Malibu Beach Recovery Center

I don’t know if this is happening on the West coast, but on the East coast, 11 hospitals in New York City are tightening up their Emergency Room policy regarding how many prescription pills can be dispensed.  Just as the flu was declared an epidemic in New York state, Mayor Michael Bloomberg took action to stop what he called a “citywide and national epidemic of prescription drug abuse.”

Soon, patients won’t be able to get more than three days’ worth of Vicodin and Percocet and other narcotic painkillers. They can’t get Fentanyl patches or methadone, and if they have stolen, lost, or destroyed prescription, they’re out of luck, according to the NYT article. The policy is already in place in Utah and Washington state.

The goal is to stop people from selling pills from medicine cabinets on the street or abusing them themselves, and reduce drug abuse overall. Of course, opponents argue that the poor and uninsured will suffer from this because the ER is often their only access to medical care. And some people with true pain need more than three days’ worth of pain pills. What if they’re waiting for surgery and in pain? 

Not to be outdone by the mayor, a few days later Raymond Kelly, the NYC Police Commissioner proposed that more pharmacies use fake prescription drug containers with GPS devices attached (called bait bottles) to deter thefts. (The idea is that knowing they might take one of  these bottles would be enough to stop robbers who are after painkillers and other addictive medications.) The fake bottles would be placed in groups of legitimate containers.

The authorities could track the bottle if there’s a robbery, and hopefully find “stash locations.”  Purdue Pharma is supplying the GPS devices, undoubtedly hoping for some positive PR since the company sells Oxycontin. 

The practice has actually been tried in other places in the country, but the police commissioner is hoping that thousands of pharmacies will be involved this time. He mentioned that the black market for oxycodone as the impetus for his proposal, and recalled the 2011 pharmacy robbery in Long Island by a man high on oxy who killed four people. He also mentioned a retired NYPD officer who became addicted to pills and then robbed pharmacies at gunpoint. 

The end of the article had an interesting anecdote of how this practice has worked. In 2010, a robber after oxycodone threatened to shoot a pharmacy employee in Maine. But the employee was able to include a bait bottle in a bunch of bottles the robber took, and the police were able to track the thief and arrest him.

I didn’t know about the bait bottles, and the ER restrictions only make sense. Recently the government offered a reward for anyone who can come up with a way to thwart those horrible robocalls (for instance, from Rachel at Card Services) because they can’t find a remedy themselves. Maybe they should offer rewards for good ideas like these two for stopping robberies and drug abuse.

As if the news about methamphetamine weren’t bad enough, meth labs have now spread to the cities and suburbs. One media source for that news is ABC News.  The labs have often been described as a rural phenomenon, attributable to the lack of ways to make a living wage in those areas. Two years ago (three, by the time you read this), I saw a wonderful movie based on that assumption—Winter’s Bone—which helped make Jennifer Lawrence, also of the Hunger Games movie, a star.

I’m pretty certain that Johnson City in east Tennessee, where four people were arrested at the end of December for having a meth lab in their car, is in a rural area. That’s right, they had an active meth lab in their car. They were stopped for a tinted window violation, and several meth officers were called to the scene. The four were being held in a local detention center when the article went to press.

But cities and suburbs have their own drug problems and drug sellers are devious, so it should come as no surprise that meth labs have reached cities. 

Methamphetamine in its crystal or crystalline form is called crystal meth. Other names are ice, glass, Tina, crank, Go-fast, Black Beauties, Biker’s Coffee, Chalk, Blade, and L.A. ice. About.com has an even longer list of names, and says that the drug is especially popular among women because they can lose weight quickly while taking it. However, the body builds up a tolerance and the weight loss doesn’t continue. Some people take it because it can increase the sex drive.

About.com explains that meth is often smoked, in pipes, injected, snorted or swallowed, or inserted into the anus or urethra. (There are few words for the lengths to which users will go.)

One effect of chronic use is that your teeth decay quickly and fall out. Overdosing can cause brain damage, hallucinations, delusions, the feeling that your flesh is crawling, to name a few, and yes, you can die as a result of cardiac arrest, stroke, or a high body temperature.

The cities listed in the ABC News article as examples of those where meth labs have been found are St. Louis, Kansas City, Mo., Nashville, Tenn., and Evansville, Ind.  According to the article, inner-city gangs are also getting involved. I suppose it was only a matter of time, right?

It seems that there are methods other than the ones popular in rural areas for making meth that make it easier for suburbanites and city dwellers to get involved with this drug. The process in rural areas results in a strong ammonia smell that would be easily detected in a more crowded area. But legislation has made it harder to purchase medicines containing pseudoephedrine, the main ingredient, so meth manufacturers have turned to “mixing cold pills with toxic substances such as battery acid or drain cleaner — in 2-liter soda bottles. Shake-and-bake meth can be made quickly with little odor in a home, apartment, hotel, even a car.” (And therein lies a major reason for the labs’ spread.)

And this, as well, from ABC News: Another reason for the rise in urban meth is a process known among law enforcement as "smurfing" —the abundance of pharmacies in cities attracts meth-makers from surrounding rural areas, who can bring in friends to help purchase pseudoephedrine pills.

Science Daily offers a wealth of information on methamphetamine. For example, one study reported on the site indicated that fruit flies have died from anorexia. Just as interesting is the article indicating that researchers have developed a medication that may help meth addicts by reducing or preventing the euphoric rush associated with the drug.

Before the election I was so worried about my candidate losing that the marijuana issue was relegated to the back of my mind. So it was a shock to read, the morning of November 8^th, that Colorado and Washington residents voted in favor of smoking pot recreationally.

This event has brought up so many issues that I hardly know where to begin. Many of them relate to a comparison between marijuana and alcohol, and whether one is more harmful than the other.
Some people have compared the results of the vote to prohibition, according to The New York Times article. Then there are the political and economic arguments that legalizing marijuana will help reduce the dangerous and illegal drug trade and free up law enforcement resources. 

Articles with titles such as “Marijuana Tourism Looms Large After Election Results” are also appearing, although this AP article on MSN notes that that’s really speculation. In any event, it was news to me, and probably others, that there will be a waiting period before the changes take effect. It will take a month for the change to be put into effect, and then state officials must write “rules, tax codes, and other regulations” for state-licensed retail marijuana shops to be opened. 

I also didn’t realize that this occurrence clashes with federal laws, and specifically the Justice Department. A Seattle police chief said there’s no danger the D.E.A will rush in to enforce the federal law in these two states, but the U.S. Attorney General refuted that.

You know I couldn’t end this post without including comments from an addiction specialist. I easily found an OPED by addiction psychiatrist Ed Gogek, who practices in Prescott, AZ, and is also a board member of Keep AZ Drug Free there. (I don’t know how long the link will be active, so won’t include it. There was lots of good information when I checked, though.)

Gogek, a Democrat himself, says: “…Democrats should think twice about becoming the party of pot. I’m a lifelong partisan Democrat, but I’ve also spent 25 years as a doctor treating drug abusers, and I know their games. They’re excellent con artists.”

He notes that many people who use marijuana for pain relief can fake pain, and it’s hard to prove them wrong. He goes on to say, “It’s possible that they all really do need pot to help them. But consider this: pain patients are mostly female, whereas a recent National Survey on Drug Use and Health found that adult cannabis abusers were 74 percent male.”

And if we need to be reminded that teenage pot use has increased 40% in four years, and heavy use – 20 times a month or more – has increased 80 percent. So he’s worried about the message this election result sends to teens -- that it’s OK to indulge and there are no consequences, yet recent research indicates pot smoking permanently lowers IQ.

The next day brought letters to the editor. One was from a representative from the National Organization for the Reform of Marijuana Laws who is also coauthor of “Marijuana is Safer: So Why Are We Driving People to Drink?” She noted that surveys by respected pollsters have found that a majority of Americans are for legalizing pot smoking within a “system of limited legalization and regulation.” A second letter calls legalization “a lesser evil,” and a third, from a psychotherapist who has treated addiction and is himself a recovering addict, said that “to focus the debate on the degree to which [pot] is harmful … is ridiculous. Of course it is harmful and of course it is addictive.”

So the future should be interesting.

The news about teens drinking and driving is that the numbers have dropped significantly, according to federal health officials, ostensibly due to stricter laws regarding drunk driving and limiting the hours teens are permitted to drive at night. The cost of gas might mean that teens are driving less, as well.

That’s great to hear, of course. I wondered, however, since more teens are smoking pot than drinking today, does that mean that more of them are smoking pot and getting behind the wheel?

There’s news about teens and the alcohol industry as well. In response to industry marketing codes, several brands, including Coors Light, are developing ways to test a user’s age before allowing them to take part in social media. In order to “follow” a brand, for example, teens will have to confirm they are 21, just as they must do when entering an alcohol brand’s website. I’d like to hear more about the whole rationale behind asking teens to give their true age. Do companies feel it’s the least they can do? The only thing?

I’ve kept an article that has an example of the actual cost of drinking and driving because you don’t often hear about the actual charges. It starts with the writer being stopped, arrested and then taken to the police station, where he the paid $40 in bail money. The next day he paid $134 to get his car out of the pound, and when he appeared in court, he paid $600 in fines and court fees. His brother-in-law lawyer went with him to court, so we never do learn what that would cost someone who had to pay a lawyer. Then he had to take an alcohol education class for $571, and also pay his nephew to drive him to pick his son up from college. That fee wasn’t mentioned.

After 45 days, he paid $500 to get his license back and saw his insurance premium double. He doesn’t give that amount, either, but it must be several thousand dollars.  These prices probably vary depending on the section of the country, but it’s pretty astounding to consider what a couple of drinks too many can cost when you’re driving. But as the writer said, the cost of killing someone, and possibly himself, doesn’t compare.

If a letter to the editor in my local paper is to be believed, research shows that a first-time drunk driver has driven under the influence at least 80 times before getting stopped. I searched on the letter-writer’s name and town and learned why he’s so insistent that ignition locks would cut drunken-driving deaths (which is both the title of his letter and his argument). In college, Steven Benvenisti was hit by a drunk driver and suffered a traumatic brain injury. He recovered (miraculously, if you saw the photo on the website) and went on to become a lawyer.

Benvenisti gives some surprising statistics. Ignition interlocks are more effective than suspending someone’s driver’s license to stop repeat drunk drivers, he says, because 50 to 75% of convicted drunk drivers continue to drive on a suspended license. If offenders are required to have an ignition lock, they’ll have to prove they’re sober before driving, and they’ll also be able to drive to work (which is not the case if their license is suspended). Finally, he says, “according to the Centers for Disease Control and Prevention, interlocks have been proven effective in reducing drunken-driving recidivism by two-thirds.” Not surprisingly, Benvenisti serves on the board of directors for Mothers Against Drunk Driving (MADD).

Joan added:  I like the idea of an ignition interlock.  One of our former staff members had one of the first genration kind.  It was attached to his steering wheel.  He had to blow into it not only to start the car, but to keep going.  I found the above photo of this newer, more high tech ignition interlock on the website of the Florida ignition Interlock Program. 

Last year I landed in the emergency with a nosebleed that wouldn’t stop. When a nurse entered the room to ask me some general questions, one of them was whether or not I drank alcohol. I answered that I do. The next one was how often, and the one after that was how much. I said I probably drank every day, and indicated two inches with my finger and thumb.

If that wasn’t a look of sheer doubt she gave me, I don’t know what was. “How much again?” she asked. (Some friends marvel that I find any more too filling.)

“This much,” I said, showing her again. “And every day?” she repeated.

“Yes,” I answered, now annoyed and defensive.

“I write about addiction and recovery, and I don’t have a problem”, I told her. “No, no, I’m just asking,” she said, as she busily wrote on the questionnaire.

Our exchange shouldn’t have annoyed me. I know she was just doing her job—and I was especially interested that this questioning had made its way to the emergency room and that a nurse was doing it. I posted quite awhile ago about the majority of ER visits being related to some form of drug use, and that post also mentioned that doctors are now being trained to perform a quick screening during normal office visits.

After that experience, I was drawn to a headline in The New York Times late last month: “Doctors Reminded to Ask Patients About Alcohol Use.” The article said that a panel of the U.S. Preventive Services Task Force found that a third of us misuse alcohol (but fewer are addicted). Even the misuse results in 85,000 deaths a year, however. More astounding is that ”alcohol abuse is the third leading cause of preventable death in the U.S., after smoking and obesity.”

But if primary care doctors ask patients a set of questions during the person’s office visit and offer a brief counseling session (or even more than one), it could help people cut down on their drinking, the panel said. One of the questions is the all-important: “How often do you have five or more drinks on one occasion?” (That indicates binge drinking.)

The article noted that the panel doesn’t suggest this technique be used with adolescents, however, because it could cause anxiety or make them feel singled out.

I remember reading that people are prone to be honest with their doctors, and if that’s true, this should help. But I don’t know, do you think those who abuse alcohol are really honest with their GP if they’re not even honest with themselves? I think of my friend’s 20-something daughter, who years ago was met by the authorities when her plane landed because her behavior was so outrageous after a few drinks in the air. Two years later she got a DUI.  I’m not sure if she’s addicted, but she definitely abuses alcohol. Would she be honest with a doctor about the amount she drinks? And would a brief intervention help her and those like her?

I also remember reading several years ago about primary care doctors being taught about screening. The New York Times article I referred to earlier was a reminder to them, reaffirming the advice given in 2004. The article does say that the technique does not help in cases where people “are already addicted and need more extensive help…like therapy in rehabilitation clinics.” Thinking about it, it sounds like a good idea for people starting to go down the wrong path. But that includes adolescents!

Should you have thoughts on the panel’s recommendations, there’s a public comment period. Anyone in favor of this screening should take heart that the Affordable Care Act requires insurance companies to cover it.

I’ve written about marijuana in several posts such as Marijuana, the Most Commonly Used Drug  (May 2011) and The Controversy Over Legalizing Marijuana (June 2012). But pot is constantly in the news (as are most drugs, right?), and two items from last month might interest you.

First, as if there’s not enough of a controversy about pot smoking, in August a few Moms admitted in print to doing it. One wrote a jazzy essay on the popular women’s site Jezebel. Also, on TodayMoms, an NBC news site, a headline almost shouted Pot-smoking Moms Tired of Being Judged by Wine Drinkers.

Sounds like these women want their 15 minutes of fame and this is their way of getting it. They’ve found something edgy, and like some of the authors of the Details magazine articles I mentioned in my last post, they ran with it. Not that I don’t believe them -- pot smoking is so rampant today that these women are documenting what’s really happening. As one of them pointed out, it wasn’t long ago that articles were appearing about Moms drinking during play dates.

I was socializing with several colleagues recently and learned that one had been stoned on pot all through college. Yet another said she still smoked every day. I almost fell off my barstool. As if I needed more proof that this “harmless” drug is so prevalent. I had no idea. By the way, yes, we were drinking, which I’ve called the most socially acceptable form of substance abuse. But none of us drinks to excess, as far as I know, so I’m not being hypocritical. I’ve also said that marijuana also seems to be just as socially acceptable, lately, which is part of the impetus to legalize it.

Recently, Steven Van Zandt, a member of Bruce Springsteen’s band, said in a New Yorker article that Bruce has never taken drugs. Ever. It has to do with his father being bipolar, if I remember correctly, and Bruce’s fear of having inherited a tendency toward the disorder. I would never have guessed that about the man who is an icon in an industry known for rampant drug abuse.

Also last month, in news on ABC TV about a study done in New Zealand, viewers learned that kids who frequently smoke pot before age 18 experience a decrease in intelligence, specifically, an “eight-point drop between the ages of 13 and 38.”  The people in the study smoked at least four times a week and were studied over two decades. Those who didn’t smoke during those years gained a point.

The lead researcher said, “Collectively, these findings are consistent with speculation that cannabis use in adolescence, when the brain is undergoing critical development, may have neurotoxic effects.” So much for what another friend of mine said to me recently—“They say it’s not as bad as drinking alcohol.”

Despite the study’s findings, I bet if you ask most kids who are heavy pot smokers, they’ll tell you that they just don’t care. If only this study could make a difference. Somehow.

According to recent medical news from a site called Ivanhoe.com, cocaine is the most abused major stimulant drug in America. Not knowing this site, and not completely trusting it because it takes advertising, I did an online search to see what might appear for “most abused drug in America.” A site titled AddictionInfo.org says that the most abused prescription drug is Adderall, which I wrote about here. So who knows? Did the first site mean illegal drug? That’s the problem with being a writer. I nitpick and want to know exactly what is meant.

In any event, researchers at the University of Kentucky are saying that enzyme therapy holds promise for treatment of cocaine addiction. The technical Journal article is here. It suggests that a certain enzyme can “prevent the drug of abuse [in this case, cocaine] from entering [the] brain to produce physiological effects.” In other words, this therapy can prevent cocaine users from getting high and thus will help in treatment.

Science Daily says there’s a series of enzymes, not one, and that the scientists have actually discovered them. (To read the article, you have to go to the page of press releases and enter “cocaine”. The title of the release is Modeling of New Enzymes Helps Develop Therapies for Cocaine Abuse but there’s no direct link.) The article reminds readers that currently there is no FDA-approved medication for cocaine addiction, so understandably it’s a high priority. The strategy, or “insights from the research,” also holds promise for other drug addiction. I love how the Science Daily writer characterized the enzymes as “detoxifying other drugs.”

In June, a Science Daily article titled Abnormal Brain Structure Linked to Chronic Cocaine Abuse reported that researchers at the University of Cambridge found that cocaine users exhibit abnormal brain structures in the frontal lobe, which may also provide insight into cocaine abuse. 

Help can’t come too soon, according to articles called Cocaine: Hidden in Plain Sight, which points out how huge a part of the social scene cocaine is. In June, Craiglist posters were actually inviting others to join them in indulging in coke.  The posts included phrases and euphemisms  like “Where are the cool Brooklyn ski bums? I’ve got tons to share.” And “Take a ride on the snow train.” Wow.

I thought pot was rampant, but people quoted in the article said you see cocaine being used in bars, parties, and just everywhere. Dr. Herb Kleber, an addiction specialist in NY, said people aren’t hiding it; the stigma isn’t there. That, in turn, leads some people to believe that it’s not that harmful.

That couldn’t be further from the truth. As the article indicates, “Besides its addictive potential, cocaine can cause elevated blood pressure, seizures, stroke, cardiac arrest or other heart problems, particularly in people with a predisposition.” And combining it with alcohol “increases its toxicity, particularly in the liver.”

The Food and Drug Administration has a long history of protecting Americans from dangerous substances. Or, as the organization says on its website:

The FDA is responsible for

• Protecting the public health by assuring that foods are safe, wholesome, sanitary and properly labeled; human and veterinary drugs, and vaccines and other biological products and medical devices intended for human use are safe and effective
• Protecting the public from electronic product radiation
• Assuring cosmetics and dietary supplements are safe and properly labeled
• Regulating tobacco products
• Advancing the public health by helping to speed product innovations
• Helping the public get the accurate science-based information they need to use medicines, devices, and foods to improve their health

That explains why the organization banned nine pharmaceutical companies from selling “illegal, unapproved pain drugs” three years ago.

It looks as though one problem was that high concentrate morphine sulfate oral solutions, hydromorphone and oxycodone, had not yet been approved. (Generic oxycodone was only approved in April 2010, two years ago.)

Boehringer was one of the companies selling the “delightfuly named” drug Roxicodone, which “… is yet another version of hillbilly heroin oxycodone, or OxyContin,” according to the article. As Joan reminded me, this is the drug that Joey Rovero died of, after which his mother April Rovero started the non-profit National Coalition Against Prescription Drug Abuse.

What is insidious about Roxicodone is that it’s so potent. However, I’m not sure why the CBS News article quoted BNET as saying it was an oversight on the company’s part. Selling it before it was approved was an oversight?

Interestingly, here is the warning letter the FDA sent to Boehringer that granted an extension for manufacturing/distributing it because “those in the pain management community” said the removal would impose extreme hardship on palliative care patients and their communities.

It seems that this organization tries to take patients’ needs into consideration as well.

But note that once again – this month, in fact -- the FDA has cracked down on non-approved Oxycodone. The Mississippi TV station WJTV, which published the news, offers a reminder that “the best way to make sure that a drug is FDA-approved is to buy it at a pharmacy.”

Other important news about OxyContin is that Purdue has asked the FDA to approve the use of this drug for children as young as 6. Currently, the company is conducting a clinical trial (one of the requisites for being granted approval) to document what happens when children take it.

Alarm bells are undoubtedly screeching in the addiction and recovery community since OxyContin has been so easily abused. The company has “admitted in court that it misled doctors and the public about OxyContin’s risk of addiction. The company and three top company executives, each charged with a felony, paid $635 million in fines.” No one wants to see children in pain, but do we really need to start people on this medication at an early age?

Skeptics are pointing to the company’s motives since a patent for the company’s original formulation expires in 2013. Selling OxyContin for pediatric pain management would open a whole new market for the drug and help Purdue’s bottom line.

In 2010 I wrote about an emergency room doctor who has a blog on www.medpagetoday.com. The particular post I was interested in was about a homeless man suffering from alcoholism who had ended up in the ER, as so many people without health insurance do.

The link between the E.R. and substance abusers is in the news again. First, Kaiser Health News noted on www.everydayhealth.com, that up to half of the people seen in the E.R. are under the influence of alcohol. What a statistic. We know that drinking causes accidents and results in fights and worse, but….up to half? That’s enlightening (or sobering, to quote the article’s play on words.). The article also points to a study showing that a brief intervention by an E.R. doctor can help in these circumstances.

However, what I found most interesting is that in more than half of states, insurance companies can deny payment for E.R. services if a person is found to be under the influence of alcohol and other drugs. Plus, ER personnel may not test for drug use to circumvent the payment problem. (There’s that humanity again that I wrote about in 2010.)  Level 1 and 2 trauma centers, which handle a large number of people involved in car accidents, must screen, however. (By the way, the article also has a link to a site I found interesting – the National Institute on Alcohol Abuse and Alcoholism’s [or NIAA’S] Alcohol Policy Information System, which bears checking out.)

The article was mostly about how the brief counseling helps, but the writer – or at least the headline writer, or the site – chose to focus on the nonreimbursement issue. An example detailed the case of one woman who admitted to having a few drinks after she broke her ankle. Her insurance company refused to pay (which explains the subtitle of the article -- “Excessive drinking could come at a high cost for your health and your wallet.”)

A second article about substance abuse and the E.R. that appeared recently involves people who show up at these centers complaining of toothaches. To the doctor quoted in the article, it’s often “a ruse to get prescriptions for narcotics.”

Sure, there are people who can’t get into a dentist because they don’t have the funds. Or maybe it’s a weekend. But after I just posted on the lengths people will go to to get high, it makes sense that they would try this, too. The people who appear in the E.R. have even said they’re allergic to everything except Vicodin, according to the doctor, who said that’s a dead giveaway.

He also mentioned doctor shopping, wondering if many of these people go on to another emergency room to get more pills. All the more reason for all states to have a prescription database and make it mandatory for healthcare professionals to use it! The article said that 40 states now have these programs and eight more have legislation to create them.

We on the East Coast often look to California, the more progressive coast, as a bellwether. But the state has dropped the ball when it comes to its CURES prescription database.  Funding was pulled at the end of last year, which is a blow to anyone concerned with the epidemic of prescription pill abuse.

Joan wrote about CURES here, in March and here, earlier this month. It’s the program that replaced the Prescription Drug Monitoring Program (PDMP) and allows pharmacists to check a database to learn whether customers wanting a prescription were filling the same prescription at another pharmacy, called “pharmacy shopping.” Both doctors and pharmacists could access the database. It’s still accessible but with very little staff and few participants.

As a New York Times article explains, Governor Brown cut the state budget of the Department of Justice, leaving the program in the lurch. The writer notes, however, that there were problems from the start. The main one seems to be that entering prescriptions into the database is optional, unlike some states’ programs. (Joan noted that “even the 49th poorest state, Kentucky, had a functioning data base and requires all doctors and pharmacists to use it.”

Here’s a quote from the article, from the executive director of the Prescription Monitoring Program Center of Excellence at Brandeis University in Waltham, Mass.: [If California does not fix its system,] “it will pay a huge price in terms of people who end up dying whose lives could have been saved, of people overdosing and going into hospitals, or nursing homes, or ultimately on disability.”

Ira Freeman, owner of North Hollywood"s Key Pharmacy, is one CA pharmacist who cares (he made headlines in 2009 for refusing to fill Anna Nichole Smith's pain pill prescriptions). In March he attended a meeting with representatives in the Attorney General’s Sacramento office to talk about CURES. The situation couldn’t appear any bleaker. He had read an article in the Bay Citizen and learned that only 4% of pharmacists in the state had signed up. “My frustration is one, that not enough pharmacists have signed up and two, the system is antiquated. Even though it’s supposed to be realtime, it takes roughly six or seven minutes to get the data. That’s a long time when you have someone looking you straight in the eye on the other side of the counter,” he said.

The only time doctor shopping gets air play is when a celebrity dies, he noted. But unfortunately, everyday citizens are doing it as well. “We want to see that patients with legitimate needs see legitimate physicians and have access to their medications,” he said. “But those who doctor shop are raising the costs for everyone. The drugs and office visits are often covered through insurance, and everyone down the line pays the cost. Everyday citizens can’t say it doesn’t affect them, it does. It adds to insurance premiums,” he explained.

Freeman recommends that insurance companies provide funding because they would directly benefit if doctor shopping decreased. He believes that for every $1 spent on drugs, there is $43 in associated medical costs. “So,” he concluded, “it’s in their best interest to fund the program.”

Alcohol abuse among Native Americans in the U.S has been a problem for a long time. Michael Dorris, author of The Broken Cord, which detailed his adopted Native American son’s fetal alcohol syndrome, called attention to it when his book was published in 1989.

If you don’t live near an area with a high Native American population, you may tend to think of this group’s alcohol problems only when you hear or read about this tragedy. A recent article reminds us that the problem is not going away.

Alcohol has been banned on the Pine Ridge Indian Reservation in South Dakota since 1970. I presume that was the result of an Oglala tribal decree, since “fetal alcohol syndrome, fatal drunken driving accidents, and beer-fueled murders have cast a pall over Pine Ridge for decades,” according to the writer. So some Pine Ridgers go to Whiteclay, a nearby town, for their poison, and as a result, the tribe has filed a lawsuit against brewers and the stores selling liquor just yards from the reservation, in Nebraska. Whiteclay residents have several responses to this finger-pointing, including the thought that the problem will just move and at least it’s contained in one area now.

The Oglala reservation’s tribal head said the majority of criminal court cases and illnesses on the reservation were the result of alcohol bought across the state line (in other words, in Whiteclay). There were 20,000 alcohol-related arrests in 2011 alone on the reservation. Four of five families have a member with a drinking problem, and there are high rates of teen suicide.

Pine Ridge is the only dry reservation left in SD, but about 1/3 of the other 310 reservations already ban alcohol. People who want to legalize alcohol on all reservations say that doing so would allow tribes to control it better and have a revenue source for providing treatment programs. The CDC, for its part, says “Excessive alcohol consumption is the leading cause of preventable death among American Indians, and they are affected at about twice the rate of the national average.”

Here’s a link to a Sioux City Journal article about the controversy. Also, an issue of Alcohol Health and Research World on the National Institute on Alcohol Abuse and Alcoholism site contains an interesting article on American Indians and Alcohol.

Or, A Response to Prescription Pill Abuse

One unfortunate repercussion of the prescription pill abuse epidemic is that it gives people who desperately need pain management a bad name. As one person commented on the Malibu Beach Recovery Center blog article, "Doctors who Fuel Addiction and Relapse," at best, they’re viewed with suspicion, and at worst, their needs can be brushed under the rug. Doctors may quit on them because they’re not getting better, as happened to that person.

You can’t blame him (I assume it’s a man) for complaining, and he’s right—Unless you’ve never faced unbearable pain and needed medication to get through the day, you can’t know what it’s like. And if those of us who write about prescription drug abuse want to be fair, it pays to include a comment that there are people who need pain medication and don’t abuse it. Or people who started out taking pain pills for a valid reason and unfortunately became addicted. There are those who hate the side effects, too -- hate the feeling of being high, but give in so they can function.

So thanks to the person who wrote in.  We’ve seen articles recently saying that the media is too heavily weighted toward ranting about the bad news, and we should have mentioned that. We should all be in the business of recovery together, trying to see that the doctors who are criminals are stopped, those who become addicted are helped, and those who need pain management are recognized and taken care of.

Last month, a NY doctor was arrested for overprescribing prescription pills, according to this article in the Huffington Post, and I believe I saw another doctor on the New York TV news this week arrested for the same thing.

But now an arrest has hit home on the West coast, and thus the Malibu Beach Recovery Center community and all others concerned with this horrendous epidemic. Today, Dr. Lisa Tseng, a Rowland Heights doctor that the DEA had been investigating for years, was charged with the murder of three men who died of overdoses.

One of the three was Joey Rovero, the son of April Rovero, who started the National Coalition Against Prescription Pill Drug Abuse, a non-profit, to increase awareness of prescription pill abuse after her son Joey, a patient of Dr. Tseng,  died of an overdose.   MBRC posted about the organization here, in December 2010. Here’s April Rovero’s statement at a California state senate press conference, attended by Joan and Malibu Beach Recovery Center alumni Krissie Bergo and Laurie Kelsoe.

Just a few weeks ago Joan received an email from another mother who had just learned that her son got pills from Dr. Tseng. (He, too, died of an overdose.) Two state medical examiners told the woman that her son had several drugs in his system, and that he was a patient of Dr. Tseng.  “I hope that they find them all,” she said, referring to doctors like Tseng. 

Joan knows firsthand about the death of Austin Klimusko, a former MBRC patient who got pills from one of these notorious doctors, and ended up dying from an overdose of heroin which she describes as "cheap oxycodone."    Like Joey Rovero’s mother, Susan Klimusko has become an activist, too, and started an organization called “Heroin Sucks, Not One More..

"Like many of our young clients, Austin was from Simi Valley, a Los Angeles bedroom community plagued by drug addiction." said Joan.  "Too many young people from Simi Valley have already died." 

Today’s arrest is a milestone in the war on drugs. The doctor was charged for prescribing pills to people who “had no legitimate need,” but to be charged with murder sends the strongest message possible to other doctors. As Los Angeles County District Attorney. Steve Cooley said in the L.A. Times article, “Dr. Feelgoods who knowingly overprescribe drugs for no medical reason other than someone asks for the drugs and pays the doctor a staggering amount of money will be dealt with severely.”

How wonderful that these mothers are getting justice.  As Joan said, “Good work on the part of the state of California and the L.A. Times reporters.”

Joan Borsten contributed to this story.

Life is funny. My post about musicians and addiction appears, and wham—Whitney Houston becomes the latest musician to join the list of those who have died. Was it an overdose? News reports from TMZ and other news stations mention prescription pills near her body, so it’s likely? Not out of the question? Who knows.

I never even thought of her when I wrote that post. Whitney was a Jersey girl, and an icon of my generation. As so many commentators have said this morning, her voice was majestic. You should hear my women friends who also loved her describe her.

But as I heard her story on a morning show, there was no escaping her similar history to others in the field.  Blessed with extraordinary talent, she had a promising future when she started out.

Then…something…insecurity?...pressures associated with fame?...a troubled relationship with a man? derailed her.  I saw one headline that blamed Bobby Brown, her ex-husband, but I didn’t want to read it. She’d been to rehab after rehab. It was so sad to hear Larry King saying he didn’t recognize her even though she was sitting at the next table.

It’s so easy to speculate and blame.  As one commentator said, let’s leave her be now. Let the family mourn. As I’ve said before about anyone who becomes addicted, there are friends and family members who love the person. She was a mother, a daughter, a goddaughter, a friend, and so much more.

When I first saw the headline, “Overdose Rescue Kits”, I thought it was a joke, a takeoff on articles about hangover remedies. But it wasn’t a joke. (FYI, since that day, the “New York Times” has changed the headline to “Kits Using Naloxone Revive Addicts After Opiate Overdose”. They make those changes occasionally.) I knew about oral activated charcoal used for drug overdoses, but this was different.

Last October I posted about states passing legislation to help those who overdose by removing the fear of being arrested if someone calls 911 to get the person help. This article is about helping people in other countries who overdose on drugs like heroin and Oxycontin.

In Europe, someone dies from a drug overdose every hour, the article says. (I wonder what the figure is in this country.) With naloxone (or Narcan, the brand name), which blocks opiate receptors, the person may be revived. I don’t know if it’s possible in every case, but it’s been “shown to work” and “has been used for decades by surgeons and paramedics.” Naloxone is “a secondary chemical in the drug Suboxone”, according to Wikipedia.

The article mentioned there’s a question about how legal it is to distribute these kits the way other countries do it, but there are groups in Central Asia and in Europe hard at work. In China, if you call a hotline, someone on a motorcycle will deliver the kit to you. In Afghanistan, however, the person who gave you a heroin injection may also provide the Naloxone shot. L

Now the cost. Roughly between  25 cents and $2.00 in other countries, in contrast to about $6 or $9 in the U.S, depending on what article you read.

Be sure and check out the photo of the kit in the article. It looks very professional, like a first aid kit you might buy for your house. A nasal spray is available as well. I wonder why I never heard of these kits before.

In a 2009 article in Time magazine, addiction writer Maia Szalavitz wrote about programs in Chicago and North Carolina in this country.  I also found mention of the kits by a Canadian blogger. Here’s an article from the Harm Reduction Journal on a government site about a study of a program in New York City. The conclusions seemed pretty positive. Finally, NPR has had a story on the kits, too.

As the New York Times writer mentions, if someone is revived with this kit, it may send him or her back to rehab. On the other hand, Szalavitz notes a problem with these programs: could drug users also think that if this is something that can resuscitate them they can continue using drugs with impunity? Which, as we know, is playing Russian roulette with your life.

About hangover remedies…there’s news on that front as well. Just before New Year’s, several new products hit the news. Enterprising entrepreneurs have been busy.

One product, a patch, goes on an area like a forearm 45 minutes before drinking and should be worn for eight hours after the last drink. It contains B and other vitamins, Acai berry, and folic and pantothenic acid. But even the doctor that helped produce the patch said that nothing will help those who drink a lot, so doesn’t this appear senseless?

Another supposed remedy is a pill that is a blend of aspirin, an antacid, and caffeine, and yet another is a mix of vitamin B and C, magnesium and cysteine. It seems to me there are so many more productive things to be doing with one’s time, and so many better things to invent for mankind.

Update from Joan Borsten:

Fifteen minutes after we published Pat's article, the phone rang.  A woman had already read it and wanted to know where to get a Naloxone kit.  She said she wanted to have one on hand in case her brother, a heroin addict, overdosed.   While researching this article, Pat had looked without luck for a manufacturer of these kits.  She tried again and discovered that kits require a prescription and the local pharmacy may or may not have a kit on hand, but there are apparently 200 naloxone distribution programs around the country.  There is a large program in New York directed by Sharon Stancliff with the Harm Reduction Coalition.  To find one in your area, type http://hopeandrecovery.org/overdose into your search engine and enter a zip code into the program locator.

In December I posted about drugs in prison. Unfortunately, drug use is a problem in our armed services as well. As the U.S. marked the end of the war in Iraq in December, experts mentioned the monetary and human price we paid. But in addition to the number of soldiers killed and maimed, there’s another cost of war that wasn’t mentioned in that tally: the number of soldiers who became addicted and/or got into legal trouble related to drugs. As far back as 2005, the website www.military.com, the online version of the military publication “Stars & Stripes,” reported that military investigators had arrested a soldier for selling cocaine in Iraq. Other drugs were a bigger problem, however.

“What's more common are soldiers who sneak liquor, marijuana, Valium, hashish and a variety of prescription drugs, such as Ritalin, onto base and pass it along to friends,” said Lt. Col. John Dunlap, the top military prosecutor for the 256th Brigade Combat Team, a National Guard unit from Louisiana, at the time.

The Lt. Col. said that he and others aggressively prosecute drug possession. I assume that’s mostly to protect the troops -- there’s too much at stake to allow a soldier to use drugs. He added that service personnel “who come forward and admit they have a problem typically face little or no punishment and are given counseling and medical treatment.”

A headline in “The Arkansas Democrat Gazette” that year was “Drugs, Booze Easy For GIs to Get in Iraq.” The article itself listed case after case of soldiers engaging in substance abuse in Iraq.

Take a group of (mostly) men far from home, have them fight a war -- a life and death situation – and many of them are bound to get into trouble with drugs and booze. How many soldiers came home from Vietnam addicted?

As if anyone needed proof that servicemen and women that are deployed have a higher rate of drug use than their counterparts at home, the figures are backed up by a Department of Defense report, according to a website called Albuquerque Rehabs. The stress and harrowing experiences of war can also lead to “self-medication of mental health issues” requiring dual diagnosis support for these service personnel when they return home.

Why is none of this surprising? And how can we do a better job at preventing it from happening?

In the last few years, we’ve heard about a huge problem in our country: meth labs, especially in remote areas in places like Missouri. Residents living in poverty with few income possibilities have turned to making meth as a way to make money, with dire consequences for the rest of the population.

Just when I thought the problem may be abating, I see a December USA Today article that the problem is still going strong in Missouri. In fact, it has been for 12 years. I did a web search for “methamphetamine” and I can’t believe how many sites with recipes for making it come up!

Meth has limited medical uses, according to NIDA, the National Institute on Drug Abuse. NIDA’s webpage for the drug  is chock full of information. You can smoke, snort, or inject methamphetamine, or dissolve it in water or alcohol and drink it (although it has a bitter taste), and it produces an intense rush when taken the first three ways I mentioned.

In NIDA’S words:

Long-term methamphetamine abuse has many negative health consequences, including extreme weight loss, severe dental problems (“meth mouth”), anxiety, confusion, insomnia, mood disturbances, and violent behavior. Chronic methamphetamine abusers can also display a number of psychotic features, including paranoia, visual and auditory hallucinations, and delusions (for example, the sensation of insects crawling under the skin). Transmission of HIV and hepatitis B and C can [also] be consequences of methamphetamine abuse. 

Throughout the nation, almost 7,000 meth labs have been seized to date. (Equipment and dump sites are included in that figure.) Luckily, similar to their actions regarding bath salts, states are stepping in and passing legislation to restrict the sale of cold and allergy medicines containing pseudoephedrine, one of the ingredients of homemade meth. I don’t know about your state, but here in NJ you have to ask for certain cold medications because they’ve been moved to behind the counter.

For many people, finding the right treatment program is not always easy. Not only do program offerings vary, but programs can be costly.  Some centers are strictly private pay and over many people’s budget. Or if programs do take insurance, they don’t take your insurance. Maybe you don’t even have insurance.

If you’re a family member looking for treatment for a loved one, the search can seem overwhelming.  Entering “Addiction treatment” or “Treatment center” and the name of your state into an internet search engine turns up numerous choices. What do you do?

Consider a web-based company that refers you to centers according to your specific needs and ability to pay. Drug and Alcohol Rehab Services (www.drugandalcoholrehab.net) in California is one such site.

Founder Debra Norton calls her nationwide referral service a “1-stop shop” that helps people find treatment programs in line with their budget. She started the website to “offer direction to people so they weren’t having to call 1,000 phone numbers and end up with only high-end services.” Indeed, Norton provided a wealth of information when I interviewed her recently.

For example, there are a number of centers that accept insurance. She explained that some accept Medicare, the federal insurance program for those 65 and older and others who are disabled. Similarly, she said, some accept TRICARE, the insurance program for military personnel and veterans.

Financing is another option if you have decent credit, Norton said. She knows of treatment programs that work with finance companies to help clients, and she has heard of payments as low as $200 per month.  “Maybe you’ve asked for help and your father has said he will help pay,” she said. Financing may be especially helpful in that case.  Norton takes the time to talk to those seeking treatment.

There are also sliding-fee programs. But one of the first questions Norton asks is whether you’re willing and able to travel, because not all programs exist in every state. In addition, you may be placed on a waiting list for some state-funded programs.

Norton suggests going to www.rehabusa.net, which will bring you to SAMHSA, a government site on which you can find various facilities. However, be careful when looking for referral sites, Norton advises. Some sites portray themselves as such (“Find Treatment Now”), but are actually treatment centers and may refer you to their three facilities, for example.

You can contact Norton at 800-515-3277, or by filling out the form on the DARS site. Her other is site is Outreach Services (www.drugandalcoholrehabchoices.com, 866-418-1397), which includes quite a bit of information on addiction.

When I saw the headline, I had a feeling I knew what the article would say. The Medpage Today article was titled: “Relatives, Alcohol, Knives, and Other ED [Emergency Department] Thanksgiving Tales.” I was right; it warned readers about holiday merriment when drinking is involved. "People need to minimize their alcohol consumption. But if they don't, stay away from relatives and carving knives," if offered.

Articles like this start appearing around Thanksgiving each year. At a minimum, it certainly doesn’t hurt to remind people of the dangers of drinking and driving at a time when people may imbibe more (especially people with a problem). Besides parties with family and friends, there are those holiday office parties, too.

 Also, college students returning home for the break and congregating in bars can be a real concern. Here’s an article (“Home for the Holiday, Time to Party”) on this yearly ritual from the Wall Street Journal. The paper referred to these events as “the alcohol-fueled get-together[s] of the old high-school crowd.” Of course you think about the drive home and hope the young drivers don’t get behind the wheel.

On the other end of the scale, inebriated family members have caused heartaches, arguments, and worse during holiday get-togethers. Every family in this situation knows what I’m talking about, and families are at different places as to how they handle a family member who drinks. Some try to overlook the drinking and enjoy the holiday despite it. A number of people roll their eyes about their “Uncle Harry” whose drinking is quite obvious during the holiday celebration. Some families insist the the family member who drinks refrain from drinking, or some family members stay away if that family member is allowed to attend. Each family – and family member – has to handle it their own way.

 Then there are the questions regarding family members in recovery. Do you drink around them? Do you only have non-alcoholic drinks? Do you ask them their preferences? It’s not always easy to know what to do.

In my last post I wrote about self-help groups organized by certain professions to help their own. That got me thinking about group therapy. Recovery programs and centers employ numerous tools, depending on the program and center: 1-on-1 counseling with an addiction specialist, nutrition education, natural remedies, medication, books, meditation, yoga, and a person who becomes a sponsor. 

Many recovery center programs, but not all, offer group therapy as well. The ones that don’t seem to appeal to people who might want confidentiality, like executives. WebMD holds that one of the greatest benefits of group therapy is that it can make people realize they’re not alone. Do a search on your state for some of the self-help groups and you’ll see how true that is—at least by sheer numbers.

Whatever is said in group therapy is supposed to be confidential, so for many people a group is a place to feel safe.  Group therapy can be run by a professional, as in a recovery center or even at a college,  or in a self-help group, by a facilitator, a group member.

The Georgetown University webpage on group therapy—which is directed at students—says

“Not only do students receive tremendous understanding, support, and encouragement from others facing similar issues, but they also gain different perspectives, ideas, and viewpoints on those issues.”

There’s an interesting group listed on the site that may attract students before their drinking develops into a full-blown addiction:

Alcohol and Other Drugs Explorations Group

This is a group designed for Georgetown students who are reassessing their use of alcohol or other substances.  There is no requirement of abstinence.  The only requirement is a willingness to examine what is happening around one's use of substances.  This is a confidential counseling group, not an AA group or a 12-step group.  Students are welcome to refer themselves, and faculty and staff may also make referrals.  Students may join at any point in the semester.  The Group Facilitator is Phil Meilman, PhD.  A brief screening and orientation meeting will be needed beforehand to ensure that students are matched appropriately to the group. No Fee.

There are a lot of good things happening on college campuses, but there are always those less than desirable events going on as well, often involving drinking to excess and all that accompanies that during the college years.  Girls Gone Wild, the risqué TV show, was due to arrive at a bar near Rutgers University in my state recently. In fact, two Rutgers University students arranged it.

Not surprisingly, some students and administrators were upset because allowing the TV program to do a video shoot at the bar “detracts from the university’s effort to promote responsible drinking and prevent sexual assault.” The Alcohol and Beverage Control stepped in and said that nudity and liquor cannot mix in a bar and the bar stands to have its liquor license revoked if the event took place. The head of the Student Assembly spoke out against the idea, too, which was nice to see.

I found it interesting that at the same time, Linn State Technical College in Missouri  was in the news for its mandatory drug testing policy as condition of enrollment. Talk about controversy. The ACLU has filed a lawsuit to fight the policy, which

“…requires all first-year degree or certificate-seeking students, as well as those students returning to the college after a leave of a semester or more, to pay a $50 nonrefundable fee and submit to testing by the collection and analysis of their urine. Students began to be pulled out of their classes the day after the policy was adopted so they could be tested, and a refusal to submit to the test will result in students being dismissed from the college.

Students whose tests come back positive will have 45 days to take a second test with a negative result in order to avoid being dismissed from the college.”

Can you imagine if every college had this policy and the courts approved? It might just mean that substance abusing students would have to take a hiatus if they wanted a degree and would return to drug abuse on graduating. But who knows? They’d be studying with a clear mind, and maybe some of them would never go back to drugs.

I suppose you can characterize attitudes toward certain drugs as either liberal or conservative. But there’s a movement regarding drinking that is so liberal as to redefine the word.

Proponents of this theory hold that it’s OK to allow alcoholics to drink rather than try to move them to treatment and save their lives. In some places across the country, alcoholics are allowed to live in houses where no treatment is provided and people are allowed to drink themselves to death. A piece on Minnesota Public Radio ("MPR") dubbed the St. Anthony Residence in St. Paul, where 60 men were living in December 2010, a "hospice".  At the time that article appeared on the MPR website, Minnesota had four “wet houses” in the state.

The arguments for and against wet houses are fairly obvious. Those in favor say treatment doesn’t work for some people and the more humane act is to give these people a home and allow them to live out their days as comfortably as possible. Some alcoholics are simply hopeless, advocates say. Why make them continue the cycle of DUIs, incarcerations, and relying on emergency rooms for emergency care? (They’re provided with medical care if they get sick in these Minnesota homes.) They also cost the government (and taxpayers) a ton of money living this way.

Critics, however, including William Moyers, author of "Broken: My Story of Addiction and Redemption," say this thinking makes no sense. Just as you don’t give up on people with cancer, you just don’t give up on people with an addiction.

A more recent article about wet houses appeared in The New York Times Magazine in April. In this article, an employee at one of the houses said people who live there actually moderate their drinking, and the houses save taxpayers money since they’re funded by non-profits and others.

These houses have to be one of the most controversial topics ever.

In a recent post on marijuana (Marijuana, the Most Commonly Used Drug), I mentioned NIDA, the National Institute on Drug Abuse. Neuroscientist Nora Volkow heads this organization. Every industry or field has its leaders, and in the addiction and recovery field, she stands out.

You may have seen Nora in the HBO special on addiction a couple of years ago. (Here’s an interview with Nora on the HBO page for the documentary.)  

Joan reminded me that Nora is the great-granddaughter of Russian revolutionary/exiled Soviet politician Leon Trotsky. She was raised in Mexico City in the home where he was assassinated.

The New York Times, which also noted her lineage, called her “A General in the Drug War.” Joan mentioned she was an early proponent of the Reward Deficiency theory originated by Dr. Kennth Blum. It was Nora who pioneered the use of brain imaging to better understand how drug addiction affects the brain.

Nora is constantly quoted, as in this USA Today article. Here’s her bio, which describes her illustrious career and wide-ranging career interests. For years she has studied and educated people about dopamine, a neurotransmitter that plays a role in reward-seeking and thus addiction. In May she addressed a group of drug experts about prescription pill abuse, according to The New York Times article. And she writes, too. One of her articles I found especially interesting is Physical Activity May Prevent Substance Abuse.

NIDA and National Institute on Alcohol Abuse and Alcoholism are due to be merged, and the NYT article says Volkow approves of the idea.

“…[S]he is all for the merger, calling the current structure ‘an artificial division with many missed opportunities,’ like having an institute for every particular variety of cancer. Addictions tend to move together, she said, sharing many triggers and a great deal of biology.”

Some years ago I met a woman in her 70’s who started taking Ambien, the sleeping pill, after her husband passed away. She couldn’t sleep without him, she said. Problem was, it’s usually prescribed for the short term, no more than a couple weeks at most, and she never stopped. “What’s the danger?” she asked. “I can think of worse things to be addicted to.”

She had a point with her second comment, but the fact remains: Ambien is addictive, according to WebMD: “Along with its benefits, this medication may rarely cause abnormal drug-seeking behavior (addiction). This risk may be increased if you have abused alcohol or drugs in the past. Take this medication exactly as prescribed to lessen the risk of addiction.”

HealthCentral offers these cautions:

Do not take a dose of this drug unless you have time for a full night's sleep of at least 7 to 8 hours. If you have to wake up before that, you may have some memory loss.

Dosage is based on your medical condition, other medications you may be taking, and response to treatment. Do not increase your dose, take it more often, or use it for longer than prescribed.

Do not take more than 10 milligrams a day. Older adults are usually prescribed a lower dose to decrease the risk of side effects.

There have been reports of people exhibiting odd or even bizarre behavior when taking Ambien.  Earlier this month a North Carolina man shot his estranged wife while on a dose of Ambien 12 times the recommended dosage (along with other medication). One of his lawyers said that, as a result of the pills, the man didn’t know what he was doing. Three years ago, www.cnnmoney.com listed people’s experiences on Ambien that included nocturnal eating, house painting and answering email, all unbeknownst to the pill-taker.

The WebMD site also notes that there are withdrawal reactions such as shakiness and nausea, vomiting and stomach cramps, and nervousness if someone stops the pills suddenly. These may be worse if they’ve been taking Ambien for a long time.

I keep hearing of more women who are taking Ambien to get to sleep. Like the woman I met years ago, they don’t see anything wrong with it. I have to admit I’ve had a few myself recently. But not often, and I’m wary. I don’t think they’re perfectly fine or safe.

Celebrities who take up the torch to spread the word about substance abuse and recovery deserve a special place in heaven. Award-winning actor Martin Sheen, a former mayor of Malibu, is one such celebrity. Many years ago I quoted him in an article when he noted how ubiquitous alcohol use is.  He once said something like: You can’t swing a cat and find someone who hasn’t been touched by addiction.  

In July, according to the L.A. Times, Sheen spoke to a Senate subcommittee in support of drug courts, which offer abusers a better chance at recovery than they could find in jail. 

As the Times reported: 

A drug court is a special docket that addresses the cases of nonviolent drug offenders. Members participate in substance abuse treatment programs – usually for at least one year – and are subject to random drug testing. There are currently more than 2,500 drug courts across the country, treating more than 120,000 Americans.

Drug courts, according to article after article, work. That doesn’t mean they’re a cure-all, and that anyone who is able to avoid prison this way doesn’t relapse. We’d like to think jail makes people wise up, mend their ways, or turn their lives around, to mention some of the euphemisms. But that’s not always the case.

Still they’re a positive, supportive move to help people recover and avoid incarceration. According to the L.A. Times article: “Drug court participants reported 25% less criminal activity and had 16% fewer arrests than comparable offenders not enrolled in drug courts, according to a Justice Department study.”

You may have heard Sheen speak about addiction in past years – he is open about being a member of a 12-step program himself for several decades. On the heels of golfer Robert Garrigus and actor Daniel Radcliffe speaking out, which I blogged about recently, it’s heartening to add the news about Sheen. 

We know that drugs beget violence, from the murderous drug cartels south of the border to the shoot-outs in U.S. neighborhoods. But the news in the last few weeks is mind-blowing. As if pill mills (which I wrote about in February) cropping up isn’t bad enough, now there’s a wave of pharmacy robberies across the U.S.

In Oakland, CA, the thieves took the store’s supply of narcotic cough medicine. On Long Island (New York), one man addicted to oxycodone allegedly shot two employees and two customers in a neighborhood drugstore in June, according to the Associated Press. His wife was arrested as well for driving the getaway car. She, too, is reportedly an addict. I’ve written that prescription pill abuse is on the rise. One statistic in the article was that the number of patients treated for pill overdoses in emergency rooms more than doubled from 2004 to 2008.

The AP article said that part of the problem is because it’s getting harder for addicts to get enough pills. Between the shuttering of Internet pharmacies and the advent of computer systems to prevent addicts from “doctor-shopping”, addicts are taking more drastic steps.  Not long ago I heard someone suggest that pharmacies hire security to protect their customers and employees. It’s a shame that it has come to this.

A NY news station reported that the shooter’s wife made a deal with the authorities – for a lighter sentence if she testifies against her husband – and that the shooter has shown no remorse for his actions.  I wonder if the shooter will feel sorry in a couple of weeks. This is a married couple in trouble. But as always, after thinking about the victims, my mind wandered to the substance abusers’ families --the mothers, fathers, brothers, sisters, and others. Addiction never hurts just the addicted individual.

I’ve said it before and I’ll say it again: It never fails to amaze me how people are driven to write about substance abuse or addiction—both those who have battled it, and those who have been affected by it. (One example is the NYT Proof blog, which is supposed to be resurrected at some point.)

I ran into another example of writing about addiction recently after finally seeing the movie Julie & Julia. I wanted to know more about Julie Powell, the woman who blogged about following Julia Child’s recipes and got a book published (on which the movie is based) as a result. I found an interview she had done on a site called Drinking Diaries.  

Drinking Diaries, the founders tell us, is “a forum for women to share, vent, express, and discuss their drinking stories without judgment.” Writers Caren Osten Gerszberg and Leah Odze Epstein have both been affected by alcoholism in their family, so it’s natural that they got the idea for the blog. They solicit stories about drinking from women and have compiled essays into a book that will be published in September 2012: “DRINKING DIARIES: Women Serve Their Stories Straight Up”.

I could spend a lot of time on this site--there’s lots of good stuff here, like an interview with Alexandra Styron, daughter of author William Styron, who wrote about his depression in his memoir, “Darkness Visible”. His daughter  has written a memoir about growing up with him, “Reading My Father.”  I also liked the Resources section, which lists books related to drinking. I’m including them here:

MEMOIRS:

At Home in the World, by Joyce Maynard

Drinking: A Love Story, by Caroline Knapp

Dreaming: Hard Luck and Good Times in America, by Carolyn See

Hungry Hill: A Memoir, by Carole O’Malley Gaunt

Mommy Doesn’t Drink Here Anymore: Getting Through the First Year of Sobriety, by Rachel Brownell

Red, White, and Drunk All Over: A Wine-Soaked Journey From Grape to Glass, by Natalie MacLean

Slow Motion, by Dani Shapiro

Smashed, by Koren Zailckas

NONFICTION:

Drinking, Smoking and Screwing: Great Writers on Good Times, edited by Sara Nickles, with Bob Shacochis

It Will Never Happen to Me, by Claudia Black

Love on the Rocks: Men, Women, and Alcohol in Post World War II America, by Lori Rotskoff

Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton

NOVELS:

Rosie, by Anne Lamott

YOUNG ADULT NOVELS:

Love You, Hate You, Miss You, by Elizabeth Scott

A Room on Lorelei Street, by Mary Pearson

.

I’ve been writing about alcohol and prescription pill abuse so often that I haven’t given marijuana its due.

As NIDA reports, it’s “the most commonly abused illicit drug in the United States.” It’s not that I haven’t been hearing about pot (or weed, skunk, Acapulco gold, tea, reefer, or any of the other terms it’s known by).  This MSN video reported that pot use is up among baby boomers these days.  

I occasionally discuss marijuana use with other parents since I have a 21-year-old. Although statistics say the numbers have been decreasing, pot smoking seems to be popular with the younger crowd in my area. Opinions among parents I’ve polled seem to run the gamut from “Everyone does it at that age. They’ll grow out of it” to true concern.

A counselor recently told me that today's pot is different from what the flower children of the 1960’s smoked. For one thing, it’s stronger today, which led her to believe it really does qualify as a “gateway” drug. She said that who are experimenting often think, “Wow, if I feel so good on this stuff, I wonder what a different drug might get me.” I don’t know if that’s true, but it’s scary.

Then there’s the standard body of thought that daily use can lead to “suboptimal functioning,” to quote NIDA again. The organization also holds that long-term use can lead to addiction, or at least to increased anxiety and depression.

In my local paper today, a 20-year-old  that attended high school with my son was arrested along with his parents for having a large cache of marijuana. The man’s brother, in a nearby town, was also arrested and charged with intent to distribute and other crimes. He had a number of guns in his house and $15,000. The 20-year-old and his parents could get seven years in prison, the article said. The 27-year-old brother, who had already been jailed for distributing pot, was expected to get up to 26 years.

Pot can decimate lives, too.

These questions, and the advice in the paragraph that precedes them, are courtesy of the CSAT site (Center for Substance Abuse Treatment), part of SAMHSA (Substance Abuse and Mental Health Services Administration) in The U.S. Department of Health and Human Services. 

The link on the CSAT site where I found them is no longer active, and I couldn’t find a page they had been moved to, either. It’s unfortunate because the information seems extremely helpful. Sometimes the best questions are the ones you wouldn’t think to ask.

If you or someone you care for is dependent on alcohol or drugs and needs treatment, it is important to know that no single treatment approach is appropriate for all individuals. Finding the right treatment program involves careful consideration of such things as the setting, length of care, philosophical approach and your or your loved one's needs.

Here are 12 questions to consider when selecting a treatment program:

On Sunday, a controversial article about alcoholism and anonymity appeared in The New York Times Styles section. In it, NYT reporter David Colman used his first and last name when he revealed that he’s in recovery, which is a no-no in the world of Alcoholics Anonymous.

“…Anonymity is fading,” reveals a professor interviewed in the article, but A.A. is standing fast to the belief that people suffering from alcoholism can only feel safe in meetings if their identity is not revealed. Numerous people in the article said that’s doing a disservice to those in recovery and actually hindering the recovery movement.

I’m sure I’m not alone in welcoming the controversy. As I wrote in October, the physical effects of alcohol abuse alone are devastating, so anything that calls attention to recovery is A-OK in my book.

Here are some reactions to the article from a few people in the Malibu Beach Recovery Center community:

"Anonymity is fiercely protected in my world.  I find that in my business connections, no one need know that I am in a 12-Step program.  The whole point is that once inside the confines of an AA meeting, I wish to be free to speak about what is on my mind as it pertains to the speaker's topic, Big Book Reading, or other 12 and 12. Feeling SAFE and not-being-judged is of paramount importance to me.

"Each individual is different so their interpretation of AA and anonymity might be different than mine.  I accept their choice, but would never want that choice to be removed from me.  (So self-will!)

"The best part of any 12-Step program is that the attendees should feel that they are in a SAFE setting with folks that will, ultimately, identify with their feelings and processes.  Non- AA's might be judgmental or not understand, thus stifling fragile, newly sober individuals. 

"'Keep Coming Back' would have not appealed to me in early sobriety if I had to worry about my crying, yelling, using foul language - EXPRESSING myself if I were fearful of someone "taking notes" on me."

-- Mike N, Alumnus

"When people talk about it [getting sober] like it is just something that some of us go through, e.g. Rob Lowe, it seems to take the stigma out of it. It even becomes a topic at the dinner table and you find that you don`t have to go to an AA meeting to hear something that might help you in your own recovery. I am all for removing the second A.:

-- Dale C, Alumnus

"I used to cringe at revealing my alcoholism.  Now, I just don't give a damn.  I do, however, believe that we need to stick w/ the original 12 traditions because they have worked for this long and if it ain't broke; don't fix it."  

-- Lori C., wife of alumnus

"Bill Wilson, the founder of AA, implies as much in a book called "Not God" written by Ernest Kurtz--Hazelden.org--publisher.  'Anonymity in time will be the effect of a world that didn't understand alcoholism, and true recovery will be available to anyone who wants it.'

"We are seeing the beginnings of it, but as long as we have the Danny Baldwin's of the world on Larry King professing to be sober, while back at his hotel there is an ounce of crack and a hooker, we have some way to go here with this.

"Anonymity is the spiritual foundation of our recovery---which basically means that in order to truly recover we need humility. Some clown who professes to be sober but is on tv, or film, attracting attention to the fact that he's a hot shit cause he's sober--then picks up (Charlie Sheen) doesn't help matters.

"Especially if there is some poor kid watching the whole fiasco who comes away thinking that recovery is a joke.

"In time, anonymity will be of a bygone era. But not right now."

-- Joe S., Malibu Beach Recovery Center professional

I’ve only taken a few yoga classes. It’s one of the things I thought I’d devote time to in retirement.

Yoga is an integral part of several recovery programs. Malibu Beach Recovery Center offers “yoga breath work,” to quote Joan, but don’t be misled by the terminology—it’s an intense, well-designed plan. Lead exerciser Oleg Yevseyev has written about the link between yoga and brain rejuvenation here. And in an earlier post, Elizabeth, an MBRC graduate, raved about it.  This excerpt from the manual explains more:

This program is most effective combined with a low glycemic diet; a specifically formulated program of food supplements and amino acids; group, individual and family therapy; and when appropriate, membership in a 12-Step program. 

The target audiences are usually unhappy, depressed and anxious people who have spent years developing chemical and emotional imbalances due in full or in part to genetic predisposition, environmental factors, stress, depression, anxiety, and high glycemic diets (rich in carbohydrates and sugars). This program of yoga-based breathing exercises helps participants feel naturally happy. It eliminates the need to self-medicate with alcohol, street drugs or prescription drugs.  The program stimulates, rejuvenates and balances brain chemistry; it repairs brain function and those parts of the brain that have been physically damaged by chemical dependency.  Different breathing exercises combined with different movements and static positions oxygenate and deepen the connection between the brain and body and appear to raise the chronically low dopamine levels of the target audiences. Like meditation, the stable pace of repeated movement helps clients focus their mind. Attending classes three times a day for at least 30 days (depending on severity of each individual’s condition) helps participants develop the habit of correct breathing which reduces stress during the day and sustains newly elevated dopamine levels.   

The program consists of three different types of classes:  Energy Replenishment (before breakfast), Energy Enhancement (before lunch) and Calming Release (before dinner).   The goal is balancing the two main systems of the body:  the system of excitement and the system of tranquility. The morning and afternoon classes are designed to last one hour each.  The evening class lasts for 1-1/2 hours.  This means that three times a day the mood of the participants is uplifted through exercises that train the brain to produce dopamine. At the end of 30 days most participants have achieved higher dopamine levels that can be sustained by continuing to do at least half an hour of yoga breathing exercises each day.

Yoga itself has numerous benefits for people recovering from a variety of ailments. The reasons it’s helpful are especially applicable to those in recovery from addiction:

• Yoga is calming and helps people manage stress. 
• Yoga helps you focus.
• You don’t need to be in great shape or flexible to do it.

Here are some websites containing information about yoga and recovery.

http://www.yogaforrecovery.net/  This site features two yoga practitioners.

http://www.adyo.org  (a free video on addiction recovery and yoga)

http://www.yogajournal.com/practice/679  (An article from Yoga Journal)

Finally, the reason I thought of writing this post: here’s the link to a 1^st-person essay in The New York Times by a yoga practitioner in recovery from  heroin addiction. She tells how hard it was to continue attending the class, yet how it helped her. She became a yoga teacher herself.

I’ve run into several people whose alcoholic family member gets up each morning and goes to a job, so the sober person says their loved one doesn’t have a problem. For people who don’t understand substance abuse and addiction, the high-functioning alcoholic can be difficult for some people to wrap their brain around.

Understanding the High-Functioning Alcoholic: Professional Views and Personal Insights, by Sarah Allen Benton, explains that some of us are influenced by the stereotype of the jobless and homeless substance abuser who’s all tapped out. That’s what an alcoholic is to them. Benton calls people who represent this stereotype “low-bottom drunks.” and I take that to mean drinking takes over these peoples’ lives to the point where they lose everything and can barely function.

Roughly 18 million people suffer from alcohol abuse or dependence in this country, and about 9% of those fit the stereotype just mentioned, according to the book. However, 20% of people who abuse alcohol may be high-functioning, Benton tells us. They work, often in prestigious careers, and they can maintain a life outside work. They often hide their disease well. Plus, their success makes it even easier for them to deny they have a problem.

But this group exhibits the same warning signs as anyone with a drinking problem: They experience blackouts, they feel shame about their drinking, they obsess about it, and they can’t stop. There are several other signs as well. Plus, they’re on the road that leads to one place only: death.

Benton speculates that there’s not a lot of research on this segment of drinkers simply because they’re higher functioning. They don’t pose as severe a problem for society and government systems as their severely addicted counterparts. Her discussion of famous “HFAs”, as she calls them, reminds us that no one is immune. The list goes on and on: Buzz Aldrin, Elizabeth Taylor, celebrity host Pat O’Brien, Representative Patrick Kennedy, Grammy winner Keith Urban, Eric Clapton, and more recently, Charlie Sheehan, to name a few. There but for the Grace of God go you and I.

The book is divided into two sections: Active Alcoholism and Recovery, which I found to be an interesting approach.  It stands to reason that the author discusses the controversial topic of cutting down, or drinking in moderation, since it’s an option most HFAs probably consider. She presents a ton of research, both pro and con, and you can guess, on reading her background, which side she’s on.

A high-functioning alcoholic herself, Benton is a mental health counselor in Boston entering her 7^th year of sobriety. Her story of alcoholism and recovery, woven throughout the book in actual entries from a journal she kept, seem especially poignant, probably because as a professional she has great insight into her experiences. “The longer I have been in recovery, the more I change my perspective on my past,” she writes.

Here’s a blog post Benson wrote for Psychology Today: http://www.psychologytoday.com/blog/the-high-functioning-alcoholic/200903/high-functioning-alcoholics-are-everywhere-are-not-gettin

There’s a lot of information in this book, but if it’s the personal story that always gets you, Benton certainly has one.

New York City owns a disturbing statistic: prescriptions for oxycodone have doubled in the last three years, according to one of its narcotics prosecutors. The Wall Street Journal article referring to it as “the city’s prescription drug abuse epidemic” was so matter-of-fact it was scary. The article said that the figures equate “to one prescription for every eight people” in the city. I’m reminded of how The New York Times posted the number of casualties in a recent military conflict every day to illustrate the rising toll. The articles about oxycodone have the same effect—chilling.

Unfortunately, the problem has a ripple effect. Less than an hour from New York City, in Newark, NJ, police uncovered an oxycodone ring whose members included a doctor and a retired policeman. Twelve people. The Wall Street Journal article appeared on March 16; the NorthJersey.com article about Newark appeared on March 24.  The culprits face up to 20 years in prison.

I love the statement in the article on the NorthJersey.com site from a government staffer: “Doctors who illegally  prescribe  are often the first link in a chain of addiction and suffering,” said U.S. Attorney Paul J. Fishman. Horrific.  But they’re not the last.

The police had this group under surveillance for a year. You wonder how these criminals approached each other. How did they know who would be interested  in joining them? How  many people did they reach ? How many people who are cut off will just find another source? Will some go for treatment?

Both these states are known for so many good things.  The prescription pill epidemic is not one of them.

I wrote in an earlier post that there’s something about addiction that makes many people want to write about their feelings. Then I learned about Tim Conley, an assistant professor of Social Work at the University of Montana who teaches two courses on addiction and counsels addicts.  He writes songs from the other side of the fence, capturing his clients’ experiences.  In The Journal of Poetry Therapy, Conley says this about his song writing:

"Through the music I was able to achieve a heightened sense of empathy and more fully experience the feelings associated with these events, finding meaning and place for them in a way that allowed me to remain emotionally resilient enough so I could continue to see other addicted clients day-by-day."

You can feel the empathy in the following two poems of Conley’s, once again proving my thesis…there’s something about addiction that makes people want to write about their feelings.

Relapse

It’s easy to get lazy, when the pain goes away.

Memories growing hazy, of the price we’ve had to pay.

Like children who will wander__from the safety of a home;

A never-ending nightmare, wakin’ up and all alone.

It’s crazy to go easy, on the things that keep us sane.

To look and find a reason, to turn and walk away.

Feeling like we’ve made it__like our wounded mind has healed itself somehow;

Even though we hate it, slipping back into that cloud . . .

People who would love us lose, leaving in the guilt regrets and shame;

Lost somewhere so far between, believing lies and feeling all the pain.

Relapse to the bottle, to the wickedness and hollow place inside;

Wandering in Madness__from the spirit poured within__you cannot hide . . .

Cannot hide.

It’s easy to get lazy, when the pain goes away.

Memories growing hazy, of the price we’ve had to pay.

Early sobriety

Now that I am sober I just don’t know how to behave

Time goes by much slower and I always seem to crave

They tell me to get numbers, to reach out and to call

I think if I don’t take 12 steps I’m surely gonna fall

Where is everybody, who said they loved me?

Have they all gone running? like I went running too?

Where is everybody, who said they loved me?

Can they see me now? Can I see them too?

If I could just forget who I was and what I’ve done

Today might be another clean__a clean and sober one

If I could just forget the hurt, the people and the pain

I might be able now to start my life again

Where is everybody, who said they loved me?

Have they all gone running? Like I went running too?

Where is everybody, who said they loved me?

Can they see me now? Can I see them too?

Now there are the meetings of my mostly sober friends

AA coffee talk in places we just don’t pretend

There’s hope in here conflicting, conflicting with despair

I think how long it took to get my ass in this chair . . .

Where is everybody, who said they loved me?

Have they all gone running? Like I went running too?

Where is everybody, who said they loved me?

Can they see me now? Can I see them too?

We hear over and over again that alcoholism wreaks havoc on the human body, but I’ll never forget the first time I learned how pervasive the damage can be.  Hearing about it is one thing, however, but seeing it in print really brought it home to me. It’s not pretty, and that’s a good place to start this cautionary post.

People who drink to excess suffer from poor nutrition because they can’t absorb vitamins properly, so aside from the physical complications, their appearance suffers. Overall poor health from alcoholism can make someone’s skin appear pasty and their hair look dull. If you’ve seen broken capillaries on someone’s face, you’ll probably agree they’re unsightly, too.

But that’s not the half of it. Let’s start at the top. Brain degeneration is a big problem, along with the possibility of severe memory loss and Wernicke-Korsakoff (“wet brain”) syndrome. Symptoms of the latter disorder include unsteady walking, hallucinating, confabulation (making up stories), and vision changes.

Experts say alcoholism can also lead to cancer of the colon, liver, larynx, and esophagus. Not only that, liver disease (alcoholic hepatitis), followed by cirrhosis of the liver, and esophageal bleeding are not uncommon, nor is pancreatitis.

The list goes on. Alcoholics can experience depression, insomnia, high blood pressure, and nerve and heart muscle damage. In women, alcoholism can lead to the cessation of menstruation, and in men, to an inability to get an erection.

On one hand, many of these are clinical-sounding unemotional medical terms that read like a Scared Straight script, the talk prison inmates give to young people to try and keep them on the straight and narrow. On the other hand, if you or a loved one has experienced some of these complications, you know how serious they can be, and how heart-breaking.

Whether or not an addict enters recovery as a result of an intervention, a court mandate, or a personal choice, the important thing is that they get there, right? Actress Elizabeth M., one of the success stories on this website, is interesting for many reasons, but one is that she knew it was time. Granted, her talent agent had recently fired her, but her story is uplifting because of how she so willingly gave herself over to the program from the start. She drank on the ride there, but there was no denial. She had told herself, ‘This is it. I have to do it.”

You might argue that she had hit bottom when she found herself without a career, and because her marriage was on shaky ground because of her drinking. She’s quick to point out that she was afraid of what her drinking was doing to her son, too. He was 9 when she entered Malibu Beach Recovery Center.

But the self-realization she owns up to is inspiring. It’s common to find people in deep denial after years of hurting themselves and others. Recently I interviewed a man who said that even weeks into his stay at a Pennsylvania program he was still lying to everyone—and himself. It’s the nature of the disease.  Elizabeth is also looking back from the perspective of a year’s sobriety, but if she’s to be believed (and there’s no reason not to) she desperately wanted her life back. Her mother had been an alcoholic and started drinking when Elizabeth was 9, the age her son was when she decided to get sober. The irony is striking. Or, as Elizabeth says about the coincidence, “the planets were aligned.”

When I asked Elizabeth to describe a little of what rehab was like, she said she doesn’t remember the first two days because she was detoxing. She remembers how frail she was when she started, and that the food was “the best she had ever eaten 28 days in a row.” She also recalls that she was determined to succeed, because she didn’t want to have to return.

Like most people I’ve talked to who are in recovery, Elizabeth has gained a truckload of wisdom about herself and about life since achieving sobriety at 46. She attends daily self-help meetings, and she still talks to her sponsor. Perhaps most important, she’s confident she’ll be around to see her son graduate from high school now, which a doctor had told her, before rehab, might not happen.

An addiction specialist I interviewed once told me that the hardest people to treat are those who are down and out financially and those who are successful. The first group figures they have nothing more to lose if they don’t stop drinking, and the second group figures they have enough financial resources that they can continue drinking for quite some time with few consequences.

Both groups are mistaken.  Just ask Elizabeth.