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Dual Addiction

Posted 01-24-2008 at 11:39 AM by Chance

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Drug and Alcohol Abuse



It is not unusual for a person to be dually addicted. Meaning, they have drug dependency and alcohol abuse problems. Addiction researchers and treatment professionals have long known that drug and alcohol abuse are strongly linked. In the last decade, research has broadened our understanding of many shared neurobiological and behavioral mechanisms that underpin the two disorders. Yet, while two in five substance abuse treatment patients abuse both drugs and alcohol, the treatment they are likely to receive will target only one disorder. A lack of science-based information on concurrent treatment of drug and alcohol abuse limits the ability of treatment professionals to provide the comprehensive treatment these patients need.

The substantial portion of drug and alcohol abusing patients in community treatment programs provides additional evidence of the need for science based information on treating dual addiction. Patients who abuse both drugs and alcohol accounted for more than 42 percent of admissions to substance abuse treatment facilities. Alcohol abuse is even more likely among patients who abuse certain drugs, such as cocaine, methamphetamine, and marijuana. For example, more than half of cocaine abusing patients who entered treatment also abuse alcohol.

Dually addicted individuals also may combine alcohol and illicit drugs because of interactions between abused substances in the body. Because both drugs and alcohol activate brain areas involved in reward, combining substances may increase these effects. Other alcohol and drug interactions may counter unpleasant effects that often accompany or follow substance abuse. Clinical reports suggest that coca ethylene, a combined cocaine-alcohol metabolite that is formed in the body following concurrent alcohol and cocaine use, appears to reduce the anxiety that can accompany cocaine use. Recent research in rats confirms that coca ethylene plasma levels remain high as cocaine levels fall, producing a delayed, relatively long-lasting rewarding effect that may counter the aversive effect induced when cocaine plasma levels recede.

Recent research suggests that some medications developed to treat drug or alcohol abuse may be useful for treating both problems. This information, along with our increased understanding of the underlying factors that drive drug and alcohol abuse, provides a strong rationale for a coordinated research effort to meet the critical need for treatments for people suffering from both disorders. Coordinated research on dually addicted patients will address the needs of the overwhelming number of Americans who abuse both alcohol and illicit drugs. More than 2.4 million of the 5.6 million people who abused illicit drugs in 2001 also abused alcohol, according to the National Household Survey on Drug Abuse. In fact, the more heavily someone abused alcohol, the more likely he or she was to use illicit drugs, the survey found. In 2001, nearly two of every three American teenagers, ages 12 to 17, who engaged in frequent drinking binges also abused drugs. In comparison, only 1 in 20 young people who didn't drink at all used drugs.

While the perceived benefits of combining alcohol and drugs may play a big part in the high percentages of people who do so, the addictive effects and harmful consequences of both substances increase when they are used together. Dually addicted patients are more likely to drop out of treatment and have poorer results than patients who abuse only one substance. However, since most studies on treating drug and alcohol abuse have examined these disorders separately, drug and alcohol treatment counselors now have little science-based information on which to base their treatment of these patients. Drug and alcohol abuse wreak incalculable damage on individuals, families, and communities. When they occur together, these disorders double the challenge to treatment providers.

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1. Another Piece Of Dual Addiction Another Piece Of Dual Addiction Drinking In General Alcohol Impairment Chart blood alcohol level by body weight Source: University of Wisconsin Center for Health Sciences, 1988 Moderate alcohol drinking is difficult to define because it means different things to different people. The term is often confused with “social drinking,” which refers to drinking patterns that are accepted by the society in which they occur. However, social drinking is not necessarily free of problems. Moderate drinking may be defined as drinking that does not generally cause problems, either for the drinker or for society. Since there are clearly both benefits and risks associated with lower levels of drinking. It would be useful if the above definition of moderate drinking were bolstered by numerical estimates of “safe” drinking limits. However, the usefulness of quantitative definitions of moderate drinking is compromised by the likelihood that a given dose of alcohol may affect different people differently. Adding further complexity, the pattern of drinking is also an important determinant of alcohol-related consequences. Thus, while epidemiologic data are often collected in terms of the “average number of drinks per week,” one drink taken each day may have different consequences than seven drinks taken on a Saturday night. 20 question test to help determine social drinking 1. Do you lose time from work due to your drinking? 2. Is drinking making your home life unhappy? 3. Do you drink because you are shy with other people? 4. Is drinking affecting your reputation? 5. Have you ever felt remorse after drinking? 6. Have you gotten into financial difficulties as a result of your drinking? 7. Do you turn to lower companions and an inferior environment when drinking? 8. Does your drinking make you careless of your family’s welfare? 9. Has your ambition decreased since drinking? 10. Do you crave a drink at a definite time daily? 11. Do you want a drink the next morning? 12. Does drinking cause you to have difficulty in sleeping? 13. Has your efficiency decreased since drinking? 14. Is drinking jeopardizing your job or business? 15. Do you drink to escape from worries or troubles? 16. Do you drink alone? 17. Have you ever had a complete loss of memory as a result of your drinking? 18. Has your physician ever treated you for drinking? 19. Do you drink to build up your self-confidence? 20. Have you ever been in a hospital or institution on account of drinking? If you have answered YES to any one of the questions, there is a definite warning that you may be an alcoholic. If you have answered YES to any two, the chances are that you are an alcoholic. If you have answered YES to three or more, you are definitely an alcoholic. Despite the complexity, numerical definitions of moderate drinking do exist. For example, guidelines put forth jointly by the U.S. Department of Agriculture and the U.S. Department of Health and Human Services define moderate drinking as no more than one drink a day for most women, and no more than two drinks a day for most men. A standard drink is generally considered to be 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof distilled spirits. Each of these drinks contains roughly the same amount of absolute alcohol–approximately 0.5 ounce or 12 grams. These guidelines exclude the following persons, who should not consume alcoholic beverages: women who are pregnant or trying to conceive; people who plan to drive or engage in other activities that require attention or skill; people taking medication, including over-the-counter medications; recovering alcoholics; and persons under the age of 21. Although not specifically addressed by the guidelines, alcohol use also is contraindicated for people with certain medical conditions such as peptic ulcer. The existence of separate guidelines for men and women reflects research findings that women become more intoxicated than men at an equivalent dose of alcohol. This results, in part, from the significant difference in activity of an enzyme in stomach tissue of males and females that breaks down alcohol before it reaches the bloodstream. The enzyme is four times more active in males than in females. Moreover, women have proportionately fatter and less body water than men. Because alcohol is more soluble in water than in fat, a given dose becomes more highly concentrated in a female’s body water than in a male’s. Since the proportion of body fat increases with age, colleagues recommend a limit of one drink per day for the elderly. For most adults, moderate alcohol use–up to two drinks per day for men and one drink per day for women and older people–causes few if any problems. (One drink equals one 12-ounce bottle of beer or wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits. Certain people should not drink at all: * Women who are pregnant or trying to become pregnant * People who plan to drive or engage in other activities that require alertness and skill, such as using high-speed machinery * People taking certain over-the-counter or prescription medications * People with medical conditions that can be made worse by drinking * Recovering alcoholics * People younger than age 21

   Posted 01-24-2008 at 11:40 AM by Chance

2. 	glad I ran into your post, very interesting
   	Posted 01-24-2008 at 12:52 PM by splashylanding

3. ALCOHOL AND TOBACCO: TWO DANGEROUS GATEWAY DRUGS The use of alcohol and tobacco has taken a great toll on youth and society and is a predictor of future alcohol abuse and addiction, as well as the use of other drugs. Therefore, Drug Watch International supports all efforts to prevent use of these drugs by youth and supports efforts to restrict advertising of them to the general public. Background: Alcohol and nicotine are legal drugs for adults in many countries. Even though these dangerous and addictive drugs are “socially acceptable” for adults, they are, to one degree or another, controlled substances for youth throughout the world. Many cultures try to limit their young from using alcohol or tobacco. Efforts to prevent the use of alcohol and tobacco by youth should not be confused with efforts to prohibit adult use of either of these drugs. However, it is time adults looked at their own alcohol and tobacco use, if they want to influence young people. In North America and other countries, alcohol is the number one drug used by teens. Its use is also the number one contributing factor in youthful deaths. In the U.S., the use of alcohol is associated with at least one-half of all car crashes, suicides, drownings, crimes of violence, unplanned sex, poor school performance, and other trauma among youth. Alcohol and tobacco kill more people annually than all other drugs combined. Alcohol alone is associated with at least one-fourth of all hospital visits in the United States. Nicotine is one of the most addictive and harmful of all drugs. There is a false perception that if a drug is legal it must cause less problems. In many countries and cultures, the use of alcohol and/or tobacco is so deeply woven into the cultural fabric of those countries that neither is acknowledged as a drug or even as a problem. Rationale: In July 1995, the U.S. Food and Drug Administration (FDA) concluded for the first time that nicotine is a drug and that it should be regulated as a controlled substance. Regulations were proposed restricting access to tobacco products and restricting attempts to make these products appealing to children and adolescents. Indeed, if alcohol and tobacco were new products seeking FDA clearance today, each would likely be rejected as hazardous and addictive. A recent study by Columbia University’s Center on Addiction and Substance Abuse, states that the earlier children use the gateway drugs tobacco or alcohol or marijuana, the more likely they are to move on to other drugs. Youth who drank alcohol were 50 times more likely to use cocaine, and those who smoked tobacco cigarettes were 19 times as likely to use cocaine. Nearly 90% of cocaine users had smoked tobacco or drank alcohol or used marijuana first. The study, based on 30,000 American households, established a clear progression that began with use of the gateway drugs of alcohol, tobacco or marijuana and led to use of other drugs. Dr. John Slade reported at the 1989 National Conference on Nicotine Dependence in San Diego, California, that tobacco smoking teaches drug acquisition skills to the youth. He said, “For the most part, they’re illegal for kids to buy. In addition, kids who smoke get firsthand experience in using a substance to adjust emotional states.” Slade reports that tobacco use teaches drug-taking skills and that tobacco use promotes an attitude that fosters other drug taking behaviors. Compounding the problem is the relative ease with which youth can access alcohol and tobacco. Both drugs are widely available, inexpensive and heavily marketed, making them especially attractive to youth, who are the most price-sensitive consumer age group. The right of adults to consume either of these drugs is a notion heavily promoted by the alcohol and tobacco industries. This argument is meaningless for many young people who have reached the legal age for use with no real choice left, because they are already addicted. They have been seduced into use of both drugs by slick marketing targeted at youth long before they have had their first drink or used tobacco for the first time. Youth are bombarded daily with alluring advertising and marketing techniques. Because new alcohol or tobacco users are rarely adults, images that imply sexual prowess, athletic ability, popularity, freedom and escape from problems are especially appealing to young people. Children grow up thinking that they cannot have a good time without alcohol or tobacco. They don’t realize that many adults choose not to drink. Alcohol can kill or cause serious problems any time a young person uses it. Yet, some youth are convinced that drinking alcohol or using tobacco does not cause immediate problems in their lives, and most are certain that they could quit at any time. The average teen smoker had his/her first whole cigarette by 13 and became a daily smoker by age 14.5. Drug Watch International recognizes and supports the various efforts of many concerned drug preventionists who are attempting to prevent the use of alcohol and tobacco by youth. Many Drug Watch members are local and national leaders in this aspect of prevention. We must never retreat in our efforts to prevent drug use by youth. Drug Watch International supports the many promising practices and strategies aimed at preventing youthful alcohol and tobacco use, including: changing social acceptance of use by youth, increasing law enforcement efforts for those who provide or procure these drugs for youth, increasing excise taxes, creating more meaningful and effective consequences for those who provide alcohol or tobacco to adolescents, increasing prevention programs, restricting advertising and marketing, and supporting legislation and public policy that limits the lobbying practices of the alcohol and tobacco industries.

   Posted 01-25-2008 at 01:50 PM by Chance

4. ALCOHOL’S DAMAGING EFFECTS ON THE BRAIN Difficulty walking, blurred vision, slurred speech, slowed reaction times, impaired memory: Clearly, alcohol affects the brain. Some of these impairments are detectable after only one or two drinks and quickly resolve when drinking stops. On the other hand, a person who drinks heavily over a long period of time may have brain deficits that persist well after he or she achieves sobriety. Exactly how alcohol affects the brain and the likelihood of reversing the impact of heavy drinking on the brain remain hot topics in alcohol research today. We do know that heavy drinking may have extensive and far–reaching effects on the brain, ranging from simple “slips” in memory to permanent and debilitating conditions that require lifetime custodial care. And even moderate drinking leads to short–term impairment, as shown by extensive research on the impact of drinking on driving. A number of factors influence how and to what extent alcohol affects the brain (1), including * how much and how often a person drinks; * the age at which he or she first began drinking, and how long he or she has been drinking; * the person’s age, level of education, gender, genetic background, and family history of alcoholism; * whether he or she is at risk as a result of prenatal alcohol exposure; and * his or her general health status. This Alcohol Alert reviews some common disorders associated with alcohol–related brain damage and the people at greatest risk for impairment. It looks at traditional as well as emerging therapies for the treatment and prevention of alcohol–related disorders and includes a brief look at the high–tech tools that are helping scientists to better understand the effects of alcohol on the brain. BLACKOUTS AND MEMORY LAPSES Alcohol can produce detectable impairments in memory after only a few drinks and, as the amount of alcohol increases, so does the degree of impairment. Large quantities of alcohol, especially when consumed quickly and on an empty stomach, can produce a blackout, or an interval of time for which the intoxicated person cannot recall key details of events, or even entire events. Blackouts are much more common among social drinkers than previously assumed and should be viewed as a potential consequence of acute intoxication regardless of age or whether the drinker is clinically dependent on alcohol (2). White and colleagues (3) surveyed 772 college undergraduates about their experiences with blackouts and asked, “Have you ever awoken after a night of drinking not able to remember things that you did or places that you went?” Of the students who had ever consumed alcohol, 51 percent reported blacking out at some point in their lives, and 40 percent reported experiencing a blackout in the year before the survey. Of those who reported drinking in the 2 weeks before the survey, 9.4 percent said they blacked out during that time. The students reported learning later that they had participated in a wide range of potentially dangerous events they could not remember, including vandalism, unprotected sex, and driving. Binge Drinking and Blackouts • Drinkers who experience blackouts typically drink too much and too quickly, which causes their blood alcohol levels to rise very rapidly. College students may be at particular risk for experiencing a blackout, as an alarming number of college students engage in binge drinking. Binge drinking, for a typical adult, is defined as consuming five or more drinks in about 2 hours for men, or four or more drinks for women. Equal numbers of men and women reported experiencing blackouts, despite the fact that the men drank significantly more often and more heavily than the women. This outcome suggests that regardless of the amount of alcohol consumption, females—a group infrequently studied in the literature on blackouts—are at greater risk than males for experiencing blackouts. A woman’s tendency to black out more easily probably results from differences in how men and women metabolize alcohol. Females also may be more susceptible than males to milder forms of alcohol–induced memory impairments, even when men and women consume comparable amounts of alcohol (4). ARE WOMEN MORE VULNERABLE TO ALCOHOL’S EFFECTS ON THE BRAIN? Women are more vulnerable than men to many of the medical consequences of alcohol use. For example, alcoholic women develop cirrhosis (5), alcohol–induced damage of the heart muscle (i.e., cardiomyopathy) (6), and nerve damage (i.e., peripheral neuropathy) (7) after fewer years of heavy drinking than do alcoholic men. Studies comparing men and women’s sensitivity to alcohol–induced brain damage, however, have not been as conclusive. Using imaging with computerized tomography, two studies (8,9) compared brain shrinkage, a common indicator of brain damage, in alcoholic men and women and reported that male and female alcoholics both showed significantly greater brain shrinkage than control subjects. Studies also showed that both men and women have similar learning and memory problems as a result of heavy drinking (10). The difference is that alcoholic women reported that they had been drinking excessively for only about half as long as the alcoholic men in these studies. This indicates that women’s brains, like their other organs, are more vulnerable to alcohol–induced damage than men’s (11). Yet other studies have not shown such definitive findings. In fact, two reports appearing side by side in the American Journal of Psychiatry contradicted each other on the question of gender–related vulnerability to brain shrinkage in alcoholism (12,13). Clearly, more research is needed on this topic, especially because alcoholic women have received less research attention than alcoholic men despite good evidence that women may be particularly vulnerable to alcohol’s effects on many key organ systems.

   Posted 01-27-2008 at 07:02 AM by Chance

5. BRAIN DAMAGE FROM OTHER CAUSES People who have been drinking large amounts of alcohol for long periods of time run the risk of developing serious and persistent changes in the brain. Damage may be a result of the direct effects of alcohol on the brain or may result indirectly, from a poor general health status or from severe liver disease. For example, thiamine deficiency is a common occurrence in people with alcoholism and results from poor overall nutrition. Thiamine, also known as vitamin B1, is an essential nutrient required by all tissues, including the brain. Thiamine is found in foods such as meat and poultry; whole grain cereals; nuts; and dried beans, peas, and soybeans. Many foods in the United States commonly are fortified with thiamine, including breads and cereals. As a result, most people consume sufficient amounts of thiamine in their diets. The typical intake for most Americans is 2 mg/day; the Recommended Daily Allowance is 1.2 mg/day for men and 1.1 mg/day for women (14). Wernicke–Korsakoff Syndrome Up to 80 percent of alcoholics, however, have a deficiency in thiamine (15), and some of these people will go on to develop serious brain disorders such as Wernicke–Korsakoff syndrome (WKS) (16). WKS is a disease that consists of two separate syndromes, a short–lived and severe condition called Wernicke’s encephalopathy and a long–lasting and debilitating condition known as Korsakoff’s psychosis. The symptoms of Wernicke’s encephalopathy include mental confusion, paralysis of the nerves that move the eyes (i.e., oculomotor disturbances), and difficulty with muscle coordination. For example, patients with Wernicke’s encephalopathy may be too confused to find their way out of a room or may not even be able to walk. Many Wernicke’s encephalopathy patients, however, do not exhibit all three of these signs and symptoms, and clinicians working with alcoholics must be aware that this disorder may be present even if the patient shows only one or two of them. In fact, studies performed after death indicate that many cases of thiamine deficiency–related encephalopathy may not be diagnosed in life because not all the “classic” signs and symptoms were present or recognized. Human Brain Schematic drawing of the human brain, showing regions vulnerable to alcoholism-related abnormalities. Approximately 80 to 90 percent of alcoholics with Wernicke’s encephalopathy also develop Korsakoff’s psychosis, a chronic and debilitating syndrome characterized by persistent learning and memory problems. Patients with Korsakoff’s psychosis are forgetful and quickly frustrated and have difficulty with walking and coordination (17). Although these patients have problems remembering old information (i.e., retrograde amnesia), it is their difficulty in “laying down” new information (i.e., anterograde amnesia) that is the most striking. For example, these patients can discuss in detail an event in their lives, but an hour later might not remember ever having the conversation. Treatment The cerebellum, an area of the brain responsible for coordinating movement and perhaps even some forms of learning, appears to be particularly sensitive to the effects of thiamine deficiency and is the region most frequently damaged in association with chronic alcohol consumption. Administering thiamine helps to improve brain function, especially in patients in the early stages of WKS. When damage to the brain is more severe, the course of care shifts from treatment to providing support to the patient and his or her family (18). Custodial care may be necessary for the 25 percent of patients who have permanent brain damage and significant loss of cognitive skills (19). Scientists believe that a genetic variation could be one explanation for why only some alcoholics with thiamine deficiency go on to develop severe conditions such as WKS, but additional studies are necessary to clarify how genetic variants might cause some people to be more vulnerable to WKS than others. LIVER DISEASE Most people realize that heavy, long–term drinking can damage the liver, the organ chiefly responsible for breaking down alcohol into harmless byproducts and clearing it from the body. But people may not be aware that prolonged liver dysfunction, such as liver cirrhosis resulting from excessive alcohol consumption, can harm the brain, leading to a serious and potentially fatal brain disorder known as hepatic encephalopathy (20). Hepatic encephalopathy can cause changes in sleep patterns, mood, and personality; psychiatric conditions such as anxiety and depression; severe cognitive effects such as shortened attention span; and problems with coordination such as a flapping or shaking of the hands (called asterixis). In the most serious cases, patients may slip into a coma (i.e., hepatic coma), which can be fatal. New imaging techniques have enabled researchers to study specific brain regions in patients with alcoholic liver disease, giving them a better understanding of how hepatic encephalopathy develops. These studies have confirmed that at least two toxic substances, ammonia and manganese, have a role in the development of hepatic encephalopathy. Alcohol–damaged liver cells allow excess amounts of these harmful byproducts to enter the brain, thus harming brain cells.

   Posted 01-27-2008 at 07:03 AM by Chance

6. Treatment Physicians typically use the following strategies to prevent or treat the development of hepatic encephalopathy. * Treatment that lowers blood ammonia concentrations, such as administering L–ornithine L–aspartate. Techniques such as liver–assist devices, or “artificial livers,” that clear the patients’ blood of harmful toxins. In initial studies, patients using these devices showed lower amounts of ammonia circulating in their blood, and their encephalopathy became less severe (21). Liver transplantation, an approach that is widely used in alcoholic cirrhotic patients with severe (i.e., end–stage) chronic liver failure. In general, implantation of a new liver results in significant improvements in cognitive function in these patients (22) and lowers their levels of ammonia and manganese (23). ALCOHOL AND THE DEVELOPING BRAIN Drinking during pregnancy can lead to a range of physical, learning, and behavioral effects in the developing brain, the most serious of which is a collection of symptoms known as fetal alcohol syndrome (FAS). Children with FAS may have distinct facial features (see illustration). FAS infants also are markedly smaller than average. Their brains may have less volume (i.e., microencephaly). And they may have fewer numbers of brain cells (i.e., neurons) or fewer neurons that are able to function correctly, leading to long–term problems in learning and behavior. Fetal Alcohol Syndrome Children with fetal alcohol syndrome (FAS) may have distinct facial features. Treatment Scientists are investigating the use of complex motor training and medications to prevent or reverse the alcohol–related brain damage found in people prenatally exposed to alcohol (24). In a study using rats, Klintsova and colleagues (25) used an obstacle course to teach complex motor skills, and this skills training led to a re–organization in the adult rats’ brains (i.e., cerebellum), enabling them to overcome the effects of the prenatal alcohol exposure. These findings have important therapeutic implications, suggesting that complex rehabilitative motor training can improve motor performance of children, or even adults, with FAS. Scientists also are looking at the possibility of developing medications that can help alleviate or prevent brain damage, such as that associated with FAS. Studies using animals have yielded encouraging results for treatments using antioxidant therapy and vitamin E. Other preventive therapies showing promise in animal studies include 1–octanol, which ironically is an alcohol itself. Treatment with l–octanol significantly reduced the severity of alcohol’s effects on developing mouse embryos (26). Two molecules associated with normal development (i.e., NAP and SAL) have been found to protect nerve cells against a variety of toxins in much the same way that octanol does (27). And a compound (MK–801) that blocks a key brain chemical associated with alcohol withdrawal (i.e., glutamate) also is being studied. MK–801 reversed a specific learning impairment that resulted from early postnatal alcohol exposure (28). Though these compounds were effective in animals, the positive results cited here may or may not translate to humans. Not drinking during pregnancy is the best form of prevention; FAS remains the leading preventable birth defect in the United States today. GROWING NEW BRAIN CELLS For decades scientists believed that the number of nerve cells in the adult brain was fixed early in life. If brain damage occurred, then, the best way to treat it was by strengthening the existing neurons, as new ones could not be added. In the 1960s, however, researchers found that new neurons are indeed generated in adulthood—a process called neurogenesis (29). These new cells originate from stem cells, which are cells that can divide indefinitely, renew themselves, and give rise to a variety of cell types. The discovery of brain stem cells and adult neurogenesis provides a new way of approaching the problem of alcohol–related changes in the brain and may lead to a clearer understanding of how best to treat and cure alcoholism (30). For example, studies with animals show that high doses of alcohol lead to a disruption in the growth of new brain cells; scientists believe it may be this lack of new growth that results in the long–term deficits found in key areas of the brain (such as hippocampal structure and function) (31,32). Understanding how alcohol interacts with brain stem cells and what happens to these cells in alcoholics is the first step in establishing whether the use of stem cell therapies is an option for treatment (33). SUMMARY Alcoholics are not all alike. They experience different degrees of impairment, and the disease has different origins for different people. Consequently, researchers have not found conclusive evidence that any one variable is solely responsible for the brain deficits found in alcoholics. Characterizing what makes some alcoholics vulnerable to brain damage whereas others are not remains the subject of active research (34). The good news is that most alcoholics with cognitive impairment show at least some improvement in brain structure and functioning within a year of abstinence, though some people take much longer (35–37). Clinicians must consider a variety of treatment methods to help people stop drinking and to recover from alcohol–related brain impairments, and tailor these treatments to the individual patient. Advanced technology will have an important role in developing these therapies. Clinicians can use brain–imaging techniques to monitor the course and success of treatment, because imaging can reveal structural, functional, and biochemical changes in living patients over time. Promising new medications also are in the early stages of development, as researchers strive to design therapies that can help prevent alcohol’s harmful effects and promote the growth of new brain cells to take the place of those that have been damaged by alcohol.

   Posted 01-27-2008 at 07:03 AM by Chance

7. 	meditation time!
   	Posted 01-30-2008 at 06:22 PM by splashylanding

8. NARCONON: A new life without drugs Through the years, tens of thousands of lives have been saved through the Narconon program. Legions of people who had surrendered to their addictions have found new hope and a new life. Indeed, that is how Narconon started. It began in Arizona State Prison through the efforts of William Benitez, a hard-core addict from the age of 13. He had unsuccessfully tried many ways to kick his 18-year heroin habit, including joining the Marines, committing himself to hospitals for care and therapy, and isolating himself in mining towns. After pleading guilty to possession of narcotics on December 22, 1964, Benitez entered prison yet again—his fourth term. A friend gave him some reading materials that included a book by L. Ron Hubbard. “That small book impressed me more than anything else I had ever read before,” Benitez said. “I read it over and over and then got additional books by Mr. Hubbard and studied them very carefully over the months. The material identified human abilities and their development.” Using this information, Benitez was able to conquer his addiction. As he continued his studies, he realized that these discoveries offered the first genuine hope to addicts, and in 1966 he began to apply that material to help his fellow inmates. Benitez wrote to Mr. Hubbard, who encouraged him to expand his efforts to help others. Until Now, No Solution The program William Benitez founded grew and, in 1971, the first Narconon center outside prison walls opened in Los Angeles. Today Narconon’s services are available at 39 drug rehabilitation and drug prevention centers in the United States, Canada, Mexico, Colombia, Spain, Italy, Switzerland, France, Germany, Sweden, Denmark, Holland, England, Russia, New Zealand and South Africa. It is officially recognized in several countries as the most effective drug rehabilitation available and receives government funding in a number of nations. Narconon has an unsurpassed success rate, according to independent studies, with up to 72 percent of its graduates still off drugs after two years. More and more, judges and government agencies refer drug addicts to Narconon for rehabilitation, rather than to jail or prison. Such an option is afforded by courts in Denmark, Italy, the Netherlands, Spain, Sweden and the United States. While it is strongly supported by the Church of Scientology, Narconon is an independent, non-profit corporation that is non-religious. Its secular program is open to people of all races and creeds. Narconon began to use a detoxification program in 1979 based on breakthroughs which Mr. Hubbard made concerning the long-term biochemical effects of drugs—a major discovery that residues of drugs and toxins lodge in the fatty tissues of the body and stay there for years after they have been ingested. These residues can create adverse effects on the individual causing fatigue, lack of perception and confused thinking. This discovery forms the basis for a revolutionary detoxification program which removes residual toxins and drugs from the body. “Customary medical procedures held no solution to this problem of drug and toxic residuals,” said Megan Shields, M.D., a medical adviser to Narconon. “Various ‘treatments’ were proffered, ranging from the psychiatric viewpoint of getting the person to believe that the problem he was experiencing from toxins was all in his mind, to the administration of drugs to suppress the symptoms exhibited. These ‘treatments’ only served to compound the problem.” The detoxification program, she said, provided the solution. Shields put both casual and long-term heavy drug users she described as physically “ravaged by the effects of drugs” through the program. “The depression, hopelessness and fear which so often accompany such problems were evident in many of these patients,” she said. “Upon completion of the program, these people were changed both physically and mentally. The common theme expressed by those who completed the program is that they were no longer encumbered by chemicals which were shutting off their lives. They expressed increased mental clarity and new hope for the future. Their lives upon completion of the program were happier, healthier and more productive.” The Narconon program also uses an exact series of drills, exercises and study steps which enable an addict to not only eliminate his habit but to assist the person to address the problem areas in his life which were a direct cause of his addiction. Further steps in the program include a series of communication exercises which assist the person to improve his relationships with others, a course which teaches the basics of how to study and courses to help the person deal with various situations that can arise in his life. The result is a person who knows that he is free from drugs and drug residuals and also free from any desire to take drugs again.

   Posted 01-31-2008 at 08:42 AM by Chance

9. Working With Drug Addicts Part 1 Originally published as “The Problem of Addiction” in Modern Drummer magazine, February 1991. A recent survey of more than 1100 personnel administrators concluded that drug and alcohol abuse are more likely to cost a person their job than incompetence. Drug abuse has affected every area of society; the music business is no exception. Some believe that drug addiction is more pervasive in show business, while others counter that this perception exists only because of the high-profile nature of the industry. The fact that drug addiction crops up everywhere suggests that it is an illness particular to human nature, not a specific industry. There is little solace in this however, when a musician you know becomes difficult to get along with, unreliable or untrustworthy, incapable of performing, or even violent due to their worsening drug or alcohol problem. It would be wonderful if we lived in a world free of drugs and drug addiction, but until that day arrives musicians may find themselves inadvertently working with others who have become victims of this very serious illness. What follows is some helpful perspective and advice for those who are struggling with this situation, or those who simply wish to know more about it. There are a myriad of attitudes concerning drug addiction, and drug addicts. (From here on we will refer to persons addicted to drugs and/or alcohol as one group: drug addicts.) Unfortunately, there are still those who believe this condition to be the result of poor judgement, or perhaps a flawed character. The consensus among modern health care professionals, including the American Medical Association (AMA), is that drug addiction is a disease. Theories concerning its origins embody the classic “nature vs. nurture” arguments: Does one become an addict because of genetics, environment and upbringing, or a combination thereof? It may be safely concluded that the origins of drug addiction are many, and complex. Cultivating an awareness of this issue begins with the realization that drug addicts are not necessarily bad people, but rather victims of their illness. Some people have what is known as an addictive personality - a predisposition to become dependent on a certain lifestyle, or substance. Examples are compulsive eaters or gamblers, those who accumulate excessive debt, and drug addicts, who become addicted to substances. For the drug addict, a simple “just say no” is insufficient. The nature of their illness is such that they have not naturally developed the kind of rational self-control that allows most people to remain free of addiction. Addicts become mired in their habit without realizing that a problem is developing, and they practice denial in order to maintain their increasingly fragile world.

   Posted 02-10-2008 at 06:27 AM by Chance

10. Working With Drug Addicts Part 2 The drug addict will go to great lengths to deny that their use of drugs is the reason for a deteriorating situation. They tend to blame their problems on those around them, including friends, co-workers, and loved ones. Being in a band with such a person is very, very difficult if that person is hostile and blaming, when it’s obvious that the drug habit is the real problem. Most groups will tolerate this situation for a while, hoping the problem “solves itself” by merely disappearing, or that the addict will respond to suggestions, or even ultimatums that they “clean up their act.” Ultimatums may be temporarily effective, but unless the addict seeks true rehabilitation, problems will invariably recur. Sadly, many addicts lose their jobs and are left alone, denying responsibility, blaming the band member(s) responsible for his or her firing. When a musician loses his or her job, it’s because the other band members have been forced to make a choice. A band is a unique environment: one third team, one third business, one third family. It’s very difficult to discharge a member of this “family” when the person is in such obvious trouble and pain. And yet, that person is most likely not contributing fully to the team effort, and may actually be severely damaging to the business effort. A band may have to cancel engagements, or whole tours if a crucial member is unable to perform, and the situation becomes more critical when the other members’ livelihoods, including the ability to feed a family, or pay rent or a mortgage are threatened. Every drug addict is an individual, and the demands of every band’s situation vary, but there are limits to the number of times band members are able to give the addict the benefit of the doubt, and to the number of broken promises a band is able to endure. The past decade has seen increased awareness of and concern for drug addicts, and increased ability to effectively treat their illness. There are full-time self-help groups such as Alcoholics Anonymous (AA), and its first cousin Narcotics Anonymous (NA) dedicated to providing drug addicts with help and support. There are many other public and private organizations with similar goals, including those oriented towards helping “concerned persons” - the family, friends, and co-workers of addicts. One of these groups is an excellent place for band members to go for help with bringing one of their own to rehabilitation. While AA and NA offer free support, private rehabilitation facilities can be very costly. The costs and types of rehabilitation programs vary however, and the addition of substance abuse to the list of illnesses recognized by the AMA has made treatment for drug addiction eligible for coverage under many health insurance policies. In the health care industry, it’s believed that in order for rehabilitation to succeed, an addict must sincerely want to be helped. There is a natural tendency, in observing a person’s debilitating addiction, to try to help the addict with a heart-to-heart talk, to try to “bring them to their senses.” As well-intentioned as this may be, most addicts feel they don’t want help, instead believing they have no problem, or that those outside their situation don’t understand. It’s also possible for a talk of this nature to backfire, leaving the addict alienated and angry with his or her friends. It may be more helpful to have a recovering (rehabilitated) addict talk to the addict, someone who does understand, someone who has been there and made it back. If you don’t know such a person, a call to a local chapter of either AA or NA may prove helpful, as these groups are in touch with successfully rehabilitated addicts who are willing to help with these situations. Frequently however, merely talking to an addict won’t inspire any significant change, regardless of who’s doing the talking. In order for many addicts to abandon their denial, and want to renounce drugs, they must first hit bottom. “Hitting bottom” is fairly self explanatory: the person’s life must reach a profound level of unhappiness, the previously unlimited reservoir of denial finally gone dry. A person may hit bottom due to a combination of undeniable circumstances, such as failing health, divorce, or arrest for drunken driving or drugs. The fact that these events are referred to as “sobering” is no coincidence. If an addict/musician you know does hit bottom, and asks for help getting straight, it behooves you to give that addict all the help and support you can. It may be difficult to completely forgive and forget all the transgressions that person may have committed as a result of his or her addiction, but remember: they were incapacitated by a very serious illness. Their previously irrational behavior was most likely irrelevant to their true personality, the one finally asking for, and deserving of your help. Not every drug addict is completely incapacitated by their addiction. In fact, the greatest numbers of addicts in society today are called “functional” drug addicts. They can regulate when they ingest their substance(s) of choice, which enables them to function in an apparently normal fashion. The functional addict can hold a job, make payments on a car or house, even maintain a family life. Amazingly, it’s even possible for the addict to keep his or her addiction a secret from a spouse! If you are in a band with such a person, you will notice their regular abuse of the substance, their devotion to it, and a tendency to promote its usage. Functional alcoholics are capable of drinking large quantities without appearing drunk, because of their increased tolerance for alcohol. Ironically, the ability to drink large amounts is viewed by some as a sign of strength, while it is in fact a warning signal of alcoholism - a long-term degenerative illness.

    Posted 02-10-2008 at 06:28 AM by Chance

11. Working With Drug Addicts Part 3 Coexistence with the functional drug addict is somewhat more feasible than with the chronic addict, but there are definite dangers. While the functional drug addict is not completely out of control, he or she is still dependent on their drug, and that dependence is more likely to show itself at times of stress or pressure. In the music business, this can manifest itself at the worst possible times, such as when a group is given an important break, and pressure is at peak level. Remember that the addict’s behavior, even the functional addict, is not necessarily based on rational thought. Thus, any working relationship with even a functional addict involves some element of risk. Again, a matter of choice: How much risk is acceptable in order to continue to work with a functional drug addict? An important part of an addict’s denial is the ability to excuse and rationalize his or her behavior. When a band is on the road, an addict will stubbornly maintain that “what I do on my own time is my business.” The rationale is that as long as they are not at the gig, they are free to do as they please. This is a flawed, dangerous argument. The road is a twenty-four hour/day work environment; the musician on the road is responsible to the band all of the time. Most top organizations subscribe to this policy, and will not tolerate any drugs at any time while on the road. The reasoning is obvious when one considers the illegal nature of many abused drugs, and that a musician’s offstage drug habits can very well affect what happens onstage. It is unlikely that a musician up all night the previous night “partying” will perform up to standards. No top organization can afford to have any member perform below par at any time. The freelance musician works in a different context than the band player. Rather than being part of a full-time “family,” the freelance works with a variety of faces from gig to gig. The dynamics are quite different than those of a band. Band members depend on one another, and the consequences of any member being in trouble with drugs are deeply felt by all. But the independent musician may not consider an addict on the gig a threat to his or her own career. The freelance may view the addict’s dependency on drugs as “someone else’s problem,” and take comfort in knowing that he or she was not responsible for a bad performance. In a world where individual survival is difficult enough, such an attitude may suffice. More likely the freelance, like the band member, will feel the stress imposed upon the work environment by the drug addict. Attempting to make music with an intoxicated musician is a difficult, sometimes embarrassing experience. It brings a sense of disappointment - even though the freelance can look forward to a different lineup on the next gig, he or she will feel cheated out of the joy derived from playing music. The experience also leaves one feeling sad. The community of professional musicians is a tight-knit group, and one need not work in the family environment of a band in order to feel concern for a friend and fellow musician. Thankfully, many millions of drug addicts have sought rehabilitation. Upon asking for help, an addict must learn to accept the knowledge that even if they give up drugs forever, they will still be addicted to them, forever. It becomes their goal to live life “one day at a time” by not doing any drugs that day, rather than dwelling on staying clean for their entire lifetime, which may seem an overwhelming task. This is a proven philosophy, and has helped millions of addicts enjoy healthy lifestyles and productive careers. The addict/musician who seeks help is faced with some special challenges, however. A large number of the opportunities to play occur in places where alcohol is not only served, but encouraged. The recovering addict will be regularly surrounded by people consuming alcohol, which can be very unnerving, especially in the first year of rehabilitation. Those helping the addict may recommend that they eliminate their exposure to drugs and alcohol entirely, which poses a very difficult situation for the musician who makes a living playing in nightclubs. There is no single solution to this dilemma; every addict is an individual. Some addicts must severely modify their lifestyle to stay clean, some are able to continue on the club circuit. If an addict must forgo the nightclub scene however, they need not completely retire from playing. There are opportunities to perform in a drug-and-alcohol-free environment, such as the recording studio, rehearsal band, orchestra pit, and of course, the concert stage. Life on the road may conflict with the recovering addict’s attempt to maintain a sense of stability in their new life. One of the ways musician/addicts are able to maintain their sobriety while on the road is by seeking the help and support of other recovering addicts. Alcoholics Anonymous and Narcotics Anonymous hold free meetings on a regular basis at their thousands of local branches. The recovering addict can find strength and support at these meetings, enough to make it through the gig and on to the next town. This is a very viable option for the travelling musician. It is important to note that it’s possible for the recovering addict to suffer a relapse, especially if that person was not truly ready to renounce drugs. A relapse is a very traumatic experience for all concerned persons, and can lead to feelings of hopelessness, and questions of the entire rehabilitation process. During this difficult time, try to remember that drug addiction is an illness, and like many other illnesses, relapse is an unfortunate fact of life. Of the millions of successful recovering addicts in our society, many have had to battle their addiction more than once. Never abandon hope for such a person. The preceding paragraphs pose a number of very difficult questions about making choices and taking risks. There are no easy answers to these questions; they are left to the individual. Working in a band, or freelance situation with one or more drug addicts can be a frustrating, confusing, even heartbreaking experience. But regardless of how difficult a situation becomes, and how debilitating an addict’s illness grows to be, there is always hope. Anyone who has witnessed a drug addict’s hitting bottom, and subsequent rehabilitation, will also witness the elation and rejuvenation of that person. Recovering addicts have enormous energy, as well as renewed feelings of clearheadedness and self-worth. It is a great joy to regain a friendship that had been disabled since the person’s addiction took over, and to witness the return of artistic prowess that had been buried for so long. In an imperfect world, full of imperfect people, this is the one silver lining found within the cloud of drug addiction.

    Posted 02-10-2008 at 06:28 AM by Chance

12. let us not neglect that addiction and addictive behavior only applies to chemical dependency. in a way i think we get side tracked a bit concerning the true causes of addiction when we focus primarily on substance abuse. i'm sure we can all agree that there are usually many, much deeper forces at work in the dark recesses of any addicts mind. usually a sort of sugar coated thanatos at work. but hell, i'm not a doctor or anything, woulda been if not for #%@*'n %*^#@s and there %@#*%'n *^@#$%^$s!!!!

    Posted 05-10-2008 at 11:05 PM by umbriago

13. 	AND right above is a fine example of addict blame game! would been this woulda been that IF it werent for BLAH BLAH BLAH! keep it real an get well blame only begets lonliness an excuses to live in denial of the true cause!!!!!!!!!!!! YOUR FUKIN SELF!
    	Posted 08-17-2008 at 03:04 AM by All About Love

14. 	Very interesting blog. I have recovered from a hopeless state of mind and body.. The 12 step programs help me and I am dually addicted. Alcohol lowered my inhibitions and then came cocaine. Using both I felt"normal." Today, I live clean/sober.. By the Grace of a loving God and the 12 step programs that taught me a "NEW WAY' of life.. Love to all. Great Blog, very informational..0
    	Posted 10-31-2008 at 01:45 PM by Butterflywings

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