In part 3 of this series, we’ll be discussing one of the oldest smoking fads: the Hookah. (Click to read Part 1 and Part 2)
The hookah dates back to the 15th century, at which time its use was revered as one of prestige amongst the upper classes. According to some sources, the hookah was invented in India by Hakim Abu’l-Fath Gīlānī, a physician, who created this system to allow smoke to be passed through water so it could be “purified.” This is still a popular perception today, with many people smoking hookahs indiscriminately, assuming the “particles” from the tobacco are being filtered out.
The hookah, in its ornate beauty, allures the young, creating an illusion of social grandiosity. It might even have a glamorous, exotic appeal: the smoke is sweet, as they are often flavored with things like cherry and vanilla, and the hookahs themselves are often quite beautiful. What a wonderful metaphor, reminding us the outsides don’t always match the insides: the hookah experience may look and even taste good, but the damage it causes is deeply embedded in its smoky tendrils.
Partaking in a session of hookah smoking is often assumed to be less harmful than smoking cigarettes, but in reality, it’s not. According to the Mayo Clinic, “Hookah smokers may actually inhale more tobacco smoke than cigarette smokers because of the large volume of smoke they inhale in one smoking session, which can last as long as 60 minutes.” (I cough just thinking about this!) Hookahs come with their own set of risks, though, some of which include:
High levels of toxic compounds, including tar, carbon monoxide, heavy metals and carcinogens;
Exposure to more carbon monoxide than cigarette smokers;
Hookah smoking is linked to lung and oral cancers, heart disease and other serious illnesses;
Hookah smoking delivers about the same amount of nicotine as cigarette smoking does, possibly leading to tobacco addiction.
So before you cozy up in the hookah lounge, attempting to have an exotic experience with friends, think again. There are much better things to do with your time, like taking the opportunity to indulge in some fabulous Indian food instead. Save the smoky allure for the history books.
Part one of a three-part blog, wherein I will begin to address the use of marijuana and synthetic marijuana. Stay tuned for parts 2 and 3, where I will address the increase in prescription drug and hookah use.
Recent studies elicited by Monitoring the Future (MTF) show a decrease in alcohol consumption and tobacco use; at the same time, they found an increase in the use of alternate tobacco products (hookah, small cigars, smokeless tobacco), marijuana, and prescription drugs.
One explanation for the increase in marijuana consumption is a lower perceived risk: “In recent years, fewer teens report seeing much danger associated with its use, even with regular use.” The call to legalize marijuana has also contributed to this new perception by extinguishing some of the associated stigma. As a result, we are seeing a denial of risk and a decline in disapproval amongst our adolescent counterparts. There seems to be a viable change in societal norms occurring at the adolescent level. No longer is marijuana use relegated to the “losers,” but rather it is now part and parcel to one’s normative social interactions with anyone, regardless of socio-economic status. With the advent of synthetic marijuana, the perception of danger has been further clouded by the sheer fact that these synthetic substances can be purchased almost anywhere. The surge in the use of synthetic marijuana products like Spice and K2 has created a maelstrom of reported symptoms which include:
paranoia;
loss of consciousness;
hallucinations, and;
psychotic episodes.
We currently see more and more kids coming into treatment with a history of Spice and K2 use. And Gil Kerlikoeske, Director of the White House Office of National Drug Control Policy (ONDCP) points out that, “Poison control center data across America has shown a substantial rise in the number of calls from victims suffering serious consequences from these synthetic drugs.” Currently, the House has voted on a ban of synthetic drugs like Spice, K2, bath salts, et cetera, asking that it be added to the “highly restrictive Schedule 1 of the Controlled Substances Act.” So far, approximately 40 states have passed laws which criminalize Spice and other synthetic substances.
Whether banned or not, there needs to be open dialogue about Spice and K2 and its various counterparts. These synthetics are popping up faster than the DEA can regulate them, proving that the drug environment is changing before our eyes. As such, it’s imperative we stay fluent in the language of our teens, and the social environments in which they operate. We all know the “thrill of the high” is often associated with the verboten nature of its purchase and consumption. Open dialogue removes the mystery, and frankly, it’s not enough to rely upon the justice system to provide the answers.
The combination of substance abuse and forms of mental illness are common. In fact, it’s what most clinicians, therapist, and counselors often expect to find when one diagnosis is confirmed. According to the NAMI (National Association on Mental Illness) more than
half of all adolescents with substance abuse issues also have a diagnosable mental illness. These diagnosable mental illnesses consist of ADHD (Attention Deficit Hyperactivity Disorder), Depression, and Bipolar Disorder. Unfortunately, history has not shown treatment for both at the same time. Typically a teenager who is in treatment for substance abuse is not referred out to a qualified mental health professional to discover a source of their drug and alcohol abuse. Self-medicating with alcohol and illegal drugs is prevalent when there is a mental health issue.
Over the years, the psychiatric and drug counseling communities have begun working together, agreeing that both of these disorders must be treated at the same time. Often with one diagnosis you have the other. With a dual diagnosis it’s been found that suicide attempts and psychotic episodes decrease rather quickly. Treatments consist primarily, but not exclusively to 12-Step programs. However, special peer groups that focus on treating both the illness and substance abuse are found to strengthen social networks.
Adolescents often seek acceptance, and support each other as they learn the role alcohol and drugs have taken in their lives so far. Learning, and in some cases re-learning, social skills will help replace self-medication with patterns of healthful and helpful behaviors.
In order to discover the presence of a confirmable dual diagnosis, one must seek a professional assessment from a psychologist or psychiatrist. Once the dual diagnosis has been established confirmed, then family members and mental health professionals are urged to work together to seek a strategy that works best for the adolescent.
Here are five tips on what to do if your adolescent has a substance abuse disorder.
Your teen is NOT a disgrace to the family.
Establish consequences for behaviors, and don’t be afraid to call upon law enforcement if your child is drinking on your property.
Don’t threaten unless you plan to follow through. Typically a parent surrenders and their addicted child learns their parent doesn’t mean what they say.
Try not to nag or lecture.
And, if your teenager is seeking and working at his or her recovery you should offer support, love and encouragement.
BIO:
Recovery Rob is a 47-year-old man who has more than nineteen years of sobriety, whose drugs of choice at one time were alcohol and drugs, and he has worked in and around the field of addiction for more than 20 years. Recovery Rob is a professional writer who has published two novels and is currently working on his third. He has been writing and working as Pat Moore Foundation’s premiere blogger and content writer, which helps keeps Pat Moore Foundation’s addiction and recovery blog top-rated.
What we have is a growing epidemic of pharmaceutical overdoses, where the age of users and overdose victims vary from teens trying to achieve a heroin-like high to adults attempting to manage a slipped disc, or other painful injury. Some of the most commonly abused drugs are OxyContin, Vicodin, Xanax and Soma, but I would be remiss if I didn’t mention Fentanyl, a relative newcomer, but a dangerous one nonetheless. Fentanyl’s allure is its heroin-like high along with its unassuming portability: it comes in the form of lollypops and patches and packs a punch 100 times harder than morphine. It’s drugs like these which are responsible for more deaths than heroin and cocaine combined.
Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. This is more than 3 times the 4,000 people killed by these drugs in 1999.
In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year.
Nearly half a million emergency department visits in 2009 were due to people misusing or abusing prescription painkillers.
Enough opiates were prescribed last year to medicate every American adult with a standard pain treatment dose of 5mg of hydrocodone (Vicodin and others) taken every 4 hours for a month.
The quantity of prescription painkillers sold to pharmacies, hospitals, and doctors’ offices in 2010 had quadrupled since 1999.
According to a recent CDC report, “3% of physicians accounted for 62% of the OPR (Opiod Pain Relievers) prescribed.” Still, there are many doctors voicing concern about this very issue. There is legitimate concern regarding prescriptions being handed out without sufficient evaluations or follow-ups. We see a lot of this in the often illegitimate pain clinics (pill-mills), who provide easy access to patients and don’t question the potentiality of doctor shopping. Still, it would benefit more physicians to become more judicious with their prescription pads and in the practice of writing a 3-day prescription rather than the ubiquitous 30-day bucket of pain meds, at least for those dealing with acute pain. So far, 48 states have instituted Prescription Drug Management Programs (PDMPs) that will flag doctors who have profiles of heavy prescribing and use. This may some of the problems, but I fear it may also marginalize those who actually need to take pain medications to manage chronic pain issues. According to CDC director Thomas Frieden, they “are still figuring out how to use them (PDMP laws) effectively.” At this point, PDMPs only provide monitoring for physicians and their patients. What they do not monitor is the fact that “seven out of 10 medication abusers get their drugs from friends and family.”
Which brings us to the other issue here, which lies in our homes, hanging out in our medicine cabinets
House Office of National Drug Control Policy says, “As much of 40% of all prescription drugs go unused.” Think that sounds like a lot? Check your medicine cabinets—there’s more than likely something there from some old root canal or surgery you had. As parents, we need to take stock and inventory those medicine cabinets. Safely dispose of what you don’t need and lock up the prescriptions you do need. This not only safeguards our kids, it also eases our own temptation to take an unprescribed medication for our own relief or pleasure. Our kids look to us for guidance. We are their first role models, and if we teach them that medication is their go-to release valve, then the natural byproduct is a lesson in numbing out. Use this as an opportunity to talk to your burgeoning adult about healthier ways in which to manage discomfort. Your kids’ lives are worth it.
A history of sexual violence can create an ideal environment for a variety of mental-health issues, addiction, and alcoholism. Often, the triggering event or events are hidden in the annals of one’s mind and perceived as shameful, deep, dark secrets too horrible to share…with anyone. As a result, drugs, alcohol, and risk-taking behaviors are often seen as the primary issue when one enters treatment. Time and again, we see that this isn’t always the case; That becomes clear when we look at it in terms of statistics:
One out of every 6 American women has been the victim of an attempted or completed rape in her lifetime (14.8% completed rape; 2.8% attempted rape)[1];
29% are age 12-17;
44% are under age 18;
80% are under age 30.; 12-34 are the highest risk years.
Girls ages 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault;
7% if girls in grades 5-8 (approx. ages 10-13) and 12% of girls in grades 9-12 (approx. ages 14-17) said they had been sexually abused;
3% of boys grades 5-8 and 5% of boys in grades 9-12 said they have been sexually abused[2].
As I frequently tweet Intervention, one of the things I notice on a regular basis is the consistency in which the women on the show are frequently struggling with a history of sexual violence, and are using drugs, alcohol, and promiscuity as their primary coping skill. From the outside looking in, it’s clear that the goal is to try to desensitize and anesthetize feelings of shame and guilt, et cetera; in other words, do anything and everything NOT to feel, remember, re-experience, or suffer from the emotional attachment to the event itself.
Twelve-step programs were written with specific goals in mind: to stop the alcoholic/addict from drinking and using. The steps work well in that regard, mostly because they are based on the disease model, addressing issues of alcoholism and addiction accordingly. However, the same tools provided to address addiction issues don’t always work in concert with mental-health issues, particularly those attached to sexual violence. We know the steps adequately provide an alcoholic/addict with the necessary skills needed to learn to take responsibility for and subsequently change their negative behaviors. They do so by asking the addict/alcoholic to take responsibility for their actions, face their fears, and acknowledge that they took part in creating their own demise. However, being sexually abused or raped isn’t a negative behavior to be changed but rather a causative, biting factor in things like:
Depression
Post-Traumatic Stress Disorder (PTSD)
Alcohol and Drug Abuse
Suicidal Ideation
Eating Disorders
What then, do we do from a recovery standpoint when the predominant disease model isn’t geared to address issues of this caliber? The Big Book, the 12-step primer, was written by men addressing men’s issues, in a time when women were typically viewed as the ones affected by their spouse’s alcoholism and not as the alcoholics themselves. As more women began to come forward as alcoholics and addicts, the tools didn’t always adapt to the new issues that arose because of gender disparity, but rather, they stayed the same, assuming a one-size-fits-all mentality. In the cases of women dealing with sexual violence, being asked to take responsibility for an abuse event has the potentiality to create more or actually deepen the existing trauma, particularly if the innate issues of shame and guilt associated with it are ignored. The reality is, being victimized by sexual violence is not the fault of the victim. What does need to be addressed, however, is the anger, self-victimization, and negative behavioral byproducts occurring as a result.
We clearly have a multi-layered healing process on our hands, so first, the negative coping skills must be eliminated: Sobriety is an obvious first step and necessary component to support the healing process. Additionally, working with meditation and mind-body awareness techniques are also useful in helping one manage their anxiety, negative feelings toward oneself, and in re-building self-esteem. A therapist skilled in treating PTSD and this sort of trauma is also important, particularly since this is often a lifelong process.
It is in forgiving ourselves that we have the ability to become free.
[1] National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.
[2]1998 Commonwealth Fund Survey of the Health of Adolescent Girls. 1998
You know things are desperate when you start soaking innocent gummy bears in…vodka. The Fix posted something about this a little over a week ago, and I’ve been sitting on it for fear that it could encourage kids NOT in the know to experiment. Frankly, it also reminds me of the absurd vodka eyeballing trend we wrote about last year. Really, what it shows is the obvious desperation that occurs when we want to get loaded, and the seemingly insane steps one is willing to take to make it happen.
It’s the true nature of adolescence to experiment, and holy heck are they creative about the way they do it. Who else would come up with soaking gummy bears in vodka or pouring vodka directly into their eyes? Think about it, no adult in their right mind is going to check their kid’s gummy bears (well, they might now.). But aside from the clandestine nature of getting drunk this way, there is certainly a clear danger. While a handful of these cute, sweet, sugary bears can get you loaded, there’s no telling how much alcohol you’re actually ingesting. Just because it’s small, doesn’t mean it’s safe.
If you’re concerned about your teen, and noticing signs of secretive behavior, then it’s likely you need to start looking beyond the obvious. Adolescents, beyond all of their bluster and displays of parental revulsion, are actually crying out for help when they behave like this. As parents, it’s our job to toughen our resolve and learn to take things less personally so we can provide the help that’s needed. No one wants to live uncomfortably in their skin, even sugared up on “boozy bears.”
The National Center on Addiction and Substance Abuse at Columbia University’s (CASA Columbia) recently published their 16th annual back-to-school survey which takes a look at adolescent behaviors regarding substance abuse in relation to social media. CASA Columbia took a look at American teens ages 12-17, their social media use and how it might ultimately affect their alcohol and drug abuse behaviors, and parent involvement or lack thereof. The findings, though not terribly surprising, were substantial: “70% of teens report spending time on social networking sites on a typical day,” which come out to approximately 17 million 12-17 year olds doing participating in some sort of social media activity on a typical day.
With the naturally uncensored dynamics of teen behavior, the typical day-to-day posts can range anywhere from being tagged in a drunken photo from the previous weekend’s house party to the false braggadocio of one’s sexual prowess. From the outside looking in, sites like Facebook and MySpace certainly show implications of promoting an environment of peer pressure. After looking at the results from this study, that impression is pretty spot on:
“Compared to teens that have never seen pictures of kids getting drunk, passed out, or using drugs on social networking sites, teens that have seen these images are:
• Three times likelier to use alcohol;
• Four times likelier to use marijuana;
• Four times likelier to be able to get marijuana, almost three times likelier to be able to get controlled prescription drugs without a prescription, and more than twice as likely to be able to get alcohol in a day or less; and
• Much likelier to have friends and classmates who abuse illegal and prescription drugs.”
Where parents tend to fall flat is in relation to their ignorance and denial of the powerful effects of suggestion, a key factor associated with the subversive allure of social media sites. Parents must be careful not to adopt the “Not my child” attitude and get informed instead. According to the CASA study, “Eighty-seven percent of parents said they think spending time on social networking sites does not make it more likely their child will drink alcohol; 89 percent of parents felt it would not make their child more likely to use drugs.” That’s not a particularly positive result, and frankly, it confirms the high level of denial that aids and abets the social media petri dish of reckless behavior.
This isn’t hopeless, though. The results of the CASA study present an opportunity for change. It’s a chance for us fuddy-duddy adults to learn to look at the world from the lenses of our kids. We were teens once, too, and though memories are often clouded, it behooves us to remember that we were once reckless and secretive and convinced that our parents were the enemy. Joseph A. Califano, Jr., CASA Columbia’s Founder and Chairman and former U.S. Secretary of Health, Education, and Welfare suggests the need for parents to “give their children the will and skill to keep their heads above the water of the corrupting cultural currents their children must navigate.” While I agree that our kids need the skills and strength of character to manage social media, I think we need to be careful not to incite a sense of imminent fear, but instead look at the results of this study as something from which we can nurture an opportunity for behavioral metamorphosis. Growing up is scary enough.
News of the the American Society of Addiction Medicine’s (ASAM) new definition of “addiction” has taken the recovery world by storm. Some are calling it radical because they suggest the new definition essentially invalidates many common perceptions regarding what addiction means to recovering addicts. Critics also suggest this new meaning deflates the common belief that mental health issues, like mood or personality disorders could be the underlying cause of one’s addiction. In other words, self-medicating to treat an anxiety or a mood disorder is not an inherently addictive behavior according to this new definition. It’s definitely a sticky subject, and not one many recovering addicts want to try to wrap their minds around. Change is difficult for many of us, but change that could belie one’s own personal identification with their addiction and their recovery could be frightening.
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related
circuitry. Dysfunction in these circuits leads to characteristic biological, psychological,
social and spiritual manifestations. This is reflected in an individual pathologically
pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral
control, craving, diminished recognition of significant problems with one’s behaviors and
interpersonal relationships, and a dysfunctional emotional response. Like other chronic
diseases, addiction often involves cycles of relapse and remission. Without treatment or
engagement in recovery activities, addiction is progressive and can result in disability or
premature death.”
Still, the ASAM does continue to outline the negative consequences of addiction and recognizes its often deadly outcome. It maintains that all addictions are essentially the same, whether they are to alcohol, drugs, sex, et cetera. The difference now is, they are defining it primarily as a neurological disorder.
The timing of this new definition is in line with the highly-publicized revision of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), which includes diagnostic criteria for addiction and the corresponding guidelines for its treatment. There are certainly differences between the ASAM’s definition and the DSM, which will define “each type of addiction as a separate disease” with its symptoms continuing “to be viewed mostly as discrete behaviors.”
In many ways, this new definition is an attempt to destigmatize addiction. It looks to treat the disease as a whole rather than treating acute, compartmentalized symptoms. The program of AA has always looked at alcoholism as a disease; those of us working in the recovery industry can tell you that it’s a brain disease. In many ways, this new definition confirms something we’ve known or suspected for some time. When we begin to address this with a critical mind, we’ll see that the threat of AA’s potential for obsolescence is more or less fear talking and not reality, and that what’s at stake here isn’t really the 12-step support groups, but the way in which insurance companies will allow the management of addiction treatment. However, digging deeper into that mess may uncover more to fear than a definition of addiction, so we’ll leave that alone for now.
So, let’s not forget the true beauty of the 12-step programs, where “The only requirement for membership is a desire to stop drinking (using, etc).” As any addict/alcoholic can tell you, we’re here because our lives depend on it. The definition may change, but our sobriety and dedication to recovery cannot.
Recovery needs to be safe. It needs to be a place where we can shed our layers of fear and self-loathing and learn to be good enough as we are. It needs not to be the predatory place it’s become, where young girls learning to navigate a sober path to recovery end up falling prey to older men acting out their rescue fantasies (or worse). The notion of the 13th step (the unwritten yet prevalent practice of someone with longer sobriety praying on the vulnerability of the newcomer of the opposite sex) is alive and well, making for high levels of emotional risk for those coming in, particularly when one shares something deeply personal from the podium at a mixed meeting.
When I got sober, I was a 21-year-old maniac. The concept of boundaries were foreign to me, and I was often known to place myself in unsafe situations—an unfortunate by-product of my previously self-depleting, self-deprecating life prior to recovery. But I got lucky. I had an Eskimo, who acted as my big brother, scooping me up under his wing and holding the predators at bay. I wasn’t protected forever, though. I still managed to get myself into incredible trouble, acting out left and right, because I hadn’t yet learned how to use to the tools of recovery. I hadn’t learned how to create and maintain boundaries. I hadn’t learned that emotional and physical safety was necessary for me to heal and get sober. It didn’t take long for me to discovery that these were the things that I needed to learn from the women in the rooms. Big brother or not, some things just don’t go over well.
It takes time to learn the value of sharing in a general way. New, we’re raw and often unedited. Add adolescence to the mix, and being unedited is par for the course especially with the innate desire to fit in, the need to individuate, and the added weight of navigating a path in recovery. Yes, there are a bevy of young people’s meetings, where the majority of the attendees are more relatable. What seems to be missing, however, is a wide variety of young people’s stag meetings. It’s too bad, because those are the meetings where you can share more candidly and without invariably placing yourself at risk.
So, what does one do when your world is crumbling and you need to drop down to your emotional bare bones? You can start by sharing the deeply personal, vulnerable, emotionally dangerous shares for those who have your best interests in mind: your sponsor, your therapist, or a friend close to you that has a solid foundation in recovery. Lean into the gendered sails of those who’ve walked the path before you. Trust me on this: getting sober is the easy part. It’s staying sober and safe that takes work. That’s what stags are there for.
The death of Amy Winehouse, mere months after another misfired attempt at rehab leaves
me thinking more and more about the misleading notion of a revolving door in recovery. I am reminded of the perceived invincibility we tend to have when we’re using and how deadly that assumption can be. Unfortunately, we’ve been subjected to inadvertent voyeurism as we’ve fallen witness to Winehouse’s public demise.
As part of a recovery community, we can certainly sit and proselytize about the myriad things she could have or should have done differently, but the fact remains: she was an addict, and her addiction ultimately won this round. Self-loathing, lack of self-worth, and self-sabotage are all symptomatic traits of addiction; Amy Winehouse expressed hers soulfully in her music, and I can’t begin to imagine the driving, internal heartache, which led her to continue on such a fatal path.
I worry that the hype around her death will somehow take the focus off of addiction or worse yet, romanticize the life and death of an extremely talented, yet deeply suffering young woman. It’s sad that we’ve lost another addict, but sadder still that it’s not surprising. The fact is, fame, talent and genius don’t make us invincible, nor do those qualities place us in an elite, protective capsule. Addiction doesn’t care. It never has and it never will.
While addiction is a treatable disease, it will always remain one that requires willingness on the addicts’ part. Without that, we risk ending up with dust in our eyes. Truth be told, I’m deeply saddened by the loss of Amy; not so much because she was a gifted artist with a broad future ahead of her, but because she could have been any one of us. She could have been a loved one; she could have been you; she could have been me.
