 mg opioid pill -- some $40 worth.

The Department of Justice calculates that "abusers could maintain their addiction with two grams of heroin daily, at a cost of one-third to one-half of prescription opioids, depending on the area of the country and the purity of that heroin."

In other words, heroin has become a down-market alternative -- an increasingly attractive one in battered economies like Crawford's. And the declining market price of black tar heroin has made the drug more popular among the young, further fueling its spread.

Black tar dealers employ what is referred to as

a "Pizza Hut/Domino" delivery model. 

After a phone order, dealers will come to you 

at your preferred drop-off location -- 

be it at home or an undisclosed parking lot. 

After the hand-off is complete, 

the dealer follows up with a phone call to ensure users received a satisfactory high. 

Simplifying the transaction also keeps it inconspicuous, 

a consumer benefit in quiet suburban communities.

(Paul Solman & Kelly Chen & Sarah Svoboda, 

"Getting High For Less: Easier Access to Better, Cheaper Heroin Cripples Small Towns," www.pbs.org/newshour, August 18 2011)

Personalized selling has helped black tar heroin dealers nurture a steady clientele; first-time customers, pleased with the quality and service, come back for more of a product they increasingly can't resist.
The entrepreneurial spirit of the black tar heroin market, in the United States and in Mexico, has further facilitated the chain of Mexican black tar sources largely operated out of Mexico's Pacific Coast, more than 1,000 miles away from the border.

In Nayarit, Xalisco, producers have easy access to poppy seed production. Together, producers and farmers tightly control the supply of black tar heroin by limiting the quantity of production. Unlike drug cartels along the border, these cells operate in small franchise networks without the fuss of the middlemen.

From Mexico, runners transport the drug to the East Coast either by plane from Phoenix or Los Angeles to Columbus or by car over the southwest border -- again to Columbus and Charlotte, N.C.

From these hubs, local dealers can dispense to smaller towns and cover the country.

"Charlotte and Columbus are important crossroads that connect the East and West, North and South...the hub of the spoke system, which then subdivides into secondary and tertiary places," said Eric Olson at the Woodrow Wilson International Center for Scholars' Mexico Institute.

As Anthony Marotta points out, the Buckeye State is not known as a drug entrepot (warehouse).

"This is Ohio we're talking about, not Miami," said Marotta. 

And yet, "Columbus is not only an end for this stuff 

but a [trafficking] source for the supply of other places." 

(Paul Solman & Kelly Chen & Sarah Svoboda, 

"Getting High For Less: Easier Access to Better, Cheaper Heroin Cripples Small Towns," www.pbs.org/newshour, August 18 2011)

Younger Clientele

"We are seeing a trend toward younger and younger people experimenting with heroin," said Dr. Gregory Collins, director of the Cleveland Clinic Alcohol and Drug Recovery Center. "They are moving from alcohol to marijuana and then heroin. It's a quick progression. Sometimes there's a brief interlude with pain pills."
("Heroin Linked to Ohio Prescription Drug Problems," Associated Press, nbc4i.com, February 21 2011)

Some people start abusing the seemingly more palatable pills and quickly transition to the more hard-core and cheaper heroin, once addiction takes hold.

"Young users with a low tolerance 

for the potent drug are especially 

at risk of death," Collins said.

(Rachel Dissell, 

"Overdose deaths Climb As Painkillers, Heroin Pour Into Ohio Market,"  

Cleveland Plain Dealer, February 20 2011)

Crack Cocaine Dealers Switching To Heroin

In a report by the Ohio Department of Drug and Alcohol Addiction Services, law enforcement officials said the heroin business is increasingly being run by Mexican drug cartels that find demand shooting up because people hooked on prescription painkillers are switching to more powerful drugs. In addition, crack cocaine dealers are switching to selling heroin, the report said.

(Alan Johnson, "Heroin Habit Grows Among Ohio's Youth,"  

The Columbus Dispatch, April 23 2011)

Snorting Higher Quality Heroin

"Much of the increase in heroin trade 

is attributed to higher quality heroin 

which makes it easier for dealers to turn a profit," 

said Assistant U.S. Attorney Joe Pinjuh. 

Purer grades of heroin can be cut and repackaged into more lots for resale. Pinjuh said the growing success of Mexican drug operations in pushing drugs into the United States has also contributed to the increased supply of heroin.

Another factor fueling demand for heroin is that dealers are turning it into a form that can be snorted, an easier and less intimidating way of ingesting than injection by needle.

(Peter Krouse, 

"Heroin Bust Points To Drug's Growing Popularity In Northeast Ohio,"  

Cleveland Plain Dealer, January 13 2011)

Heroin In the Southern Suburbs

Orman Hall with the Ohio Department of Alcohol and Addiction Services said that heroin is a growing problem in Ohio, and it's not just in big cities. "The opiate and heroin problem we currently have in our state is centered in the southern part of the state in rural and suburban communities," said Hall.

 ("Heroin Bust Takes Down Major Distributor,"  

www.onntv.com, August 18 2011)

Professionals and Business Execs Choosing Heroin

Opiates, including heroin, are quickly becoming the drug of choice for many people, including some pillars of the community."We're seeing business professionals, business executives, housewives, college students," said Dr. Jeffrey Stuckert, of Northland Outpatient Rehab and The Ridge Residential Rehab and Treatment Center.

"There's certainly a problem with doctors, pharmacists, nurses. 

It knows no socioeconomic boundaries."

("Professionals Among New Faces of Heroin Addiction," 

News 5, wlwt.com, 

May 25 2011)

Billboard Asks "Do You Know Where Your Heroin Has Been?"

An Ohio family services organization has one question for heroin users: Do you know where your heroin has been? An eye-catching billboard sponsored by Hardin County Jobs and Family Services has turned heads with its honest - and slightly disgusting message to potential or current drug users. Here is the message:

Summer 2009, Police arrested a Kenton Man

with over 900 balloons of Heroin Up his Butt

"Where has your heroin been?"

(Nina Mandell, 

"Ohio Anti-drug Billboard Sparks Controversy with Message About Heroin's Long Journey to Users,"  

New York Daily News, 

May 21 2011)

Heroin Abuse Fuels the Need For Foster Parents

"Clermont County is critically in need of foster parents," said Tim Dick.  In 2010, the Clermont County Department of Job and Family Services’ (DJFS) Children’s Protective Services (CPS) division removed 235 children from homes, because of abuse or neglect; that is a 51 percent increase over 2009.

Heroin abuse has had a big impact on this situation," said CPS Deputy Director Tim Dick.

“Too many times law enforcement 

has called our staff to the scene 

where a parent has overdosed 

and the child was there to see it, 

living in filthy conditions.  

There have even been cases 

where the child has pricked himself

with a heroin needle he picked up at his home 

or ingested prescription drugs that had been obtained illegally.  

It is sad.”

("Heroin Abuse Has Big Impact On Local Child Abuse Cases,"  

Loveland Magazine, 

January 31 201)

Chasing the Dragon Surge

They call it: ''Chasing the dragon.''

Although it might seem like some magical image 

from a Harry Potter movie, authorities in Summit County

say it's a deadly catch phrase for a growing number of heroin users

who cannot resist, or stop, taking the drug.

Heroin use in the area has risen to such an alarming extent, Summit County Medical Examiner Lisa J. Kohler recently released fatality statistics showing that the number of heroin-related deaths this year through mid-October is nearly double the total from last year.

Kohler reported 20 heroin-related deaths in 2010, compared to 11 for all of 2009, when she began tracking the numbers and types of cases for drugs that can kill.

The heroin surge, Kohler said, partly can be attributed to users abandoning the age-old method of directly injecting the drug into the bloodstream with a needle in favor of inhaling the drug by smoking it.

(Ed Meyer, 

"Summit County Officials Report Alarming Surge in Heroin Deaths,"  

Beacon Journal - ohio.com/news, 

November 5 2010)

A Deadly Pinch of Salts

Thank you Representative Margaret Ann Ruhl, 

Representative Clayton Luckie,

and Senator Dave Burke. 

Your sponsorship of House Bill 64 will, undoubtedly, 

protect the health and lives of residents of Ohio.

Ruhl, R-Mount Vernon; Luckie, D-Dayton; and Burke, R-Marysville announced that House Bill 64, which was signed into law in July, will be effective on October 17th. ("Statewide K2 Bath Salts Law Takes Effect Oct. 17," Bellefontaine Examiner, October 8 2011)

The act — jointly sponsored by Ruhl and Burke — bans the possession, use and sale of synthetic drugs commonly known as "K2" or "spice" and adds six synthetic derivatives of cathinone that have been found in bath salts to the list of Schedule I controlled hallucinogenic substances.

Under H.B. 64 penalties for the possession or trafficking of K2 or spice will be the same as currently enforced for marijuana — a minor misdemeanor for possession and a fifth degree felony if convicted of trafficking in the vicinity of a school or juvenile.

"K2 and bath salts have already taken the lives of many Ohioans,” Senator Burke said. “As a pharmacist, I understand the effect these substances have on the human body. Making these products illegal is the only way to stop the shadowy underworld of these designer drugs."
H.B. 64 received widespread bipartisan support in the Ohio House and Senate where the bill was adopted 95-1 and 33-0, respectively.

These substances are popular among illegal drug users because, until now, they were legal and virtually undetectable on average employment drug-screen tests. They have drawn the attention of law enforcement when people began showing up in hospitals and even dying after smoking or snorting them.

Last fall, Alliance and Hartville officials outlawed K2, which police, users and even manufacturers said mimics the effects of marijuana yet does not contain THC, the main psychoactive ingredient in pot. Thirteen states already had deemed K2 and its chemical ingredient, JWH-018, as illegal. (Lori Monsewicz, "Bath Salts -- the New Drug of Choice -- Are Outlawed," CantonRep.com, July 18 2011)

State Representative Kirk Schuring, R-Jackson Township, stated, “The folks that are producing this stuff keep on changing it, making slight variations to the chemical compound,” Schuring said. “They cleverly try to use a different recipe to mix their cocktail. Yet, they are still using the cannabinoids and the (same) primary ingredients.”

Schuring said the H.B. 64 casts “a wider net." The legislation contains a provision that allows state officials to add any future substances designed to imitate the effect of illegal drugs to Ohio's list of controlled substances.

“So, as this stuff keeps evolving into different types of chemical combinations, we can use law enforcement to reign them in,” he said. “These are very dangerous drugs, particularly the bath salts and what it does.”

Side Effects of Bath Salts

Hallucinations
Extreme Paranoia
Agitation
Dependency
Psychosis From Sleep Withdrawal
Fear
Delusions
Self-Mutilation
Increased Blood Pressure and Heart Rate
Overdose
Death - By way of Overdose, Self-Harm, or Suicide.

One additional problem with bath salts overdoses is that they are difficult to treat even when the victims are brought to the emergency room because medical professionals do not know what toxin may be causing the problem. With other drugs, including opiates, there are readily available injections that can counteract bad effects and overdose situations. Bath salts overdoses may go untreated, and can be misdiagnosed as other issues since the drugs themselves aren't discovered in standard drug testing.

Bath Salts Incidents 

A Tennessee man high on the drugs threatened to perform surgery on himself, believing something was in his leg.

A Florida man walked into Tampa traffic, yelling and banging on cars, and later died of a bath salts overdose.

A couple high on bath salts in West Pittston, Pennsylvania., thought 90 people were hiding in their apartment walls. "They were actually ripping the drywall off the walls and trying to stab people inside the walls with large knives," a police officer said.

In Washington state, a family wound up dead after the parents took bath salts. An Army Sgt., a medic with post-traumatic stress disorder, shot his wife and then himself during a police chase. Authorities later found the couple's 5-year-old son suffocated with a bag tied over his head at their trashed home, where several open packages of bath salts were spotted. Tests showed both parents had bath salts in their systems.

In Kansas, a 21-year-old  ran onto Interstate 135, waving his hands, before he was struck and killed by a van. In his pocket, police discovered a container of Blue Magic Bath Salts.

A 29-year-old committed suicide in Missouri, allegedly after a binge on Ivory Wave bath salts. He had reportedly been off painkillers for two years when he developed an addiction to Ivory Wave. His father told media he found several packets of the bath salts in his son's room. His friends and family described him as emaciated, paranoid, and sleepless in the days leading to his death.

In Minnesota, the boom of a gunshot jolted a mother out of bed. Holding her breath as she ran down the stairs to the garage, she flung open the door. Her 32-year-old son calmly came inside clutching a Winchester rifle. She grabbed the gun and called 911. "Can't you see them? There's people messing with my car," she remembers him saying as he paced from window to window in the living room, flipping on yard lights and peering outside. "There they are." His mother looked. The dark street was empty. She learned that night that her son, who she said had a history of chemical abuse, had taken a man-made substance with the slang name "plant food," better known as bath salts.

In Winona, Minnesota, a 26-year-old, said he had been drug-free for "quite some time." But when someone at a party offered him a free sample of the new drug and told him it was legal, he decided to try it. He ended up using the stimulants for six months. He said he hallucinated about angels and demons and once swallowed more than 2 grams when he thought that police were coming to get him. He watched as other users ripped their clothes off in search of imaginary surveillance devices, tore walls down and even picked holes into their faces. "I've never experienced any other drug like this," he said. "This is complete psychosis."

In Mississippi, a man high on bath salts shot a sheriff's deputy who tried to subdue him with a Taser. Five men struggled to control him. "We all got out there and fought with him ... we tried to tie him down with gurney straps ... he just broke them like it wasn't anything," said the sheriff's investigator. "I've messed with people on meth, cocaine, LSD, everything just about, and I've never seen anything like it."

Pass the Buck to the Pill

"Passing the buck" is the act of attributing 

another person or group with responsibility 

for one's own actions.

Poker became very popular in America during the second half of the 19th century. Players were highly suspicious of cheating or any form of bias and there's considerable folklore depicting gunslingers in shoot-outs based on accusations of dirty dealing. In order to avoid unfairness the deal changed hands during sessions. The person who was next in line to deal would be given a marker. This was often a knife, and knives often had handles made of buck's horn - hence the marker becoming known as a buck. When the dealer's turn was done he "passed the buck." The tradition of marking the progression of the game became known as passing the buck. (http://www.phrases.org.uk)

In modern society, people in general avoid taking responsibility for their own wrong actions. They feel the need to place blame on someone else when something goes wrong. When bad things happen, they pass the buck to someone or something else. For example, some people seem to think if they are not the person directly stealing, lying, or committing any other sinful act, they hold no liability..

But, in truth, when humans stand by and let something happen, or worse, enable it to happen, they may actually be committing a graver offense because they know it is wrong. A lack of direct proximity somehow makes many people feel free of culpability.

Criminals, be they thieves or scoundrels without a conscience, do not care who they hurt, financially or otherwise. After all, how many people would buy goods they suspicion had been stolen as long as their dirty hands had not been involved in committing the robbery? Someone else did the offense; the "innocent" buyers are simply taking advantage of a "bargain."

Imagine you have the opportunity to make big money, potentially millions of dollars. All you have to do is pass the buck. To be a part of this wealthy venture, you may own the business, prescribe the orders, distribute the products, or just defend the operation by extolling some of its marginal benefits.

You are aware that the business practices are questionable, the products are potentially lethal, and the tremendous distribution has no absolute accountability, but you excuse yourself from any wrongdoing because you are never directly involved in harming any customers. Sure, many of those who misuse and abuse your products become very ill and even die; however, you, personally, never force them to destroy their lives.

The money you make is great and the growth potential is sky high. You convince yourself that the limited benefits of your business warrant continued operation despite any hazards to others.

The chain of operations in this lucrative business involves the following:

1. Pharmaceutical Corporations,
2. Business owners,
3. Medical doctors,
4. Pharmacists,
5. Business employees,
6. Legal representatives,
7. Patients,
8. Dealers,
9. Addicts,
10. Proponents.

America must stop passing the buck to end the deadly epidemic of prescription drug abuse. Those who feel they have no responsibility for the carnage must search their conscience and realize their obligation to the whole of society. Anyone who contributes to the advance of illegal operations must face charges, no matter who they are. All of these criminals share considerable blame for mayhem and murder.

"For what shall it profit a man, 

if he shall gain the whole world, 

and lose his own soul?" 

King James Bible, Mark 8:36

Long-term Opioid Therapy

"Guidelines for long-term opioid therapy 

should not be developed by the field of pain medicine alone. 

Rather, experts from general medicine, 

addiction medicine, 

and pain medicine 

should jointly reconsider 

how to increase the margin of safety." 

(Michael Von Korff, ScD, Group Health Research Institute, 

"Long-term Opioid Therapy Reconsidered," Annals of Internal Medicine, 

American College of Physicians, 2011) 

 An epidemic of opioid abuse and overdose exists. Michael Von Korff and his team of researchers report: "Given the warning signs and knowledge gaps, greater caution and selectivity are needed in prescribing long-term opioid therapy. Until stronger evidence becomes available, clinicians should err on the side of caution when considering this treatment."

Clinicians and their professional societies can take action now to increase the margin of safety for patients and society. 

How about the public? What should everyone know about long-term opioid therapy? Knowledge of the risks of therapy can prevent adverse effects and save lives. A series of questions in this blog entry may increase general understanding and help ensure public safety. Here are some questions concerning long-term opioid therapy related to both the physician and the patient. Before entering into such treatment, a person may want to seek many answers.  

Questions About the Physician

1.Does the physician advocate acute pain management strategies that reduce the chance of unplanned transitions to long-term use of opioids?

2. Does the physician practice careful patient selection before initiating long-term opioid therapy?

3. Does the physician advocate strategies acknowledging that long-term opioid therapy entails medical, psychosocial, and addiction risks that need to be disclosed and managed? 

4. Does the physician adhere to recommended opioid prescribing practices?

5. Does the physician practice judicious opioid prescribing, particularly increased caution with higher doses?

6. Does the physician conduct proper monitoring of opioid treatment? 

7. Does the physician practice increased caution in opioid dose escalation?

8. Does the physician taper and discontinue long-term opioid therapy in patients who do not benefit from it or who seriously misuse opioids?

9. Does the physician care to limit the amount of opioid medication in the community, decreasing the potential for diversion?

Questions About The Patient

1. Are all the patient's medications managed by a single physician?

2. Has the patient completed a clinical risk evaluation?

3. Has the patient completed a treatment agreement? 

4. Has the patient completed urine drug screening?

5. Has the patient had all treatments documented in his/her medical record?

Until we better understand how to ensure the safety of long-term opioid therapy, gaps in knowledge and uncertain risks must be carefully considered. At present, physicians need to be selective, cautious, and vigilant when considering long-term opioid therapy. Lives depend on it.

Read the entire article: "Long-Term Opioid Therapy Reconsidered" -- http://www.annals.org/content/155/5/325.full#T1

Doctor Doses: Tolerance To Dependence To Addiction

According to the 2008 U.S. National Survey on Drug Use and Health, 

an estimated 1.3 million people aged 18 or older 

were dependent on pain relievers or heroin. 

(SAMHSA, Office of Applied Studies, 2008)

The number of deaths from prescription painkillers -- opioids, such as OxyContin, Vicodin and hydrocodone -- in the United States has now surpassed that of skin cancer, alcoholic liver disease and HIV, according to a new study published online in the British Medical Journal. (Irfan Dhalla et al., "Facing Up To the Prescription Opioid Crisis," British Medical Journal, August 1 2011)

The deaths may be linked with an increase in doctors prescribing the drugs to patients with chronic pain -- like osteoarthritis -- and not just cancer patients, according to Dhalla and the other University of Toronto researchers.

Between 1999 and 2007, the number of deaths associated with opioid analgesics increased from 4,041 to 14,459, the researchers also reported.

Another study, published this year in the Journal of the American Medical Association, also acknowledged the increase, and pointed out that overdose deaths were most common among patients prescribed high doses of opioids. (AS Bohnert et al., "Association Between Opioid Prescribing Patterns and Opioid Overdose-related Deaths," Journal of the American Medical Association, April 6 2011)

Tara Gomes, a researcher and epidemiologist at Ontario's Institute for Clinical Evaluative Sciences, reports a recent study (2011) shows that "about a third of people who are receiving prescriptions for long-acting oxycodone are in fact receiving doses that are considered to be high or very high dose, based on published clinical guidelines.” (Anne-Marie Tobin, "High Doses, Frequency of Opioid Prescribing Are 'Troubling': Ontario Study," The Canadian Press, January 25 2011)

What Is Considered "A High Dose?

"How high of a cliff do I have to jump off of before the fall will actually kill me?" 

Consider the above as an analogy with opiates. Doesn't the answer vary depending on the person, the cliff, the area, and many other factors? Many things may also contribute to opiate overdose.

Opiates work on the part of the brain that controls breathing. An overdose of any of them can cause a user to stop breathing. If the user is alone at the time, he or she could die of suffocation. The inability to breathe is one of the leading causes of death in oxycodone overdose cases.  

Some drugs need to "build up" in the body before the user suffers a fatal overdose. That is not the case with opiates. They can be fatal with the first use, or at any time. Even people with a high tolerance for oxycodone can experience breathing problems if they take the medicine improperly. Abusers run a high risk of fatal breathing problems each time they mishandle a pill. (http://www.enotes.com, 2011)

Tolerance, Dependence, and Addiction

Tolerance and dependence are normal physiological consequences of extended opioid therapy. In its model guidelines on the use of controlled substances for the treatment of pain, the Federation of State Medical Boards said flatly that neither physical dependence nor tolerance should be considered addiction.  (Fred Gebhart, "Doctor Shopping," http://drugtopics.modernmedicine.com, November 18 2002)

Fred Gebhart attempts to shed some light on the subject.

A. Analgesic Tolerance 

For patients with ongoing or chronic pain, a doctor may increase a dose of opioids over time as the pain worsens. The patient may also develop a tolerance to the drug and need more medicine to achieve the same results. Analgesic tolerance is the need to increase the dose of opioids to achieve the same level of analgesia. Tolerance does not equate with addiction.

B. Physical Dependence

Physical dependence is a physiological state of neuro-adaptation characterized by the emergence of a withdrawal syndrome if drug use is stopped or decreased abruptly, or if an antagonist is administered. Physical dependence does not equate with addiction. 

C. Addiction

But, repeated use of opioids, especially to get high, can lead to eventual addiction. Users will need higher and higher doses of the medicine to achieve the high. Addiction is a neurobehavioral syndrome with genetic and environmental influences that result in psychological dependence on a substance for its psychic effects. Addiction is characterized by compulsive use despite harm.

D. Pseudoaddiction

Pseudoaddiction is a pattern of drug-seeking behavior by patients who are not receiving adequate pain relief. Once adequate pain management is provided, what looks like addictive behavior disappears. 

Dangerous "Shopping" Activities Kill

"Doctor shoppers" are people who visit more than one doctor so they can get multiple prescriptions for the same medication. Fred Gebhart identified three different kinds of doctor shoppers, with three different reasons for engaging in this illegal activity:

• Intentional Diverters are people who either feign illness or take the same illness to multiple physicians. The goal is to obtain multiple scripts, either for abuse or resale. The resale market is lucrative.
• Accidental Shoppers simply don't know any better. They are people who see a number of different specialists for various ailments. They do not let the doctors know when they are prescribed a drug by a different physician. Accidental shoppers run the risk of having bad drug interactions or even an overdose if more than one doctor issues a prescription for pain.
• Productive Shoppers are people who cannot get enough pain relief from one doctor. They keep going to other doctors until they receive enough medication to manage their pain. These shoppers engage in this activity because some doctors under-prescribe painkillers for people in real need of relief. Their behavior is often called pseudoaddiction, addictive-type drug-seeking activities that continue until the underlying pain is finally resolved. 

Gebhart's article: http://drugtopics.modernmedicine.com/drugtopics/article/articleDetail.jsp?id=116769

Research: Self-efficacy and Addiction

 
"Young adults undergoing addiction treatment arrive ready and willing

to make the personal changes that bring about recovery, but it's the help

and guidance received during treatment that build and sustain those changes, 

according to a longitudinal study published electronically and in press

within the journal Drug and Alcohol Dependence."

The study was conducted collaboratively by the Center for Addiction Medicine at Massachusetts General Hospital and Harvard Medical School and the Butler Center for Research at Hazelden. ("Young Adults Want to Recover from Addiction but Need Help to Make It Happen, Study Suggests," ScienceDaily, September 30, 2011)

Retrieved October 2, 2011, from http://www.sciencedaily.com­ /releases/2011/09/110930123048.htm. Read the article here: http://www.hazelden.org/web/public/young_addicts_need_help_to_recover.page 

"This study suggests that strong motivation to change may exist from the get-go among young adults with severe addiction problems entering residential treatment, but the know-how and confidence to change come through the treatment experience," explains John F. Kelly, Ph.D., of the Center for Addiction Medicine who authored the study with Center colleagues Karen Urbanoski, Ph.D., and Bettina Hoeppner, Ph.D., and Valerie Slaymaker, Ph.D., of the Butler Center for Research at Hazelden.

When entering treatment, study participants reported high levels of motivation to remain abstinent but lower levels of coping skills, self-efficacy and commitment to mutual support groups. During-treatment increases in these measures predicted abstinence from alcohol or other drug use at three months post-treatment.  

Self-efficacy or increased confidence in ability to sustain recovery was the strongest predictor of abstinence.

The study found that young people who make meaningful changes in residential treatment position themselves for improved outcomes.

These things help provide the boost that young people need to succeed:

1. Reducing their psychological distress,
2. Developing their recovery-focused coping skills,
3. Increasing their commitment to AA and other groups,
4. Enhancing their overall confidence to stay clean and sober.

Self-efficacy

Psychologist Albert Bandura (1986, 1993, 1997) and other researchers have demonstrated, self-efficacy can have an impact on everything from psychological states to behavior to motivation. This is known as the social cognitive theory. Self-efficacy may be understood as a person’s belief in his or her ability to succeed in a particular situation.

Specifically, self-efficacy is defined as people's beliefs about their capabilities to produce designated levels of performance that exercise influence over events that affect their lives. Beliefs in personal efficacy affect life choices, level of motivation, quality of functioning, resilience to adversity and vulnerability to stress and depression.

People with a strong sense of self-efficacy actually view challenging problems as tasks to be mastered. They seem to develop a deeper interest in activities in which they participate and form a stronger sense of commitment to these activities and their interests. They also recover quickly from setbacks and disappointments.

Conversely, those with a weak sense of self-efficacy often avoid challenging tasks while believing these situations are beyond their capabilities. They are much more apt to focus on personal failings and negative outcomes, so, naturally, they quickly lose confidence in their personal abilities.

Young adults must cope with many new demands. They are faced with beginning a productive vocational career in a modern workplace of rapid technological changes. Many find themselves dealing with the expanded role of both parent and spouse, and increasing numbers of mothers are joining the work force either by economic necessity or personal preference.Combining family and career has now become the normative pattern. It can be a trying period for those who lack a sense of efficacy to manage the expanded demands. They are highly vulnerable to stress and depression.

People improve their self-efficacy by

1. Mastering Experiences

A resilient sense of efficacy requires experience in overcoming obstacles through perseverance, even in the face of pressing situational demands, failures and setbacks that have significant repercussions

2. Social Modeling (Vicarious Experience)

“If they can do it, I can do it as well.” Seeing people similar to oneself manage the demands of tasks successfully increases self-efficacy. This process is more effectual when a person sees him- or herself as similar to his or her own model. If a peer who is perceived as having similar ability succeeds, this will usually increase an observer's self-efficacy.

3. Social Persuasion

Social persuasions relate to encouragements/discouragements. Getting verbal encouragement from others helps people overcome self-doubt and instead focus on giving their best effort to the task at hand.

4. Psychological Responses

Our own responses and emotional reactions to situations also play an important role in self-efficacy. Moods, emotional states, physical reactions, and stress levels can all impact how a person feels about their personal abilities in a particular situation.

A person who becomes extremely nervous before speaking in public may develop a weak sense of self-efficacy in these situations. However, Bandura also notes "it is not the sheer intensity of emotional and physical reactions that is important but rather how they are perceived and interpreted" (1994). By learning how to minimize stress and elevate mood when facing difficult or challenging tasks, people can improve their sense of self-efficacy.

Implications

Young adults desperately want to recover from debilitating dependency, but many who resolve to change their relationship with an addictive incentive do not have realistic expectations about the nature of their challenge. Consequently, they relapse, become demoralized, and lose faith in their ability to overcome their problem. They lack sufficient self-efficacy.

Effective treatment should include concentrated instruction of coping skills, exercises in developing confidence (especially in the face of possible setbacks), and development of commitment to mutual support groups.

Help For Dependency

"Only half of drug- or alcohol-addicted family members seek help -- but when they do, 82% get better, a survey of American families finds." (Daniel J. DeNoon, "Family Poll: Half of Addicts Seek Help," WebMD Health News, August 18 2006)

A Gallup poll, the USA Today/HBO Family Drug Addiction poll, interviewed 902 U.S. adults who said that a member of their immediate family is or was addicted to drugs or alcohol.
The major findings:

• 51% said their addicted family member never sought treatment.
• 41% said their addicted family member has "overcome" his or her addiction.
• 65% said a family member admitted an addiction to them -- but two-thirds of the time, only after they confronted the addict.
• Once a family member admits his or her addiction, that person is more likely to seek treatment than those who do not admit their addictions.
• Three-fourths of addicts were alcoholics, while 30% were drug addicts. Some were addicted to both drugs and alcohol.
• 23% of addicts who sought treatment went to a rehab center; 17% went to AA meetings, classes, or 12-step programs; 11% sought psychological counseling; and 8% went to hospital programs.
• 82% said that their addicted family member got better after treatment -- including 38% who reported their family member made a "complete recovery." 

Where To Begin?

1. The first step in getting help is admitting the problem. 

This may very well be the most difficult aspect of recovery.

Drug and alcohol addiction have traditionally been looked down upon in many communities around the world. A lot of the reason for this is lack of education. People mistakenly believe that addicts lack the willpower to quit or that they simply enjoy being under the influence of these substances. Of course, those misconceptions are far from the truth. Addiction is a disease that causes real changes in a person’s brain and body. Dependent people need to face the reality that, without help, this disease will worsen.

The addict certainly can't be counted on to help him or herself. If an addict had the coping mechanisms necessary for self-regulation, he or she wouldn't have become an addict.

In truth, many addicts are afraid of going to seek help because they associate the act with weakness. They have deep feelings of shame and guilt about their addiction. They hate the very thought of being labeled "dependent." And, some may already be so deeply buried under substance abuse that they don't even realize they experience these emotions.

Dr. Phil suggests that addicts ask themselves "Why do I do it?" to acknowledge their purpose for the behavior. He says people can't change what they don't acknowledge. He believes people need to answer this question to take first steps: "What purpose does the behavior serve for you? If you're an alcoholic, you're not just drinking because you're thirsty. Admit to yourself: 'I'm medicating myself for anxiety, depression and pain. It numbs me to life.'" (Dr. Phil McGraw, "Seven Steps To Breaking Your Addiction," www.drphil.com, 2009)

Dr. Phil continues, "You (dependent) understand at a conscious level, at an intellectual level that your addiction is unhealthy, yet you continue and this perplexes you...You may need to count on others to help you think rationally."

Bringing family members together for education and support is important in helping people get on the road to sobriety. Family members often provide great support. But, many experts agree that one of the biggest mistakes that families make is trying to keep an addiction a secret and dealing with it alone. "The disease of addiction is tricky and sophisticated, and recovery begins with the family. Most families don't have the tools or the knowledge needed to help an addict overcome his or her dependency without the help of an outside professional." ("First Steps: How To Get Help For Yourself or Someone Else," TLC, Discovery Communications, 2011)

Mark Samuels of the Texas Drug Rehab writes:

"What most drug addicts suffer from is not the addiction itself (which is bad enough), but denial of the addiction. The first thing people always say is that they can quit whenever they want to (and they can't) or that it isn't really affecting them (it is) or to simply tell people to butt out of their lives and leave them alone. 

"The second thing that most people will say is that it would cost too much to go into rehab, they don't like talking to other people and butt out of their lives. The whole thing leads to a lot of stress and bad feeling which can be accompanied by a spike in drug activity. It usually takes a good sharp shock and lots of support to overcome this huge hurdle; such as being kicked out of a home, losing children, losing jobs or being hurt. (Mark Samuels, "Dealing With Addiction: The First Step," ezinearticles.com) 

  

2. The next step can be making an appointment with a general practitioner.

The first point of call can be a GP (family doctor). GPs probably have the best access to the services and treatment dependent people need to get better. Patients may be panicking about whether they can trust their doctor to keep their problems confidential, but most GPs have a confidentiality policy.  Patients can find out what it is, so they can decide whether they feel comfortable seeking advice.

A GP may refer patients to a mental health professional for an evaluation that may help to assess the problem and determine a course of treatment. A psychiatric evaluation may provide the medical treatment that a co-occurring mental illness will require.

In 2004, as reported by a survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), there were 4.6 million adults with both serious psychological distress and a substance use disorder of which 41.4% received treatment only for mental health problem; 5% received treatment only for substance use problems; 6% received treatment for both mental health and substance use problems; and 47.5% did not receive any treatment. These numbers are astoundingly high and seem to make it obvious that more attention needs to be paid to the proper treatment of people with co-occurring disorders.(Pedro Church, "Co-Occurring Disorders -- Addiction and Mental Health Treatment Issues, www.zimbio.com, Health, September 27, 2011)

Also, mental health support groups can provide the reassurance that addicts are not “crazy” or “unlovable.” These groups offer strong evidence that addicts are not alone in dealing with their problems.

Conclusion

This blog entry is, by no means, all inclusive. Some first steps are discussed here. Many rehabs and extensive programs go far beyond these simple steps to start dealing with dependency. I am not a counselor or a medical professional. I am merely offering some basic information for help. So many times people look for a place to begin -- here are some "baby steps" that may serve some purposes.