A new study published November 5th in the Journal of the American Medical Association seems to show that addicted teens that are treated long-term with detoxification medications, including buprenorphine and naloxone, respond better than those treated for a short time. The drugs that were used in this study are two medications that were approved in 2002 by the FDA for the treatment of opioid addiction. Only about 7,000 physicians in the country are registered as potential providers of these drugs, and even less of that number will administer them to young people.

Opiate Detoxification Medications

Buprenorphine is a medication that significantly reduces the cravings of opioids. When combined with naloxone, an opioid antagonist, the results seem to be even better. Naloxone reduces or prevents the effects of drugs such as heroin or prescription painkillers, making them much less desirable to the addict. Naloxone also prevents the patient from misusing the buprenorphine combination because those that would try to inject the drug for a high (instead of taking it orally as prescribed) would suffer severe withdrawal symptoms.

While these medications have been used for adults in many instances, there has been little research on the effectiveness among young people addicted to opioids. The overall number of adolescents that abuse drugs has decreased since 2002, and while this is a very positive trend, the number of painkillers and opioids abused among teens has increased.

Study on Treating Adolescents

Dr. David A. Fiellin of the Yale University School of Medicine reports that as many as 10 percent of ninth graders have used opioids, and that 200,000 to 400,000 adolescents have abused some of these drugs. It seems that drugs are even more readily available to teens today than alcohol, as teens are able to order drugs online or steal them from their parents’ medicine cabinets. Often drug addiction starts as a fun thing that teens try, and ends up as a lifetime of dependence on the substance.

The study done by Dr. George Woody of the University of Pennsylvania’s Department of Psychiatry is one of the first of its kind. As was reported this week, researchers found that those teens that were put on a buprenorphine/naloxone combination (Suboxone) for an extended period of time (12 weeks or longer) were more likely to stay opioid free than those only given the medication for a short period of time. When taken off the medication, the drug use went up. Even with detoxification and counseling, the individuals that were taken off the Suboxone were back to using drugs in a short period of time.
While more research needs to be done on this topic, it seems that Dr. Woody and his team of researchers have shown that Suboxone is an effective treatment in the addiction of opioids when used for an extended period of time. There are those that disagree with the use of drugs to treat drug addiction, but if it means these adolescents have a chance to continue their life free of opioid addiction, many think these more drastic measures are worth taking.

Sources

Reinberg, Steven Extended Therapy Helps Drug-Addicted Teens November 4, 2008

Carver, Alice Extended Therapy for Young Opioid Addicts Better than Short Term Detox, Study November 5, 2008

Opiate Detox

How would you feel if your insurance provider told you that the doctors’ visits and treatment costs for your illness were not going to be covered, or that you would have to pay a high deductible? Many people in our country are being told just that, and the reason is that the illness they have is substance abuse. There has long been a view in the world that substance abuse is a choice, or a character flaw, not a mental illness. Things are changing, however, and more and more research is being done on the complexities of the brain and its reaction to substance abuse. People today are beginning to see that while substance use might start as a decision to try something new, it quickly becomes an addiction that can’t be controlled.

Congress approves Mental Health Parity Act

Congress approved legislation last week that would change the way insurance providers handle claims for mental illness and substance abuse. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 provides “equity in the coverage of mental health and substance use disorders by ensuring that group health care plans do not charge higher co-payments, coinsurance, deductibles, and impose maximum out-of-pocket limits and lower day and visit limits.” Supporters of this measure include many in the House and Senate, businesses, insurance companies, and physicians. However, a few questions remained and until last week, it was uncertain whether or not the bill would pass before Congress went into recess this year. By attaching it to the Wall Street bailout bill, however, Congress was able to pass it quickly.

Help is needed

Help can’t come soon enough for many Americans struggling with drug or alcohol addiction. According to the National Alliance on Mental Illness and the National Council for Community Behavioral Healthcare, mental illness is the leading cause, and substance use is the second leading cause, of disability among adults. Many of these adults are not getting the help they need to recover from their mental illness, and often it is because of the high cost of treatment. Another reason is fear of discrimination from their employer if they do seek treatment.

Equal Coverage for an epidemic

With legislation such as the Mental Health Parity Act, those with a substance abuse disorder can be reassured that their insurers will not be able to set a cap on healthcare coverage for mental illness or substance abuse that isn’t set for other illnesses.

In order to deal with the epidemic of substance abuse, we need more good addiction treatment facilities, more affordable health care to addicts, and more support behind families dealing with substance abuse. Through the passage of this bill, those with addiction should be encouraged to move forward and seek treatment, so that we can work toward decreasing the incidence of drug and alcohol abuse.

Sources

Congresswoman Shea-Porter Hails Passage of Mental Health Parity Act September 24, 2008

Many State Reform Initiatives Are Neglecting Mental Illness, Says Study July 08, 2008

Layton, Lyndsey Congress Approves Mental Health Bill Private Insurers Would Provide More Benefits Sept. 24, 2008

Ault, Alicia Equal Coverage For Mental Health?
Many States Require Parity, and Congress May Order It Nationwide November 6, 2007

Curley, Bob Congress, Bush Approve Addiction and Mental Health Parity Legislation October 3, 2008

Many in the recovery community claim to be “Clean and Sober” But, what exactly does this mean? Clean refers to living without using drugs. Sober is used in the same context. However, the definition of “Sober,” also reveals a path, and a desired character. A path, and character, prescribed and modeled, by the founders of the 12 Step Fellowships. A path, and character, prescribed for spiritual living. Let us begin with the basics. Following is the dictionary definition for “Sober:”
1. Habitually abstemious in the use of alcoholic liquors or drugs; temperate.
2. Not intoxicated or affected by the use of drugs.
3. Plain or subdued: sober attire.
4. Devoid of frivolity, excess, exaggeration, or speculative imagination; straightforward: gave a sober assessment of the situation.
5. Marked by seriousness, gravity, or solemnity of conduct or character. Marked by circumspection and self-restraint.

The first, and second, parts of the above definition are about abstinence. The other three parts describe attributes. The person that displays these attributes is Sober, not just abstinent from chemicals, not just clean. His, or her, Sobriety is manifested in “all their affairs:”This person practices Sobriety, with a capital S.

This Sobriety with a capital S is manifested in the way people live their lives, not in what they say. Sobriety is life lived in the pursuit of simplicity, and “serenity;” a way of life that avoids “excess.” For excess is the way of addiction. Addiction is excess in everything. Excess in using chemicals, and in exaggerated thinking, and behaving. The addict is addicted to extremes, and drama, as much as he, or she, is addicted to a chemical. To incorporate the above described attributes into a Sober character is the antidote for addiction. And, the acquisition of this character is the foundation of recovery. As well as, the goal of any program, or therapy, that seeks to treat addiction.

To counter the addicted character, an addict must be confronted with a person that has developed a Sober character. A person that is capable of modeling what this character is. That is capable of displaying it in daily living. Capable of showing the addict how life can be lived Sober. Modeling for the addict new ways of dealing with the challenges of life from a Sober perspective.

Then, by observation, and practice, an addict begins to substitute old patterns of thinking, and behavior. Through exposure to a Sober character, they can begin to live “as if” they had this character. By ‘faking it, till they make it,” they get a sense of what Sober life is. When their new behaviors begin to yield responses that reinforce them, they become incorporated into a new pattern of dealing with life. Through this process, a new character is formed.

In the process of this new character formation, the presence of a Sober sponsor, mentor, or therapist is fundamental; the presence of a person that personifies Sobriety. If the sponsor, mentor, or therapist has not internalized, and manifest the attributes of Sobriety, all that the addict is exposed to is another role to play: The role of “recovering person.” Because addicts are adept at role playing, the modeling of a person who is clean, but not truly Sober, will invite the addict to create yet another persona, or mask. Recovery becomes a new way to act, speak, and relate to others, without true change, without authenticity.

Many in the recovering world have adopted the persona of a recovering addict. A person can become “clean,” if this is the price that he, or she, pays for sustaining new friendships, lovers, work, or status. For, they now belong to a community where respect, admiration, business opportunities, and popularity are founded on “clean time.” However; such a person is clean, not Sober. This kind of recovery is dangerous. It is dangerous to those who practice it, and for those who are seeking recovery.

A person with “clean time,” regardless of character development, is in a position to be a sponsor, a therapist, or even to run a treatment center. They can be in a position to dictate the process of addiction treatment. They can place themselves in a position of authority. They can be in a position of power. They can be in a position to do harm.

For, without the grounding influence of a Sober character, power, money, and status, become tools of the ego. They become tools for exploitation. They become means that allow the clean, but non-Sober addict to indulge in their addictive character traits. Under the guise of recovery, and “helping,” a clean, but non-Sober person can indulge in drama, chaos, blaming, and self-righteousness. They can exercise control over the lives of others, for self-gratification. They continue to act from the basis of their “defects of character,” even if they are not using chemicals. They harm themselves, and others.

The goal of the 12 Step programs, therapy, and all interventions of addiction treatment, is to “remove” these “defects of character;” not to find a new way to manifest them under the disguise of being “clean.” According to the founders of the 12 Step programs, in order to remove these defects of character, a person must engage in a spiritual path, seek a “spiritual solution.” A spiritual solution that is ancient, and Universal. A spiritual solution that has been taught by every spiritual master in history. This solution is to become free from the “bondage of self.”

What is this “bondage of self?” It is the bondage of a flawed self that the addict has constructed through the process of his, or, her life. Once this self became chronic, the addict constructed a character to protect it, to defend it. But, this self, and character are false. They were constructed as protections, and maladaptive strategies for survival. They cover up the true Self: the Self that was created by a Higher Power. So, every true spiritual path seeks the return to this true Self. Every true spiritual path offers a way, a method, and a program, to return to true living; to return to living life on “life’s terms,” to live Sober.

For, in Sobriety, life is again experienced, as it is. When the false self no longer rules a person, its demands for power, money, status, reputation, excess, drama, etc. no longer rule that person’s thoughts and actions. As a result, the person becomes free. The person is free to enjoy simplicity. Free to recognize the mystical of the everyday. And, through this recognition, a free person can find joy, pleasure, contentment, and fulfillment in the ordinary. They can again embrace life with the joy of a child at play, not because everything is perfect, but because it is all part of life; and life is good enough in its own terms. This is spiritual living. This is Sobriety.

This Sobriety is hard to attain. It is not easy to live Soberly in a culture that is increasingly hysterical. In a culture that prizes image above substance. We live in a culture of hysterical “personalities.” A culture of dramatic, “reality” television shows, screeching religious leaders, flashy gurus, “spiritual guides,” and shocking, instantaneous, psychotherapies. It is not surprising that the development of a Sober character is not a modern, or popular quest. However; for a recovering addict it is the essential quest. Just as it was for the suffering addicts that found their salvation in it, and prescribed it to future generations; as all spiritual seekers before them had done. In order for many to stay clean, many have to become Sober.

J. E. Lesende

Sober Definition From Answers.com

It is a problem that has been around for decades. Adolescents feel stress from personal or family problems, high expectations at school, and peer pressure. One way teens deal with the pressure is to turn to drugs. In the past it was marijuana, LSD, heroin or cocaine that lead curious teens to try drugs. There are countless stories of teens who have suffered severe consequences because of abuse of drugs such as these. Brain damage, seizures, toxicity, and death are only some of the side effects of drug abuse.

With all the anti-drug campaigns in communities today, it seems that teens may be getting the point about the dangers of some of these “street drugs” and are actually turning away from them in some cases.

Prescription Drugs

Today, however there are many more drugs available to teens, and different drugs of choice are making their way into schools and homes. Prescription painkillers like oxycodone and Vicodin® have been used more and more by adolescents in recent years. Many teens today believe there is nothing wrong with prescription drugs when taken once and while for fun, yet statistics show that oxycodone and Vicodin® are the most common drugs involved in fatal overdoses by young people.

The risk with these drugs is that young people do not believe they are dangerous or illegal because they are prescribed by a doctor. Another danger with these prescription drugs is that teens are able to get them for a very low cost or even free from friends or relatives. The easy accessibility of these drugs leads to a higher number of teens getting their hands on them, simply stealing the pills from their parents’ medicine cabinet.

Drugs such as oxycodone and Vicodin®, when used under the supervision of a physician, can be very beneficial to patients. On the other hand, the abuse of these drugs can cause strokes, seizures, comas, addiction, and even death. These prescription drugs can be just as addictive as street drugs, and the effects can be serious on the bodies and minds of young, developing teens.

Prevention

Even though the problem seems staggering, there are ways for parents to help prevent the misuse of drugs in their homes. Parents need to keep track of their prescription drugs, and be aware that their children may be able to get drugs from family members or friends very easily. Parents should talk with their children about the use of medication, and alert them to the severity of abusing prescription drugs.

While it seems that many anti-drug campaigns have been beneficial in the past, funding is becoming an issue when it comes to teen drug prevention. Every year, Congress gives money to states for drug treatment prevention, allowing the states to divide up the money among some of the programs they wish. A recent trend shows many states often spend very little of the money on adolescent drug prevention. With the new problem of prescription drug abuse in teens, it seems it is important that organizations that educate teens on prevention and treat teen addicts would receive funding to continue to fight this national problem.

Sources

More Kids Dying, New York Times July 18, 2008

Heroin’s Hold on the Young, New York Times Jan. 13, 2008

OxyContin, Vicodin Grow Popular as Teen Drug Use of Choice, Think and Ask nonprofit news February 2007

Teens Turn Away from Street Drugs, Move to Prescription Drugs, New Report Reveals ONDCP Press Release February 14, 2007

Rx—A New Intentional High for Teens National Youth Anti Drug Media Campaign, Greater Dallas Council on Alcohol and Drug Abuse 2006

Since 1971, qualified physicians in the United States have been prescribing narcotic medications such as methadone to treat opioid addiction. But this treatment hasn’t come easy, or without its share of debate.

The Methadone Controversy

Russia is one of several countries where methadone is controversial. Recently, members of a Kremlin youth group launched a protest outside a methadone conference, where a group of physicians and specialists were gathered to discuss methadone treatment for drug addictions. In Russia and other countries struggling over this debate, critics of methadone argue that it traps patients in their addictions for life, leaving them addicted to yet another drug.

Methadone is used as a gradual therapy for recovering heroin users, allowing physicians to relieve their patient’s craving for heroin and block the effects of opiates. With methadone, the gradual and mild onset of the “high” prevents users from gaining the pleasurable effects associated with heroin.

However, opponents argue that methadone treatment substitutes one opioid for another, and fear of methadone being sold on the black market is a big concern. Often patients are left struggling with their addiction to methadone, causing their treatment to be lengthy or fail altogether.

In the United States, methadone treatment has become more regulated and widespread in recent years. An individual’s methadone treatment is often viewed as treatment for a disease rather than a poor moral choice. Therefore, treatment may continue throughout the patient’s life, allowing their bodies to be maintained with methadone and avoiding the symptoms of withdrawal altogether. While not a complete solution for a drug free life, methadone treatment has been found to decrease heroin related deaths and crime, and help individuals achieve greater control of their lives.

Buprenorphine and Suboxone

Today a new opioid medication is making its way into treatment facilities, doctor’s offices, and even homes. Buprenorphine is a partial opioid agonist, which causes it to be less addictive than either heroin or methadone. The “high” produced by buprenorphine is less intense, and the side effects are less dangerous. In general, buprenorphine is safer than methadone, and it is easier for a patient to discontinue buprenorphine than to detox from methadone. The NIDA views buprenorphine as a safer, more acceptable maintenance drug than methadone for the treatment of heroin addiction.

A form of buprenorphine, Suboxone, has been rapidly gaining approval for the treatment of opiates. Suboxone contains buprenorphine and naloxone, an opioid antagonist which is to be taken orally. As long as it is taken by mouth as prescribed, the naloxone causes no side effects. If a user would dissolve the Suboxone and inject it in order to get high, the injected naloxone would cause sever withdrawal symptoms. This special formulation of buprenorphine and naloxone is considered safer than just buprenorphine because it so strongly discourages misuse.

The future of drug addiction treatment with Suboxone looks promising. With the support of the NIDA and the SAMHSA, and with further testing, there is hope that in the future this will be a widespread, successful treatment for drug addiction in the United States and other countries.

1. Schwirtz, Michael, Russia Scorns Methadone for Heroin Addiction The New York Times July 22, 2008
2. Blaine, Jack D., Buprenorphine: An Alternative Treatment for Opioid Dependence NIDA Research Monograph, Number 121, 1992
3. National Institute on Drug Abuse, 1999. Principles of Drug Abuse Treatment: A Research-Based Guide. NIH Publication No. 99-4180.
4. Marion, Ira J., Methadone Treatment at 40 Science and Practice Perspectives December 2005
5. Wunsch, Martha Buprenorphine: Balancing Access with Quality of Care (NIH) February 2008
6. Condon, Timothy P., and Clark, Wesley Buprenorphine in the Treatment of Opioid Addiction: Balancing Medication Access with Quality Care (NIH) February 2008

We have all received them in our email boxes, messages from purveyors of prescription drugs claiming to offer these drugs at on-line pharmacies. These types of emails are not only annoying but they offer a portal into an on-line realm of readily available controlled substances. In a society where we are constantly being bombarded by the notion that every ailment from clinical depression to cancer has a “one pill fixes all” solution the availability of these dangerous drugs with little to no oversight causes real problems for our society.

According to the CASA report a total of 365 web sites were found which advertise or offer for sale controlled prescription drugs. Granted of the 365 206 were only advertising the sales of controlled substance but 159 actually offered these drugs for sale. Only two of these 159 websites were certified by the National Association of Boards of Pharmacy as legitimate on-line pharmacies. (you’ve Got Drugs V, Pg.1)

This puts dangerous drugs into the hands of anyone surfing the internet. It is no wonder that prescription drug abuse and addiction rates have been steadily on the rise since 2001, even as rates of other illicit drug use have dropped. It is troubling also to note the trends of who uses the internet when discussing how easily controlled substances are available in these on-line pharmacies. The CASA report states that while only 68% of adults in the U.S. have access to the internet nearly 100% of college students and 78% of children aged 12-17 years old have online access regularly (you’ve Got Drugs V, Pg. 2).

These internet pharmacies are also not verifying the age of customers either. Users 13 and under were allowed to purchase drugs even while admitting their true age (you’ve Got Drugs V, Pg. 9). This dangerous combination of ready availability and access by young people to the internet has led to an increase of prescription drug use especially by teenagers and young adults.

No longer is it necessary to venture to “the wrong side of tracks” to find drugs. There is no need to associate with drug dealers or have to seek them out any longer. Today drugs are so readily available on the internet that anyone can use them and purchase them at will. The disturbing statistics released in the CASA report reveal that we all need to be vigilant in watching our children and their friends for signs that they may be an addict, and offering the appropriate help when necessary.

Download the Full CASA report for free here
Sources:
You’ve Got Drugs V CASA whitepaper
Prescriptions drugs Abuse and Addiction, a research Report by the NIDA

It is widely accepted by addiction professionals throughout the country that the first phase of recovery from drug addiction or alcoholism is a medical detox. Detoxification is an essential element of drug treatment as it helps manage medical symptoms associated with drug withdrawal, while assessing and treating any accompanying medical problems. Most drug detox programs will manage drug withdrawal symptoms by designing a protocol for each patient and dispensing the appropriate medications to offset withdrawal. Due to the medical issues that can accompany drug withdrawal, not to mention how compromised a person’s health is, there should be a physician trained in addiction medicine and 24 hour nursing care.

When most people hear the words detox, they automatically think of managing drug withdrawal. While this certainly is the most important aspect of any drug detox, a service equally important is the ability to evaluate every individual as to their need for ongoing treatment. For this reason all centers need to employ clinicians trained in addiction and mental health problems, in conjunction with medical personnel, to evaluate each patient’s individual needs.

Credentials

There are many factors to consider when choosing a drug detox such as; ensuring that you are choosing a reputable and effective program. One way to achieve this goal would be to review the licensure of the program and the credentials of the staff.

Licensure

A program should always be licensed by the state in which they provide services. In Florida for example, it would be the Department or Children and Family Services. Secondly, and most important, is a program should be accredited by the Joint Commission on Accreditation of Hospital Organizations (JCAHO). This accreditation insures the drug detox maintains certain standards of care as determined the Joint Commission.

Drug Detox Staff Credentials

The physicians providing the drug detox services should be board certified in their particular discipline and secondly credentialed by A.S.A.M., the American Society of Addiction Medicine. This insures the physician has a thorough understanding regarding the disease of addiction and drug detoxification protocol. The nursing staff should consist of Registered Nurses (R.N.) and Licensed Practical Nurses (L.P.N.) both trained in the treatment of drug addiction, alcoholism and the dynamics that accompany the person in drug detox. The clinical staff should as a minimum be master’s degreed or be a Certified Addiction Professional (C.A.P.). They should have experience in the treatment of drug addiction, alcoholism and psychiatric disorders and have spent some time working in a drug detox.

This article was provided by Dan Clark with Recovery Connection Addiction Treatment Helpline at www.recoveryconnection.org