Thursday, December 18, 2008

Marijuana Law Comes With Challenges

BOSTON — Last month, voters approved a statewide measure decriminalizing the possession of small amounts of marijuana. Now, wary authorities say, comes the hard part. They are scrambling to set up a new system of civil penalties before Jan. 2, when the change becomes law. From then on, anyone caught with an ounce or less of marijuana will owe a $100 civil fine instead of ending up with an arrest record and possibly facing jail time.

It sounds simple, but David Capeless, president of the Massachusetts District Attorneys Association, said the new policy presented a thicket of questions and complications.

One of the most basic, Mr. Capeless said, is who will collect the fines and enforce other provisions of the law. For example, violators under 18 will be required to attend a drug awareness class within a year, but it is unclear who will make sure that they do so. The fine increases to $1,000 for those who skip the class.

A complicating factor, said Mr. Capeless, the district attorney in Berkshire County, is that state law bans the police from demanding identification for civil infractions.

“Not only do you not have to identify yourself,” he said, “but it would appear from a strict reading that people can get a citation, walk away, never pay a fine and have no repercussion.”

Wayne Sampson, executive director of the Massachusetts Chiefs of Police Association, says he anticipates that many violators will lie about their identities.

“You can tell us that you’re Mickey Mouse of One Disneyland Way,” Mr. Sampson said, “and we have to assume that’s true.”

The authorities, he said, will also have to be sure that the substance they hand out citations for is marijuana, which will involve sending it to the State Police crime laboratory.

“You’re going to appeal it and go to the clerk’s hearing,” Mr. Sampson said, “and if we don’t have an analysis from the drug lab, the clerk is going to throw the case out.”

Mr. Sampson predicted that the law would result in de facto legalization of marijuana because it would prove too difficult to enforce.

“I would argue that the proponents knew these complications right from the beginning,” he said.

About 65 percent of state voters supported the decriminalization measure, which was promoted by a group that spent more than $1.5 million on the effort.

The group, the Committee for Sensible Marijuana Policy, said that in addition to ensuring that people caught with marijuana no longer have a criminal record, the change would save about $29.5 million a year that it estimates law enforcement currently spends to enforce existing drug laws.

A spokesman for the Marijuana Policy Project in Washington, which supports the drug’s legalization and created the Committee for Sensible Marijuana Policy to get the ballot question passed here, said that judging from the experience of other states with civil penalties for marijuana possession, Massachusetts officials were exaggerating the challenges.

“I can’t help but think that the real difficulty in implementing it,” said the spokesman, Dan Bernath, “is they don’t want to do it.”

Eleven states have decriminalized first-time possession of marijuana, though in most it is technically a misdemeanor instead of a civil offense.

In Nebraska, where possession of an ounce or less of marijuana is punishable by a $300 civil fine, the process has worked smoothly for three decades, said Michael Behm, executive director of the Nebraska Crime Commission.

In New York, possession of an ounce or less of marijuana is a noncriminal violation but is still processed through the criminal system, said Robert M. Carney, the district attorney in Schenectady County.

“They are brought down to the police station so their identity is established,” Mr. Carney said of violators, “but they are not fingerprinted because it’s not an arrest.”

In Massachusetts, the Executive Office of Public Safety is working with state and local law enforcement and court officials to determine how to apply the changes. Mr. Capeless said education officials were also in on the discussions because it was unclear whether public schools and universities could forbid marijuana possession under the new law.

A spokesman for the public safety office said its legal counsel was considering “a lot of questions” as the deadline drew near. But the spokesman, Terrel Harris, would not elaborate.

“We are just trying to make sure we have all the answers,” Mr. Harris said.

Mr. Capeless said that in particular the department needed to address a clause in the new law that said neither the state nor its “political subdivisions or their respective agencies” could impose “any form of penalty, sanction or disqualification” on anyone found with an ounce or less of marijuana.

“It appears to say that you get a $100 fine and they can’t do anything else to you,” he said. “Can a police officer caught with marijuana several times get to keep his job and not be disciplined in any fashion? Can public high schools punish kids for smoking cigarettes but not for having pot?”

Mr. Bernath agreed that the law was “not completely clear” on how to handle such situations, but predicted that they would be rare.

“I think the resistance has to do with dealing with something new,” he said. “We’re pretty confident that once this gets going and the newness of it wears off, a lot of the apprehension will go away.”
source: New York Times

Monday, December 8, 2008

Florida Drug Rehab Center Now Offering Extended Stay Programs

Ambrosia Treatment Center, a holistic-based drug rehabilitation center located in Port St Lucie Florida, now offers extended stay addiction treatment programs specifically tailored to the needs of the patient.

When it comes to health problems, a quick and neat solution is preferred nowadays. We have pills and syrups to ease every possible symptom. Surgery procedures that can be performed the same day and leave minimal scarring. However, when it comes to drug and alcohol addiction there is no such thing as a 'quick and neat solution.' Recent scientific studies have shown that the longer the treatment, the better the recovery and the more permanent the sobriety.

Therefore, drug rehab centers nationwide have begun lengthening their programs and making recommendations to possible patients for longer treatment stays that are still cost effective. Ambrosia Treatment Center, a world-class holistic drug rehab facility located in Port St. Lucie Florida, has begun offering both 60-90 day programs and 6-12 month programs, in addition to their shorter programs, in order to provide specialized treatment for all of their clientele.

According to the National Institute on Drug Abuse, over forty to sixty percent of people 'will relapse after drug treatment.' Addiction experts are now proving that longer treatment where client's specific needs are taken into account will alleviate the massive weight of addicts relapsing and cycling between 30-day hospitalizations for years and years. Dr. David Lewis, director of Visions Rehabilitation Center in Malibu, says that 30-day treatment programs were originally established for the Air Force and were only scheduled in that manner for bureaucratic reasons--'men and women didn't need to be reassigned if they were away from duty for more than 30 days. Other treatment centers followed suit.'

However, there was at the time no direct scientific evidence that showed that 30 days was adequate time for treatment. Today, we know that there are no 'magic numbers' when it comes to drug and alcohol abuse treatment and those 30 days is not nearly enough. The Ambrosia Treatment Center, as a holistic-based drug rehab facility, follows this pattern by treating the 'whole' person in order to resolve the underlying issues that may be causing the addiction in the first place. Often times, treating the 'whole' person requires more than simply 30-days.

However, many people find that an extended stay beyond 30-days is too much for addiction treatment. People argue that they have jobs, school, families--the normal day-in-day out routine that needs attention. What they want from rehabilitation is a quick fix. Yet, as stated before, there is no quick fix for drug and alcohol addiction and abuse. Studies have shown that addiction is best analogized to a chronic disease, such as heart disease--addiction requires critical attention and perseverance in terms of treatment in order to remain healthy. The Ambrosia Treatment Center family provides strong and capable staff, each of which carry over 20 years experience treating substance abuse and addiction treatment clients from all walks of life. Their attention to detail enables them to provide each client with an individualized regiment of treatment and not necessarily 'cookie cutter' their therapy.

At the end of the day, this is what sets The Ambrosia Treatment Center different from other rehabilitation clinics--they care. They want to see your loved ones get well. They never give up on an addicted person. And, at the end of the day, they believe that you never fail unless you just quit trying.

For additional information on the AMBROSIA TREATMENT CENTER and drug abuse treatment please call 1-866-616-0069 or visit

Friday, December 5, 2008

Drug And Alcohol Abuse Double Risk Of ICU Admission

While the personal health and safety risks of drug and alcohol abuse are well-documented, a new study by researchers at LDS Hospital and Brigham Young University suggests substance dependence increases medical costs by way of the intensive care unit.

Analysis of intensive care unit admissions at LDS Hospital in Salt Lake City shows drug and alcohol abuse make a patient twice as likely to be admitted to intensive care, according to the new study, published in the December issue of Intensive Care Medicine.

"Since these patients are admitted to an intensive care unit, which is geared to treat patients with a much higher acuity, medical costs are higher than for those admitted to a general ward in the hospital," reported Mary Suchyta, M.D., lead author and a physician at Intermountain Medical Center and LDS Hospital.

The researchers reviewed records for 742 patients admitted to LDS Hospital's intensive care unit over a one-year period. Nineteen percent of those patients had a history of drug and alcohol dependence prior to becoming critically ill. That's twice the rate of the population served by LDS Hospital.

"It appears that that patients with drug or alcohol dependence are at higher risk for intensive care unit admission compared to the general population, which would increase overall medical costs," said Ramona Hopkins, a psychology professor at BYU and researcher at Intermountain Medical Center and LDS Hospital.

Patients with drug or alcohol dependence were on average six years younger than the rest of ICU patients.

"What's alarming is that substance dependence meant that these individuals were critically ill and admitted to the ICU at a much younger age than the general population," Hopkins said. "If these individuals do not completely recover and return to work, that represents large potential societal costs."

The new study earned praise from the editors of Intensive Care Medicine, who noted that there are significant gaps in this type of knowledge in most ICU settings and while this article did not answer many of the questions posed by these gaps, it should stimulate further research and collaboration.

Both Drs. Suchyta and Hopkins agree that the detection of substance dependence earlier would allow doctors to address those issues and this may improve recovery.

"Dr. Hopkins and myself have thought for many years that patients with drug and alcohol dependence were over represented in the ICU populations that we have studied over the last 10-15 years and this study suggests that we were correct," noted Dr. Suchyta.

BYU undergrad Callie Beck is also a co-author on the new study. It's her second time publishing an academic paper alongside Hopkins. In 2006 she co-authored a study on brain imaging, a field she would like to pursue in graduate school. Beck is applying to nine graduate schools, including UCLA, Vanderbilt and the University of Maryland.

"Callie is an amazing student," Hopkins said. "She was involved in many aspects of the research, including data analysis and writing. That level of experience will make her stand out as she applies to graduate school."
source: MediLexicon

Wednesday, December 3, 2008

Not Such A Happy Christmas For Addiction Sufferers

It may be the season to be merry for most people but according to experts at the Priory Group, the UK's leading independent provider of addiction treatment services, Christmas is often the most difficult time of year for people suffering from an addiction.

The euphoria and excitement surrounding Christmas reinforces feelings of low self-esteem and low self-worth which are common in addicts. This makes it even harder to manage their addictions during the festive period.

An estimated two million people in the UK are believed to suffer from an addiction of some sort. The three most common addictions are also the ones that are the most difficult to cope with at Christmas:

- Alcohol
- Food
- Shopping

Dr Philip Hopley, consultant psychiatrist at The Priory Roehampton explains: "It can become very difficult for people to deal with the stress and anxiety caused by the financial and consumer pressures of the festive season, and by difficult family and relationship situations that often arise at this time of year. For an addict this is intensified by trying to avoid temptation at a time when the rest of the population appears to be having a fantastic time.

"During December alcohol consumption in the UK increases by 41%. Christmas puts a significant strain on people and this often leads to people using more alcohol in a bid to relax or avoid facing issues.

"There are a number of reasons why some people end up drinking too much at a consistent level, including the need for confidence in social situations, such as the office Christmas party. the financial strain caused by overspending; the pressure to be upbeat and act as the 'perfect host'; spending extended periods with relatives; and

"One of the most difficult times of the year for those recovering from alcoholism is the Christmas holidays because so many people appear to be having a good time whilst drinking. The New Year can seem like a very bleak place for alcoholics facing a long road ahead. Dr Hopley continued: "Christmas is often seen as a good excuse to indulge in overeating and excess, but to people with eating disorders it can spell despair.

"People with conditions such as bulimia and anorexia nervosa can become extremely distressed to the point of feeling suicidal because of the pressure to eat at Christmas.

"Bulimic behaviour often peaks over the holiday period and some sufferers resort to self-harm, which can become destructive addictive behaviour."

Christmas is also a very challenging time for those suffering from a shopping addiction, or Oniomania as it is clinically known, according to Priory addictions specialist Dr Hopley: "Shopping addiction or impulse buying is when someone gets a 'high' from spending money on goods and spends excessively on items that they want rather than need. At Christmas the shops are full of glitzy displays designed specifically to encourage people to buy.

"One of the main implications of shopping addiction is debt. People who are addicted to shopping may spend even when they have no money to spend with, which can soon lead to debt problems. Debts can often spiral out of control and can soon become unmanageable. Other consequences are denial and desperate acts to cover up the addiction leading to the breakdown of close relationships."

Dr Hopley concluded: "While the vast majority of people enjoy a wonderful time at Christmas there are those for whom it is a desperate time. Admitting to a having a problem and consequently seeking treatment can be the first and most important step towards being able to enjoy the festive season in the future."

Tuesday, December 2, 2008

Binge drinking linked to increased stroke risk

Binge drinking linked to increased stroke risk. It’s well-known that binge drinking is not good for your health and a new study shows it may have an even more pronounced effect on your brain than you thought. In fact, the researchers say that making binge drinking a habit could increase your risk of a stroke.

Binge drinking often occurs at parties or in social settings where people take in large amounts of alcohol at one time. In this study, researchers defined it as consuming six or more alcoholic drinks for men or four or more drinks for women in one session. They looked at almost 16, 000 Finnish men and women age 25 to 64 years. They participated in a risk factor survey and were followed up for 10 years afterward.

In that time there were 249 participants who had a first stroke. The researchers found that while average alcohol consumption did not seem to be associated with the strokes, sessions of binge drinking showed a clear link with the occurrences. The binge drinkers were 1.85 times as likely of having a stroke compared to the non-binge drinkers and 1.99 times as likely when adjusting for the risk of ischemic (clotting) stroke alone.

The researchers concluded that heavy sessions of alcohol consumption might be an independent risk factor for stroke.

The Heart and Stroke Foundation does not recommend that you drink alcohol for the purpose of reducing your risk of heart disease and stroke. For those healthy adults who drink alcohol, consumption should not exceed 2 drinks* a day with a weekly limit of 14 drinks for men and 9 drinks for women. Binge drinking should be avoided.

(A standard drink is 341 ml of 5% beer, 142 ml of 12% wine, and 43 ml of 40% spirits.) *
source: On the Pulse News

Wednesday, November 26, 2008

Huesik: Korean for binge drinking

A classic South Korean working day usually ends up in Huesiks, binge drinking sessions cast as social events. But behind the drunken smiles lurks an alarming variety of health problems that stem from heavy drinking.

Night falls on Seoul as workers leave their offices. It is time for Huesiks, boozy meals shared by coworkers at least twice a week. Taking part in them is highly recommended as those who do not can find themselves quickly ostracized from the group.

This means drinking a lot; and quickly. Part of the aim is to find summon courage to lose one’s inhibition and criticize the boss. We follow one group as they treated a client in a Japanese restaurant. They are going to talk business. But, above all, they will raise toast after toast. That's already four in less than ten minutes.

Soju is Korean people’s favorite drink. It is made of rice, potatoes or barley, is very cheap and usually contains about 25% of alcohol. So, a few hours and several bars later, these employees aren’t exactly in professional shape anymore.

Having left the bar, these heavy drinkers drunkenly wait on subway platforms or stumble out onto Seoul’s streets. One businessman we come across has drunk one bottle of whisky every day for the last 20 years. Despite a recent recovery from stomach cancer, he remains a heavy drinker.

In Korea, warnings against heavy drinking are still very rare. Advertising is legal. Yet, for the local authorities, the cost of alcohol abuse is mounting. One in 10 korean adults suffers from various health problems stemming from heavy drinking. And it is not about to change as average alcohol consumption rose again in September.
source: France 24

Monday, November 24, 2008

Heroin treatment also works on cocaine: study

Methadone, a drug used for many years to treat heroin addiction, appears to work well in cocaine addiction, too, a new Canadian study suggests.

Psychologist Francesco Leri of the University of Guelph has been making rats addicted to cocaine, and then treating them with methadone.

Most of the rats responded well, he says. They lost their powerful urge for cocaine, and in addition, their brains "re-set" themselves into the same pattern that existed before they first used cocaine.

"It can be done tomorrow with humans, and should be done tomorrow," he said.

That's because methadone -- unlike a new drug -- already exists as a tested drug, with clear prescription rules and clinical staff trained in giving it out.

"There is an entire system that is already in place for the employment of methadone," that could be used for cocaine addicts.

Mr. Leri said the U.S. National Institute for Drug Abuse is looking into the use of methadone -- or a similar drug such as buprenorphine -- in a clinical setting.

The idea came up because in real life, people mix drugs.

There's no such thing as a "pure heroin addict," he said. "The norm is people who are addicted to opiates, so heroin or prescription opiates, and they co-abuse cocaine at the same time."

Researchers have wondered what happens to their cocaine problem when they start taking methadone for the heroin addiction.

But it's hard to tease apart the two addictions in humans. In his Guelph lab, Mr. Leri worked on rats with a cocaine addiction, but no exposure to heroin.

The cocaine-addicted rats in his lab didn't get a cocaine high on methadone, he said. Instead, "the methadone may be able to curb the desire that they have for that drug (cocaine)."

In addition, methadone actually reversed changes in the rats' brains that are caused by cocaine, and are known to play a key role in addictive behaviour.

"What's interesting is that, among the rats given cocaine and then methadone, these regions of the brain looked similar to how they appeared in the rats that were never exposed to cocaine.

"We feel we may have the hope of re-setting the brains of some individuals to a type of normality," he said. "I think it should be tried and I guarantee you there will be some individuals -- not everybody -- who will do better on methadone, who will be stabilized on methadone."

The study means a person who is motivated to stop taking cocaine may benefit from methadone as one tool to help, the psychologist says.

"You cannot give methadone left and right and hope that it is going to work. You need to work with individuals who in addiction to social support, in addition to cognitive therapy, will need something to curb their desire" for cocaine.

His study is published in European Neuropsychopharmacology, a research journal.
source: The Ottawa Citizen

Friday, November 21, 2008

Task force could help stem underage college drinking

Colleges and universities should take lead on setting and enforcing rules on their campuses.

Stopping underage drinking on college campuses should be a top concern of parents and academia. In recent years, there have been tragic alcohol-related deaths, and something should be done to address this issue.

Yet, we agree with state Sen. Shirley Turner, D-Mercer, the solution is unlikely to be found in legislation that imposes a uniform fix for the state's many campuses. As Turner said, the universities and colleges should be allowed to set and enforce their own rules. If the problem spills off campus, there already are laws to handle underage drinkers.

Some academic leaders have proposed lowering the drinking age from 21 to 18, when people are considered adult in other areas of society, such as the health-care, criminal justice and military systems. The Amethyst Initiative, a group of 134 college presidents and chancellors, favor making it legal for their 18- to 20-year-old students to drink. Most now do so illegally and colleges have proved inadequate to stop this behavior.

Under federal law, states can set the legal drinking age for their residents, but would lose 10 percent of their federal highway funds. The federal penalty recognizes that young people too often are involved in drinking-and-driving accidents.

On the other hand, many European countries have a much lower drinking age than the United States but balance that with much tougher drunken driving laws. Generally, there are not higher rates of alcohol-related incidents among European youths than here.

It is an issue worthy of more study, as Turner has proposed. She and Senate President Dick Codey, D-Essex, support creating a task force to look into the issue. But lowering the drinking age probably won't be acceptable to many New Jerseyans, especially those who have lost a loved one in an alcohol-related incident. But that doesn't mean the whole issue should not be reviewed. Students, parents, educators and lawmakers need to have this conversation to figure out how to get students and others to act more responsibly.
source: Courier Post Online

Tuesday, November 18, 2008

Vodka makers may have to pay for addicts' treatment

Amid criticism from alcohol producers, a bill was introduced in the lower house of the Russian parliament (Duma) according to which
producers of vodka and other alcoholic beverages will have to pay for the treatment of chronic alcoholics.

Lawmaker Viktor Zvagelsky of the ruling United Russia party has introduced the bill which will bound the producers of alcoholic beverages to bear the 'moral and financial responsibility' and pay for the treatment of chronic alcoholics, according to a report.

Zvagelsky proposes to set a mandatory mechanism for compensation of damage to health of citizens caused by consuming alcoholic drinks

Earlier last month, Russian interior minister Rashid Nurgaliyev had recommended to restore the Soviet-era system of forced treatment of alcohol abusers.

According to the lawmaker, the alcohol producers will have to pay approximately four roubles for per litre of vodka produced by them into a self-regulated fund to finance the network of clinics and sanatoria involved in the treatment of alcoholics.
source: Times of India

Wednesday, November 12, 2008

Avoiding alcohol's temptations in 'overwhelming' war zone

Once each week, in a fluorescent-lit room in a stout building near the heart of Kandahar Air Field, a multinational mix of troops and civilians gather to take on a battle that can't be fought with conventional weapons.

Sitting around a table, or on overstuffed furniture, they talk about bad days, frustrating bosses and how it is that a fellow soldier can become a drunk on a dry base in a mostly dry country.

Called Sober in the Sand, the group is this base's own chapter of Alcoholics Anonymous. For many who spend much of the year living abroad in Afghanistan, their weekly meetings have become a lifeline to staying sober far from the supports of home.

Jennifer, a 31-year-old from Winnipeg, has been sober for 10 years. Still, when she arrived to work at the base five months ago as a civilian, she was anxious about the strain that living in a war zone might cause.

"It's not like I'm shaking for a drink all the time," she said.

But she added that the base, which serves as a temporary home for more than 10,000 people from dozens of countries and is the frequent target of insurgent rocket attacks, can be "overwhelming" at times.

"It's a really crazy place."

That craziness was tempered, though, when she walked into her first AA meeting.

Instantly, she felt she belonged.

"There's a base level of understanding between alcoholics. They know you, you know them. It's almost like family."

The group operates like most conventional AA groups, meeting once a week and setting up links between new recovering alcoholics and those with more sober years under their belts. But there are unconventional elements that come with operating in a war zone.

"Here we worry about our fellow alcoholics going out and not coming back alive, which is a little harder to deal with," said Ed, a 47-year-old mechanic from Midland, Ont.

Typically, the group has about five regular members, but has swelled to more than 15 at different times.

Often, the group will gather for special meetings if soldiers are coming through who are normally stationed off base at one of the smaller outposts.

"If they need a meeting, well, darn it all, somebody should be there," said Ed, adding that those who come to the AA group for support but have to leave to work off base are usually given literature, including copies of The Big Book, a step-by-step guide to getting sober that explains the Alcoholics Anonymous tradition.

"My book I was carrying around for 14 years went out to a forward operating base with them," Ed said. "If you have no meetings out there and guys at least have something to read, at least you have some comfort."

John, a 31-year-old U.S. Army soldier from the Bronx, said it took some work to find the AA meetings when he arrived on base.

At times the program has nearly faded away, largely because of the transience of people at the base. But it has always been revived.

"People are not only coming here to talk about problems with alcohol," he said. "We come here for peace of mind. I've actually had the opportunity to help people."

For that reason, no matter how many troops and contractors move on and off the base, the group will always exist, said Chuck, a 55-year-old civilian from Minnesota who with 26 years of sobriety, is the unofficial dean of Sober in the Sand.

"AA is a program of principles. If everybody shipped out, the next recovered alcoholic coming through Kandahar would initiate it again.

"This meeting will always be here after we've gone. The AA will keep reconstituting itself, just like the Taliban."
source: Globe and Mail

Sunday, November 9, 2008

Kicking Depression: Recognize underlying disorders, tackle them, too

By Christine Stapleton

Palm Beach Post Staff Writer

Oh that we could have just one mental illness afflict us at a time.

Many of us diagnosed with one mental illness have another lurking - often undiagnosed or untreated. Doctors call it "co-morbidity." Others call it "dual-diagnosis." I call it "unfair."

Two weeks ago I started sliding. Hours of feeling OK, then hours of feeling down. The OK hours slowly shrunk to OK minutes. The down hours became a day, then another and another. On the second down day the switch between my brain and stomach flicked off.

Three days later, I had already lost 5 pounds. A trainer at the gym told me I was getting too thin. A couple of my girlfriends invited me to dinner. Another threatened an intervention. I ate a sweet potato and a little cup of chicken soup.

My therapist calls this anorexia. I call it lack of appetite. It's not like I'm a waif you could blow over with a hair dryer. I just don't want to eat, and I weigh myself twice a day and track the numbers in my weight journal. Did I mention I don't eat wheat and very little refined sugar? What's the big deal? Apparently that's called an "eating disorder." It's just one of a few other "disorders" I deal with, like hypomania - a type of bipolar.

My brain plays dominoes with these disorders. A bout of mania knocks over the depression domino, which knocks over the anorexia domino, which knocks over the exercise-drug-alcohol addiction domino, which goes on and on.

It took decades for me to figure this out. It took even longer to realize that the chain-reaction that effortlessly topples the dominoes does not work in reverse. They won't automatically pop up if I manage to right just one.

Each disorder has its own treatment. Successfully treating one will not necessarily cure the other. A bipolar drug addict who gets clean is still going to have eye-popping mood swings, bursts of energy and paralyzing depression if the bipolar is not treated, too.

A food addict who smokes and gets treatment for her eating disorder but keeps smoking is still addicted to nicotine. Same with the alcoholic who cuts herself. She is not necessarily going to stop cutting just because she gets sober.

Like I said, it's not fair. It is even worse because many doctors don't understand this. They treat one illness but fail to diagnose the companion disorder(s). Then we blame the antidepressants or therapy for not working and we quit. Life becomes hell, all over again.

My solution: Surrender. Recognize the other disorders and treat them, too. I don't think of it as being a loser. I just joined the winning side.
source: Palm Beach Post

Friday, November 7, 2008

Alcoholics Have Problems Recognizing Danger

Alcoholics have trouble recognizing and avoiding dangerous situations because the area of their brain that is used to appreciate those kinds of concerns is functioning at a reduce level, stunting their ability to perceive danger. This may help explain why they do not react to the concerns of their friends and family members about their drinking.

Previous studies have shown that alcoholics have problems recognizing facial expressions and many other studies have shown cognitive deficits in alcoholics. A new study indicates that alcoholics may also have emotional processing deficits also.

Researchers studied 11 alcoholics and 11 healthy males and used fMRI brain imaging to track their brain-blood oxygenation level dependent (BOLD) responses while they were given facial-emotion decoding tasks.

Sensation Seekers

The subjects were ask to determine the intensity of happy, sad, anger, disgust and fear displayed via facial expressions. The results showed that alcoholics were most deficient at recognizing negative emotional expressions.

These deficits showed up on the fMRI images in the affective division of the anterior cingulate cortex -- part of the prefrontal brain area.

"The cingulate is involved in many higher order executive functions such as focused attention, conflict resolution and decision making," said Jasmin B. Salloum, research scientist at the National Institute on Alcohol Abuse and Alcoholism, in a news release. "Alcoholic patients are known to be sensation seekers and are less likely to shy away from signals that suggest danger."

Findings Have a Silver Lining

"Both sensation seeking and avoidance of danger are characteristic of subjects with axes II personality disorders, which many of our subjects had," Salloum said. "The findings in this study may shed some light on some of the problematic and psychopathological behaviors that are manifest in this patient group. It remains to be determined if the dysfunction of the anterior cingulate precedes alcoholism or is a result of long term drinking."

The study did have a silver lining, according to Andreas Heinz, director and chair of the department of psychiatry at Charite – University Medical Center Berlin.

"Now we can begin to understand why patients have problems avoiding dangerous situations and, particularly, why they may not react to the concerns of their friends and relatives: the brain area that should help them appreciate these concerns is functioning at a reduced level," said Heinz.

But Happy Faces Work

"Furthermore, we observed a normal or even increased brain response to happy faces. Our group recently made a similar observation, in that patients with strong brain responses to pleasant pictures have a reduced relapse risk," Heinz said. "So, relatives and friends may want to support alcoholic patients with positive messages that strengthen their self-esteem while being particularly careful, and even repetitive, in pointing out the dangers of alcohol and alcohol-associated environments. Otherwise, the patients may miss the message."

The study was published in the September 2007 issue of Alcoholism: Clinical & Experimental Research.

Wednesday, November 5, 2008

Somewhat Better Outcomes With Longer-Term Treatment For Opioid-Addicted Youth

New research published in the November 5 issue of JAMA reveals that long-term therapy rather than short-term therapy for opioid-addicted adolescents yields better results. Those who received continuing treatment with the combination medication buprenorphine-naloxone were less likely to test positive for opioids and reported lower rates of opioid use compared to adolescents who participated in a short-term detoxification program with the same medication.

Adolescents tend to abuse opioids in the form of heroin or prescription pain-relief medications. Recent research suggests that more and more young people are abusing these types of drugs, and therefore treatment needs are rising as well. "The usual treatment for opioid-addicted youth is short-term detoxification and individual or group therapy in residential or outpatient settings over weeks or months. Clinicians report that relapse is high, yet many programs remain strongly committed to this approach and, except for treating withdrawal, do not use agonist medication [drugs that mimic the effect of opioids by altering the receptor]," write George Woody, M.D. (University of Pennsylvania, Philadelphia) and colleagues.

To compare outcomes of opioid-addicted adolescents who receive either short-term detoxification or long-term treatment using buprenorphine-naloxone, Dr. Woody and colleagues conducted a study with 152 patients, 15 to 21 years of age. The long-term treatment medication consists of an oral medication that relieves symptoms of opiate withdrawal (buprenorphine) and a drug that prevents or reverses the effects of injected opioids (naloxone). Patients who were randomized to receive the 12-week buprenorphine-naloxone treatment received up to 24 mg. per day for 9 weeks and smaller amounts through the twelfth week. The remaining participants (the detox group) received up to 14 mg. per day, with doses tapering off through day 14. Individual and group counseling was offered to all participants.

Wood and colleagues found that at weeks 4 and 8, the detox group had a higher percentage of opioid-positive urine test results. Specifically, after 4 weeks, 61% of participants in the detox group had opioid-positive urine test results compared to 26% of participants in the 12-week buprenorphine-naloxone group. The figures after 8 weeks were 54% positive in the detox group and 23% positive in the 12-week buprenorphine-naloxone group. By the twelfth week, the buprenorphine-naloxone group had been tapered off of their treatment and 43% tested positive for opioids compared to 51% of detox group patients.

About 21% of detox group patients and 70% of buprenorphine-naloxone patients remained in treatment by week 12. Patients in the 12-week buprenorphine-naloxone group reported, during weeks 1 through 12, less use of opioids, cocaine and marijuana, as well as less injecting and less need for additional addiction treatment. Both groups measured high levels of opioid use at follow-up.

The authors clarify that, "Taken together, these data show that stopping buprenorphine-naloxone had comparably negative effects in both groups, with effects occurring earlier and with somewhat greater severity in patients in the detox group."

"Because much opioid addiction treatment has shifted from inpatient to outpatient where buprenorphine-naloxone can be administered, having it available in primary care, family practice, and adolescent programs has the potential to expand the treatment options currently available to opioid-addicted youth and significantly improve outcomes," conclude Woody and colleagues." Other effective medications, or longer and more intensive psychosocial treatments, may have similarly positive results. Studies are needed to explore these possibilities and to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence."

David A. Fiellin, M.D. (Yale University School of Medicine, New Haven, Conn.) writes in an accompanying editorial that more evidence is necessary in order to claim any treatment is effective for opioid-addicted individuals.

He concludes that: "The results of this trial should prompt clinicians to use caution when tapering buprenorphine-naloxone in adolescent patients who receive this medication. Supportive counseling; close monitoring for relapse; and, in some cases, naltrexone should be offered following buprenorphine tapers. From a research perspective, additional efforts are needed to provide a stronger evidence base from which to make recommendations for adolescents who use opioids. There is limited research on prevention of opioid experimentation and effective strategies to identify experimentation and intercede to disrupt the transition from opioid use to abuse and dependence."
source: MediLexicon News

Sunday, November 2, 2008

Women and drug addiction

The most shocking thing about the modern drug user? That she could be someone like you.

Andrea Mackenzie 57, a divorced mother of three from Newquay, was first prescribed valium for back pain as a trainee teacher in 1969. She became addicted and continued to take it for almost 40 years.

When I think of the person I was before I took diazepam, or Valium as it was called back then, I don't get angry, I get upset. I was at college in London, training to teach dance and drama and I loved putting on shows. Most students around me looked forward to the holidays, but I looked forward to the start of each term.

I went to my GP because of muscle ache in my back. He prescribed some pills and in those days you didn't ask questions, you just took them. It helped with the pain and seemed to relax me. When I went for a repeat prescription no questions were asked. For year upon year the box was just ticked. They really were handed out like sweets.

Diazepam is probably one of the most addictive drugs there is and that doctor was prescribing me an illness. It gives you a numb feeling, blanks out your emotions so everything becomes sort of dull. If you've suffered a terrible bereavement it can calm you down, but if you take it all through life you sleepwalk; nothing touches you.

My overriding feeling was always, 'I can't be bothered.' I qualified as a teacher but didn't work as one because I met my husband, an engineer, young and started a family. I took those tablets three times a day, as prescribed, and my life revolved around them. I had to have 'my tablets' with me all the time just to feel safe and, if I forgot them, I'd start hysterically panicking and we'd have to go back.

It's funny – even though I built up a tolerance, I didn't ever up the dosage or abuse them because they were on prescription. My body was craving them so I had all sorts of symptoms and went through life feeling unwell with so many non-specific things. I'd feel strange and dizzy, I'd shake, sound would be magnified, lights were too bright. I basically thought I was a hypochondriac. My family used to laugh about it.

We had three children; I loved them, I lived for them, but I was removed from them. The best way to describe it is the way you feel when you have a hangover and you've kids to look after. I didn't crawl around on the floor playing dress-up or jump on a trampoline with them. I didn't participate at children's parties. They weren't neglected, though, and I don't feel guilty because it wasn't my fault. Thank goodness they're all happy, healthy adults. We've never sat down and talked about my addiction – though of course they must know.

No one ever really suggested I should stop taking Valium. After my mother died of a heart attack right in front of me, I became hysterical and the doctor just put me on a higher dose. It comforted me – but stopped me grieving. When my marriage broke down, I really wasn't that bothered. People would talk about the 'trauma of divorce', the 'stress of moving home'; I didn't feel it.

As the years passed, people became more aware of the dangers of diazepam. I read about it, realised what was happening to me – and by the time my last daughter went to university I knew it was time to come off it. It took me three years. By then I had a fantastic, supportive GP who helped me do it so, so gradually. It made me really ill – my speech was slurred, I was permanently exhausted. At one point I had to be tested for Parkinson's.

I've been totally clear for two and a half years now and I'm a different person – the person I would have been. I don't smoke or drink alcohol or caffeine and I exercise daily on my Air Walker. I'm motivated, full of energy. I spent last week with friends at Center Parcs. My daughter joined me for a day and we rode around on our bikes – something I'd never have done when she was younger.

The real difference, though, is emotional. I feel so much more. I'm affected by things. When my own children were born, yes, I was happy – but somehow nothing seemed to stick. When my first grandson was born seven months ago it was absolutely amazing. I couldn't believe how excited I was. I've so many activities planned for him. It's like my second chance.

Monday, October 27, 2008

Third of routine drinkers get potentially fatal liver damage

One third of routine drinkers sustain enough liver damage to put themselves at risk of an early death, researchers have found.

A study at University College London found an unexpectedly high level of liver abnormalities among "normal working people" who consume more alcohol than average but would not regard themselves as alcoholics.

Professor Rajiv Jalan, head of the liver failure group at University College London hospitals and one of the authors of the study, said: "These are people working in offices who we routinely encounter.

"They are representative of working people in our society and they are at risk."

The study looked at results from more than 1,000 men and women, mostly aged 36 to 55, who used home testing kits to measure liver damage.

The kits measure specific enzymes in the blood, high levels of which indicate liver abnormalities.

More than 70 per cent of those involved in the study said they regularly drank more than the government's recommended limit of 14 units of alcohol a week for women and 21 units for men, and 41 per cent of them said they drank every day.

The results showed at least 30 per cent of the people tested had liver abnormalities.

The worrying findings will be published this week in the medical journal Hepatology and come as the government considers the introduction of national screening to counter rising levels of liver disease.

Up to two million people in Britain have chronic liver disease and many are unaware of their illness.

Deaths from the disease have increased by eight times in men aged 35 to 44 and by seven times in women over the past 30 years.

Doctors warn that symptoms of liver disease are not felt until too late and by that time patients have up to a 50 per cent chance of dying early.

A Medical Research Council study found that intelligent people can be at greater risk of alcohol problems as they seek to cope with stressful jobs.

Saturday, October 25, 2008

Struggling With Alcohol? Better Quit Smoking, Too

Overcoming alcoholism is tough enough. That's one reason many alcoholics who smoke continue to light up even while they're in recovery from alcohol dependency.

But new research suggests that tackling both addictions simultaneously may offer the best chance of success.

Recovering alcoholics often admit they're using nicotine as a drug, said Dr. Michael M. Miller, president of the American Society of Addiction Medicine.

"They can tell you, 'I don't want to quit [smoking], because it changes the way I feel. I use it to deal with stress,' " added Miller, who's also director of NewStart, a chemical dependency rehabilitation program at Meriter Hospital in Madison, Wis.

A study of alcoholics in treatment for their alcohol problems used brain scans to examine how performance on cognitive tests changes with abstinence from alcohol. Twenty-five alcoholics stopped drinking for six to nine months, but the 12 who smoked continued to smoke.

"We found that the smoking alcoholics over six to nine months of abstinence did not recover certain types of brain function as the non-smoking alcoholics did," said study author Dieter J. Meyerhoff, a professor of radiology at the University of California, San Francisco. Decision-making skills, thinking speed, 3-D visualization and short-term memory were affected, calling into question the prospects of long-term sobriety, he noted.

And while smoking and non-smoking alcoholics improved on several other cognitive tests, such as learning and remembering words, smokers' brain function, in general, took longer to recover.

The findings were published in the journal Alcoholism: Clinical and Experimental Research.

Studies indicate that 60 percent to 75 percent of people in alcohol-treatment programs smoke cigarettes, and 40 percent to 50 percent are "heavy" smokers, consuming more than a pack a day.

Yet treatment for tobacco dependence is not routinely included in alcohol treatment programs, Boston University researchers reported recently in the journal Alcohol Research & Health, published by the U.S. National Institute on Alcohol Abuse and Alcoholism.

"I would say that over half of chemical dependency treatment agencies now talk about nicotine, encourage patients to stop [smoking] and provide them assistance to stop, such as with nicotine-replacement therapy or prescriptions for Zyban or Champix," Miller said. "So that's a tremendous advance."

Oftentimes, though, smoking is excused. "What you don't see," Miller said, "is building nicotine into the treatment plan and considering tobacco use to be a relapse of addiction."

The concern had been that addressing both dependencies concurrently would pose "too great a difficulty for the patient" and impede recovery from alcoholism, the Boston researchers noted. But studies now suggest that quitting smoking does not derail alcohol treatment -- and may even improve the likelihood of longer-term sobriety, they said.

In fact, Miller said studies show that people in recovery for other addictions who delay smoking cessation can later relapse to their chemical dependency because of the stress of quitting smoking six to 18 months later.

"So stopping everything at once -- getting all the psychological stress out of the way at once -- is the best way to go, and also getting all the physical withdrawal syndromes out of the way at once is the best way to go," he concluded.

Meyerhoff agreed that tackling smoking as part of an alcohol treatment program is a smart tactic.

"The alcoholics have shown that they are willing to change one behavior, namely excessive drinking," he said. "If they are in that mindset, it is a great opportunity for treatment specialists to also convince them of the negative effects of continued chronic smoking."
source: U.S.News & World Report

Friday, October 24, 2008

Survey: Alcohol abuse remains problem at UConn

STORRS, Conn. --One of every four University of Connecticut students say they have blacked out from heavy drinking during Spring Weekend festivities, according to a new survey.

The review, conducted by UConn's Center for Survey Research and Analysis, also says two of every five students surveyed say they got "severely drunk" during the annual party.

Some UConn officials said they were shocked by the findings, especially since the university has stepped up enforcement and offers many alcohol-free recreation events. However, national experts and some students say they were less surprised.

The survey mirrors national trends, said Brandon Busteed, founder and chief executive officer of Outside the Classroom, a company that works with colleges to fight high-risk drinking.

"That is a very frightening statistic, but I don't think it's too far out from national statistics, which is kind of depressing," Busteed said of the 25 percent blackout figure.

The university's Department of Wellness and Alcohol and Other Drug Prevention Services commissioned the survey to gauge what students want out of Spring Weekend, and how UConn can make it safer and more memorable for them.

The festivities, which occur just before final exams, draw up to 20,000 students and their guests each spring.

Unsanctioned off-campus parties at nearby apartment complexes frequently generate dozens of arrests, assaults and ambulance trips for inebriated and injured party guests.

UConn Spring Weekend events gained national attention in 1998, when a party in an off-campus parking lot led to rioting. This year, the student newspaper's editor said she was sexually accosted at one of the parties and wrote about it on the paper's front page.

A committee examining Spring Weekend has been holding informal hearings for the past two weeks to get suggestions from police, doctors, student, apartment complex owners, Mansfield town employees and others.

The survey results come from an online questionnaire sent in March to all of the approximately 15,000 UConn undergraduates ages 18 or older on the Storrs campus.

The survey did not include the most recent Spring Weekend in April, since it was distributed about a month earlier.

A total of 2,571 students responded, with 1,709 answering the question about whether they had blacked out due to substance use during a Spring Weekend.

The survey defined "blacking out" as being conscious, but having no recollection due to substance use. It distinguished blacking out from "passing out," which was described as being unresponsive due to substance use.

Twelve percent of students reported passing out at a Spring Weekend.

"I agree that it's a shocking number," said Julie Elkins, assistant to the vice president for student affairs at UConn. "In some ways, it reminds me of folks who usually drink responsibly, and then New Year's Eve hits and they make choices they normally don't. I think Spring Weekend is their New Year's Eve."

Given the level of drinking, Student Body President Ryan McHardy said, the number of blackouts reported was right on the mark.

"Am I surprised? No, and it's unfortunate. That's the behavior I've seen in Spring Weekend," McHardy said.

"There's an expectation that's going to happen," McHardy said. "That, to me, seems to be the No. 1 issue that needs to be addressed."

Thursday, October 23, 2008

Gene mutation in worms could further understanding of alcoholism in humans

Scientists at the University of Liverpool have found that a genetic mutation in worms could further understanding of alcoholism in humans.

The work follows a study carried out by Oregon Health and Science University, which suggested a link between a gene mutation in mice and tolerance to alcohol. Researchers at Liverpool have investigated this in worms, looking specifically at the role the gene plays in communication between cells in the nervous system.

This gene specifies the ways in which amino acids arrange themselves into a protein called UNC-18 - or Munc18-1 in humans, an essential component of the nervous system. Researchers found that a naturally occurring change in this gene can result in a change in the nature of one of the amino acids, which then alters communication between cells in the nervous system. As a result of these changes the nervous system becomes less sensitive to the effects of alcohol, allowing the body to consume more.

Professor Bob Burgoyne, Head of the University's School of Biomedical Sciences, explains: "Alcohol consumption can affect the nervous system in a number of ways. Low concentrations of alcohol can make the body more alert, but high concentrations can also reduce its activity, resulting in motor dysfunction and a lack of coordination. Some people, however, are more susceptible to these effects than others, but it has never been fully understood why this is.

"We used the nematode worm as a model to look at the role genes play in alcohol tolerance because all of the worm's genome has been characterised and we can therefore identify its genes easily. The gene we looked at corresponds to a gene in humans that performs the same function in the nervous system. Mutations in genes can occur naturally without any known cause and will persist if they are not particularly harmful."

Dr Jeff Barclay, co-author of the research, added: "We investigated alterations in amino acids in two genetically identical worms. One carried a mutation that was exactly the same as the genetic change our American colleagues found in mice and the other carried a different change within the same gene. Both these mutations altered the way communicate occurs between cells in the nervous system. The mutations reduce the negative behavioural effects of alcohol and so more can be consumed before the body starts to react badly to it.

"Now that we have shown the link between the gene and alcohol tolerance in worms, it is possible to search the human gene to see if there are any spontaneous changes that could help identify individuals with a predisposition to alcoholism."

The research is published in Molecular Biology of the Cell.

Tuesday, October 21, 2008

Cocaine usage continues to rise, report finds

One in 20 Irish people and almost one in 10 young people has taken cocaine, a major all-Ireland study of the use of the drug has established.

Men are twice as likely to use cocaine as women and regular and even daily use of the drug is increasing, according to the drug prevalence study carried out for the National Advisory Committee on Drugs (NACD).

North Dublin, where almost 16 per cent of young people reported use of the drug, emerges as the country’s cocaine blackspot, but prevalence rates are rising steeply throughout the country.

Use of the drug by 15-34-year-olds has risen five-fold in the north-eastern counties over the past five years, and more than three-fold in the midlands and the west.

The vast majority of cocaine users start taking their drug in their early twenties and the most popular means of obtaining it is from friends and family, the study finds.

One in four people said they knew someone who took cocaine, compared to 14 per cent in the last all-Ireland survey carried out in 2002/03.

The study reveals that cocaine users are taking the drug more often, with one-in-four users snorting the drug once a week and 7 per cent reporting daily use. No-one reported daily use in the earlier survey.

Overall lifetime use now stands at 5.3 per cent, up from 3 per cent in the last survey. Some 1.7 per cent of respondents reported using the drug in the previous year, up from 1.1 per cent, and 0.5 per cent said they had taken cocaine in the previous month, up from 0.3 per cent.

“While these figures are of concern, we should not lose sight of the fact that they are reasonably low and that any perception that ‘everyone is at it’ is far from the true situation,” commented Minister of State with responsibility for drugs strategy, John Curran.

The survey also shows that cocaine use varies greatly between different regions, with the highest rates recorded in the more densely populated areas in the east of the country, roughly from Louth to Cork. “The challenge is to ensure that the lower rates are kept at such levels while the problem is tackled comprehensively in the areas of higher use.

Mr Curran said the risks attached to cocaine use were often ignored or underestimated by users. “Cocaine use is linked to heart conditions, strokes and to various other physical complaints that vary depending on the route of administration of the drug. Frequent (or long-term) use of cocaine can also have a powerful effect on the user’s mental health, through depression, anxiety, agitation, compulsive behaviour and paranoia.”

He defended the efforts being made to tackle drug misuse, pointing out that the over €61 million was allocated to the area in last week’s Estimates. The Government is spending over €200 million on measures aimed directly at problem drug use, he said.

Almost 7,000 people were surveyed north and south for the study, which was carried out between October 2006 and May 2007.
source: © 2008

Monday, October 20, 2008

12-stepping Alcoholics into the 21st century

After 73 years, program continues to help addicts and loved ones

God grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.

Editor’s note: Anonymity is the spiritual foundation of all of the traditions of Alcoholics Anonymous, according to the organization’s literature. For that reason, we have chosen to identify by first name only the AA members quoted in this story.

On May 16, 2004, Bob awoke at 2 a.m. in the driver’s seat of his car with a bottle of vodka in his lap. He was in the parking lot of a convenience store, but he had no idea where the store was.

“I had developed a tendency to get angry and drink and drive and be gone for a couple of days,” Bob says. “This was one of those crazy excursions. I could have been in Arkansas or Minnesota. I figured it would seem stupid to stagger into the store and ask where I was, so I drove around until I figured it out.”

He shakes his head. “Great logic.”

Luckily, he was in Conyers.

“When I got home, my heart was pounding, I was sweating and the room was spinning, like a thousand times before. But I’d scared myself so much that the fear of continuing to live like that overcame my fear and reluctance of turning my life and will over to God.”

Bob was willing to admit that he was powerless over alcohol and prayed to God to take the burden from him.

“It sounds stupid, but I felt the presence of something in the room,” he says. “I could feel it, and then it felt like an elephant had been sitting on my chest, and it got up and walked away. Something big and good had happened.”

Bob hasn’t had a drink since, and attributes his abstinence to the five Alcoholics Anonymous (AA) meetings he attends every week.

“Every time I go, I’m reminded that I’m an alcoholic and I have a problem,” he says. “But it can be overcome, and I am overcoming.”

It’s been 73 years since AA began, and the 12-step concept it fathered is more popular than ever. Twelve-step programs now treat millions around the world for everything from drug addiction, gambling and overeating to clutter, sexual compulsion and workaholism.

“Twelve-step programs are very helpful for a lot of people, especially when it comes to substance abuse issues,” says Dr. Tommie Richardson, a staff member of the Ridgeview Institute. “They are the most successful modality we know of right now. The fact that they’ve been around so long and continue to thrive tells you that.”

“It’s a brilliant program,” says Tere Tyner Canzoneri, a minister and pastoral counselor at The Emmanuel Center for Pastoral Counseling in Atlanta. “There’s not a person on the planet who couldn’t benefit from working the steps.” Robby Carroll, a minister at Shallowford Presbyterian Church and a marriage and family therapist, regularly refers clients to 12-step programs because “they’re the only programs that understand the challenge of addiction.”

Addiction has resisted the best efforts of science, medicine, psychiatry, social workers and social pressure before and since the providential meeting in 1935 of Bill Wilson, a New York stockbroker, and Dr. Bob Smith, an Akron, Ohio, surgeon.

Both were alcoholics, but Wilson used spiritual principles and the insight that alcoholism was a disease to get sober. After he persuaded Smith to follow suit, they began working with other alcoholics and started the first AA group that same year.

Favorable publicity and the publication in 1939 of Wilson’s book “Alcoholics Anonymous” anchored the program’s status and popularity.

Today AA is the largest of the 12-step programs (followed by Narcotics Anonymous and Al-Anon) with an estimated worldwide membership of 2 million. Experts, citing the difficulty of estimating anonymous fellowships, believe the numbers are much higher.

There are more than 400 groups and 1,100 AA meetings a week in the Atlanta area alone. Dr. Steven Lee, medical director of Summit Ridge Hospital and director of Addiction Services in Gwinnett County, estimates addictions affect 15 to 20 percent of the population in Gwinnett alone.

“We’re just touching the tip of the iceberg that needs treatment,” he says.

The 12 steps are a rigorous program of spirituality, self-examination and self-renewal that Smith, affectionately remembered as “Dr. Bob” by 12-steppers, summarized as “Trust God, clean house and help others.”

Trusting God doesn’t come easily, however. Many participants either don’t believe in God or blame Him for their difficulties, which is why the steps refer to “a Power greater than ourselves” and “God as we understood him.” Mention of religion during meetings is forbidden, and rigorously enforced.

Nevertheless, therapists say that some find spirituality of any stripe objectionable and don’t return. Nor do 12-step programs always work with those in the early stages of addiction.

“I see folks who have gotten into treatment after a DUI or who think it’s an aberration,” says Bob Fredrick, a clinical social worker and therapist in Atlanta. “They say ‘I just don’t connect there’ or ‘I’m not as bad as them.’ There’s a lot of denial with addiction.”

Lee says there is an organization for physicians that relies on conventional therapy and medication rather than meetings. “I disagree,” he says, “but they’re not the core of the recovery community. It’s hard for them to admit they’re powerless.”

There are other recovery groups, says Scott Maddox, an addiction counselor and executive director of Alpha Recovery in Atlanta and Brunswick, “but all the evidence shows that the 12-step approach is the most successful.”

And while individual therapy gets to core issues faster, he says, 12-step programs are superior because, “You have people who have common problems and experience with solutions to those problems. They provide a support network for ongoing recovery that therapy doesn’t provide.”

“They’re one of the few places that folks really feel understood,” AA member Frederick says. “Folks ready to deal with addictions find kindred spirits who understand that they’re dealing with a disease, and it’s not a willpower or moral issue.”

Bob says he thinks the steps are pure genius.

“When they started to take hold,” he says, “I realized it wasn’t about stopping drinking, it was really about living sober.”

The program, he says, offers a systematic formula for living life.

“It’s a toolbox,” he says, “to get me through life. Before, I had one tool, and that was a bottle opener.”

Al-Anon Helps Spouse Deal With Disease

Peggy knows how long she’s been in Al-Anon by calculating how long her husband’s been sober: 25 years.

“I’ve been in 27 years,” she says. “In the beginning I didn’t really want it, but I needed it. Then I realized I really wanted it, that it was good for me. I knew what was going on. He couldn’t con me anymore. I went to a lot of AA and Al-Anon meetings, so I was very aware of the disease.

“The alcoholic is drinking, and we’re hugging the alcoholic. We’re perfectionists, sensitive, fun and caring. It’s almost the same disease, except we’re not allergic to alcohol.”

She attends two or three Al-Anon meetings a week, and accompanies her husband to AA meetings a couple of times a month.

“It’s a miracle,” she says. “I’ve learned so much, but I don’t know it all, so I keep going. I think it’s for all people, not just those with alcohol problems. It just makes for a better life.”

‘Your Part Is The Only Thing You Have Control Over’

Karen, a single mother with a 9 1/2-year-old daughter, is a recovering alcoholic who’s been sober and attending AA meetings for 22 years. Two years ago, she began going to Al-Anon as well.

“I was dating a crack addict,” she said. “It was the most insane thing I could do. I knew I loved alcoholics; that’s the gist of it. They’re fabulous people, exciting. In Al-Anon, you learn to focus on yourself because your part is the only thing you have control over.”

Karen’s daughter attends a weekly meeting of Alateen (for children and teens affected by alcoholism in a family member) and “loves it. She’s never known me to drink, but she gets a lot of help with what she’s going through with her father.”

Karen says the meetings “taught me to apply spirituality in a way I didn’t learn in church. I have freedom to do anything I want to do, to be anything I want to be… .”


1. We admitted we were powerless over alcohol —- that our lives had become unmanageable.

2. Came to believe that a Power greater than ourselves could restore us to sanity.

3. Made a decision to turn our will and our lives over to the care of God as we understood Him.

4. Made a searching and fearless moral inventory of ourselves.

5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.

6. Were entirely ready to have God remove all these defects of character.

7. Humbly asked Him to remove our shortcomings.

8. Made a list of all persons we had harmed, and became willing to make amends to them all.

9. Made direct amends to such people wherever possible, except when to do so would injure them or others.

10. Continued to take personal inventory and when we were wrong promptly admitted it.

11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out.

12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics, and to practice these principles in all our affairs.

Note: Other 12-step groups have adapted AA’s steps, sometimes changing the wording to accommodate the needs of their constituents. Al-Anon, for example, changed one word, replacing “alcoholics” in Step 12 with “others.”
source: Atlanta Journal-Constitution

Friday, October 17, 2008

Alcohol admissions triple at central London hospital

Adult alcohol-related admissions to an inner London hospital have tripled in the last four years, according to new research.

Trends in admissions were studied at the emergency departments and in medical admissions at two inner London hospitals – University College Hospital and the Whittington Hospital from 2004-8.

The total number of adult in-patient admissions at the two hospitals rose from 998 in 2004-05, to 2,690 in 2007-08. Adult attendances linked to alcohol in the emergency departments rose too - from 2,560 in 2004-05 to 3,434 in 2007-08.

Dr Andrew Smith, lead researcher, and colleagues found the figures for University College Hospital demonstrated a clear trend. This was not the case with the Whittington data.

University College Hospital is located in an area with a high concentration of pubs and nightclubs whilst the Whittington is not, which might be the reason for the increase in alcohol-related attendances at this hospital, they suggested.

Separately, they examined trends in teenage alcohol-related presentations. No increase in hospital admissions was observed, although the number of A&E attendances for under-18s rose from 98 in 2004/05 to 165 to 2007/08.

‘This increase coincides approximately with the change in the licensing laws. While under-18s might not generally be expected to be drinking in licensed premises, the law changes also affected off-licenses which may be of relevance,’ said Dr Smith.

The Licensing Act 2003 came into effect in November 2005. This change appears to have been paralleled by an increase in the presentation of alcohol-related illnesses in these two hospitals, conclude the authors.

‘A three-fold increase in the total number of adult admissions is noted at one hospital which if repeated at other centres, would have significant ramifications on NHS resources if this trend continues,’ they added.

The data were presented at the Royal College of Psychiatrists’ Faculty of General and Community Psychiatry Annual Meeting in Manchester today.

It follows last week’s calls for strong public policy measures to counter the alcohol problem in society. Dr Nick Sheron and colleagues said changes to price and availability of alcohol would work better than clinical treatments or Government initiatives to cut alcohol-related harm.

Writing in Gut, they say evidence from the WHO, the Academy of Medical Sciences and the EU, show that the best way of reducing consumption and alcohol-related harm is to tackle price.
source: On Medica

Wednesday, October 15, 2008

A tough-on-crime approach to justice that actually works

Instead of jailing repeat petty criminals, we should send them to mandatory addiction treatment

In a season of tough talk on crime, I propose a challenge to our political leaders. In Canada, one group of criminals commits a disproportionate number of crimes that we could easily reduce with more coercive sentencing. However, our usual form of coercion -- imprisonment -- doesn't work for them. They need a different kind of sentence. But to make that happen -- and to significantly reduce the number of crimes they commit -- would require will and wisdom that our legislators can't seem to muster.

The legal system refers to these men -- they are almost all men -- as chronic offenders. What everyone knows, but the justice system doesn't acknowledge, is that they are also drug addicts, hooked on heroin or crack cocaine. They steal not for gain but to support their addiction, to pay for their next fix.

This has nothing to do with getting high. For an addict, the point is to avoid the effects of withdrawal, which in the case of heroin can include cramps and muscle spasms, fever, cold sweats and goose bumps (hence the phase "cold turkey"), insomnia, vomiting, diarrhea and a condition called "itchy blood," which can cause compulsive scratching so severe that it leads to open sores. For addicts, drug use is not a lifestyle choice that's easy to change.

Many have been addicted for their entire adult lives, and as a result have spent half their lives behind bars, serving dozens of sentences for minor crimes. These are the "revolving door" criminals -- arrested, tried, sentenced to a few weeks or months, then dumped back out on the street, only to be arrested, tried and convicted again a few weeks later.

Canada has hundreds of criminals like that, mainly in the larger cities. Vancouver alone recently identified 379. According to a report by the Vancouver Police Department, the vast majority were addicted to drugs or alcohol. Many also suffer from a mental disorder, generally untreated. Between 2001 and 2006, Vancouver's few hundred chronic offenders, as a group, were responsible for 26,755 police contacts -- more than 5,000 contacts per year, 14 a day. The costs are staggering. Arrests, prosecutions and incarcerations end up costing some $20,000 per criminal per month -- per month! There has to be a better way.

Punishment alone is not it, though, for a couple of reasons. For one, the idea of punishing criminals is based at least partly on the concept of specific deterrence. You steal, we lock you up. Applied most strongly to property crimes -- which is what these offenders mainly commit -- specific deterrence assumes that the criminal is a rational actor who will consider: Is it worth it? And in fact, specific deterrence often works; many offenders really do stop committing crimes after fairly short jail sentences.

But not addicts.

The problem is the presumption of a rational actor. That is exactly what we do not have with drug addicts, who do not -- usually cannot -- stop to consider the likely punishment for a crime they are about to commit. They see only the escape from the more immediate and dire punishments of drug deprivation. By comparison, the threat of being caught and thrown in jail is nothing.

As well, because chronic offenders tend to commit minor crimes and draw short sentences -- say, 30 to 90 days for theft -- their lives shift constantly between jail and the streets.

We could use longer sentences to "warehouse" chronic offenders -- the American "three strikes and you're out" approach. But long-term imprisonment would be a very high-cost way to deal with what is really a public health issue.

And there's the crux of the problem.

The criminal justice system is not designed to treat addicts. While prisons do provide some drug treatment, it is almost always short-term and underfunded.

Clearly, Canadians need more protection from chronic offenders than we are now getting.

With chronic offenders, we have an issue of both criminal law and public health. Addicted offenders must be required to undergo serious, long-term drug treatment.

Since 1996, Alberta law has required minors with an apparent alcohol or drug addiction to participate, with or without their consent, in an assessment and treatment program. Saskatchewan and Manitoba have similar legislation and even allow parents of drug-addicted children to ask a court to require treatment, whether or not the child is in trouble with the law.

Although the research is scant, mandatory treatment does appear to have about the same success rate as voluntary treatment. A 1970s American study looked at the effectiveness of methadone maintenance treatment for those who entered the program under high, moderate or no coercion and found no significant difference in outcomes for the three groups.

Given the costs of incarceration -- not counting the costs to future victims -- paying for mandatory drug treatment for them hardly seems an issue, even if it only works some of the time. As for whether mandatory treatment is somehow inhumane, how humane is it to sentence these addicts to punishments we know don't work and then dump them back on the street no better than before?

Politics aside, Canadians deserve evidence-based criminal justice policies that actually reduce crime. Our challenge is to make the tough choices that move beyond "tough on crime" rhetoric and produce real change.
source: James C. Morton and The Ottawa Citizen

Tuesday, October 14, 2008

The Big Question: Why is opium production rising in Afghanistan, and can it be stopped?

Why are we asking this now?

Nato and the US are ramping up the war on drugs in Afghanistan. American ground forces are set to help guard poppy eradication teams for the first time later this year, while Nato's defence ministers agreed to let their 50,000-strong force target heroin laboratories and smuggling networks.

Until now, going after drug lords and their labs was down to a small and secretive band of Afghan commandos, known as Taskforce 333, and their mentors from Britain's Special Boat Service. Eradicating poppy fields was the job of specially trained, but poorly resourced, police left to protect themselves from angry farmers. All that is set to change.

How big is the problem?

Afghanistan is by far and away the world's leading producer of opium. Opium is made from poppies, and it is used to make heroin. Heroin from Afghanistan is smuggled through Pakistan, Russia, iran and Turkey until it ends up on Europe's streets.

In 2008, in Afghanistan, 157,000 hectares (610 square miles) were given over to growing poppies and they produced 7,700 tonnes of opium. Production has soared to such an extent in recent years that supply is outstripping demand. Global demand is only about 4,000 tonnes of opium per year, which has meant the price of opium has dropped. In Helmand alone, where most of Britain's 8,000 troops are based, 103,000 hectares were devoted to poppy crops. If the province was a country, it would be the world's biggest opium producer.

In 2007, the UN calculated that Afghan opium farmers made about $1bn from their poppy harvests. The total export value was $4bn – or 53 per cent of Afghanistan's GDP.

Is it getting better or worse?

There was a 19 per cent drop in cultivation from 2007 to 2008, but bumper yields meant opium production only fell by 6 per cent. Crucially, the drop was down to farmers deciding not to plant poppies, and that was largely a result of a successful pre-planting campaign, led by strong provincial governors, in parts of the country that are relatively safe.

Only 3.5 per cent of the country's poppy fields were eradicated in 2008. High wheat prices and low opium prices are also a factor in persuading some farmers to switch to licit crops.

In Helmand, one of the most volatile parts of Afghanistan, production rose by 1 per cent as farmers invested opium profits in reclaiming tracts of desert with expensive irrigation schemes. Opium production was actually at its lowest in 2001. The Taliban launched a highly effective counter-narcotics campaign during their last year in power. They used a policy of summary execution to scare farmers into not planting opium. Many analysts attribute their loss of popular support in the south, which contributed to their defeat by US-led forces in late 2001, to this policy.

How are the drugs linked to the insurgency?

The Taliban control huge swaths of Afghanistan's countryside, where most of the poppies are grown. They tax the farmers 10 per cent of the farm gate value of their crops. Antonio Maria Costa, head of the UN Office on Drugs and Crime, said the Taliban made about £50m from opium in 2007.

They also extort protection money from the drugs smugglers, for guarding convoys and laboratories where opium is processed into heroin. The UN and Nato believe the insurgents get roughly 60 per cent of their annual income from drugs. The Taliban and the drug smugglers also share a vested interest in undermining President Hamid Karzai's government, and fighting the international forces, which have both vowed to try and wipe out the opium trade.

What about corruption?

The vast sums of drugs money sloshing around Afghanistan's economy mean it is all too easy for the opium barons to buy off corrupt officials.

Most policemen earn about £80 a month. A heroin mule can earn £100 a day carrying drugs out of Afghanistan. Most Afghans suspect the corruption reaches the highest levels of government. President Karzai is reported to have called eradication teams to halt operations at the last minute for no apparent reason.

When an Afghan counter-narcotics chief found nine tonnes of opium in a former Helmand governor's compound, he was told not burn it by Kabul – but he claims he ignored the order.

President Karzai's brother, Ahmed Wali Karzai, is widely rumoured to be involved in the drugs trade – an allegation he denies. The New York Times claimed US investigators found evidence that he had ordered a local security official to release an "enormous cache of heroin" discovered in a tractor trailer in 2004. Privately, Western security officials admit they suspect that a number of government ministers are drug dealers.

Where does that leave the international community?

Right across Afghanistan, the government is corrupt and Afghans are fed up. The police organise kidnappings. Justice is for sale. Violence is spreading and people don't feel safe. The progress promised in 2001 hasn't been delivered.

Education is a rare success. There are now more than six million children at school, including two million girls, compared with less than a million under the Taliban.

But the roads which link the country's main cities aren't safe. Taliban roadblocks are increasingly normal. UN convoys are getting hijacked.

A report published by 100 charities at the end of July warned violence has hit record highs, fighting is spreading into parts of the country once thought safe, and there have been an unprecedented number of civilian casualties this year.

General David McKiernan, the US commander of almost all the international forces in Afghanistan, insited to journalists at a press conference on Sunday that Nato isn't losing. The fact he had to say it suggest public perception is otherwise. He also said that everywhere he goes, everyone he speaks to is "uniformly positive" about the future. Those people must be cherry-picked.

Crime in the capital, Kabul, is rising. The Taliban broke 400 insurgents out of Kandahar jail this summer, and they attacked the provincial capital in Helmand last weekend. People are frustrated at the international community's failures and scared that the Taliban are coming back.

What does that mean for the future?

President Karzai has touted peace talks with the Taliban through Saudi intermediaries. The international community maintains it will support the Afghan government in any negotiations, but privately diplomats admit that if they opened talks tomorrow they would not start from a "perceived position of strength".

General David Petraeus is about to take command at CentCom, which includes Afghanistan, and he is expected to focus on churning out more Afghan soldiers and engaging tribes against the insurgents.

Meanwhile, in Pakistan, it remains to be seen whether Asif Ali Zardari will rein in his intelligence service and crack down on the Taliban safe havens in the Pakistani tribal areas, which they rely on to launch attacks in Afghanistan.

There are also elections on the horizon. The international community is determined that they must go ahead, despite the obvious security challenges, and anything the Afghan candidates do should be seen in the context of securing people who can deliver votes.

Does the war on drugs undermine the war on terror?


*Working to eradicate poppies will remove farmers' best source of income and turn them against Nato

*Using resources to fight against the entrenched poppy trade diverts them from the war with the Taliban

*Corruption in government means that battling opium turns the mechanism of the state against our forces


*In the end, an Afghanistan without opium production will be much less prone to the influence of the Taliban

*Money from the international drugs trade may find its way to terrorists outside of Afghanistan

*Removing the source of corruption will strengthen the country's institutions in the long term

Monday, October 13, 2008

Alcohol-related arrests up at IU Southeast

The Indiana University Southeast Campus Police Department is now dealing with a problem many campuses have had for years — alcohol offenses.

For the first time, IUS offers on-campus housing for students this year. With residents comes more students trying to test the limits.

Less than two months since the residence halls opened, campus police have already made nine alcohol-related arrests. Several others have been cited or given referrals. By comparison, IUS reported only two on-campus alcohol violations and six referrals from 2004 until 2006. The 2007 crime reports will be released next month.

“This is something we’ve never really had to deal with before,” said Dennis Simon, campus chief of police. “We’ve had very few arrests in the past.”

In fact, the police department is in the process of changing its crime reporting system so that an arrest log will be available in the campus police office. In the past, there were so few arrests they never had to worry about that.

So far, two arrests were made and three citation issued for minor consumption. There have been four operating while intoxicated arrests, two disorderly conduct arrests and one possession of marijuana arrest.

Simon believes the number of alcohol violations will continue to drop as students realize campus police and school administrators will not tolerate alcohol on campus.

“Problems have decreased significantly after the first two weeks,” he said. “We indicated to people that you can’t get away with breaking the rules.”

Most of the problems have involved non-students visiting students on campus, Simon said. Six out of nine people arrested were not students.

The university prohibits alcohol, tobacco and weapons on campus. The only exception is when alcohol is allowed at certain events approved by the chancellor.

Simon met with Floyd County Prosecutor Keith Henderson earlier this year, and both agreed to let the school handle minor offenses like alcohol consumption. In those situations, campus police will issue referrals and Student Affairs decides the discipline. The range of penalties include probation and suspension or even removal from campus housing for repeat offenders.

“We want students to have a good college experience,” Simon said.

Simon also thanked the Community Advisors, students who are selected to monitor residence halls, saying they had been “vigilant.”
source: News and Tribune

Saturday, October 11, 2008

Don’t wait for cops to detect alcohol abuse

Rightful outrage over dangerous drunken drivers has fueled new demands for tougher laws and penalties.

And who can argue?

But with Wisconsin on top of most lists for binge drinking or drunken driving, you know there are many more folks out there who are risks but have yet to become a statistic or headline.

So let’s not overlook another, better way to get at the nub of the problem.

A pilot prevention program, if broadened as many respected medical associations say it should be, would screen many more people for problem drinking or drug use before it’s too late. It would intervene with information and, where needed, treatment, before these problem drinkers end up in highway carnage or handcuffs.

It would start at the doctor's office.

One of my doctors requires me to complete an annual survey that asks, among other things, about alcohol or drug consumption. The trouble is, most doctors don't have time to talk about it. They can barely deal with your high blood pressure or arthritis or other painful ailment as it is.

Waukesha's Family Practice Center is one of 20 clinics participating in the promising prevention effort through the Wisconsin Initiative to Promote Healthy Lifestyles, financed with a $12 million, five-year federal grant. (See www.wiphl.comfor information.)

Betzaida Silva-Rydz is the specially trained health educator at the Waukesha clinic. She describes a woman who came to the clinic for medical issues and, like others, completed four screening questions - like when was the last time she had four drinks in one sitting.

After she was provided information, without judgment, the woman recognized that both she and her husband had a problem in ways they hadn't considered, affecting their health, their family, their finances.

Through a few more sessions, the couple saw their way to changes that put more effort into family and less into social drinking.

It's the kind of story repeated last week at a meeting of health care professionals where early screening and intervention were hailed by the likes of Milwaukee Commissioner of Health Bevan Baker and Milwaukee County District Attorney John Chisholm.

Baker, quoting his wife, said it's not just taking the bull by the horns - which can leave you gored - it's removing the horns.

The National Institute on Alcohol Abuse and Alcoholism says one in four Wisconsinites is a problem drinker or drug user, but only 10% to 20% of them get help. The state estimates the consequences cost $5 billion a year in health care, social services and criminal justice. One brief screening and intervention saves $1,000, a state study reports.

The National Commission on Prevention Priorities, which tries to identify the biggest bang for the buck in public health spending, has an eye-opening ranking of how to best make us healthier:

First, men older than 40 and women older than 50 should take a daily aspirin for cardiovascular health. Second, children should be immunized. Third, help people quit smoking.

And fourth? Have routine alcohol screening and intervention. It's ahead of cholesterol screening, blood pressure screening. even cancer screenings.

It's that important. So more clinics should get involved. More insurance plans should cover it. And more people desperate to do something about drunken drivers should demand it.
source: Milwaukee Journal Sentinel

Tuesday, October 7, 2008

Doctors can't treat your drinking problem

The rise in alcohol abuse should be a matter for social policy not the GP's surgery

‘Your GP is the first place to turn if you are concerned about your drinking.’ This was the concluding advice of a recent eight-page Guardian supplement devoted to ‘Britain’s harmful relationship with alcohol’. Once regarded as a manifestation of moral turpitude, excessive drinking is now defined as a medical condition. GPs have taken the place of evangelical ministers at the head of the modern temperance crusade. The fact that these same doctors come second only to publicans in terms of death from alcohol-induced cirrhosis of the liver has not diminished medical authority in this area.

The rise of GPs in dealing with alcohol problems is based on claims for the effectiveness of ‘brief interventions’. This means doctors giving patients a quick, but empathetic, lecture on the adverse health consequences of alcohol before advising them to stop. But close scrutiny of these studies reveals that their high success rates are achieved at a cost. They exclude patients who are alcohol dependent (including only those deemed to have ‘hazardous’ levels of drinking). They follow up for a short period (usually less than 12 months). And they define success in terms of a reduction in total consumption or episodes of binge drinking (rather than achieving abstinence).

If doctors suggest to patients drinking over the odds that they should consider cutting back, they do, for a while, before resuming their old habits. A desperate resort to old-fashioned medical paternalism? – yes. A solution to ‘Britain's harmful relationship with alcohol’? – no.

Prominent doctors and medical organisations instinctively recognise the ineffectiveness of medical intervention – and indeed of medical treatment. They have campaigned for prohibitionist measures to deal with excessive drinking. No newspaper or television feature on alcohol is now complete without a leading liver specialist, psychiatrist or GP demanding more regulations on the sale of alcohol. They call for banning advertising, raising prices and for tougher policing of licensing laws. But if doctors cannot treat alcoholism in their surgeries, why should anybody accept their proposals in the sphere of social policy? After all, they have no expertise there whatsoever.

The notion that doctors can treat the nation’s alcohol problem is a delusion that is convenient for the medical profession and for politicians eager to respond to the latest moral panic. But it marks an evasion of the real issues. Self-destructive patterns of alcohol consumption express personal and social demoralisation. This is not susceptible to medical – or political – quick-fixes.
source: The Times

Monday, October 6, 2008

Stress of Ike recovery also strains recovery of addicts

Houstonians are still confronting the lingering effects of Hurricane Ike: damaged homes, piles of debris, lost work and ends that won't meet. But for recovering alcoholics and addicts, coping with post-Ike realities may also mean reaching out to sobriety buddies instead of the bottle or drugs.

Stress is the greatest threat to people fighting addictions, Houston experts say, and Ike's toll could trigger relapses.

"What underlies addiction and substance abuse is fear, anxiety and stress. People drink and use because it medicates their anxiety," said Dr. Scott Basinger, a neuroscientist and associate dean at Baylor College of Medicine. "Don't get too hungry, too angry, too lonely or too tired, because being hungry, angry, lonely or tired are well-known risk factors for relapse."

The risk is heightened during a disaster, when loss of power, phone service and transportation cuts contact with counselors. Afterward, assessments of the damage, joblessness and other factors could create a perfect storm for recovering addicts to slip.

"A lot of times, these things have a delayed effect," said Joy Schmitz, a psychologist at the University of Texas Health Science Center at Houston who studies behavior and substance abuse. "It could be a challenging time for patients who are trying to maintain abstinence, especially if they recently quit."

Many people did reach out for help in Ike's aftermath.

Calls flooded area treatment centers, and some support groups held meetings by candlelight just hours after Ike passed. The Sunday after the storm, for instance, people showed up for substance abuse meetings at Memorial Hermann's Prevention and Recovery Center.

"I think people seek out the fellowship, they seek out each other to have someone to lean on, to talk to and to support," said center CEO Matt Feehery. "People who have a solid recovery network will do just fine. Isolation is an enemy if you've lost something — property, power, a loved one."

Heather, who agreed to speak on the condition that her last name not be used, admitted that Ike tested her newfound sobriety. She had voluntarily gone to treatment, she said, to overcome alcohol and cocaine abuse.

But on the evening that Ike made landfall, she found herself with an unopened beer in her hand at a hurricane party. She reached in her pocket to feel for her silver coin — a recovery reminder handed out at Alcoholics Anonymous meetings.

"I surprised myself by not drinking," the former bartender said.

"I thought underneath those stressful situations I would relapse, but I didn't," said Heather, who resumed treatment at a Houston center after the storm.

Because of the chance of relapse under stressful post-storm conditions, the Texas Department of State Health Services has required state-funded substance abuse treatment services to track clients impacted by hurricanes Katrina, Rita, Gustav and Ike.

"This information can help service providers offer better screening, assessment and referral services as they will have an idea of what environmental factors, such as being a disaster survivor, may have contributed to the change in behavior," agency spokeswoman Emily Palmer wrote in an e-mail.

Substance abuse counselors are concerned that Ike will continue to spin off stress, leading people deeper into addictions.

"They go through something like this, and they start to self-medicate, and the problem starts to escalate," said Dr. Jason Powers, chief medical officer at The Right Step, a Houston treatment center.