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Teaching people how to moderate or control their drinking, or to otherwise
exchange unhealthy drinking habits for healthier ones, is an approach
that is receiving wider acceptance among health professionals who
treat alcohol problems. Interventions which focus on harm reduction,
i.e. reducing the risks of harm or negative consequences from drinking,
as well as cutting down on overall alcohol consumption, have been
proven to be effective for many people.
In one of the most effective programs, Behavioral Self-Control Training,
participants learn to slow their rate of drinking, figure out what
triggers the desire to drink (e.g. stress, social anxiety) and explore
alternatives to achieve a similar effect (e.g. relaxation) without
drinking. They also set specific goals for how much and how often
they will drink, and monitor their drinking. On average, following
the BSCT program results in a reduction in drinking by 30 to 50 percent.For more information
about BSCT, read “Controlling Your Drinking” by Miller
and Munoz. There are also a number of websites and self-help programs
for people who want to change their drinking habits. A good place
to start is http://www2.potsdam.edu/hansondj/DrinkTooMuch.html
However, controlled drinking is not for everyone! Those most likely
to succeed have had mild to moderate alcohol-related problems for
less than 10 years, and are not physically dependent.
PRESCRIPTION
DRUG ABUSE (October
2006)
It seems everyone
has an opinion about NFL star Terrell Owens’ recent drug
overdose (was it accidental, as he claims, or a suicide attempt
related to a relationship break-up, or just another attention-grabbing
stunt?) but the facts are these: he had recently had surgery for
an injury, was prescribed a popular pain reliever, Vicodin, and
he took more than the prescribed dose, enough to give the police
cause to take him to the hospital.
Could he have taken enough pills to kill himself, accidentally or
not? Most definitely, given the amount in the bottle he had. In
fact, his celebrity status makes this news, but the real news
is that prescription painkillers like his cause more lethal drug
overdoses than either cocaine or heroin. U. S. emergency room
records show that from 1990 to 2002 the mortality rate from “unintentional
drug poisoning” increased by more than 200 percent. Most of
those deaths involved middle-aged men.
The non-medical
use and abuse of prescription medications, particularly pain relievers,
has reached an unprecedented level in our society. Results of a
2004 national survey indicate that about 6 million Americans age
12 and older, which represents 2.5 percent of the population, used
prescription medications for non-medical purposes.
Abuse of prescription
drugs is a serious problem among teens seeking a new “high”
(9% of 12 graders report use of Vicodin without a prescription,
and 5% report using Oxycontin, a powerful prescription opiate drug)
and is increasing among the elderly, who are more likely to forget
or get confused about how many or which of their many different
medications they’ve taken.
Two relatively
recent phenomena have contributed to this crisis: first, there is
a new trend among doctors to treat chronic pain more aggressively,
with stronger medications and higher doses, due to a growing recognition
that pain impedes recovery from illness. Potent new drugs like
Oxycontin are showing up in home medicine cabinets throughout the
country, and are also being "diverted" to the street where they
may be sold for $50-80 a pill.
The other phenomenon
is occurring through the Internet, where anyone with a credit card
can purchase unlimited quantities of almost any medication they desire,
without having to see a doctor to obtain a legitimate prescription,
and without any monitoring. And if that isn't dangerous enough, many
of these "Internet pharmacies" are not FDA-approved, and may be selling
medications that are counterfeit, outdated or improperly manufactured.
All prescription painkillers and tranquilizers have the potential
for abuse/addiction (despite what some doctors and most ads will tell
you). When used as prescribed, the risk of addiction is fairly
low, however tolerance does develop over time, resulting in decreased
effectiveness. These medications are most effective when used for
short periods of time (e.g. after surgery), or on an infrequent basis
(e.g. for occasional panic attacks or insomnia).
"Best practices" for use include: a) start with the smallest dose
and increase gradually, b) in-form your doctor promptly if a medication
doesn't seem to be working, c) monitor your meds to prevent unauthorized
use/theft, d) never give someone else medication prescribed for you,
and e) know the signs of abuse and addiction.
MARIJUANA ADDICTION (May
2006)
A recent article in the Wall Street Journal reports on a growing
trend: people seeking treatment for addiction to marijuana. About
16% of people entering substance abuse treatment programs in 2003
cited marijuana as their primary problem, as compared with just
7% ten years earlier.
The article
also noted the recent publication of a new book called “Cannabis
Dependence”, which contains the results of over two decades of research
on whether marijuana is addictive. This research confirms what those
of us who treat substance abuse problems have known for years: yes,
marijuana can be addictive!
The studies
show that about 10% of those who try it will become addicted. This
puts marijuana at about the same addictive potential as alcohol
– although, among daily marijuana users, the rate of addiction is
significantly higher than among those who drink alcohol daily.
One of the
likely explanations for the increase in people addicted to marijuana
is that the potency of the drug has increased dramatically over
the years. According to Dr. David Smith, Medical Director of the
Haight Ashbury Clinic, the marijuana sold on the street today is
about ten times stronger than what was available in 1967, when the
Clinic was founded. Anyone who smoked pot back in the 70’s may have
a hard time believing that marijuana is addictive, for the simple
reason that the quality of the drug they used was far inferior to
the quality today.
Another reason
people may not view marijuana as addictive is that they don’t see
marijuana use leading to the same serious consequences that drugs
like cocaine and heroin, even alcohol, can cause: loss of jobs,
relationships, health, even lives. However, it is not nearly as
harmless as many people would have you believe.
In my practice,
I have seen clients who use marijuana on a daily or near daily basis,
and may not perceive they have a problem with it, yet they have
come to counseling because they feel “stuck” in some aspect of their
lives, and don’t know why: maybe their jobs or relationships aren’t
going well, or they may feel anxious, stressed, or depressed for
no obvious reason.
Often these
vague feelings of dissatisfaction with their lives can be traced
to the effects of the marijuana, and usually these clients are quite
surprised to discover that, if they stop using it for awhile, the
anxiety or depression is gone, replaced by a renewed energy and
sense of purpose.
Other clients
have been surprised to find out how difficult it is for them to
stop using, as they experience the effects of withdrawal: increased
irritability and anxiousness; difficulty sleeping, relaxing or concentrating;
as well as headaches or other physical aches and pains. Many people
are also surprised to learn how strong the cravings for the drug
can be, and for how long the cravings may persist – all signs that
yes indeed, they had become addicted.
Resources for
Marijuana Addiction
If you are concerned that you or someone you care
about may have a marijuana addiction:
- For info
on treatment programs in California: www.adp.cahwnet.gov
- Or call
the nation-wide Substance Abuse Treatment Hotline at (800) 662-HELP
- Look into
joining a support group like Marijuana Anonymous - check their
website for meeting locations
(www.marijuana-anonymous.org)
AM I ADDICTED? (August 2005)
Clients sometimes
ask me this question, as we’re discussing their drinking habits
or drug use. Or they’ll answer it themselves, saying something like
“Yeah, I’ve got a problem, but I don’t think I’m addicted to
it,” as if that’s an important distinction. “You’re asking
the wrong question,” I’ll respond. The important question is,
“Has your drinking (or drug use) caused any problems in your
life?”
For example,
have your friends or family members complained about it? Has it
led to misunderstandings or conflicts in your relationships? Have
you done or said things while under the influence that you’ve seriously
regretted later? Has your use led to financial, legal or health
problems? Have you broken promises, to yourself or others, due to
your use? If you can answer “yes” to even one of these questions,
then it’s a problem.
Two things
interfere with most people being able to recognize if they are addicted
to a substance: 1) lack of knowledge about what addiction is, and
2) an understandable unwillingness to admit that they may not be
in control of their life. No one wants to admit that they can’t
always control their behavior, let alone consider the idea that
they might be an alcoholic or an addict.
So I tell clients
it’s not necessary to answer the question: if you know you drink
too much, either sometimes or all the time, you don’t need to decide
whether or not you’re an alcoholic – you just need to accept that
drinking has become a problem for you, and be willing to do something
about it. The same goes for a problem with drugs, whether illegal
or prescription – or cigarettes, caffeine, sugar, gambling, work,
sex or anger (all things that people can get addicted to).
If your honest
answer is “yes, it’s causing problems in my life”, then my
advice is to do something, now. You can try to cut down on your
own, or try substituting a healthier habit, like exercise. If that
works, great! If it doesn’t, then it’s time to seek help:
- Ask your
doctor for a referral
- Call your
company's EAP
- Go to a
“12-Step” meeting, like AA
- Call the
Substance Abuse Treatment Hotline at (800) 662-HELP
- Find out
what programs are in your area through findtreatment.samhsa.gov
- Contact
me for an evaluation or referrals
By the way,
the official diagnostic criteria for addiction are: 1) tolerance,
that is, you need to consume increasingly more of the substance
to achieve the desired effect; 2) withdrawal symptoms (physical
and/or psychological) when you stop using; and 3) a pattern of compulsive
behavior involving the substance. Because signs of tolerance and
withdrawal aren’t always present, or obvious, it’s best to focus
on the behavior.
Such behaviors
might include consuming more than you intended to, sneaking or lying
about your use, planning your day around when you get to use, and
giving up activities or friendships that interfere with using. Making
lots of rules for yourself about when and where you can use, or
repeated but unsuccessful efforts to cut down or stop using, are
also behaviors that point to a probable addiction.
SUDAFED ABUSE? (April 2005)
Have you bought
any Sudafed recently? Did the drugstore clerk ask for your ID, or
were you told you needed a doctor’s prescription? No, of course
not – but that scenario could happen under a proposed federal law.
Several states, including Oregon, have already enacted laws which
restrict the sale of Sudafed and similar cold or allergy medicines.
The reason? To try to curb the growing problem of methamphetamine
abuse.
These cold
and allergy products contain pseudoephedrine, which can be
“cooked” down in a relatively simple process to produce the illegal
drug. About 20 percent of the meth available today in the U.S. comes
from small “labs” in someone’s home or garage (the rest is made
in large quantities by “superlabs” in Mexico, Canada and elsewhere).
Whether or
not you agree with the idea of restricting pseudoephedrine sales,
you’ve got to admit that methamphetamine abuse has become
an epidemic. In a recent survey by the National Institute on Drug
Abuse, 12 million Americans admitted that they have used meth. A
recent article in the SF Chronicle described two groups of meth
users that might surprise you: employees of high tech companies
in Silicon Valley, and suburban “soccer moms”. Middle school and
high school students are also at risk, because meth is cheap and
easily obtained.
What attracts
people to methamphetamine are its initial effects: increased
energy and alertness, decreased appetite, and an enhanced sense
of well-being. As a stimulant, it is similar to cocaine and to legal
amphetamines like Dexadrine, however meth is far more dangerous.
This is because it can’t be metabolized very well, so it stays in
the body much longer and continues to damage brain and nerve cells.
Meth (also
known as “speed”, “crank”, “ice” or “crystal”) is extremely addictive,
because it acts on the neurotransmitter dopamine, which is sometimes
referred to as the “pleasure center” of the brain. However, long-term
use ultimately leads to the inability to experience pleasure, as
both dopamine and seratonin cells are destroyed.
Symptoms
of methamphetamine use can include increased anxiety or depression,
anger, violent behavior, mental confusion, insomnia, weight loss,
and acne. Chronic abuse can actually cause psychotic behavior, characterized
by intense paranoia, visual and auditory hallucinations, and out-of-control
rages. Chronic abusers may also develop attention and memory problems
as well as Parkinson’s-like tremors.
Meth addiction
is difficult to treat, and even low-dose users tend to have a very
hard time quitting. Most treatment professionals recommend a combination
of cognitive-behavioral therapy, nutritional supplements, and participation
in a “12-step” support group for at least a year, as that’s how
long it typically takes for the cravings to stop and the brain to
return to some semblance of normal. The good news: recent research
has shown that at least some meth-induced brain damage is reversible.
For more information
about methamphetamine abuse and treatment, contact the National
Clearinghouse for Alcohol and Drug Information at 1-800-729-6686,
go to the website for the National Institute on Drug Abuse (www.nida.nih.gov),
or call me!
ALCOHOL: KNOW THE FACTS (August 2004)
August is the most dangerous month for drinking
and driving, according to a report just released by the Automobile
Club of Southern California, which analyzed state-wide data for
the past five years. More Californians are injured or killed in
alcohol-related collisions during August than in any other month.
The obvious explanation: summer vacations and outdoor recreational
activities, which often include drinking.
Indeed, this is the time of year when most of us
look forward to some time to kick back and relax for awhile, whether
at the beach, the lake, or some other vacation destination. And
relaxing is associated with drinking for many adults (and too many
teens and kids!)
Trips to emergency rooms, court, and the cemetery
rarely come to mind as we kick back and share good times with friends
and family over a few beers or a pitcher of margaritas. Yet that
may be the outcome if you drink and drive, or get into a car, boat
or other vehicle with an intoxicated person, or are unlucky enough
to be in the path of a drunk driver.
How to avoid such a scenario in your life? First,
know the facts about alcohol and alcohol abuse:
- For most
adults, moderate alcohol use--up to two drinks per day for
men and one drink per day for women and older people--causes
few if any problems. There is no “safe” level of drinking for
pregnant women, people under 21, recovering alcoholics, or those
taking certain medications.
- “One drink”
is defined as: a 12 oz. beer, a 5-oz. glass of wine, or a 1.5
oz. shot of hard liquor. When you’re pouring drinks, do you
measure?
- Women become
more impaired than men do after drinking the same amount of alcohol,
even when differences in body weight are taken into account. This
is because women's bodies have less water than men's bodies, and
their metabolism is different.
- The ability
to “drink everyone else under the table” is an early sign of alcoholism.
- It takes
about an hour for the body to metabolize one drink, in other words
for the alcohol to get out of your bloodstream and into your bladder.
However, impairment is greatest in the second half of the hour
– and if you’re drinking at a faster rate than one drink an hour,
you will get more impaired, and stay impaired longer.
- Drinking
coffee won’t sober you up any faster – you’ll just be an alert
drunk!
- You do get
drunk faster on an empty stomach – also if you haven’t slept well
the night before; if you’re taking certain medications; if you’re
premenstrual; or if you’re over 65.
- While it's
believed that small amounts of alcohol (one drink with dinner)
may help protect against heart disease by reducing the risk of
blood clots in the arteries, you can achieve the same health benefit
from a low-fat diet with plenty of fruits and vegetables.
- Heavy drinking
increases the risk of heart failure, stroke, and high blood pressure.
- The cost
of a first-time DUI is estimated at over $12,000: this includes
fines, DMV fees, legal fees, the increase in car insurance, and
alcohol education classes.
So have a safe
and healthy summer – don’t drink and drive, or get into a vehicle
with someone who has been drinking or seems drunk. And if you are
the host, don’t allow any guest who has been drinking to drive home.
For more information about alcohol abuse, go to www.niaaa.nih.gov
- or call me!
ARE YOU A CO-DEPENDENT PERSON? (May 2004)
It has been said that every person with an alcohol
or drug abuse problem affects the lives of at least four other people:
their spouse or partner, parents, children, co-workers, friends.
Just as alcoholism tends to run in families, children who grow up
with an alcoholic or addict are far more likely to fall in love
with, marry, or go to work for another addicted person. What do
we mean by co-dependent behavior?
- We feel
responsible for other people’s feelings, thoughts, actions, choices,
wants, needs and well being.
- We tend
to “stuff” our feelings, or have lost the ability to feel or express
our feelings.
- It is
easier for us to be concerned with others rather than ourselves.
This in turn has allowed us to neglect our own needs and ignore
our own shortcomings.
- We say “yes”,
even when we want to say “no”. We experience guilt feelings when
we stand up for ourselves instead of giving in to others.
- We judge
ourselves harshly, and have a low sense of self-esteem.
- We have
difficulty trusting people and developing intimacy in our relationships.
- We confuse
love and pity, and tend to “love” people we can pity and rescue.
- We are terrified
of abandonment. We will do anything to hold on to a relationship
in order not to experience painful abandonment feelings which
we may have received from living with people who were never there
emotionally for us.
- We take
life too seriously, and have trouble having fun.
- We have
developed our own compulsive behaviors, such as overeating, compulsive
spending, workaholism, or addiction to prescription medications
or alcohol.
- We have
become addicted to drama. We feel bored if we don’t have a crisis
in our lives, someone else’s problem to solve, or someone to help.
- We are reactors
in life rather than actors.
How many of
these statements are true for you? Even if you are not presently
living with, working with, or spending time with someone with an
alcohol or drug abuse problem; and even if you didn’t grow up with
an alcoholic or addict in your family; if you recognize yourself
in the above statements, you may be a co-dependent.
You can benefit
from attending Al-Anon (www.ncwsa.org),
or groups like Codependents Anonymous (www.codependents.org),
or Adult Children of Alcoholics (www.adultchildren.org).
You may also benefit from individual counseling.
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