When the manufacturers of OxyContin changed their formula in 2010 to lesson its potential for abuse, I don’t think they intended to drive addicts to use other drugs. Unfortunately, that’s what happened. As a result of OxyContin’s new formula being harder to snort or inject, addicts ultimately flocked to the streets. The unfortunate drug of choice: heroin—because it’s easier to obtain and cheaper than its pharmaceutical counterpart.
Addicts and drug abusers had clearly moved to the streets, the suburbs, and to heroin. They have essentially migrated toward a drug that is easier to inject or snort, much like the old formulation of OxyContin. Dr. Cicero compared drug abuse to a “large balloon.” He explains it thusly, “You press in one area, and the volume doesn’t decrease, it just simply moves to another spot.” This analogy fits well here as we look at the decline in OxyContin use and the increase in heroin use. As Dr. Cicero’s analogy deftly points out, the Oxy problem hasn’t really been solved; it has just been diverted.
While OxyContin is regulated and easily identifiable, heroin is not. In a weird way, you know what you’re getting with Oxy. But let’s be honest, anytime we put something in our arm or in our noses in an effort to alter our mind and body, we are playing the part of lab rat. Heroin is a problem: it’s unpredictable from one source to the next – sometimes it’s nearly pure, increasing one’s potential for an overdose.
The bottom line is the overall increase in opioid use: this is troublesome and growing into an epidemic. While we can treat addicts when they’re ready, how can we prevent addiction or abuse in the first place? Let’s start the conversation before it becomes a problem, taking preventative measures during the early years of our children’s lives: that perfect time when they’re just starting to dip their toes in the burgeoning years of curious adolescence.
According to a recent study by Michigan State Researchers, the “Peak risk for misusing prescription pain relievers occurs in mid-adolescence, specifically about 16 years old and earlier than many experts thought.” (Science Daily)
It’s always been assumed that drug and alcohol use starts in the latter years of adolescence, and while that may be the average, by the time some of these kids hit high school, preventative measures may be too late. This study is suggesting that preventative programs be introduced much earlier than in current practice. I echo this sentiment and am a huge proponent of early preventative measures. How early? As soon as the questions start coming up. You can make a difference at home too:
Tell your child in a general way what drugs are and how they can negatively impact their life.
Teach the value and power of saying “No” and walking away from people or situations where drugs are involved.
Store your medications responsibly: Behind lock and key if necessary.
Model good behavior: if you are stressed, take a deep breath instead of a drink or a pill. Your kids learn from you first.
Transparency: If you are in recovery, and your kids ask you a question about your history, answer them within reason.
Know who your kids’ friends are and who their parents are.
Stay in tune with current events and trends.
Be social media savvy so you can understand the temperature of this generation.
If you discover drugs or alcohol on your child, use it as a doorway to create dialogue. If you find that the drug use is more of a pattern, please get some help.
There are definitely organizations that teach preparedness and prevention, but the first teachers our kids ever have is us. Showing our kids we’re there for them may be the best preventative measure of all.
This past decade, Visions has set a mission to provide a treatment plan that truly caters to youth and their families. We’ve coexisted alongside a myriad of recovery centers, working hand in hand with them to bring a sense of healing to the entirety of the family dynamic. As we celebrate 10 years of providing treatment, our professional growth, and the program development we’re embarking on, it behooves us to acknowledge and celebrate our treatment team and the culture they have built at Visions.
There is something that lies within every single person at Visions, something which connects all of us in a very unique way. As I’ve sat and pondered what that “thing” is, I‘ve realized it’s the sense of being of service which we all embody. The thing that drives us to get up and “do it again” isn’t the promise of a paycheck or the gratification of completing a task on time; instead, it’s the desire to put forth the effort in watering the seeds of recovery planted at the very beginning of treatment. It’s a continuum, this process, one which starts at intake and continues on to supporting healthy living. There is no “end” to the dedication and perseverance of our team. Selflessness is what I continue to notice about those who’ve been here since the beginning and in those just planting their feet. There is an element of altruism within the team, not forced, just naturally there and engaged beyond any expectations placed upon us by simply being an employee.
Amidst all of the selflessness and service, however, runs an underlying tone of never taking ourselves too seriously. The team wears their hearts on their sleeves and carries laughter in their hearts. Frankly, we can’t see any other way to show our clients our authenticity. As we know, adolescence is strife with the mistrust of adults and a deep need for autonomy; having adults who care for them and are willing to share their ability to be themselves while maintaining positive boundaries is crucial. There’s nothing forced about this, and the organic factor allows us to be consistent in our care and treatment. Remember, teens can suss out a fake in two seconds flat…especially when it comes to adults.
The treatment world understands a language all its own. It feels the pain of the mentally ill, the addict, the depressed, the eating disordered, the anxious, and the suicidal. From our perspective, there’s no judgment, just the sincere effort to help someone heal. There comes a point where the need to “just” be of service ceases to solely focus on recovery and begins to seep into paving the path to living better lives. At Visions, we shoot for the families’ new beginning and aim to be the best examples of recovery, compassion and fun. As Dr. Seuss liked to say, “Fun is good.”
Monitoring the Future released their latest study, noting that alcohol use was down, but marijuana, synthetic marijuana, and prescription drugs were up. In part one of this series, we focused on marijuana and its synthetic counterparts, bringing attention to the
perceived harmlessness of marijuana and the growing trend toward the use of synthetics. Here, we’ll talk about the rampant use of prescription drugs and the myriad dangers which accompany their use.
When it comes to prescription drugs, the ease of acquisition is often as simple as going through a parents’ or relative’s medicine cabinet, raiding a friend’s house, or simply trading with friends at school or at parties. The use of opioid prescriptions like Oxycontin and Vicodin are rampant…and deadly. As reported in Monitoring the Future’s 2010 National Results on Adolescent Drug Use: Overview of Key Findings, “54% of high-school seniors said ‘opioid drugs other than heroin (e.g., Vicodin) would be fairly easy to get.’” Why are teens using prescription drugs with such frequency? Could it simply be the ease with which they’re obtained? Or is it the built-in societal respect for doctors and their judgment which allows us to look away when the pen flies across the prescription pad.
Losing interest in personal appearance, extracurricular activities, sports
Sudden changes in appetite
Sudden drop in grades and/or academic or athletic involvement
Borrowing money or having extra, unexplained cash
Acting especially angry or abusive, or engaging in reckless behavior
Physical Signs and Symptoms (these are varied, depending on the drug being used/abused):
Stimulants can bring about:
Fast or irregular heartbeat
Elevated body temperature
Loss of appetite or sudden and unexplained weight loss
Sedatives/depressants can bring about:
Loss of coordination
Opioids can bring about:
Sleep deprivation or “nodding.”
Pinpoint/constricted pupils, watery or droopy eyes
Nausea, vomiting, constipation
Slow, slurred speech
Dry skin, itching, infections
Constant flu-like symptoms
Track marks (bruising at injection sites)
The unfortunate, but common misconception is that prescription drug use is safer than illegal drugs like cocaine and heroin: because it’s been prescribed, it’s “okay.” The problem with this ideology is doctors consistently prescribe and sometimes inadvertently over-prescribe narcotics, A: because they work, and B: because it’s easy. What this influx of prescription drugs does, however, is provide an underground stockpile of prescription opioids in the homes of our adolescents and their friends. As patients, start asking for non-narcotic alternatives. It makes no difference to the doctor but it may make the difference of life and death for you or someone in your family.
Start disposing of any unused medications and store those that are necessary in a secured place. Honestly, these days, the medicine cabinet should probably only be used for toothpaste and Tiger Balm.
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);
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.
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:
Post-Traumatic Stress Disorder (PTSD)
Alcohol and Drug Abuse
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.
 National Institute of Justice & Centers for Disease Control & Prevention. Prevalence, Incidence and Consequences of Violence Against Women Survey. 1998.
1998 Commonwealth Fund Survey of the Health of Adolescent Girls. 1998
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.
A new CASA (The National Center on Addiction and Substance Abuse) report on adolescent substance abuse hit the wires today. Their findings were disheartening, stating, “Adolescent substance abuse is America’s #1 health problem.” The report studied smoking, drinking, the misuse of prescription drugs, and illicit drugs. CASA also delved into the science of addiction itself, identifying it as a “complex brain disease with origins in adolescence,” and going on to document how “adolescence is the critical period for the initiation of substance use.” They not only looked at the drugs being used or the age of the user, but at American culture itself—for example, the way the media romanticizes the use of alcohol in its advertising.
90 percent of Americans who meet the medical criteria for addiction started smoking, drinking, or using other drugs before age 18.
1 in 4 Americans who began using any addictive substance before age 18 developed an addiction, compared to 1 in 25 Americans who started using at age 21 or older.
75 percent of all high school students have used addictive substances including tobacco, alcohol, marijuana or cocaine; 1 in 5 of them meet the medical criteria for addiction.
46 percent of all high school students currently use addictive substances; 1 in 3 of them meet the medical criteria for addiction
The ads we see plastered on enormous billboards on the busiest corners in Los Angeles are there to intrigue us. They aren’t just selling a beer, or some whiskey, they’re selling a lifestyle: one that’s full of handsome men and gorgeous women, all ready and willing to party at will. Life looks perfect in those ads, but we all know it is anything but perfect. It sure can seem alluring, though, particularly when we’re young, rebellious, and feeling the pressures of growing up and being “cool.” The intrigue is also directly fueled by the current generation’s perpetually perceived boredom, which stems from our culture of instant gratification. In our current climate, drugs and alcohol are culturally accepted: we have medical marijuana and a pill for every problem.
Our brains are vulnerable in adolescence and at the height of development. In fact, they aren’t fully developed until we’re around 25! As we spoke about in our recent post, once we begin indulging in the use of mind-altering substances, we are essentially performing science experiments on ourselves.
Susan Foster, senior investigator of the study, notes: “By recognizing this as a health problem and respondingto it, we can actually make the difference by improving the life prospects ofteens and saving costs in society.” This brings us back to what I always say, get involved and start talking to your kids! Teens are under an inordinate amount of pressure: school, peers, hormones, et cetera. At some point, we have to start looking at how those we love are actually managing such an incredible stress load. I once heard a therapist say, “Little people, little problems; big people, big problems.” She was specifically talking about the value in addressing issues when they begin rather than waiting things explode. When we’re trying to preserve and heal family dynamics, it’s far less challenging to deal with an angry 8-year-old than a drug-addicted teen.
Is your teen playing doctor? Surely, this is an appropriate question for parents of adolescents who are concerned about teens entering a sexually intimate relationship before he or she is ready.
Unfortunately, this is not what I’m addressing. John Lieberman, our Director of Operations sees quite a bit of this and is concerned that “adolescents are literally playing doctor in the worst way, taking both prescribed and over-the-counter medications to treat perceived illnesses and issues.” They are reading information on the Internet, getting advice from peers as to what medications they should take, and they’re often mixing and matching drugs while they’re at it. While some of these Internet sites have some valuable information regarding symptom checks and corresponding information about illnesses, they also present a danger. Any time we look at something from the perception of a layperson, we risk finding and relating to symptoms within the descriptions of many illnesses. That’s what real doctors are for: differentiating reality from the natural misinterpretation from those of us lacking the vital MD title. Pharmaceutical-related overdoses have increased, proving the increasing danger in this behavior, and spurning an all out war against the pharmaceutical industries.
Drugs like Vicodin, Oxycontin, Percocet, and Demoral are all opium derivative drugs. This particular class of drug is highly addictive and can easily lead to an overdose. Xanax, Ativan, Klonopin, Soma, Lunesta and others are benzodiazepines. These, too, can create a physical addiction in a short period of time and in worse cases, cause death. Adderal, Ritalin, and Vyvance are amphetamines primarily used to treat ADHD and are subsequently very powerful drugs that can cause heart attack and stroke, particularly when used inappropriately. The latter are often traded amongst kids in an effort to get high, or even as an attempt to increase their focus at school.
Our kids are playing doctor with quite a varied array of drugs, and this does not take into account the rampant abuse of illicit drugs or alcohol. According to John Lieberman, “Our teens are using very powerful psychoactive drugs during a time in their lives when they are emotionally vulnerable and when their brains are in a major stage of development.” According a 2010 statement by the APA:
“The brain’s frontal lobes, essential for functions such as emotional regulation, planning and organization, continue to develop through adolescence and young adulthood. At this stage, the brain is more vulnerable to the toxic and addictive actions of alcohol and other drugs.”
This isn’t just about playing doctor, kids are also doing chemistry experiments…with their own brains.
Spice, K2, Cloud Nine, Potpourri: call it what you will, it’s all the same: a legal, synthetic, psychotropic drug lurking at the counters of your local liquor store. Some use these drugs once and walk away, disillusioned by the multitude of negative effects. The addiction-prone continue, disregarding the negative nuances, anxious to get high. Addiction is funny that way: the bad never seems bad enough to stop.
Recently, 20/20 did an exposé on bath salts, K2, and Spice, exposing the dangers and widespread concern amidst parents and law enforcement officials. Our medical director, Dr. David Lewis, addressed some of the risks related to these substances, telling 20/20: “If you take a developing brain and you put a tremendously psychoactive substance in the middle of that, that developing brain, what you really have is a chemistry experiment.” Dr. Lewis is all too familiar with the negative consequences manifesting in kids who have been using these drugs, and like parents, he also worries about the ease with which one can purchase K2 and Spice. Lewis says, “These people sell the drugs to our kids, no matter what the consequences are.” When 20/20 sent in hidden cameras with underage kids, the truth of this was caught on tape. The retailers are in it for the buck. Show them the money, and they’ll sell you the drugs, regardless of the 18-and-over age restriction.
Unfortunately, this rampant, devil-may-care attitude is substantiated by Dan Francis, the Executive Director of The Retail Compliance Association, who says, “a ban is dangerous” because it “sends it underground.” He even questions the government, saying,” What is wrong with euphoria and what gave them the right to regulate it?” Nothing is wrong with euphoria if it’s obtained through non-harming activities like completing a marathon, or a 2-hour Ashtanga yoga class. But that’s not what’s happening here—instead shops are selling a chemical recipe for disaster. We essentially have kids purchasing substances that have the capability of eliciting a desire to self-harm or increase the potentiality of suicidal ideation. It would be irresponsible if we ignored it.
Recovering from opiate addiction is no walk in the park. With something like heroin, symptoms can occur within 12 hours of the last high, causing addicts several days of sheer misery. Some addicts have no other choice but to detox on their own, suffering the miserable consequences of their addiction. In some ways, if they can make it past that second day, they have a good chance for a successful detox. Some, however, have the opportunity to go to treatment, which provides addicts the benefit of supportive care and medications to ease the pain and discomfort of withdrawal. A common medication used for this is called Suboxone (bupenophine and noloxone) and purportedly shortens the length of the detox while also treating the withdrawal symptoms. It’s also used for long-term maintenance much like methadone has been used in the past, sans the stigmatization. A prescription for Suboxone means you don’t have to stand in a clinic line for your daily dose, but rather, you get your 30-day rx from a physician.
There are three phases to the using Saboxone in opioid addiction therapy. The induction phase, which is a “medically monitored startup” of the medication, begun 12-24 hours after the addict has abstained from opiates and is in the early stages of withdrawal. This is typically done under observation in the doctor’s office. Next is the stabilization phase, which happens when the patient has “discontinued or greatly reduced” the use of their drug of abuse and is suffering from little to no cravings. Last is the maintenance phase, which culminates in a “medically supervised withdrawal.”
Nothing is ever that simple, though, when it comes to treating addiction. While Suboxone certainly has its value for assisting with opiate withdrawal and turning people’s lives around, there is a dark side. It is just another opiate after all. Some addicts will inject it, some will take more than their prescribed dose, if just for a brief bout of euphoria. Suboxone reportedly has a “ceiling effect,” which means it levels off after a certain amount. Additionally, the naloxone component of the drug is supposed to “precipitate withdrawal symptoms” when the drug is injected. Still, the state of Maine has reported some pretty disturbing news events surrounding Saboxone, with reports of the drug being smuggled into prison, hidden behind postal stamps and kids’ coloring pages. Prison smuggling of this drug is widespread, creating problems from New Mexico to Massachusetts.
Despite the reports of abuse and prison smuggling, the use of Saboxone is still proving to be a promising component to treating opiate addiction. Some experts suggest more training for physicians and tighter regulation of the drug in order to address the rate of abuse. This is definitely something the recovery industry will be paying attention to.