Substance abuse and recovery
(addiction in various forms)


Addiction, treatment, and recovery (generally)


Effective Addiction Treatment (Jane E. Brody, NY Times, 2-4-13) 'Contrary to the 30-day stint typical of inpatient rehab, “people with serious substance abuse disorders commonly require care for months or even years,” she wrote. “The short-term fix mentality partially explains why so many people go back to their old habits.”' "Look for programs using research-validated techniques, like cognitive behavioral therapy, which helps addicts recognize what prompts them to use drugs or alcohol, and learn to redirect their thoughts and reactions away from the abused substance."
"Other validated treatment methods include Community Reinforcement and Family Training, or Craft, an approach developed by Robert J. Meyers and described in his book, Get Your Loved One Sober, with co-author Brenda L. Wolfe. It helps addicts adopt a lifestyle more rewarding than one filled with drugs and alcohol."
The Office of National Drug Control Policy (ONDCP) convened a meeting to raise awareness of the importance of incorporating medication assisted treatment (MAT) as part of a comprehensive treatment regimen for incarcerated persons with opioid use disorder (OUD). "We should all remember that we have evidence-based community-standard medications that work for the disease of opioid addiction, and this should become the standard of care in corrections, and the criminal justice system broadly."-Dr. Kathleen Maurer, Connecticut Department of Corrections
.• The addiction habit (Marc Lewis, Aeon). By the author of The Biology of Desire: Why Addiction Is Not a Disease (which combines "an account of brain change in addiction with subjective descriptions of what it’s like to live inside addiction"). Medical institutions define addiction as "‘chronic disease of brain reward, motivation, memory and related circuitry." If only the disease model worked. Yet, more and more, we find that it doesn’t. Addiction changes the brain but it's not a disease that can be cured with medicine, writes Lewis. In fact, it's learned – like a habit. Addiction perpetuates the need it was intended to satisfy and the addict learns to satisfy the need by getting and doing more. Neuropsychological habits develop through repetition – not merit, rationality, value or success. Thought-provoking.
This American War on Drugs (Brooke Gladstone and Bob Garfield, WNYC, On the Media, 4-14-17) Four segments: Breaking News Consumer's Handbook: Drugs Edition, The Man Who Declared War On Drugs (a fascinating and shameful history, in which a man named Harry does a huge disservice to singer Billie Holiday), A (Long) History of American Drug Panics, A Case for Law Enforcement. A whole lot of injustice with various presidents in starring roles. Drug fear often stands in for fear of "the other."
Making Space for Sobriety (Ryan Caron King, Atavist, published on WNPR). When a person who addicted to drugs or alcohol is discharged from rehab, they’ll sometimes live in what’s called a sober house -- a place where there’s supposed to be no drugs or alcohol around. Same as or similar to How One Agency Is Improving Conditions in Connecticut's Sober Houses (Ryan Caron King, WNPR, 10-4-16) "When someone who is addicted to drugs or alcohol is discharged from rehab, they’ll sometimes pay to live in a privately-owned sober living home like this one, Right Path House. But private sober houses aren’t regulated by the state, and experts in the field say some houses don’t enforce their own sobriety rules -- which can jeopardize the safety of the people that live there and the neighborhood the house is in. So Aligata is working to train and certify sober house owners across the state through a voluntary program. He wants to compile an online database of certified sober houses that he hopes will make it easier for people with addiction to find a place to continue their recovery after rehab."
Shattering the Silence (Perry Gaidurgis's video about alcoholism, addiction, children of alcoholics, and recovery)
Understanding Addiction: How Addiction Hijacks the Brain (HelpGuide.org) Addiction involves craving for something intensely, loss of control over its use, and continuing involvement with it despite adverse consequences. Addiction changes the brain, first by subverting the way it registers pleasure and then by corrupting other normal drives such as learning and motivation. Although breaking an addiction is tough, it can be done.
Help With Addiction and Substance Use Disorders (American Psychiatric Association) Links to useful articles and other resources.
What Is Addiction? (excellent quickie overview of current views and explanations of addiction, from Lumiere, a chain of healing centers)
Medicaid Coverage For Addiction Treatment Varies Dramatically (Carmen Heredia Rodriguez, Kaiser Health News, 12-6-16) A study published in the journal "Health Affairs found significant disparities in coverage among the states. Researchers sought to determine the number of substance treatment services available in each state in 2014. They analyzed coverage for the four tiers of services recognized by the American Society for Addiction Medicine, which are classified as outpatient (including group and individual therapy as well as recovery support services), intensive outpatient, short- and long-term residential inpatient and intensive inpatient care for detoxification. At the time of the study, 21 states had expanded Medicaid. The federal health law required states that chose to expand their Medicaid programs to include coverage for substance abuse treatment. But it gave states control to decide the type of treatment and medication that would be covered. Overall, the researchers found the level of Medicaid coverage for substance abuse treatment did not correlate with Medicaid expansion....In particular, states shied away from covering residential interventions, which the federal government had historically chosen not to reimburse for mentally ill patients insured by Medicaid....The coverage disparity across the nation extended to medications used to manage addiction. Every state and the District of Columbia insured buprenorphine, and all but two states covered injectable naltrexone. However, only 32 Medicaid programs covered methadone, one of the most effective drugs in managing addiction, according to the American Society for Addiction Medicine." "But the study also revealed several hurdles in accessing services and life-saving medication. It found many states limited access to substance abuse treatment by requiring preauthorization, imposing annual maximums or asking for patients to pay a share of the costs."
How to Choose an Addiction Treatment Program, an excerpt from The Recovery Book: Answers to All Your Questions About Addiction and Alcoholism and Finding Health and Happiness in Sobriety by Al J. Mooney M.D. and Catherine Dold.
Behavioral Health Treatment Services Locator (SAMHSA) A confidential and anonymous source of information for persons seeking treatment facilities in the United States or U.S. Territories for substance abuse/​addiction and/​or mental health problems. Or Call
SAMHSA’s National Helpline
1-800-662-HELP (4357)
1-800-487-4889 (TDD)
Cognitive-Behavioral Therapy for Substance Use Disorders (R. Kathryn McHugh, Bridget A. Hearon, and Michael W. Otto, Psychiatr Clin North Am. 2010 Sep; 33(3): 511–525.) Cognitive behavioral therapy (CBT) for substance use disorders has demonstrated efficacy as both a monotherapy and as part of combination treatment strategies. This article provides a review of the evidence supporting the use of CBT, clinical elements of its application, novel treatment strategies for improving treatment response, and dissemination efforts.
A physician enters rehab. What happens next should disturb you. (Anonymous doctor, KevinMD, 7-4-15) "The price paid in dollars, reputation, and emotional upheaval in the family might have been justified if these treatment centers had a record of success. Unfortunately, without monitoring and contingency management, there’s no evidence that physician health programs achieve more than the abysmal rates of remission seen with non-MD clients." "Although Alcoholics Anonymous and its many spinoffs do not have a record of success, my medical licensure was contingent upon participation after rehab....without constant and obsessive AA attendance and a relationship with a sponsor that was contingent upon talking about something I had no interest in discussing ad nauseum, the PHP claimed I would not be “in recovery.”
You Can Rely on Drugs Without Being an Addict (Maia Szalavitz, Vice, 12-20-16) "It may seem like a trivial or academic distinction, but addiction is not dependence, and dependence is not necessarily a problem...if addiction is properly understood as compulsive drug use despite negative consequences, maintenance cannot be seen as addiction. What maintenance does, in fact, when it works most effectively, is replace compulsive drug-seeking (in the face of harm) with simple physical dependence. This is not a problem if someone has a safe, regular supply."
A 20-Year-Old Went to Rehab and Came Home in a Body Bag (Wilbert L. Cooper, Vice, 11-4-14). An expose of the high-end-$$ drug treatment world, through the story of one boy and family it failed: Brandon Jacques, whose dual diagnosis of bulimia and alcohol addiction called for better treatment and medical care than the overpriced "treatment" facility could provide. ("...it's illegal for residential drug and alcohol programs like Morningside to provide any medical care in the State of California, because of an old, controversial law that is a vestige of the rehab industries' AA-based, nonmedical beginnings....Because the State of California has done such a poor job of enforcing the ban on in-house professional medical care, facilities like Morningside get the best of both worlds--they can market themselves as medical facilities to attract more clients without fear of getting shut down, but they don't have to spend the money on medical care or jump through the regulatory hoops required of a facility practicing medicine.") Here is video on the same story: From Rehab to a Body Bag: Dying for Treatment (Vice video, Nov 2014) "Although non-hospital residential treatment serves only about 10 percent of those in recovery in the US, the exorbitant cost of such care--as high as $75,000 a month--has made it extremely lucrative....these centers operate in a gray zone somewhere between legitimate medicine and total quackery, offering things like horseback riding and meditation as solutions to addiction, and often promising medical care that they are unable to provide--sometimes with disastrous results."

Find Help (SAMHSA's links for substance abuse and mental health services)

Neurobiologic Advances from the Brain Disease Model of Addiction (Volkow ND, Koob GF, McLellan AT. N Engl J Med. 2016 Jan 28;374(4):363-71. DOI: 10.1056/​NEJMra1511480) Free full text of a good review article on the science of addiction.

Why It’s Easier to be Prescribed an Opioid Painkiller than the Treatment for Opioid Addiction (Jeffrey Hom and Krisda Chaiyachati, Health Policy$ense, UPenn LDI, 5-31-16) Despite alarming statistics about opioid abuse and the significant attention focused on the epidemic, a hidden regulatory imbalance exists between two types of opioids – those prescribed for pain and those prescribed to treat opioid addiction. "As physicians, we need to obtain only a license from the Drug Enforcement Agency (DEA) in order to prescribe opioid painkillers. Maintaining it requires a licensing fee every three years, but there is no mandatory training on how to safely prescribe these medications and no requirements to monitor patients who receive them. There is, in short, little oversight.
"In contrast, heavy regulations restrict those providers wishing to treat addiction by prescribing buprenorphine, the mainstay of medication-assisted treatment for opioid addiction outside of methadone clinics. Although buprenorphine was approved by the FDA in 2002, it remains underused, far below the levels needed to meet the growing number of individuals requiring treatment."
Why ‘Substance Abuse’ Is a Label We Should All Reject (Maia Szalavitz, Pacific Standard, 3-26-14) 'Frame addiction as “substance abuse” and it is easy to see why it should be a crime, but call it “substance use disorder” and it sounds like something to be treated medically. If we want to make progress in ending stigma, we should think hard about the words we use....The “substance abuser” label encompasses the whole person, defining him or her by dysfunction. In contrast, the “substance use disorder” tag simply describes one problem, rather than an entire identity.' In a venue for health care journalists, Maia explains: "Addiction, as defined by the National Institute on Drug Abuse and summed up in the DSM, is compulsive drug use despite negative consequences. Substance misuse is just that: taking a drug in a way that it was not intended to be taken....The former "substance abuse" is now "substance use disorder, mild." and the former drug dependence is now 'substance use disorder, moderate to severe.' Personally, I just use addiction and substance misuse." Maia is the author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction. (The reviews on Amazon alone are enlightening.)
What’s in a Word? Addiction Versus Dependence in DSM-V (Charles P. O’Brien Nora Volkow T-K Li, American Journal of Psychiatry, 5-1-06) Do not use the word "dependence" to mean addiction," wrote Maia Szalavitz to her fellow health care journalists. DSM dropped that "because dependence can occur without addiction and addiction can occur without dependence. People on maintenance treatment and people in chronic pain can be physically dependent on opioids and people are physically dependent on some antidepressants and blood pressure medications, but if the treatments are
working, these are NOT addictions."
Recovering Together: The Benefits Of Adopting A Companion Animal While In Addiction Recover (DrugRehab.org) The benefits of a companion animal.
Why It's Wrong to Call Drug Users "Addicts" (Megan Ralston, AlterNet, 3-25-14) We don't say "My mother, the blind" or "my brother, the bipolar."
The Fix (“Addiction and recovery, straight up”). A website about addiction and recovery, featuring a daily mix of breaking news, exclusive interviews, investigative reports, essays and blogs on sober living, lifestyle and cultural resources, as well as knowledge and wisdom from expert counsel. Offers "offer rigorously reported Rehab Reviews ("Zagat-like reviews of rehab facilities"), with input from thousands of alumni, plus extensive directories and practical guides for dealing with addiction and related mental health and life issues." See Challenging the Second ‘A’ in A.A. (David Colman, NY Times, 5-6-11) and Is It Time to Take the Anonymous Out of AA? (Susan Cheever, The Fix, 4-7-11)

Unbroken Brain: A Revolutionary New Way of Understanding Addiction by Maia Szalavitz, to be released in 2016. "Challenging both the idea of the addict's 'broken brain; and the notion of a simple 'addictive personality,' Unbroken Brain offers a radical and groundbreaking new perspective, arguing that addictions are learning disorders and shows how seeing the condition this way can untangle our current debates over treatment, prevention and policy. Like autistic traits, addictive behaviors fall on a spectrum -- and they can be a normal response to an extreme situation. By illustrating what addiction is, and is not, the book illustrates how timing, history, family, peers, culture and chemicals come together to create both illness and recovery- and why there is no "addictive personality" or single treatment that works for all. Combining Maia's personal story with a distillation of more than 25 years of science and research, Unbroken Brain provides a paradigm-shifting approach to thinking about addiction."

Picking Addiction Help (Jane E. Brody, NY Times, 2-11-13) '“Treatment is not a prerequisite to surviving addiction.” This bold statement opens the treatment chapter in a helpful new book, Now What? An Insider’s Guide to Addiction and Recovery, by William Cope Moyers, a man who nonetheless needed “four intense treatment experiences over five years” before he broke free of alcohol and drugs.'

Substance abuse treatment often impossible to find (Larry Copeland, USA Today) Promising strategies gather dust: 'It's hard to get anyone to pay attention until it happens again.' Joan Ayala now works as a mental health clinician trying to help others avoid her decades-long ordeal.

Pornography: Does it pose a public health crisis? (Sarah Glazer, GQ Reports, 10-21-16) Yes, porn addiction is a problem.

We must change the way we think about drug addiction in Maryland (Dan Morhaim, Opinion, Wash Post, 2-5-16) An emergency room physician for more than 30 years, Morhaim is introducing four bills that would fundamentally transform drug policy in Maryland. His proposals aim to reduce the harms associated with drug use, including rates of addiction, deadly overdoses, the spread of infectious disease and the incarceration of people who use drugs. One bill would require addiction treatment in ERs. That’s where addiction treatment should begin, and it’s more effective than jail. Another bill would keep drug users who use minimal amounts out of the criminal-justice system, saving critical resources and avoiding the costs of saddling more Maryland citizens with criminal records and the related adverse consequences. The other two bills require a shift in how we think about and treat addicts. One would allow for the administering of pharmaceutical-grade drugs to a small and unresponsive group of heroin abusers, with medical supervision. The final bill calls for the creation of a safe-consumption program that would create supervised spaces for individuals to consume controlled substances, reducing rates of overdose death and the spread of infectious disease and connecting them with rehabilitation programs.

CRAFT: An Alternative to Intervention (Robert J. Meyers, page on the essence of CRAFT, from the HBO program on ADDICTION)

What I Wish I Had Done Differently With My Drug-Addicted Kid (Ron Grover, Drugfree, 8-13-13). Read the comments for a variety of responses.

The Science of Addiction: Drugs, Brains, and Behavior. Two NIH institutes — the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) — have joined with HBO to reveal startling new advances in the fight against alcohol and other drug addiction.
Treatments for Substance Use Disorders (SAMSHA, the federal Substance Abuse and Mental Health Services Organization)

Narcotics Anonymous (NA)
Alcoholics Anonymous (AA)
Al-Anon Family Groups (strength and hope for friends and families of problem drinkers)
Nar-Anon Family Groups (a 12-step program for families & friends of addicts)
Co-Dependents Anonymous (CoDA) What it was like...we found in each of our lives that codependence is a deeply rooted compulsive behavior born out of our dysfunctional family systems.
The Hidden Link Between Autism and Addiction (Maia Szalavitz, The Atlantic, March 2017) It’s believed that people on the spectrum don’t get hooked on alcohol or other drugs. New evidence suggests they do. You can follow Maia on Twitter: https:/​/​twitter.com/​maiasz
Recovery and Recovery Support (SAMSHA)
Drug Abuse (NIDA, links to many resources, including NIH clinical trials locator)
A to Z list of Programs, Campaigns, Initiatives, Technical Assistance Centers, or Resource Centers (SAMHSA)
Where do 12-step or self-help programs fit into drug addiction treatment? (National Institute on Drug Abuse, NIDA)
Medication-Assisted Treatment (MAT), including opioid treatment programs (OTPs), combines behavioral therapy and medications to treat substance use disorders.
Treatment centers: 12-step and MAT should coexist (Allison Insinger, Alcoholism Drug Abuse Weekly, 2-24-14, posted by Twin Town Treatment Centers)
DC Calls it Quits (David Zauche, Altarum Institute, Systems for Better Health, 9-24-15). "Smoking is the leading cause of preventable death and disease in the United States, taking more than 480,000 lives annually. The economic costs due to smoking-related illness in the United States are estimated at more than $300 billion each year in direct medical expenses and lost productivity. Many states and cities across the nation are answering the call to action by implementing policies to protect against the devastating effects of tobacco. Altarum's ActionToQuit program supports this DC campaign and hopes that more cities will follow suit." See resources on the Altarum website: Altarum Institute.
Substance Abuse: A guide for parents and educators (AddictionResource)
Peer Support and Social Inclusion
Addiction, Heart Disease, and Stroke (Recovery Connection)
Addiction and HIV (Human Immunodeficiency Virus) (Recovery Connection)
Can addiction be treated successfully? (NIDA, or National Institute on Drug Abuse) NIDA states in its Principles of Drug Addiction Treatment, “To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems.”
Drugs, Brains, and Behavior: The Science of Addiction
Alcohol and Your Health ( NIAAA, or National Institute on Alcohol Abuse and Alcoholism)
Find an AA meeting (Alcoholics Anonymous)
Refuge Recovery (a Buddhist path to recovering from addiction)
Harm reduction (Harm Reduction Coalition -- a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use)
Ayahuasca Can Change Your Life -- As Long as You're Willing to Puke Your Guts Out (LA Weekly, 11-21-13)
Differences Between SMART Recovery and AA (Smart Recovery)
Why SMART Recovery Will Never Replace Alcoholics Anonymous (Matthew Leichter, The Fix, 9-23-14) Five reasons why SMART Recovery will never push out AA as the main model of recovery, despite higher success rates.
Evidence-Based Approaches to Drug Addiction Treatment, read online this chapter from Principles of Drug Addiction Treatment: A Research-Based Guide (National Institute on Drug Abuse)
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The addiction paradox (Bruce Bower, Science News, 3-7-14). Drug dependence has two faces — as a chronic disease and a temporary failure to cope

Effective Addiction Treatment (Jane Brody, NY Times, 2-4-13)

Adolescent Brain Cognitive Development Study (Collaborative Research at NIH) The ABCD Study is a national longitudinal study that will assess the short- and long-term impact of substance use on brain development. The project will recruit 10,000 youths before they begin using alcohol, marijuana, tobacco and other drugs, and follow them over 10 years into early adulthood. See frequently asked questions about the study and The CRAN blog.

One Hundred Years Ago Today, Prohibition Began in Earnest. We’re Still Paying. (Maia Szalavitz, Substance.com, 12-17-14). On December 17, 1914, Congress passed the Harrison Act, making nonmedical opium and cocaine illegal. It was really about punishment, not public health. And it set the tone for a disastrous century.

Addiction Medicine: Closing the Gap Between Science and Practice (CasaColumbia, June 2012) “Only a small fraction of individuals receive interventions or treatment consistent with scientific knowledge about what works.”

The Clean Slate Addiction Site (maintained by Maia Szalavitz).

Rat Park, Stuart McMillen's comic about a classic study of (experiment about) drug addiction conducted in the late 1970s (and published in 1980) by Canadian psychologist Bruce K. Alexander and his colleagues.

Closing the Addiction Treatment Gap) (CATG, 'Addiction is a disease. Let's treat it that way.") A national program of the Open Society Institute, founded in 2008. This PDF is a 2010 report on three-year $10 million effort to expand treatment by expanding insurance coverage, increasing public funding, and making systems and programs more efficient.

Addiction Recovery Basics

The Recovery Book: Answers to All Your Questions About Addiction and Alcoholism and Finding Health and Happiness in Sobriety by Al J. Mooney M.D. and Catherine Dold

Alcoholics Anonymous: The Big Book, 4th Edition.

Faces & Voices of Recovery (FAVOR) (why living in safe, sober and peer supportive environments matters in recovery) Faces & Voices believes that our nation’s response to the crisis of addiction should be based on sound public health science and the grassroots engagement and involvement of the recovery community – people in recovery, their families, friends and allies – organized in identifiable and mobilized networks of recovery community and allied organizations that foster collaboration, advocacy and public education about the reality of addiction recovery.

ManyFaces1Voice No longer will we remain silent. We want to sensationalize recovery, because recovery is sensational." Together we will change public perception, and ultimately the public response to the addiction crisis.

Gateway Drugs: How Does Addiction Start? (Michael's House).

The Trouble With Tough Love (Maia Szalavitz, Wash Post, 1-29-06) A MUST READ. "The trouble with tough love is twofold. First, the underlying philosophy -- that pain produces growth -- lends itself to abuse of power. Second, and more important, toughness doesn't begin to address the real problem."

NIH State-of-the-Science Conference Statement on Preventing Violence and Related Health-Risking Social Behaviors in Adolescents (NIH, 2004) "Programs that seek to prevent violence through fear and tough treatment appear ineffective. Intensive programs that aim at developing skills and com­petencies can work."

ManyFaces1Voice, a campaign to transform public attitudes and policies affecting people seeking or in recovery from addiction to alcohol and other drugs. Whether behind the scenes or on the front line, every recovery voice is needed. See trailer to the film The Anonymous People.

Crack baby myth goes up in smoke (Todd Reed, America Tonight, Aljazeera, 3-10-15). A Philadelphia study found no gap in health and life outcomes for babies exposed to crack versus ones who weren’t. Poverty, however, posed a major risk.

Exercise: Alternative reward for those battling addiction (James Fell, Chicago Tribune, 6-12-13)

The D.S.M. Gets Addiction Right (Howard Markel, Opinion, NY Times, 6-5-12)

A New Scientific American eBook, Understanding Addiction, Examines the Multifaceted Issue of Substance Abuse (9-17-13)
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Addiction to opioids and psychoactive drugs


Psychoactive drugs are typically categorized as stimulants, depressants, opiates & opioids, and hallucinogens. As explained on Castle Craig Hospital's very helpful (UK) website:

STIMULANTS--cocaine, crack cocaine, amphetamines (speed) and ecstasy (also a hallucinogen).
These "act on the central nervous system and are associated with feelings of extreme well-being, increased mental and motor activity."

DEPRESSANTS--alcohol and cannabis, in particular, as well as barbiturates and benzodiazepines (e.g. valium, temazepam).
These "slow down the central nervous system and suppress brain activity causing relief from anxiety."

OPIATES & OPIOIDS--heroin, morphine, opium, methadone, dipipanone, and pethidine.
These "provide pain relief, euphoria, sedation and in increasing doses induce coma."

HALLUCINOGENS--cannabis, LSD, ecstasy and psilocybin ("magic mushrooms").
These "cause changes in a person's perception of reality."

We focus at first on the opioid crisis.
OPIATES & OPIOIDS--heroin, morphine, opium, methadone, dipipanone, and pethidine.
These "provide pain relief, euphoria, sedation and in increasing doses induce coma."

Another Circle of Hell: Surviving Opioids in the Fentanyl Era (Martha Bebinger, WBUR, KHN, 4-7-17) More powerful and more deadly than heroin, the synthetic opioid fentanyl has sparked a new set of survival rules among people who abuse opioids. "Fentanyl is an opioid 50 times more powerful than heroin. There’s a legal, Food and Drug Administration-approved version. But labs in China are churning out cheap versions of fentanyl that dealers are selling on the streets mixed with fillers, heroin or other drugs. Buyers have no idea how much fentanyl they are getting or how much risk they are taking with every injection." Fentanyl may be especially lethal because it’s strong, it’s mixed with other drugs in varying amounts unknown to the user, and it can trigger an overdose within seconds. Unlike heroin, fentanyl routinely shuts down breathing in seconds, and it’s becoming more common.
Delivered ‘Like A Pizza’: Why Killer Drug Fentanyl Is So Hard To Stop (Martha Bebinger, WBUR/​KHN, 12-2-16) Just a few grains of pure fentanyl is enough to kill most users. But law enforcement sources say stopping the supply of the deadly synthetic opioid from China and Mexico is very difficult.
Down The Rabbit Hole: A Chronic Pain Sufferer Navigates the Maze of Opioid Use (Janice Lynch Schuster, My Narrative Matters, Health Affairs, July 2014). Read full story. See also http:/​/​www.pbs.org/​newshour/​updates/​one-woman-manages-chronic-pain-invisible-affliction/​ (Ruth Tam's interview with Schuster on PBS Newshour, 7-9-14).
The Truth About Suboxone (Maia Szalavitz, The Fix, 12-01-11) Studies show that maintenance therapy is the most effective treatment for opiate addiction. So why are abstinence fundamentalists so bitterly against it?... an outdated and stigmatizing attitude towards maintenance treatment can—and frequently does—kill hundreds of struggling addicts who depend on these meds to stay off the streets....Even the Betty Ford Center agrees that people taking daily methadone or buprenorphine should be considered every bit as "in recovery" as those who just “don’t drink and go to meetings.” A 2007 consensus panel to define recovery convened by that august facility put it plainly: "To be explicit, formerly opioid-dependent individuals who take naltrexone, buprenorphine or methadone as prescribed and are abstinent from alcohol and all other non-prescribed drugs would meet this consensus definition of sobriety." Some in abstinence-based recovery feel compelled to proselytize about the dangers of the substances they once could not live without. This “drug-free” rhetoric helps them avoid temptation. It also gives the added buzz of self-righteousness that comes from feeling superior to others. [But] It’s not necessary for maintenance to be bad to make abstinence good.

Facing some unpleasant truths about opioids (David Juurlink, Making Evidence Matter, also Globe & Mail) "Despite the best of intentions, we flooded North American homes with opioids purer and often stronger than heroin. These drugs increasingly fell into the wrong hands, destroying young lives and countless families in the process. But another unfortunate truth is that even when patients with chronic pain followed our instructions, we caused more harm than we anticipated. By some estimates, 10 percent spiraled into addiction, even though we’d been told this would happen only rarely."
The opioid epidemic: It’s time to place blame where it belongs (Ronald Hirsch, MD, Kevin MD, 4-6-16) 1) Physicians ...overprescribe opioids, just as they overprescribe antibiotics. 2) Despite a lack of increased efficacy in treating pain compared to older medications, Purdue Pharmaceuticals, Oxycontin's manufacturer, mounted an aggressive marketing campaign (using scare tactics) which doctors fell for. 3) The "American Pain Society, introduced the “pain as the 5th vital sign” campaign, followed soon thereafter by the VA adopting that campaign as part of their national pain management strategy." 4) The Joint Commission issued "standards requiring the use of a pain scale and stressing the safety of opioids. According to the Wall Street Journal, they even published a guide sponsored by Purdue Pharma....The Joint Commission framed pain as a patient’s rights issue, inferring that inadequate control of pain would lead to sanctions." 5) "Press Ganey deserves a place with their emphasis on patient satisfaction. They monetized their concept, selling not only surveys but also consulting services to help hospitals improve their scores." 6) "Because CMS was now attaching significant reimbursement to patient satisfaction, hospital administrators developed initiatives to improve their scores and avoid a penalty." Making patient satisfaction a comparative advantage has boosted the "business" of medicine but harmed patient safety. (I apologize for summarizing his article but he makes important points. Read Dr. Hirsch's article!)
‘You want a description of hell?’ OxyContin’s 12-hour problem (Harriet Ryan, Lisa Girion and Scott Glover, Los Angeles Times investigative series, 5-5-16). The Times investigation into how America's bestselling prescriptive painkiller helped fuel a nationwide opioid epidemic won a Barlett & Steele bronze award. The Times reporters discovered that marketers at Purdue Pharma had knowingly misrepresented the drug as providing 12-hour relief from pain, an exaggeration that led to abuse and addiction. Here's Sally Kilbridge's story of How They Did It.
Five signs a loved one is abusing painkillers (Dr. Carlos Tirado and CBS News, 2-20-13) 1. Drowsiness, lack of energy; 2. Inability to concentrate, lack of motivation; 3. Social behavioral changes; 4. Changes in appearance; 5. Increased secrecy.
Confessions of a 75-Year-Old Drug Addict (Arlene Silverman, Pulse, 1-22-10) "There's sort of a war going on in the field of pain management, he continues. One camp worries about opiate addiction; the other is more concerned about the effects of long-term pain. It seems that, given my pain's severity, my doctors opted for opiates." This personal story conveys what an elder's addiction and attempts to withdraw feel like. Physicians: Please read.
How Prince Concealed His Addiction: Aspirin Bottles of Opiates (Joe Coscarelli and Serge F. Kovaleski, NY Times, 4-17-17) At the time of Prince’s death, his Paisley Park home and recording compound in Minnesota were strewn with “a sizable amount” of narcotic painkillers for which he did not have prescriptions, including some hidden in over-the-counter vitamin and aspirin bottles and others issued in the name of a close aide, according to newly released court documents. Those documents "sketch a picture of how this musician, a strict proponent of clean living who suffered from chronic hip pain, concealed his opioid addiction using a variety of methods, including mixing various prescription pills in bottles for everyday products like Bayer and Aleve." He died from a "fatal amount of fentanyl, which is often used to manufacture counterfeit pills that are sold on the black market as oxycodone and other pain relievers."
Prince search warrants lay bare struggle with opioids (Amy Forliti, AP, WaPo, 4-18-17) Associates at Paisley Park also told investigators that Prince was recently “going through withdrawals, which are believed to be the result of the abuse of prescription medication,” an affidavit said. Search warrants and affidavits shed no new light on how Prince got the fentanyl that killed him. In practice, laws against prescribing drugs for someone under a false name are not usually enforced when a doctor intends to protect a celebrity’s privacy, said Los Angeles attorney Ellyn Garofalo. They would be indicting every pharmacist in Beverly Hills if this were strictly enforced,” Garofalo said.
My Life Ruined By Oxycodone in 2 Weeks (Healthy Living) Her life is nearly destroyed by two weeks of oxycodone prescribed by a well-meaning physician for arthritis.
Making pain a vital sign caused the opioid crisis. Here’s how. (orthopedic surgeon Thomas D. Guastavino, Kevin MD, 10-6-16) "I place the blame where it started. Those, no matter how well intended, who convinced themselves and had the power to pressure others that pain was a disease onto itself, not what it really is: a symptom. If health care has any hope of getting a handle on this crisis, then we have to go back to a time when physicians first determined why their patients have pain instead of just shooting the messenger. While we’re at it get rid of pain scales, fifth vital signs, and anonymous patient satisfaction scores. If we have not learned by now that these have caused more problems than they have solved, I don’t know what will."

Opioids Contribute to a Rising Death Toll: 28,647 in 2014 (Nicholas Bakalar, Science, NY Times, 12-24-16) 20In 2014, according to the Centers for Disease Control and Prevention, there were 47,055 deaths from accidental drug overdoses. Opioids were implicated in 28,647 of them, 60.9 percent of the total. "Morphine and codeine are natural opioids found in the opium poppy. Semi-synthetic opioids like oxycodone, hydrocodone and hydromorphone are derived from them. Many opioids are familiar under brand names — oxycodone is sold as Percocet and Percodan, for example, and hydrocodone as Vicodin." The report suggested several steps, including continuing the careful control of opioid prescriptions and intensifying efforts to distribute naloxone, a drug that reverses an opioid overdose.

The $4,500 injection to stop heroin overdoses (Shefali Luthra, Kaiser Health News, Business, Washington Post, 1-29-17). "Evzio is used to deliver naloxone, a life-saving antidote to overdoses of opioids. As demand for the product has grown, Kaleo has raised its twin-pack price to $4,500, from $690 in 2014....The problem...is that policymakers haven’t found a solution to get people needed medication and keep pricing in line with value. “EpiPen happened, and everyone was like, ‘Wow, this is terrible, we shouldn’t allow this to happen,’ ” he said. “And we haven’t done anything about that, and it’s not clear what the solution is. Now, shocker, it’s happening again.”
Where opiates killed the most people in 2015 (Christopher Ingraham, WaPo, 12-13-16) "Nationally, there are about 10.4 deaths by opioid overdose for every 100,000 people. But as you can see, these deaths aren't evenly distributed across the county. New England and the Ohio/​Kentucky/​West Virginia region stand out as two obvious hot spots....Synthetic opioid deaths — again, we're primarily talking fentanyl — are almost exclusively an East Coast phenomenon. Nationally, the death rate from synthetic opioids is 3.1 per 100,000. But in Rhode Island, it's 13.2; in Massachusetts, 14.4; and in New Hampshire, which has the highest synthetic opioid death rate in the country, 24.1 out of every 100,000 people died from synthetic opiates in 2015." As for "deaths from what we might call the “classic” opioid painkillers — substances like hydrocodone and oxycodone.... These deaths are highly concentrated in two places: West Virginia in the East, and Utah in the West. "...there's not just one opiate epidemic but several. Solving the problem will similarly require a more nuanced basket of solutions than a blanket “war on drugs.” One unintended consequence of years of crackdowns on prescription painkillers was a resurgence in the use of heroin, for example."
Mother's obituary for Kelsey Grace Endicott, who died from a heroin overdose. "The disease of addiction is merciless. It is up to us to open our minds and hearts to those who are still sick and suffering." (See story by Buzzfeed (ignore the glaring graphics).
This is what heroin addiction looks like (Debbie Moore-Black, RN, Kevin MD, 4-6-17) What can I tell you? It started out innocently. College exams were over. And that meant one thing — party time! Bubbly, shots, beer, cocaine and Percocet. Pam came from a pretty strict religious family: no alcohol, no premarital sex and no crazy music growing up....How could I tell this woman what happened to her son?
Medicare Survey Could Be Contributing To Opioid Epidemic (Jacquelyn Corley, HuffPost, 6-23-16) 'The tragic growth in opioid-related deaths is not an aberration; it’s part of a 15-year-long trend the Centers for Disease Control and Prevention says is now a “national epidemic.” Researchers have identified numerous contributing factors related to the opioid crisis, including the changing dynamics of the doctor-patient relationship, the creation of more potent and long-acting drugs, and trends started by influential medical experts and academic societies in the late 1990s suggesting total pain control should be treated as an attainable medical ideal—the so-called “fifth vital sign.” "Doctors are faced with the challenge of curing patients and treating their pain, but they must also avoid unsafe prescribing practices that could lead to drug tolerance, addiction, or both. The HCAHPS survey inadvertently adds to this dilemma by making patients’ pain management effectively more important than their long-term health."

Pain as a vital sign has contributed to the opioid epidemic (Skeptical Scalpel, KevinMD, 9-10-14) "Vital signs are the following: heart rate, blood pressure, respiratory rate, temperature.
What do those four signs have in common?
They can be measured.
A sign is defined as something that can be measured. On the other hand, pain is subjective."
And that's where a major crisis started.

Nearly 1 in 3 on Medicare Got Commonly Abused Opioids (Carla K. Johnson, ABC News, 6-22-16) The leading opioids taken by Medicare patients were OxyContin, Percocet, Vicodin, fentanyl or their generic equivalents. Overdose risk for older Americans is heightened by medication interactions and alcohol.
Counterfeit Opioid Poisonings Spread To Bay Area (Barbara Feder Ostrov, Kaiser Health News, 4-28-16) In March and April 2016 patients were treated for overdoses after taking what they thought were tablets of Norco, a brand-name painkiller that combines acetaminophen and hydrocodone. But the counterfeit Norco, which the patients bought off the street, mostly contained the opiate fentanyl, which is 100 times more powerful than morphine, according to the CDC. They also contained promethazine, an allergy drug that’s believed to intensify the effects of fentanyl. The only safe prescription to take is one prescribed to you by your doctor and received from a legitimate pharmacy – not from a coworker, a friend or off the street.

America's Heroin Epidemic (Kate Snow and Janet Klein, NBC, 4-7-14). An award-winning series. Click on links to many related stories in the series. Here, Infographic: America's Heroin Epidemic (Janet Klein and Ronnie Polidoro).

Be the Death of Me (Kate Silver, Chicago Health, 8-29-15. Award winner.) Heroin deaths are rising as state-funded treatment falls in Illinois. "Heroin is the second most addictive drug there is--behind nicotine." "On those streets, he says, the DEA is seeing a higher demand coming from younger, wealthier, suburban folks who have been abusing painkillers. They turn to heroin for a simple reason: price."

Prescription For Death: How Painkillers Destroyed the Town of War, West Virginia (Vince Beiser, Playboy, 3-1-14) Prescription pills—especially painkillers—now kill more Americans every year than heroin, cocaine and all other illegal drugs combined. The overdose death rate in the backwater Appalachian town in which this award-winning story takes place is 16 times the national average.

Russia finally admits to its hidden heroin epidemic (Shaun Walker, Independent, 3-10-09) Surge in abuse blamed on West's failings in Afghanistan, but addicts go untreated

Painkiller politics: Effort to curb prescribing under fire (Matthew Perrone, Associated Press, 12-20-15). Perrone examines struggling efforts by the Centers for Disease Control and Prevention to rein in opioid abuse by releasing new guidelines on their use. Facing pushback from the drug industry and the FDA, CDC moved its deadline. Read the story! Also, read While heroin use grabs headlines, don’t forget coverage of prescription pain meds (Susan Heavey, Covering Health, Association of Health Care Journalists, 1-11-16)

Here’s how the White House plans to address rural America’s struggle with heroin (Juliet Eilperin, Washington Post, 1-14-16) The rural poor are “most stricken by the epidemic and have the least access to treatment.” Obama picks Tom Vilsack to address heroin spike (Kevin Liptak, CNN, 1-15-16) Four in five heroin users started out using prescription drugs, says Obama. So prescription drugs are the gateway to heroin addiction.

In Heroin Crisis, White Families Seek Gentler War on Drugs (Katharine Q. Seelye, NY Times, 10-30-15) "When the nation’s long-running war against drugs was defined by the crack epidemic and based in poor, predominantly black urban areas, the public response was defined by zero tolerance and stiff prison sentences. But today’s heroin crisis is different. While heroin use has climbed among all demographic groups, it has skyrocketed among whites; nearly 90 percent of those who tried heroin for the first time in the last decade were white....Over all, drug overdoses now cause more deaths than car crashes, with opioids like OxyContin and other pain medications killing 44 people a day."
Drug Overdoses Propel Rise in Mortality Rates of Young Whites (Gina Kolata and Sarah Cohen, NY Times, 1-16-16)
Organ Donation And The Opioid Epidemic: ‘An Unexpected Life-Saving Legacy’ (Martha Bebinger, WBUR, Kaiser Health News, 10-19-16) So far this year, more than one in four, or 27 percent, of organ donations in New England are from people who died after a drug overdose. Nationally, that rate is 12 percent for the same time period. Alexandra Glazier, president and CEO of the New England Organ Bank said the 12 transplant centers in that region may be more aggressive about finding a match for patients with failing hearts, livers or kidneys. And she said New Englanders tend to be pragmatic about end-of-life decisions.
Prescription Drug Abuse Among Older Adults Is Harder to Detect ) Constance, Gustke, NY Times, 6-10-16) The death of Prince highlighted the extent of prescription drug abuse among older adults, particularly those with plenty of money to spend. More older adults are becoming addicted to powerful pain pills like OxyContin and Percocet to drown out the aches and pains of aging. By 10 days of usage, you can be addicted. The loss of self-worth that sometimes comes with retirement, especially after a lifetime of achievement and accolades, can be the spark. Moreover, addiction thrives on a lack of structure and accountability. A lot of baby boomers are now retired, anxious and have trouble sleeping. Add in arthritis, multiple prescription drugs and more drinks, and that can be the beginning of addiction. “It’s the perfect storm,” said Brenda J. Iliff, executive director of Hazelden Betty Ford Foundation in Naples, Fla.
How the Epidemic of Drug Overdose Deaths Ripples Across America (Haeyoun Park and Matthew Bloch, NY Times, 1-19-16)
Strict opioids laws hit chronic pain sufferers hard (Felice J. Freyer, Boston Globe, 6-18-16) This is the other side of America’s war on opioids. As federal and state regulators rush to curtail access to drugs that have claimed thousands of lives, the rules they’ve enacted fall hard on people who legitimately need relief from pain.
Across Rural America, Drug Casts a Grim Shadow (Fox Butterfield, NY Times, 1-4-04) Lovell, population 2,264, and two nearby towns have become infested by methamphetamine. "What is happening in Lovell is happening across much of Wyoming, the least populated state in the country, where methamphetamine use is now more than twice the national average, according to the federal Substance Abuse and Mental Health Services Administration. Methamphetamine use and crime are also overrunning rural counties in Iowa, Nebraska, Kansas, Colorado, North Dakota and the Texas Panhandle, law enforcement officials say." "To the experts, methamphetamine is both a symptom of rural decline, as people give up on faltering farms and factories, and a cause that makes the decline worse."
‘How’s Amanda?’: A story of lies, truth and American addiction (Eli Saslow, Unnatural Causes: Sick and Dying in Small-Town America, The Washington Post’s series exploring rising death rates for white women in rural America continues with a story about Amanda Wendler — a 31-year-old woman struggling to get clean in the eleventh year of her opiate addiction. The days of waiting — for a key injection (of a drug called naltrexone) that could help curb Amanda’s heroin cravings — seem to go on forever. "... the fact that matters most for a chronic user is what it takes for just one addict to get clean. The relapse rate for heroin has been reported in various studies to be as high as 97 percent. The average active user dies of an overdose in about 10 years, and Amanda’s opiate addiction was going on year 11."
The Lonely Road of Staying Clean (Anne Hull, WaPo, 6-11-16) Jasper, Ala. In a town where pills are currency, opioid addicts have few options. "During a high school volleyball game in the 10th grade, she injured her spinal cord and was prescribed OxyContin. By 17, Jessica was crushing and snorting the pills. With a copy of her MRI, Jessica said she could leave a doctor’s office with prescriptions for 120 Roxicodone pills in 30-milligram strength, 90 additional Roxicodones in 15 mg strength, and 120 blue bars of Xanax — a total of 330 pills with fresh refills in a month."
Nearly six in 10 Americans have leftover narcotics at home (Lenny Bernstein, WaPo, 6-13-16)
CDC warns doctors about the dangers of prescribing opioid painkillers (Karoun Demirjian and Lenny Bernstein, WaPo, 3-15-16) “Starting a patient on opiates is a momentous decision, and it should only be done if the patient and the doctor have a full understanding of the substantial risks involved.” The CDC is encouraging patients to question doctors who prescribe opioids for chronic pain.
For Teenagers, Adult-Sized Opioid Addiction Treatment Doesn't Fit (Heidi Benson, Shots, NPR, 1-15-16) "While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they are rarely employed," reported the National Center on Addiction and Substance Abuse. And lack of effective treatment in the teen years can blight an entire life. This piece reports on evidence-based treatments--treatments that work. These include Screening, Brief Intervention and Referral to Treatment (SBIRT), a preventative protocol for early detection; Motivational Interviewing (MINT), a counseling approach that guides individuals to set goals; and Functional Family Therapy (FFT), which treats teens in a family setting.

The Opioid Crisis: Facts that news coverage is missing (Alan Cassels, Health News Review, 1-27-16)
Most Americans See Personal Tie toRising Prescription Painkiller Abuse (Lisa Gillespie, Kaiser Health News, 11-24-15) More than 56 percent of the public say they have a personal connection to the issue, reports the latest monthly tracking poll of the Kaiser Family Foundation. That share includes those who say they know someone who died from a painkiller overdose, have been addicted themselves or know someone who has and those who know someone who took painkillers not prescribed to them, the poll’s results show.
How I Learned to Stop Worrying and Love Methadone (Maia Szalavitz, The Fix, 8-19-12) 'Just like ex-junkie Russell Brand, I used to believe that “maintenance” was as bad—if not worse—than active addiction. Here’s how I came to understand how fatally wrong I was.' Maia is the author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, to be released in 2016
Experts Highlight A Growing Problem Of Substance Abuse Among Older Vermonters (Peter Hirschfeld, Vermont Public Radio, 11-5-15)
Covering the growing, underreported problem of elder substance abuse (Liz Seegert, Association of Health Care Journalists, 11-9-15)
Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014 (CDC, Morbidity and Mortality Weekly Report (MMWR), 1-1-16)
Using Patient Review and Restriction Programs to Protect Patients at Risk of Opioid Misuse and Abuse (a fact sheet from PEW Charitable Trusts, July 2015). As one strategy for minimizing deaths from opioids overdoses associated with prescription drug abuse, public and private insurance plans are using patient review and restriction (PRR) programs to encourage the safe use of opioids and other controlled substances. PRR programs identify patients who are at risk for prescription drug abuse and ensure that they receive controlled substance prescriptions only from designated pharmacies and prescribers. These programs have the potential to save lives and reduce health care costs by helping state Medicaid programs and private health plans better coordinate patient care and prevent inappropriate access to medications susceptible to abuse. Medicare beneficiaries could also benefit from PRR programs, but current federal law prohibits their use in this group of enrollees.
Two Acres of Hope for Recovering Addicts (Cara Buckley, NY Times, 8-14-09)
For teens with opioid use disorders, buprenorphine maintenance better than detox (Alison Knopf, Alcoholism Drug Abuse Weekly, 11-24-14)
The drug Suboxone could combat the heroin epidemic. So why is it so hard to get? (Susan Svrluga, Washington Post, 1-13-15)
Dying To Be Free (Jason Cherkis, Huff Post, 1-28-15) There’s A Treatment For Heroin Addiction That Actually Works. Why Aren’t We Using It?
The Neurobiology of Cocaine Addiction (Eric J. Nestler, NCBI, Sci Pract Perspect. Dec 2005; 3(1): 4–10).
Crack: The Drug That Consumed the Nation's Capital (listen online to WAMU-FM, NPR). 25 years ago, dealers sold crack at hundreds of open-air drug markets, addiction swept across entire neighborhoods, and D.C. came to be known as the "Nation's Murder Capital." In this five-part series, WAMU 88.5 explores the legacy of that era and how D.C. continues to grapple with an epidemic that affected families, neighborhoods, politicians, policemen, and schools. Read transcript here.

A Mother's Perspective on Her Son's Addiction (Angela Haupt, US News, her half of a two-part series, 7-24-13). Anita Devlin’s son was a drug addict. She explains how she helped him get better. See also:
One Man's Story: How I Beat Addiction Mike Devlin overcame his addiction to painkillers, cocaine, heroin and more. He shares his story. (Newsweek, his half of a two-part series, 7-24-13)

STIMULANTS--cocaine, crack cocaine, amphetamines (speed) and ecstasy (also a hallucinogen).
These "act on the central nervous system and are associated with feelings of extreme well-being, increased mental and motor activity."

Generation Adderall (Casey Schwartz, NY Times Magazine, 10-12-16) Like many of my friends, I spent years using prescription stimulants to get through school and start my career. Then I tried to get off them. I was terrified I had done something irreversible to my brain, terrified that I was going to discover that I couldn’t write at all without my special pills.
Understanding Stimulants (Addiction Center.com (855) 993-5977)
The most common prescription stimulants are amphetamines and methylphenidates. Prescription stimulants are used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy and sometimes obesity.
Treating addiction to prescription stimulants (National Institute on Drug Abuse, NIDA) "Treatment of addiction to prescription stimulants, such as Adderall and Concerta, is based on behavioral therapies used in treating cocaine and methamphetamine addiction. At this time, there are no medications that are FDA-approved for treating stimulant addiction. Thus, NIDA is supporting research in this area."

ADHD and Substance Abuse (WebMD) See ADHD and Drug Abuse Directory

Overcoming cocaine or stimulant addiction (Harvard Mental Health Letter)

How Stimulants Affect the Brain and Behavior (Chapter 2 from Treatment for Stimulant Use Disorders (free from SAMHSA

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Dealing with the opioid crisis

The opioid epidemic in the United States has been triggered largely by prescription drugs, exacerbated by heavy marketing of drugs for pain relief (and doctors being persuaded to emphasize treatment of pain, in the 1990s). There is no question we're in the midst of an opioid crisis. The question is, how do we best control or end it? How do we identify and address underlying causes?
The opioid epidemic: It’s time to place blame where it belongs (Ronald Hirsch, Kevin MD, 4-6-16) "I call on Congress to hold hearings and compel the top executives from Purdue Pharmaceutical, the Joint Commission, Press Ganey, and CMS and hospital administrators to appear and testify as to their role in this national epidemic."
The opioid epidemic may be even deadlier than we think (German Lopez, Vox, 4-26-17) The current drug crisis already kills more people than guns or cars. But a new study suggests it’s even worse than the current numbers say. See section labeled "The opioid epidemic, explained in fewer than 600 words."
Public Restrooms Become Ground Zero In The Opioid Epidemic (Martha Bebinger, WBUR, Kaiser Health News, 5-11-17) People often turn to public restrooms as a place to get high on opioids. It has led some establishments to close their facilities, while others are training employees to help people who overdose.
Getting Patients Hooked On An Opioid Overdose Antidote, Then Raising The Price (Shefali Luthra, Kaiser Health News, ) First came Martin Shkreli, the brash young pharmaceutical entrepreneur who raised the price for an AIDS treatment by 5,000 percent. Then, Heather Bresch, the CEO of Mylan, who oversaw the price hike for its signature Epi-Pen to more than $600 for a twin-pack, though its active ingredient costs pennies by comparison. Now comes Evzio, a device that administers just enough naloxone (Vivitrol) to stabilize someone who has overdosed on drugs. Its manufacturer, Kaleo, may be positioning itself to find profits in a dire health care crisis. (Will Republicans, who are heavily supported by the pharmaceutical industry, be willing to limit price-gouging on life-saving medicine and devices?)
Drug Epidemic: 1 Small-Town Mayor Takes on Pill Distributors (AP, NY Times, 4-7-17) In this once prosperous West Virginia coal town of 1,900 people, residents say it's not just the decades-long demise of mining that hurt the community — it's the scourge of drug use that came with it. Here, almost everyone knows someone who became addicted. And the Appalachian town is fighting back by suing some of the biggest U.S. drug distributors, hoping to make them pay for the damage done by addiction. Lawyers say growing pushback by communities, many in West Virginia, could ultimately rival the scope of litigation against tobacco companies over smoking.
Prisons fight opioids with $1,000 injection: Does it work? (Carla K. Johnson, AP, AARP, 11-14-16) "The evidence for giving Vivitrol to inmates is thin but promising. In the biggest study, sponsored by the National Institute on Drug Abuse, about 300 offenders — most of them heroin users on probation or parole — were randomly assigned to receive either Vivitrol or brief counseling and referral to a treatment program. The evidence for giving Vivitrol to inmates is thin but promising. In the biggest study, sponsored by the National Institute on Drug Abuse, about 300 offenders — most of them heroin users on probation or parole — were randomly assigned to receive either Vivitrol or brief counseling and referral to a treatment program. After six months, the Vivitrol group had a lower rate of relapse, 43 percent compared with 64 percent. A year after treatment stopped, there had been no overdoses in the Vivitrol group and seven overdoses, including three deaths, in the other group.... Yet addiction is stubborn. When the injections stopped, many in the study relapsed. A year later, relapse rates looked the same in the two groups."

A little explanation (drawn from website of The National Alliance of Advocates for Buprenorphine Treatment): "An agonist is a drug that activates certain receptors in the brain. Full agonist opioids activate the opioid receptors in the brain fully resulting in the full opioid effect. Examples of full agonists are heroin, oxycodone, methadone, hydrocodone, morphine, opium and others."
"An antagonist is a drug that blocks opioids by attaching to the opioid receptors without activating them. Antagonists cause no opioid effect and block full agonist opioids. Examples are naltrexone and naloxone. Naloxone is sometimes used to reverse a heroin overdose."
Methadone and buprenorphine are "agonists." Vivitrol is an extended release formulation of naltrexone, an opioid receptor "antagonist." Buprenorphine is a "partial agonist," meaning it activates the opioid receptors in the brain, but to a much lesser degree than a full agonist. Buprenorphine also acts as an antagonist, meaning it blocks other opioids, while allowing for some opioid effect of its own to suppress withdrawal symptoms and cravings....Buprenorphine is in a category of its own and therefore should not be seen as “replacement” or "substitution" for anything else.
Addiction Treatment With a Dark Side (Deborah Sontag, NY Times, 11-16-13) The Double-Edged Drug. Many addicts credit buprenorphine, sold mostly in a compound called Suboxone, with saving their lives. "Suboxone is the blockbuster drug most people have never heard of. Surpassing well-known medications like Viagra and Adderall, it generated $1.55 billion in United States sales last year, its success fueled by an exploding opioid abuse epidemic and the embrace of federal officials who helped finance its development and promoted it as a safer, less stigmatized alternative to methadone. But more than a decade after Suboxone went on the market, and with the Affordable Care Act poised to bring many more addicts into treatment, the high hopes have been tempered by a messy reality. Buprenorphine has become both medication and dope: a treatment with considerable successes and also failures, as well as a street and prison drug bedeviling local authorities. It has attracted unscrupulous doctors and caused more health complications and deaths than its advocates acknowledge. It has also become a lucrative commodity, creating moneymaking opportunities — for manufacturers, doctors, drug dealers and even patients — that have undermined a public health innovation meant for social good."
"Intended as a long-term treatment for people addicted to opioids — heroin as well as painkillers — buprenorphine, like methadone, is an opioid itself that can produce euphoria and cause dependency. Its effects are milder, however, and they plateau, making overdoses less likely and less deadly."
In other words, Methadone and buprenorphine are subject to "street use" and abuse -- partly because of the hoops we make people jump through to get access to them.
At Clinics, Tumultuous Lives and Turbulent Care (Deborah Sontag, NY Times, 11-17-13) "Buprenorphine was developed as a safer alternative to methadone for treating heroin and painkiller addiction, a take-home medication that could be prescribed by doctors in offices rather than dispensed daily in clinics. But in some areas a de facto clinic scene, unregulated, has developed, and it has a split personality — nonprofit treatment programs versus moneymaking enterprises built by individual doctors, some with troubled records....Since March, The New York Times has visited and tracked the patients of two of the largest buprenorphine programs in this region, where addiction rates are high, for-profit clinics have proliferated, doctors go in and out of business and the black market is thriving."
• In a discussion among health journalists in March 2017, Elizabeth Leary (MSN, RN) explained : "Vivitrol at least is not an opioid and, for patients who are so addicted that they are in the criminal justice system, not having to give a daily dose is actually more effective for what is essentially a homeless and transient street population. Good luck getting them into clinic every day for observed drug therapy. With Vivitrol you can reduce the cravings by not trading one opioid for another, and the patient's thought process begins to change. The real downside to Vivitrol is if the patient happens to need surgery within the 28 days that the shot lasts, because these are high risk patients (often GI bleeders from alcohol abuse for example) where the need for surgery is a real risk and you can't give them opioids for pain control with Vivitrol on board. You basically have to control the pain with anesthesia, which is less than ideal."
When you stop using Vivitrol for opioid treatment, you have a very high risk of death from relapse to opioid use. You don't have that same risk of death using Vivitrol to treat alcoholism, because alcohol relapses are rarely deadly, says journalist Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, who has written extensively on addiction and treatments for it.
A Shot in the Dark: Can Vivitrol Help Us Control Our Addictions? (Walter Armstrong, The Fix, via Pacific Standard, 5-7-13) "Called Vivitrol and made by Boston-based biotech Alkermes, it has been on the market for alcoholism since 2006 and for opiate addiction since 2010. It is not, however, a new drug. It is a new injectable formulation of an old drug called naltrexone, a once-a-day pill prescribed since the mid-‘90s for addiction. The newsiest thing about Vivitrol may be its price tag. While naltrexone, a generic, has an insurance copay averaging $11 a month, Vivitrol costs — deep breath! — about $1,100 a month. A growing number of health insurers are covering all or part of the bill." "Many doctors, when faced with a patient with a drinking problem, don’t think to offer it as a treatment option. Likewise, this addiction medication often gets short shrift in rehabs and 12-step programs. But being a patient means advocating for yourself, so if you want to, you may have to demand to give this shot a shot....The prevailing treatment philosophy is that no single approach is best for everyone. Tailoring the treatment to the individual is the standard of care, even if doing so can involve trial and error." An exploratory article worth reading.
Here’s What’s Wrong With How US Doctors Respond to Painkiller Misuse(Maia Szalavitz, Substance.com, 1-13-15). Too often, Americans with painful medical conditions who misuse pain pills like Oxycontin are denied further treatment and even prosecuted. There are more effective, enlightened responses—as the UK has shown for decades.
Update on Medication Assisted Treatment (MAT) in a County Health and Behavioral Health System (Robert Paul Cabaj, MD, San Mateo County report to SAMHSA) San Mateo reported a dramatic drop in ER visits (from 5.8 to 0.2) and number of drinking days for the patients they treated with Vivitrol.
Former Addict: What Indiana Can Learn From New York About Needle Exchanges (Maia Szalavitz, Time, 4-5-15) "The fact that in 2015, federal funding is still banned for needle exchange and 25 states still require people to get a prescription to buy needles is an outrage — both from the human and from the economic perspective. But what’s even more frustrating is that politicians and many journalists still see needle exchanges as controversial when the data on their safety and efficacy is actually stronger than for virtually any other public health intervention, including condoms."
Nonprofit Provides Financial Assistance For Opioid Treatment (Zoe Mitchell, Deborah Becker, WBUR, 2-22-17) Despite efforts to stem the tide of opioid overdose deaths in Massachusetts, the latest numbers suggest that a record number — some 2,000 people — died of overdoses last year. One of the grassroots groups working to make a dent in this crisis is called Magnolia New Beginnings. It was formed by parents on the North Shore a few years ago to provide support to other parents and to help financially, providing scholarships for long term substance use treatment, which typically is not covered by health insurance.
Facing Pressure, Insurance Plans Loosen Rules For Covering Addiction Treatment (Shefali Luthra, Kaiser Health News, 2-21-17) Insurance companies slowly reconsidering the insurance practice of requiring "prior approval" before doctors prescribe particular medications-- such as Suboxone--that are used to mitigate withdrawal symptoms, drugs typically given along with steady counseling. Addiction specialists say this red tape puts people’s ability to get well at risk. It gives them a window of time to change their minds or go into withdrawal symptoms, causing them to relapse. “If someone shows up in your office and says, ‘I’m ready,’ and you can make it happen right then and there--that’s great.
Pharmacies Thrive Selling Opioids For Depressed Small Town Pain (Phil Galewitz, Kaiser Health News, 2-8-17) Eleven drug stores, mostly independents, are scattered about a tiny Kentucky city of 1,500 people. Manchester’s closest inpatient drug treatment facility carries a waiting list of 100 people that’s grown more than 50 percent in recent years. The state’s Medicaid expansion was both good and bad for those fighting the opioid epidemic. “It did enable people to get pain pills for free if they can get someone to prescribe them but it also increased their ability to get treatment because they now had a way to pay for it." If the ACA made cheap drugs more available, it also made treatment more accessible because it required coverage of mental health and substance abuse treatment.
I am a doctor, but I didn’t cause the opioid epidemic (Tanya Feke, Kevin MD, 5-26-16) "While JCAHO did not demand doctors write prescriptions for narcotics per se, their emphasis on pain led to significant changes in medical practices. Patient satisfaction surveys too have permeated health care. Patients often give low scores when their pain is not *completely* controlled or when they do not get the medications they want. This, in turn, affects how hospitals are paid, and hospitals go on to penalize doctors. Clearly, these surveys should not be tied to financial incentives....Decreasing the number of opioid prescriptions will not solve the problem on its own. The problem is much larger than that.... We need an American detox, and we need one now. The large majority of doctors are not part of the problem but can be part of the solution. A group of physicians in my hometown of New Bedford, Massachusetts has formed a group, Physicians to Prevent Opioid Abuse, to combat the issue. We bring creative solutions to a challenging problem, but we cannot do it alone. We need your help. America needs to stand together, not pointing fingers, but working as one to make a difference and save lives.
My Personal Experiences with the Medical Marijuana Business and the Opioid Epidemic (David Meerman Scott, Healthcare in America, 1-4-17) Marijuana is a safer alternative to opioids for pain relief, but you have to jump through hoops to qualify for medical marijuana. A business story that may prove helpful.
Drug firms poured 780M painkillers into WV amid rise of overdoses (Eric Eyre, Charleston Gazette-Mail, 12-17-16). Part of its Painkiller Profiteers series, which includes Drug wholesaler agrees to pay $3.5M to settle WV lawsuit (1-3-17). See also WV’s horrible painkiller death toll (12-21-16), Painkiller Profiteers ; Opioid Abuse in West Virginia; Pill Rules Not Enforced; Suspicious Drug Order Regulation Not on Pharmacy Boards Radar.
Doctor charged with selling pain pills pleads not guilty (AP, WaPo, 4-7-17) A New Jersey doctor has pleaded not guilty to charges that he sold prescriptions for highly addictive opioid painkillers to people who had no medical need for them, including one man who died from an overdose. An attorney representing Dr. Byung Kang, of Little Falls, entered the plea during a court hearing.
Is Prescription Opioid Abuse a Crime Problem or a Health Problem? (Nancy Shute, NPR, 12-3-15) Although many people know someone who has abused prescription opioids, people still think of opioid abuse as a criminal justice issue more than a health problem, a study finds. When it came to possible solutions, more than half the news stories, 64 percent, mentioned law enforcement...41 percent mentioned prevention, and just 3 percent mentioned expanding treatment.
Paper makes audacious decision to highlight silent epidemic (Susannah Nesmith, Columbia Journalism Review, 12-2-16) "The Palm Beach Post made the bold decision to profile all 216 people who died of an opioid overdose in its coverage area last year, risking the wrath of victims’ families, some of whom were horrified to have their private pain publicized. The stark display of photos of each of the dead, accompanied by brief profiles, effectively served The Post’s goal—drawing attention to the magnitude of the crisis in a way statistics simply could not, while bringing addiction out of the shadows. The “Generation Heroin” project, rolled out last month, was motivated by the reporters’ discovery that many people were overdosing inside controversial sober homes where they had gone to get better. When the reporters dug deeper, they realized the sheer scope of the problem was far worse than they had imagined: More people died in Palm Beach County from heroin, fentanyl, or illicit morphine overdoses in 2015 than in car accidents.
Killer Drugs: Tackling Opioid Addiction and Overdose (Kristin Gourlay, Rhode Island Public Radio). Also of interest: RI Hospital ER Chief: "There has to be a better way." (about a Rhode Island plan to open a sobering center in Providence, to move people who simply need to sober up out of the emergency room, to a place where they can be offered substance abuse treatment and other resources, like housing. Says Brian Zink, that would save money and free up beds, and would mean that addicts get more appropriate treatment.
Hooked: Tracking Heroin's Hold on Arizona, a special investigative report and documentary produced by advanced journalism students at the Walter Cronkite School of Journalism and Mass Communication on the growing perils of heroin and opioid use (Cronkite News Online, 1-13-15). As the drug pours into the state, an epidemic of addiction threatens a generation of young people, their families and friends. Many pieces here.
Drug maker thwarted plan to limit OxyContin prescriptions at dawn of opioid epidemic (David Armstrong, STAT, 10-26-16) Officials of West Virginia's state employee health plan "noticed a surge in deaths attributed to oxycodone, the active ingredient in the painkiller OxyContin. They quickly decided to do something about it: OxyContin prescriptions would require prior authorization. It was a way to ensure that only people who genuinely needed the painkiller could get it and that people abusing opioids could not. But an investigation by STAT has found that Purdue Pharma, the manufacturer of OxyContin, thwarted the state’s plan by paying a middleman, known as a pharmacy benefits manager, to prevent insurers from limiting prescriptions of the drug."
John Oliver Explains How Drug Companies Helped Cause Our Opiate Epidemic (Bryan Menegus, Gizmodo, 10-24-16) "In John Oliver’s latest report, he unpacks the alarming history of the epidemic, and how the drug companies we entrust with our health helped create it....Opiates were hardly prescribed in the 90s except in the most extreme cases of pain management. How did we go from that to nearly half a million opiate-related deaths between 2000 and 2014? The answer, as John Oliver explains, lies in greedy drug companies. When Oxycontin was developed by Purdue in the late 90s, the company marketed it aggressively—in itself not unusual. Oliver points out that what made Purdue’s campaign bad was how grossly it misrepresented the product’s addiction potential. Not only did the company invent the term “pseudo-addiction” to discredit the seriousness of patient dependence, but it also claimed actual addiction befell “less than 1 percent” of those prescribed Oxycontin."...
"Easily the shadiest and most disgusting example Oliver gives involves the company Insys getting fentanyl into the hands of people who didn’t really need it. Easily the shadiest and most disgusting example Oliver gives involves the company Insys getting fentanyl into the hands of people who didn’t really need it. While only approved for use in treating cancer pain, Insys found a loophole to get this powerful drug prescribed to patients, and to get insurance companies to pay for it."
How Doctors Helped Drive the Addiction Crisis "The rate of death from prescription opioids in the United States increased more than fourfold between 1999 and 2010, dwarfing the combined mortality from heroin and cocaine. In 2013 alone, opioids were involved in 37 percent of all fatal drug overdoses....starting in the 1990s, there has been a vast expansion in the long-term use of opioid painkillers to treat chronic nonmalignant medical conditions, like low-back pain, sciatica and various musculoskeletal problems. To no small degree, this change in clinical practice was encouraged through aggressive marketing by drug companies that made new and powerful [i.e., dangerous] opioids, like OxyContin, an extended-release form of oxycodone...What the public — and physicians — should know is that there is strong evidence that nonsteroidal anti-inflammatory drugs (Nsaids), like Motrin, and other analgesics like Tylenol are actually safer and more effective for many painful conditions than opioid painkillers." Physicians: Stop prescribing opioids promiscuously!
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Kratom as alternative to opioids


Is Kratom a Deadly Drug or a Life-Saving Medicine? (Bryan Gruley Medium, 12-11-16)
What’s Next for Kratom after the DEA Blinks on Its Emergency Ban? (Angus Chen, Scientific American, 10-17-16) "Public pressure keeps the herbal supplement unregulated for now, encouraging users and researchers seeking a safer alternative to opioids. The DEA’s about-face comes about a month and a half after it first announced its intent to put kratom in its most restrictive drug category, Schedule I, which is reserved for substances deemed to have no currently accepted medical use and a high risk of abuse. It also includes heroin and LSD....For its next step, the DEA is opening a six-week period for the public to comment on concerns, research and science related to kratom. After that the agency will look to the Food and Drug Administration to complete an evaluation of kratom’s medical and scientific potential."
Kratom Drug Ban May Cripple Promising Painkiller Research (Angus Chen, Scientific American, 9-27-16) Compounds from the Southeast Asian tree offer hope for a safer opioid alternative, but research could slow to a crawl as the DEA steps in
Should Kratom Use Be Legal? (Larry Greenemeier, Scientific American, 9-30-13) Thailand is considering legalizing kratom as a safer alternative for meth addicts, and U.S. researchers are studying its potential to help opiate abusers kick the habit without withdrawal side effects. Is that a good thing?
Recreational Drug Kratom Hits the Same Brain Receptors as Strong Opioids (David Kroll, Scientific American, 6-8-16) Researchers studying the neurochemistry of alkaloids from the Mitragyna plant show for the first time that kratom’s primary constituent, mitragynine, and four related alkaloids bind to and partially activate human µ-opioid receptors (MORs), the primary targets of strong opioids in the brain, spinal cord, and gastrointestinal tract. For recreational drug users looking for an opioidlike high without the legal problems of heroin, fentanyl, and oxycodone, the Southeast Asian plant called kratom (Mitragyna speciosa) has provided an attractive alternative. But, acting on anecdotal reports of people becoming dependent on kratom, six states, including Vermont and Indiana, have banned the sale and use of the herb.
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Alcoholism--and approaches to treatment

Alcohol Does More Harm than Heroin and Crack (Temma Ehrenfeld. YourCareEverywhere, 6-3-15) 'Legal drugs are the deadliest. Alcohol use causes more than 4 percent all deaths worldwide, more than the number caused by HIV/​AIDS, violence, or tuberculosis, according to a 2011 report by the World Health Organization. It is associated with violence, child neglect and abuse, crime, missing work-days, and of course, traffic accidents. ”Yet, despite all these problems, the harmful use of alcohol remains a low priority in public policy, including in health policy,” the authors write. We spend huge sums on fighting a war on illegal drugs and pay little attention to the misuse of a legal one.'
Alcoholics Anonymous: The Big Book and Twelve Steps and Twelve Traditions (Alcoholics Anonymous). Or go to a meeting. Eleven of the steps do not mention alcohol. As one reviewer, Barry, writes, "Sobriety is about a new way of life free of alcohol, and this life is meant to be happy, joyous and free, not merely 'dry' and miserable. The best way to achieve this is to get a sponsor and make use of that sponsor, which will likely involve reading these books and considerable other action as well."
Hiding Addiction Behind Depression (Temma Ehrenfeld, The Fix, 03/​03/​16) Alcoholism cost him his life, after professionals said. my partner was just depressed. A must read if someone you love is struggling with both depression and a tendency to drink too much.
Does Alcoholics Anonymous Work? (Scott O. Lilienfeld and Hal Arkowitz, Scientific American 2-17-11) For some heavy drinkers, the answer is a tentative yes.
After 75 Years of Alcoholics Anonymous, It's Time to Admit We Have a Problem (Maia Szalavitz, Pacific Standard, 2-10-14) Challenging the 12-step hegemony -- a review of several books on addiction treatment and thereby a survey of treatment. Definitely read this one.
The Recovery Book: Answers to All Your Questions About Addiction and Alcoholism and Finding Health and Happiness in Sobriety by Al J. Mooney MD and Catherine Dold
Alcoholics Anonymous (AA) is self-help group, organised through an international organization of recovering alcoholics, that offers emotional support and a model of abstinence for people recovering from alcohol dependence using a 12-step approach. (M Ferri, L Amato, M Davoli, Cochrane Primary Review Group, 7-19-06). "No experimental studies unequivocally demonstrated the effectiveness of AA or TSF [twelve-step] approaches for reducing alcohol dependence or problems. One large study focused on the prognostic factors associated with interventions that were assumed to be successful rather than on the effectiveness of interventions themselves, so more efficacy studies are needed."
Alcoholism In-Depth Report (NY Times)

Trading Alcoholism for Sugar Addiction: Here’s the Not-So-Sweet Truth (Promises Treatment Center). See also The Importance of Nutrition in Addiction Recovery
5 Things I Miss About Alcoholism (Emerson Dameron, Be Yourself, 12-6-16) A look at life viewed through those rose-colored glasses he took off when he went sober.
A daughter’s lifetime with a father’s slow self-destruction (Alisa Schindler, WaPo, 2-29-16) "Amazingly, a small glimmer of childhood idolization lingers. Forget the hospital stays, the dependencies, the self-destruction, the emotional manipulation, the cries for help that always leave me crying. I want to believe that this 73-year-old man will somehow find his way back..."
Alcoholism: The Science Made Easy (free, Addiction Technology Transfer Center Network)
Alcoholism and alcohol abuse (Medline Plus)
Giving up alcohol opened my eyes to the infuriating truth about why women drink (Kristi Coulter, 24-Hour Women, Quartz, 8-21-16) I’m newly sober and dog-paddling through the booze all around me. It’s summer, and Whole Foods has planted rosé throughout the store....
Why SMART Recovery Will Never Replace Alcoholics Anonymous (Matthew Leichter, The Fix, 9-23-14) "Alcoholics Anonymous thrives as a social network, more than a recovery program. In terms of being a place where someone can go on a daily basis to socialize, Alcoholics Anonymous kicks everyone else into the dirt. Clubhouses, halfway houses, and thousands of meetings a day all across the United States place this goliath as #1 in accessibility. Regardless of anything else, their mere size and emphasis on constant contact and socialization is something that no other program has been able to replicate....While recovery rates are better for SMART Recovery in clinical settings, SMART Recovery® fails to embrace the idea of building a social network. While they encourage a healthy support group, they really don’t do anything about it....While AA is rather zealous in its demands for attending meetings, the fact is that some people do need a new daily social structure to start their new life. Even Dr. Lance Dodes in his book the Sober Truth, a brutally critical account of AA, recognizes that the social aspect of AA is valuable."
Mom's Night in the Slammer (Leslie Schwartz, Narratively, 6-4-14) A recovering alcoholic rebuilds her life and becomes the perfect doting mother, until a fateful relapse sparks a downward spiral and a tumultuous night in jail.
The little pill that could cure alcoholism When an alcoholic doctor began experimenting with Baclofen, he made what could be the medical breakthrough of the century. Is alcoholism "a physical condition with a spiritual solution," as Alcoholics Anonymous has long insisted? Dr Olivier Ameisen no longer thinks so --having successfully ended his own debilitating addiction, he thinks he's found a revolutionary cure for the disease in the form of a widely available pill. His book: The End of My Addiction: How One Man Cured Himself of Alcoholism.
The Drunk's Club: A.A., the Cult that Cures (PDF, Clancy Martin, Harper's, Jan. 2011)
Surviving an Alcoholic (Paula Ganzi Licata, NY Times, 5-27-16) Shame is just one challenge for survivors of alcoholics. But it’s nothing compared with the guilt.
Alcohol and Cirrhosis of the Liver (Recovery Connection)
A 20-Year-Old Went to Rehab and Came Home in a Body Bag (Wilbert L. Cooper, Vice, 11-4-14). An expose of the high-end-$$ drug treatment world, through the story of one boy and family it failed: Brandon Jacques, whose dual diagnosis of bulimia and alcohol addiction called for better treatment and medical care than the overpriced "treatment" facility could provide. ("...it's illegal for residential drug and alcohol programs like Morningside to provide any medical care in the State of California, because of an old, controversial law that is a vestige of the rehab industries' AA-based, nonmedical beginnings....Because the State of California has done such a poor job of enforcing the ban on in-house professional medical care, facilities like Morningside get the best of both worlds--they can market themselves as medical facilities to attract more clients without fear of getting shut down, but they don't have to spend the money on medical care or jump through the regulatory hoops required of a facility practicing medicine.") Here is video on the same story: From Rehab to a Body Bag | Dying for Treatment (Vice video, Nov 2014) From Rehab to a Body Bag | Dying for Treatment. "Although non-hospital residential treatment serves only about 10 percent of those in recovery in the US, the exorbitant cost of such care--as high as $75,000 a month--has made it extremely lucrative....these centers operate in a gray zone somewhere between legitimate medicine and total quackery, offering things like horseback riding and meditation as solutions to addiction, and often promising medical care that they are unable to provide--sometimes with disastrous results." (I've repeated this entry from general section above on addiction, treatment, and recovery, generally, because it makes an important point.)
The scientific effects of drunk driving (Substance.com infographic)
Is your health care provider an addict? The problem we can’t ignore (Judi Kanne, Georgia Health News, 9-11-16)
50 Essential Tips To Help You Stay Clean And Sober
and Alternatives To AA and Is There Such Thing As An Alcoholic Personality? (Clean and Sober Live)
Did Alcoholism Kill Joan Didion's Daughter? (Jenna Sauer, Jezebel, 12-13-11)
The pseudo-science of Alcoholics Anonymous: There’s a better way to treat addiction (Dr. Lance Dodes and Zachary Dodes, Salon, 3-23-12). An excerpt from their book The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry. Read the comments on Amazon, for views pro and con, including "one size does not fit all."
Acute alcohol use temporally increases the odds of male perpetrated dating violence: a 90-day diary analysis (PubMed Jan. 2014)
Alcohol Awareness. Emphasizes how alcohol is often abused as a way to deal with depression, which may make the symptoms worse, and lead to suicide.

Helpful books about addiction and recovery


Unbroken Brain: A Revolutionary New Way of Understanding Addiction by Maia Szalavitz (2016). She argues "that addictions are learning disorders and shows how seeing the condition this way can untangle our current debates over treatment, prevention and policy. Like autistic traits, addictive behaviors fall on a spectrum -- and they can be a normal response to an extreme situation. By illustrating what addiction is, and is not, the book illustrates how timing, history, family, peers, culture and chemicals come together to create both illness and recovery- and why there is no "addictive personality" or single treatment that works for all." Writes the Wall Street Journal reviewer: "Ms. Szalavitz deftly threads her life story through the book to illustrate the dynamics that put people at risk of addiction."
Inside Rehab: The Surprising Truth About Addiction Treatment--and How to Get Help That Works by Anne M. Fletcher (2013). Review from Publishers Weekly: "Some things never change. And as Fletcher (Sober for Good) finds in this bold report on 15 rehab facilities—from high-end, celebrity-friendly outposts to those treating people on welfare—that fact especially pertains to addiction treatment. Collecting stories from more than 100 interviews, Fletcher methodically dissects the myths about the programs that treat 2.5 million people every year. She finds, for example, that rehab isn't necessary for recovery—some heal on their own, attend self-help groups, or see therapists; that most of the treatment in rehab programs is handled not by highly trained pros but by counselors with varying levels of education and training. She debunks myths, such as that the 12 steps of Alcoholics Anonymous are essential for recovery. Fletcher concludes that traditional programs, such as group treatment, 12 step programs, and counseling, work for some but not for all. Dimitri, for instance, began abusing drugs at 15 and cycled in and out of programs that failed to help him. Fletcher also highlights the exorbitant cost of rehab: one young woman's treatment drained her parents.... Fletcher presents what works, why, where to find it, and how much it costs. It's startling, difficult, and important information for those traveling toward recovery, and anyone who wants to help."
Clean: Overcoming Addiction and Ending America’s Greatest Tragedy by David Sheff, author of Beautiful Boy: A Father's Journey Through His Son's Addiction. "Addiction is a preventable, treatable disease, not a moral failing. As with other illnesses, the approaches most likely to work are based on science — not on faith, tradition, contrition, or wishful thinking. These facts are the foundation of Clean, a myth-shattering look at drug abuse by the author of Beautiful Boy. Based on the latest research in psychology, neuroscience, and medicine, Clean is a leap beyond the traditional approaches to prevention and treatment of addiction and the mental illnesses that usually accompany it. The existing treatment system, including Twelve Step programs and rehabs, has helped some, but it has failed to help many more, and David Sheff explains why. He spent time with scores of scientists, doctors, counselors, and addicts and their families to learn how addiction works and what can effectively treat it. Clean offers clear, cogent counsel for parents and others who want to prevent drug problems and for addicts and their loved ones no matter what stage of the illness they’re in. But it is also a book for all of us — a powerful rethinking of the greatest public health challenge of our time."
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Rehab facilities


First, the bad news
10 things rehab centers won’t tell you (Charles Passy, MarketWatch, MSN, 5-16-04). They aren't always effective, their success rates may mean little, a pricier program is not necessarily a better program, their staff may not be all that well-schooled. they'll invade your neighborhood, they may be a scam, you may be better off at home, etc. "The month-or-longer stint in rehab may be the classic treatment model, but it’s far from the only option. And depending on a patient’s needs and situation, it may not even be the best, according to many in the field. In fact, some studies have shown that success rates – in terms of maintaining sobriety – are just as high for outpatient programs (which are often much more affordable) as inpatient ones. On top of that, Fletcher, author of Inside Rehab raises the notion that some addicts may also do just as well with one-on-one counseling or self-help programs. Or to quote a subheading in one of the chapters of her book: 'Does anyone need residential rehab?'"
The Rehab Racket: The Way We Treat Addiction Is a Costly, Dangerous Mess (John Hill, Mother Jones, May.June 2015 issue) On December 30, 2012, as part of a series called Drugged, the National Geographic Channel aired an hourlong documentary about a 28-year-old named Ryan Rogers. It appeared to be a classic tale of a drunk trying against the odds to sober up, albeit with especially harrowing footage and an unusually charismatic protagonist, often shown with a radiant smile on his handsome face. Ryan Rogers was a 28-year-old alcoholic who entered a posh rehab facility to sober up. "Ryan took a courageous step," the narrator intoned. "But 17 days into rehab, he died."
"What transpired at Bay Recovery is one example of why the rehab regulatory system is so often described as fragmented. DADP was responsible for licensing the facility, but it's unclear whether it knew about Rand's earlier probations. And while the medical board had charged that Rand was admitting patients who were too medically and psychologically unstable to be treated at his facility, DADP never addressed this issue while Ryan was alive."
Rehab Racket (Center for Investigative Reporting) The programs are supposed to help struggling addicts. But scammers make millions running troubled rehab clinics, even inventing fake clients to rip off taxpayers. The Center for Investigative Reporting teamed with CNN to expose fraud in California's taxpayer-funded drug and alcohol counseling program.
---Bill seeking background checks for rehab clinic owners advances (Will Evans, 4-24-14)
---California rehab clinics bill taxpayers for fake clients, addictions (Will Evans, Christina Jewett, 7-29-13)
---Lax oversight leaves California drug rehab funds vulnerable to fraud (Christina Jewett, Will Evans, 7-29-13)
---Clinic leaders tied to fraud in LA reap taxpayer funds in Riverside County (Christina Jewett, Will Evans, 7-29-13)
---Video: Watch CNN's three-part series "Rehab Racket."
---Amid fraud allegations, rehab doctor OKs treatment without seeing patients (Will Evans, Christina Jewett, Special to CNN, 10-22-13)

I am still trying to figure out how to guide others on how to find the good rehab facilities. Advice welcome.
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Sober living housing options

Making Space for Sobriety (Ryan Caron King, Atavist, published on WNPR). When a person who addicted to drugs or alcohol is discharged from rehab, they’ll sometimes live in what’s called a sober house -- a place where there’s supposed to be no drugs or alcohol around. Same as or similar to How One Agency Is Improving Conditions in Connecticut's Sober Houses (Ryan Caron King, WNPR, 10-4-16) "When someone who is addicted to drugs or alcohol is discharged from rehab, they’ll sometimes pay to live in a privately-owned sober living home like this one, Right Path House. But private sober houses aren’t regulated by the state, and experts in the field say some houses don’t enforce their own sobriety rules -- which can jeopardize the safety of the people that live there and the neighborhood the house is in. So Aligata is working to train and certify sober house owners across the state through a voluntary program. He wants to compile an online database of certified sober houses that he hopes will make it easier for people with addiction to find a place to continue their recovery after rehab."
Sober Living Homes and Housing Options (Rehabs.com) What are sober living homes? How are they different from rehab centers? Why types of rules do sober living facilities require? Who can live in a sober living house? How much does it cost?
Living With a Recovering Drug Addict or Alcoholic (Recovery.org)
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Miscellaneous issues associated with addiction

Prescription Drug Costs Are On The Rise; So Are The TV Ads Promoting Them (Bruce Horovitz and Julie Appleby, Kaiser Health News, 3-20-17) Pharmaceutical advertising exceeded $6 billion in 2016, with television picking up the lion’s share. Critics say the ads encourage patients to ask their doctors for expensive, often marginal — and sometimes inappropriate — drugs that are fueling spiraling health care spending. The American Medical Association called for a ban on such ads, but "Such a prohibition is unlikely. Previous efforts to push such an outcome have stalled, generally on free-speech arguments by the powerful drug lobby and assertions that such ads provide valuable information to patients about treatment options." “A lot of these ads target the caregivers and the children of older folks." The United States is one of two countries — the other is New Zealand — that allows direct-to-consumer drug advertising.
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (National Academies Press). Read online free, or download PDF.
New York Announces Health Insurance Reforms to Combat Opioid Crisis (Insurance Journal, 12-30-16)
My Damn Mind. Act 1: When Your Hospital-Borne Infection Is a Bullet. (This American Life, 2-12-16) The story of patient Alan Pean and how his delusions lead him to a situation that's just as strange as the worst thoughts his mind is cooking up. This story is a collaboration with the following NY Times story.
When the Hospital Fires the Bullet (Elisabeth Rosenthal, NY Times, 2-12-16) More and more hospital guards across the country carry weapons. For Alan Pean, seeking help for mental distress, that resulted in a gunshot to the chest."Like Mr. Pean, [mentally ill] patients seeking help at hospitals across the country have instead been injured or killed by those guarding the institutions. Medical centers are not required to report such encounters, so little data is available and health experts suspect that some cases go unnoticed. Police blotters, court documents and government health reports have identified more than a dozen in recent years. They have occurred as more and more American hospitals are arming guards with guns and Tasers, setting off a fierce debate among health care officials about whether such steps — along with greater reliance on law enforcement or military veterans — improve safety or endanger patients." (See also the preceding radio story on This American Life.)
No, Native Americans aren't genetically more susceptible to alcoholism (Maia Szalavitz, The Verge, 10-2-15) Time to retire the 'firewater' fairytale. There’s "no evidence that Native Americans are more biologically susceptible to substance use disorders than any other group, says Joseph Gone, associate professor of psychology at the University of Michigan. American Indians don’t metabolize or react to alcohol differently than whites do, and they don’t have higher prevalence of any known risk genes."
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Smoking and smoking cessation


Nonsmokers benefit under the Affordable Care Act, but there is evidence that quitting smoking is not easy and that most interventions have a low success rate. See these two articles, especially: Smoking Cessation (Graham McMahon, New England Journal of Medicine blog, 9-30-11) "The prevalence of smoking has declined dramatically in the United States over the past half century, decreasing from about 42% in the 1960s to about 20% today. However, this decline has stalled recently, and higher prevalence rates are concentrated in populations with low incomes, low educational levels, and psychiatric conditions."
Treating Smokers in the Health Care Setting (Michael C. Fiore, M.D., M.P.H., M.B.A., and Timothy B. Baker, Ph.D., New England Journal of Medicine, 9-29-11). This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations.
Smokefree.gov , links to resources for people who want to quit smoking.
Know the Risks: E-cigarettes and young people (U.S. Surgeon General) Statement from Action on Smoking and Health on E-Cigarettes Following the U.S. Surgeon General’s Report: E-Cigarette Use Among Youth and Young Adults. U.S. Surgeon General Vivek Murthy released a report Dec. 8, 2016, explaining that while electronic cigarettes are less harmful than cigarettes, they are not harmless. "“While alternative nicotine delivery devices may have a role in cessation, this role needs to be supported by science. In addition, there is a worrying trend that major tobacco companies such as Philip Morris (Altria), British American Tobacco, Japan Tobacco International, RJ Reynolds and others are aggressively expanding into the electronic cigarette markets, in part due to the less strenuous regulatory environment.” "E-cigarette use poses a significant – and avoidable – health risk to young people in the United States. Besides increasing the possibility of addiction and long-term harm to brain development and respiratory health, e-cigarette use is associated with the use of other tobacco products that can do even more damage to the body. Even breathing e-cigarette aerosol that someone else has exhaled poses potential health risks."
Why Tobacco Companies Are Spending Millions To Boost A Cigarette Tax (Alex Smith, KCUR, Kaiser Health News, 11-3-16) Interesting insight into the politics of smoking taxes. Tobacco companies are backing a low (60-cent) cigarette tax, and anti-smoking groups are against it, because they worry that creating such a small tax now might eliminate the chance of future tax that would be big enough to significantly change smokers’ behavior. Linda Rallo and early education advocates proposed a 60-cent tax to help fund early education in Missouri, but public health researchers say the size of the tax in Rallo’s amendment is too small to make a difference in smoking rates. Meanwhile Amendment 3 pits the Big Tobacco giant against smaller manufactures, known collectively as “Little Tobacco.” "At 17 cents for a pack of cigarettes, Missouri’s tax is the lowest in the country — a fraction of what you’d pay in many states. New York’s tax is the highest at $4.35 a pack, for example, and Florida ranks around the middle of the states at $1.34 a pack. Missouri’s cigarette tax hasn’t changed since 1993."
VAPing and Parenting Guide (Mig Vapor) Using e-cigarettes, also known as vaporizers or just e-cigs, is many times safer than smoking. But do you want your kids to vape? No, and here's why. See also What is vaping? Myths vs. facts. Mig Vapor is an online store selling ecig starter kits, vape mods, refillable ecig tanks, custom e-liquid, etc. and boy, can they use an editor, but there is also information here. See also The Potential Dangers of E-Cigs for Teens and Young Adults (Quitsmokingcommunity.org)
E-cigarette critics get research dollars from industry competitors (Kathy Hoekstra, MinnesotaWatchdog.org, 4-10-17) The nicotine patch "is one of four nicotine replacement therapies (NRT) approved by the FDA to help people quit smoking. Three others are prescription-only. Nicotrol NS is a nicotine nasal spray, while Chantix and Zyban are non-nicotine medications. The FDA, however, does not report success rates for these products. And the best Smokefree.gov can do is say they “increase your chances of quitting successfully.” FDA doesn't report success statistics on quitting smoking, doesn't list e-cigarettes as a way of quitting smoking (despite a known success rate), and the research criticizing e-cigarettes is funded by pharmaceutical firms.
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Eating disorders


National Eating Disorders Association (NEDA) (forums and other forms of support)
Eating Recovery Center
***Patient Voices: Eating Disorders (NY Times Health Guide) How does an eating disorder take over someone’s life? Is it a matter of losing control or trying to seize it? Eight men, women and children tell of their struggles with anorexia, bulimia and other forms of eating disorders. Join the discussion.
Eating Disorders News (blog of Psychology Today)
Unhealthy Weight Loss or Gain from Eating Disorders (Pritikin Wellness Resources)
Critical Points for Early Recognition and Medical Risk Management in the Care of Individuals with Eating Disorders (10 pages, free download from Academy for Eating Disorders (AED) .
Videos about eating disorders (Academy for Eating Disorders)
Anorexia (NY Times fact sheet)
Eating disorder not otherwise specified (EDNOS), Wikipedia entry\
Something Fishy (website on eating disorders)
Eating Disorders (free detailed booklet describes the symptoms, causes, and treatments of eating disorders, National Institutes of Mental Health)
National Eating Disorder Information Centre's blog
My name is Ron, and I am a food addict (Ron Cothran, CNN, 3-28-14 ) He writes that after gastric bypass surgery, "I no longer could eat to feel better; I needed to find a healthier way to deal with life." One reader comments: "You know what's worst of all? The treatment for chronic overeating is to think about every food choice you make for the rest of your life."
A Small Loss (Mary W's blog about her struggle with weight loss-gain-loss).
Eating disorders 'prevalent among fitness professionals' (Rhiannon Beacham, BBC News, 12-31-12)
Gaining: The Truth About Life After Eating Disorders by Aimee Liu, whose memoir of life with anorexia, Solitaire, came out when she was 25.
YMCA patrons stage intervention for anorexic woman (Steve Hartman, CBS News, 5-2-14)
Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher. Written at 23 for young adults, this brutally candid memoir may "trigger" those still in grips or early stages of disease, say some readers, serving as a how-to guide for eating disorders. Good insight for families of those with ED.
Mirror, Mirror Off the Wall: How I Learned to Love My Body by Not Looking at It for a Year by Kjerstin Gruys
Diabulimia: All in Our Heads? (Amy T, DiabetesMine, 10-28-10). In 2007, journalists began writing about diabulimia (women with type 1 diabetes, who were shunning their medication for fear of getting fat-- or restricting or stopping taking their insulin to lose weight). See articles by expert Ann Goebel-Fabbri, at the Joslin Diabetes Center. There is a new book by Maryjeanne Hunt about battling this eating disorder: Eating to Lose: Healing from a Life of Diabulimia, which is reviewed here.
Binge Eating in Men: Understanding a Widely Misunderstood Eating Disorder (Carolyn C. Ross, Psychology Today, 10-2-12)
Narrowing an Eating Disorder (Eating Disorder Not Otherwise Specified, or Ednos, by Abby Ellin (NYTimes, 1-18-10)
Shattered Image: My Triumph Over Body Dysmorphic Disorder by Bryan Cuban
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Addiction to gambling


How the Brain Gets Addicted to Gambling (Ferris Jabr, Scientific American) Addictive drugs and gambling rewire neural circuits in similar ways.
Gamblers Anonymous
National Council on Problem Gambling (NCPG)
Call 1-800-522-4700
Chat ncpgambling.org/​chat
Text 1-800-522-4700
National Center for Responsible Gaming (NCRG), exclusively devoted to funding research that helps increase understanding of pathological and youth gambling and find effective methods of treatment for the disorder.
Know the Odds (resources for help with gambling problems)
Do You Have a Gambling Problem or Addiction? (HelpGuide)
Understanding gambling addiction (MIT News, 2012) For machine gamblers, it’s not whether they win or lose — it’s how much they play the game.
Gambling addiction linked to brain reward system (BBC News, 10-19-14) he 'high' or feeling of euphoria created by addictive behaviour is less obvious in the brains of problem gamblers, research suggests.

Losing Everything to Gambling Addiction (Peter Jaret and Bill Hogan, AARP Bulletin, Jan/​Feb 2014) "In 2013, for the first time, the American Psychiatric Association officially recognized compulsive gambling as an addiction (rather than a personality disorder), acknowledging that it shares many features with alcoholism and drug addiction....The nation's $40 billion a year gambling industry aggressively targets older customers, as they have accumulated wealth and are especially vulnerable, experts say, to wagering more than they can afford. The enticements range from free bus trips, meals and even discount prescription cards to "comped" hotel accommodations — not to mention the private jets dispatched to pick up high-rollers like O'Connor."
"Older people with dementia are at especially high risk because they are unable to recognize limitations or use appropriate judgments. And dopamine agonists, a class of prescription drugs used to treat the symptoms of Parkinson's disease and restless legs syndrome, seem to be associated with compulsive gambling as a side effect, according to Marc Potenza, M.D., a professor of psychiatry at Yale University who studies problem gambling.
"Psychologists also suspect that people are more likely to run into problems if they turn to gambling for the wrong reasons — to escape loneliness, depression or even chronic pain."
Problem gambling. This Wikipedia entry provides an excellent overview, with plenty of references.
The Billion-Dollar Jackpot: Engineered to Drain Your Wallet (Jeff Sommer, NY Times, 8-12-16) If your goal is actually to win money, your chances are much better at the blackjack table in a casino. "Mr. Mehta persuaded me to crunch the numbers to see what effects the government-sponsored lotteries are having on people who buy tickets regularly. The results are troubling."
Gambling addiction affects more men and women, seduced by growing casino accessibility (Daniel Bortz, NY Daily News, 3-28-13)
A Prepaid Card for Recovering Addicts The Next Step Prepaid Mastercard, the first prepaid card designed for recovering addicts, allows a caregiver to put money onto the card and then monitor how the money is spent.
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Virtual addiction-- to smartphones, the internet, video games, online technology

(aka "dependence syndrome")

Are Teenagers Replacing Drugs With Smartphones? (Matt Richtel, NY Times, 3-13-17) Amid an opioid epidemic, the rise of deadly synthetic drugs and the widening legalization of marijuana, a curious bright spot has emerged in the youth drug culture: American teenagers are growing less likely to try or regularly use drugs, including alcohol. Use of smartphones and tablets has exploded over the same period that drug use has declined. Are teenagers using drugs less in part because they are constantly stimulated and entertained by their computers and phones? “Playing video games, using social media, that fulfills the necessity of sensation seeking, their need to seek novel activity,” Dr. Silvia Martins said, but added of the theory: “It still needs to be proved.”
What is video game addiction? (Illinois Institute for Addiction Recovery) Video game addiction is described as an impulse control disorder, which does not involve use of an intoxicating drug and is very similar to pathological gambling. Video game addiction has also been referred to as video game overuse, pathological or compulsive/​excessive use of computer games and/​or video games." A page about what the known facts are.
Frequently asked questions about Internet addiction (The Center for Internet and Technology Addiction)
HouseSmarts KidSmarts Tech Addiction, Episode 170 (Dr. David Greenfield). It's a process addiction, as opposed to a substance addiction. It's a mood-altering behavior. "All of us are unable to keep track of time or space while we are on it." It gives us the illusion of being more efficient, but it actually makes us more distracted. We experience withdrawal when it is taken away from us. It will usually affect social, family, and personal relations. Setting limits on use is important. (Along the right side are links to Dr. G speaking about other aspects of technology addiction.
Internet Sex Addiction: Case Studies and Treatment (Dan Pollets, Psychology Today, 8-6-08)
Are we addicted to technology? (Zoe Kleinman, BBC News, 8-31-15) Symptoms and suggestions for change.
Teens say they’re addicted to technology. Here’s how parents can help. (Amy Joyce, Washington Post, 5-3-16)
Technology Addiction: Concern, Controversy, and Finding Balance Common Sense Media polled over 1,200 parents and teens to find out how the saturation of mobile devices in family life is playing out in homes and child-parent relationships. See the infographic Dealing with Devices: The Parent-Teen Dynamic
We Spend More Time Watching Netflix Than With Our Friends (Lindsay Holmes, HuffPost, 5-17-16)
American Time Use Survey: Leisure time on an average day (Bureau of Labor Statistics) Watching TV takes up far and away the most time.
Smartphone dependency: a growing obsession with gadgets (Ellen Gibson, Associated Press, USA Today, 7-27-11) More Americans are ditching their iPods, cameras, maps and address books in favor of the myriad capabilities of a smartphone.
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Helpful organizations and publications

Self-help groups
Alcoholics Anonymous (AA) Very popular, but does not work for everyone.
Narcotics Anonymous (NA)
SMART Recovery (Smart Management and Recovery Training)
Dual Recovery Anonymous (men & women who meet to support each other in our common recovery from two No-Fault illnesses: an emotional or psychiatric illness and chemical dependency)
Co-Dependents Anonymous (CoDA) We found in each of our lives that codependence is a deeply rooted compulsive behavior born out of our dysfunctional family systems.
Al-Anon Family Groups (strength and hope for friends and families of problem drinkers)
Nar-Anon Family Groups (a 12-step program for families & friends of addicts)
Self-Help Groups for Drug Addiction (with descriptions)
Women for Sobriety (WFS) and WFS Message Forum and Chat/a>
Secular Organizations for Sobriety (SOS), a nonprofit network of autonomous, non-professional local groups, dedicated to helping individuals achieve and maintain sobriety/​abstinence from alcohol and drug addiction, food addiction and more.

Addiction and Suicide (Ocean Recovery)
Addiction Journal
Alcoholism & Drug Abuse Weekly
American Society of Addiction Medicine (ASAM) (The Voice of Addiction Medicine -- professional society representing over 4,200 physicians, clinicians and associated professionals ) Connect. Advocate. Educate. Treat.
Drug Abuse (NIDA, links to many resources, including NIH clinical trials locator)
Drug Facts: Understanding Drug Abuse and Addiction (NIDA)
Foundation for Advancing Alcohol Responsibility
Harm Reduction Coalition Founded in 1993 and incorporated in 1994 by a working group of needle exchange providers, advocates and drug users--today, strengthened by a network of allies who challenge the persistent stigma faced by people who use drugs and advocate for policy and public health reform. See The Controversial Answer To America’s Heroin Surge (John Knefel, Buzzfeed, 5-16-14) With heroin use at epidemic levels, harm reduction — a bold, long-contested approach to treating addicts — is gaining political traction. But are we ready to make it easier to shoot heroin even if it means fewer deaths?
Legal Action Center. Nonprofit U.S. law and policy organization that fights discrimination against people with histories of addiction, HIV/​AIDS, or criminal records, and advocates for sound public policies in these areas. Staff members serve as legal advocates for drug and alcohol abuse treatment centers and their patients.
National Institute on Drug Abuse (NIDA)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Registry of Evidence-based Programs and Practices (NREPP) (SAMHSA)
Partnership for Drug-Free Kids (Helpline: 1-855-DRUGFREE)
Physicians to Prevent Opioid Abuse (Facebook page)
Prevention Coalition (founded by a group of retired school counselors and therapists to provide an accessible drug use and abuse prevention resource for parents, teachers, counselors and other concerned adults)
Substance Abuse and Mental Health Services Administration (SAMHSA)

Addiction Treatment Events (event announcements from national organizations, AddictionResource)
Rehab.com (listings for individuals and families seeking treatment: 15,936 alcohol treatment centers, 14,732 drug treatment centers, and 16,946 mental health centers in U.S. and Canada) For 24/​7 Treatment Help Call: (888) 352-9771

Memoirs and fiction about addiction and alcoholism
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The war on drugs

This company’s drugs helped fuel Florida’s opioid crisis. But the government struggled to hold it accountable. (Lenny Bernstein and Scott Higham, WaPo, 4-2-17) "To combat an escalating opioid epidemic, the Drug Enforcement Administration trained its sights in 2011 on Mallinckrodt Pharmaceuticals, one of the nation’s largest manufacturers of the highly addictive generic painkiller oxycodone....the DEA and federal prosecutors would contend that the company ignored its responsibility to report suspicious orders as 500 million of its pills ended up in Florida between 2008 and 2012 — 66 percent of all oxycodone sold in the state....Florida’s lax laws, dishonest doctors and unscrupulous pharmacists had turned the state into ground zero for the nation’s prescription opioid crisis....Prosecutors noted that the DEA had twice placed the industry on notice about its responsibility to report suspicious orders. They also said Mallinckrodt was aware of enforcement actions the agency had taken against distributors for failing to report the inordinate amounts of painkillers they were shipping to retail customers in states such as Florida." Significant cash sales are an indication of diversion (to illegal sales of drugs). Look for patterns of pharmaceutical firms illegally promoting off-label drug use and paying kickbacks to doctors. Sources close to the negotiations said that the two sides had recently reached a tentative agreement to settle the case for $35 million. Mallinckrodt told its shareholders the investigation “will not have a material adverse effect on its financial condition” because it has set aside the money."For a company the size of Mallinckrodt, a $35 million fine is “chump change,” one government official said.
"Drug manufacturers have paid much larger fines for other misdeeds. Glaxo­SmithKline was fined $3 billion, and Pfizer was fined $2.3 billion for illegally promoting off-label drug use and paying kickbacks to doctors. Purdue Pharma paid a $600 million fine, and three of its executives pleaded guilty to charges that they misled regulators, doctors and patients about the risks of the painkiller that is widely blamed for setting off the nation’s opioid crisis: OxyContin. All of those cases were initiated by the Food and Drug Administration. The largest fine the DEA has levied against a drug distributor was the $150 million that McKesson, the nation’s largest drug wholesaler, recently agreed to pay following allegations that it failed to report suspicious orders of painkillers."
Investigation: The DEA slowed enforcement while the opioid epidemic grew out of control (Lenny Bernstein and Scott Higham, Washington Post, 10-22-16) "he epidemic began in the late 1990s after the introduction of the powerful, long-acting opioid OxyContin and an aggressive marketing campaign by the drug’s manufacturer, Purdue Pharma, to persuade doctors to prescribe it for all kinds of pain. A new philosophy of pain management resulted in a surge in demand and the U.S. addiction rate. From 2000 to 2014, 165,000 people died of overdoses of prescription painkillers nationwide. The crisis has also fostered follow-on epidemics of heroin, which caused nearly 55,000 overdose deaths in the same period, and fentanyl, which has killed thousands more. The number of U.S. opioid prescriptions has risen from 112 million in 1992 to 249 million in 2015." The Justice Department "issued a statement saying that the drop in diversion cases reflects a shift from crackdowns on “ubiquitous pill mills” toward a “small group” of doctors, pharmacists and companies that continues to violate the law."
"In the summer of 2014, Rannazzisi said that he received an unusual request. To foster better relations with industry, the Justice Department wanted to meet with senior representatives of drug distributors and pharmacy chains. Rannazzisi said he was appalled. Some of the companies were either under investigation or in the midst of settlement negotiations with the DEA diversion office, he said....That summer, lobbying by the pharmaceutical industry intensified on Capitol Hill. Several members of Congress, led by Reps. Tom Marino (R-Pa.) and Marsha Blackburn (R-Tenn.), were proposing a measure that critics said would undercut the DEA’s ability to hold drug distributors accountable. Four major players lobbied heavily in favor of the legislation, called the Ensuring Patient Access and Effective Drug Enforcement Act. Together, McKesson, AmerisourceBergen, Cardinal and the distributors’ association, the Healthcare Distribution Alliance, spent $13 million lobbying House and Senate members and their staffs on the legislation and other issues between 2014 and 2016, according a Post analysis of lobbying records."
Overcoming Opioids: The Quest for Less Addictive Drugs (AP, NY Times, 4-17-17) "Tummy tucks really hurt. Doctors carve from hip to hip, slicing off skin, tightening muscles, tugging at innards. Patients often need strong painkillers for days or even weeks, but Mary Hernandez went home on just over-the-counter ibuprofen. The reason may be the yellowish goo smeared on her 18-inch wound as she lay on the operating table. The Houston woman was helping test a novel medicine aimed at avoiding opioids, potent pain relievers fueling an epidemic of overuse and addiction." (KHN)
Locating blame in the opioid epidemic (Washington Post editorial, 10-30-16) "Destructive and persistent, the epidemic of opioid addiction is also deeply ironic: Unlike previous drug scourges in U.S. history, this one spread via perfectly legal channels. Millions of people were introduced to addictive pain-killing medications by doctors’ prescriptions, filled at pharmacies, ultimately supplied by pharmaceutical manufacturers. All of this went on in one of the most heavily regulated sectors of the U.S. economy — health care — which is supervised by a veritable army of officials working for dozens of agencies, state and federal.
Controversies involving Corizon Health (Wikipedia). "CMS became Corizon Health, Inc., in 2011, after essentially merging its operations with PHS Correctional Healthcare (previously known as Prison Health Services, Inc.), its largest competitor in the correctional health care industry. Corizon Health, like its predecessors CMS and PHS, and its competitors, along with self-operated correctional health programs, has faced criticism from government officials, public-health advocates and experts for being more concerned with maintaining lucrative government contracts than effectively treating sick inmates, who are considered the most chronically and profoundly physically and mentally ill members of any society." It keeps changing its name.
Medicaid Coverage Inconsistent for Addiction Tx (Neel A. Duggal, MedPage Today, 12-22-16) Some states skimp, others generous. "Overdose deaths are robustly correlated with lack of treatment access." -- David Kan, MD, of the University of California San Francisco, on the wide variation among states in their Medicaid coverage of substance abuse treatments.
How drugs intended for patients ended up in the hands of illegal users: ‘No one was doing their job’ (Lenny Bernstein, David S. Fallis and Scott Higham, WaPo, 10-22-16) "For 10 years, the government waged a behind-the-scenes war against pharmaceutical companies that hardly anyone knows: wholesale distributors of prescription narcotics that ship drugs from manufacturers to consumers....Many companies held back drugs and alerted the DEA to signs of illegal activity, as required by law. But others did not. Collectively, 13 companies identified by The Washington Post knew or should have known that hundreds of millions of pills were ending up on the black market, according to court records, DEA documents and legal settlements in administrative ­cases, many of which are being reported here for the first time.
"A review of the DEA’s campaign against distributors reveals the extent of the companies’ role in the diversion of opioids. It shows how drugs intended for millions of legitimate pain patients ended up feeding illegal users’ appetites for prescription narcotics. And it helps explain why there has been little progress in the U.S. opioid epidemic, despite the efforts of public-health and enforcement agencies to stop it. A Post investigation published Saturday revealed that beginning in 2013, some officials at DEA headquarters began to block and delay enforcement actions against wholesale drug distributors and others, frustrating investigators in the field.
"The 13 companies include Fortune 25 giants McKesson, Cardinal Health and Amerisource­Bergen, which together control about 85 percent of all pharmaceutical distribution in the United States. They also include regional wholesalers such as Miami-Luken and KeySource Medical, both based in Ohio, as well as Walgreens, the nation’s largest retail drugstore chain. Many of the distributors are tiny operations with just a few employees."
Where the most prescriptions are prescribed, the most overdoses happen. Counties with high rates of prescription and overdose include Appalachia, the California-Oregon border, Pennsylvania, Oklahoma, and Arizona.

Drug industry hired dozens of officials from the DEA as the agency tried to curb opioid abuse (Scott Higham, Lenny Bernstein, Steven Rich and Alice Crites, WaPo, 12-22-16) Critics say the revolving door undercuts the agency’s ability to curb the rising opioid epidemic. Since 2004, "the pharmaceutical companies and law firms that represent them have hired at least 42 officials from the DEA — 31 of them directly from the division responsible for regulating the industry, according to work histories compiled by The Post and interviews with current and former agency officials."
An opioid epidemic is what happens when pain is treated only with pills (Joel Achenbach, WaPo, 12-23-16)Yet the crisis masks a "pain gap" for many people.
One-third of long-term users say they’re hooked on prescription opioids (Scott Clement and Lenny Bernstein, WaPo, 12-9-16) And 6 in 10 day say doctors aren’t helping them figure out how to quit.

The Likely Cause of Addiction Has Been Discovered, and It Is Not What You Think (Johann Hari, author of Chasing the Scream: The First and Last Days of the War on Drugs, Huffington Post, 1-20-15)
The Controversial Answer To America’s Heroin Surge (John Knefel, Buzzfeed, 5-16-14) With heroin use at epidemic levels, harm reduction — a bold, long-contested approach to treating addicts — is gaining political traction. But are we ready to make it easier to shoot heroin even if it means fewer deaths? "There’s the just-passed plan to have New York City police officers carry a heroin “antidote” to reverse overdoses, part of a $5 million program; the state legislature passed a Good Samaritan law to protect users who call 911 if they witness an overdose and another law that decriminalizes heroin residue in used needles. At the federal level, Attorney General Eric Holder has endorsed first responders carrying similar kits, and a spokesperson for the Drug Enforcement Administration echoed support for the programs. But a significant reason for the shift in lawmakers’ attitudes is the advocacy work done on the national level by groups like the New York City-based Harm Reduction Coalition, and the local organizing that groups like Brooklyn’s VOCAL-NY are doing on the city and state level."
Opioid Crisis: Can recent reforms curb the epidemic? (Peter Katel, CQ Researcher, 10-7-16) "Overdoses of opioid drugs, including powerful prescription painkillers and heroin, have killed almost 250,000 Americans since 2000, leading many experts to compare the crisis to the HIV and AIDS epidemics. Opioid addiction, once largely an urban minority affliction, has spread to every corner of the United States, hitting young adults and white people especially hard. One study has found that more adults use prescription painkillers than cigarettes, smokeless tobacco and cigars combined. As opioid abuse grows, propelled in part by a flood of cheap heroin from Mexico, alarmed authorities are trying to figure out how to fight back. In July, President Obama signed a bill encouraging the expansion of treatment programs and the development of alternatives to opioid painkillers. But many experts are divided over how best to help opioid addicts. Some advocate providing them with limited doses to control their addiction, while others say that such an approach would make the crisis worse."

Why I stopped prescribing narcotics, and never looked back (Alan A. Berg, Kevin MD, 4-10-16) "After 30 years, I have learned that I can’t recognize who has a drug problem and I don’t want to play the game any longer."

Political Gridlock Blocks Missouri Database For Fighting Drug Abuse (Bram Sable-Smith, Side Effects Public Media, 4-14-16) In the battle against America’s surging opioid drug addiction, 49 states, the District of Columbia and even Guam have all implemented some kind of prescription drug monitoring program (PDMP). Missouri is the sole holdout. State Sen. Rob Schaaf blocks it in the state senate, saying the bill interferes with the right to medical privacy, fearing hackers.

Legalize It All: How to win the war on drugs (Dan Baum, Harper's, April 2016) "Nixon’s invention of the war on drugs as a political tool was cynical, but every president since — Democrat and Republican alike — has found it equally useful for one reason or another. Meanwhile, the growing cost of the drug war is now impossible to ignore: billions of dollars wasted, bloodshed in Latin America and on the streets of our own cities, and millions of lives destroyed by draconian punishment that doesn’t end at the prison gate; one of every eight black men has been disenfranchised because of a felony conviction." Nixon's top aide John Ehrlichman revealed to Baum that the invented "war" targeted Vietnam war protesters and Black Americans: "We knew we couldn't make it illegal to be either against the war or Black, but by getting the public to associate the Hippies with marijuana and Blacks with heroin, then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up meetings, and vilify them night after night on the evening news. Did we know we were lying about drugs? Of course we did."
Baum reports, "I must have looked shocked. Ehrlichman just shrugged."

Republicans — Then And Now — Talking About Drug Addiction (Eyder Peralta, The Big Listen, 2-8-16). "This talk of redemption and second chances fits right in with conservative narratives of sin and redemption.'...This suggests a conservative model of treatment couched in terms of sin and salvation rather [than] diseases and cures--which is in keeping with certain conservative ideas about religion and individual responsibility. From that perspective, drug abuse remains a moral failing but one that can be better addressed in treatment than in prison. But again the key point is that so far, such a model of drug treatment has been more inclined to find possibilities for redemption among white drug users than among drug users of color."

Should Even Heroin Be Legal? (Andrew Sullivan, The Dish, part 1 of book club discussion of Johann Hari's book Chasing the Scream: The First and Last Days of the War on Drugs. See also part 2. "In Chasing the Scream, Hari reveals his startling discoveries entirely through the true and shocking stories of people across the world whose lives have been transformed by this war. They range from a transsexual crack dealer in Brooklyn searching for her mother, to a teenage hit-man in Mexico searching for a way out. It begins with Hari’s discovery that at the birth of the drug war, Billie Holiday was stalked and killed by the man who launched this crusade – while it ends with the story of a brave doctor [in Portugal] who has led his country to decriminalize every drug, from cannabis to crack, with remarkable results." Listen to Hari's TED talk Everything you think you know about addiction is wrong (June 2015) or read the transcript (TED talk, June 2015). "For 100 years now, we've been singing war songs about addicts. I think all along we should have been singing love songs to them, because the opposite of addiction is not sobriety. The opposite of addiction is connection."

The Use of Confrontation in Addiction Treatment: History, Science, and Time for Change (William L. White and William R. Miller, Counselor, 2007) "It is time to declare a final moratorium on the use of harsh, humiliating confrontational techniques in addiction treatment. It is time to lay to rest once and:for all the arrogant notion that we should or even can dismantle other human beings and then put them back together in better and wiser form. With impressive consistency, research tells us that authoritarian confrontation is highly unlikely to heal and may well do harm, particularly to the more vulnerable among those we serve. Within this context, such confrontational treatment is professionally unethical, and is doubly problematic when used with coerced populations such as court-ordered or employer-mandated populations." (p. 24)

War on Drugs (Wikipedia's helpful overview. which places the drug war in political and military context)

Impact of the War on Drugs on Incarceration (Human Rights Watch on racially disproportionate drug arrests). See Summary and Recommendations.
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Memoirs and fiction about drug abuse, addiction, and alcoholism


The Basketball Diaries by Jim Carroll (about his teen years, growing up hip, with drugs and sex, on New York"s mean streets)
Beautiful Boy: A Father's Journey Through His Son's Addiction (David Scheff chronicling a precocious teenager's spiral downward from abuse of mind- and mood-altering drugs to meth addiction)
Double Double: A Dual Memoir of Alcoholism, mystery novelist Martha Grimes and her son Ken Grimes' memoir about alcoholism, creeping up on them until in 1990 they faced the problem and dealt with it, she at a rehab clinic, he through a 12-step program.
Drinking: A Love Story by Caroline Knapp. "Freelance journalist Knapp began drinking in her early teens and continued unabatedly until she "hit bottom" in 1995 and checked herself into a rehab at the age of 36....a confession utterly devoid of self-pity, an extraordinarily lucid and very well-written personal account of a common addiction that is filled with insights as well as a comprehensive treatment of the subject." --Publishers Weekly
A Drinking Life: A Memoir by Pete Hamill. As a child during the Depression and World War II he learned that drinking was to be an essential part of being a man, it was only later he discovered its ability to destroy lives.
Dry: A Memoir by Augusten Burroughs. "Imagine coming home to find hundreds of empty scotch bottles and 1,452 empty beer bottles in your apartment. This is what Burroughs (Running with Scissors) encountered upon returning from Minnesota's Proud Institute (supposedly the gay alcohol rehab choice). "--Publishers Weekly
How to Stop Time: Heroin from A to Z by Ann Marlowe. "Part memoir, part cultural criticism and part junkie riff, journalist Marlowe's fragmented reflections on her seven years as a heroin addict....She also proves to be an excellent cultural commentator, presenting insights into why people start using drugs, how society glamorizes heroin whereas actual users do not and how men and women take drugs differently."~Publishers Weekly. “Addiction is a mourning for the irrecoverable glories of the first time"
I’m Dancing as Fast as I Can (Barbara Gordon on her addiction to prescription drugs)
Junky by William S. Burroughs. "Burroughs fictionalized his experiences using and peddling heroin and other drugs in the 1950s into a work that reads like a field report from the underworld of post-war America. The Burroughs-like protagonist of the novel, Bill Lee, see-saws between periods of addiction and rehab, using a panoply of substances including heroin, cocaine, marijuana, paregoric (a weak tincture of opium) and goof balls (barbiturate), amongst others."
Lit by Mary Karr (her memoir about alcoholism, getting sober, and getting God, by the author of The Liars' Club (in which the addiction is her mother's).
The Los Angeles Diaries: A Memoir by James Brown. Brown details in vignettes how, after growing up with an emotionally disturbed mother and drifting with his brother and sister into addiction, "he screwed over his first wife, children, sister, writing students, and agent--all while feeding addictions to booze, crank, and novels by hustling hollow teaching and scriptwriting gigs....Brown says meeting his second wife changed his life and then keeps the process to himself, omitting the third act. Even though his is a story of selfishness selfishly told, Brown's blackout days make for a darkly alluring read. This is the kind of book that becomes an underground classic for all the wrong reasons." ~Booklist

Mother Daughter Me: A Memoir by Katie Hafner. "“Weaving past with present, anecdote with analysis, [Katie] Hafner’s riveting account of multigenerational living and mother-daughter frictions, of love and forgiveness, is devoid of self-pity and unafraid of self-blame."~Cathi Hanauer, Elle
The Night of the Gun: A reporter investigates the darkest story of his life. His own. by David Carr. Built on sixty videotaped interviews, legal and medical records, and three years of reporting, The Night of the Gun is a ferocious tale that uses the tools of journalism to fact-check the past. Carr’s investigation of his own history reveals that his odyssey through addiction, recovery, cancer, and life as a single parent was far more harrowing—and, in the end, more miraculous—than he allowed himself to remember.
Parched: A Memoir by Heather King. "It’s a story about a good girl gone bad - gone good. "Parched,"…lays naked her 18 years wrapped in drugs and alcohol: sweet memories, toilet rims and all." - Jeanné McCartin, Portsmouth Herald
Permanent Midnight by Jerry Stahl. “Permanent Midnight is one of the most harrowing and toughest accounts ever written in this century about what it means to be a junkie in America, making Burroughs look dated and Kerouac appear as the nose-thumbing adolescent he was.”~Booklist
Portrait of an Addict as a Young Man: A Memoir by Bill Clegg. A charismatic, high-profile literary agent with an inferiority complex binges on crack cocaine. The Globe and Mail called Clegg's unflinching, intelligent, and grim account "a skillfully conjured, slow-motion train wreck from which it's impossible to look away."
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The problems with drug courts

Dying To Be Free (Jason Cherkis, Huffington Post, 1-28-15) This investigation into how the drug treatment system was failing heroin addicts spotlighted Kentucky’s drug courts and their failure to embrace medical treatment options for opiate addicts. (Powerful story supplemented by video.) A powerful piece of reporting. Twelve-step programs treat alcohol and drugs according to the same principles. But heroin changes the way the brain works. There is a treatment for heroin addiction that actually works. Why isn't it being used? One point among many: There is a "newer maintenance medication on the market sold under the brand name Suboxone. Like methadone, Suboxone blocks both the effects of heroin withdrawal and an addict’s craving and, if used properly, does it without causing intoxication. Unlike methadone, it can be prescribed by a certified family physician and taken at home, meaning a recovering addict can lead a normal life, without a daily early-morning commute to a clinic. The medical establishment had come to view Suboxone as the best hope for addicts like Patrick. Yet of the dozens of publicly funded treatment facilities throughout Kentucky, only a couple offer Suboxone, with most others driven instead by a philosophy of abstinence that condemns medical assistance as not true recovery. Even at clinics that offer the medication, the upfront costs and budget limitations render it out of reach for the vast majority who come through their doors." But read the whole story of how the criminal justice approach to the "war on drugs" is failing Kentucky.
"There’s no single explanation for why addiction treatment is mired in a kind of scientific dark age, why addicts are denied the help that modern medicine can offer. Family doctors tend to see addicts as a nuisance or a liability and don’t want them crowding their waiting rooms. In American culture, self-help runs deep. Heroin addiction isn’t only a disease – it’s a crime. Addicts are lucky to get what they get."

New Meds Block Heroin Craving, But Reporter Finds Treatment Centers Don't Use Them (Terry Gross, Fresh Air, NPR, 2-4-15). Listen to the story or read the text. The Huffington Post's Jason Cherkis investigated the heroin epidemic in Kentucky, and found that the abstinence-based approach used in most treatment centers was leading to many fatal relapses. If you relapse on alcohol, the chances of dying are slim. When you relapse on heroin, especially after a period of abstinence, there's a much greater chance of dying. A 30-day drug treatment program is common, partly because that's what insurance will cover, but that's not long enough to deal with the changed brain. Methadone was use to help addicts get off heroin as far back as the '70s, but you have to go to a clinic to get methadone, which is regulated. Now there are new drugs, buprenorphine and Suboxone, which doctors can prescribe and which block the craving for heroin, makes addicts feel normal, calms them down, and cuts down on the painful withdrawal. They can begin to rebuild their life. A combination of such "medication and counseling is sort of the accepted standard of care among medical authorities in the United States but is not largely practiced."

Kentucky Considers Changes To Drug Courts For Heroin Addicts (Jason Cherkis, Huffington Post, 2-25-15)

How America Overdosed on Drug Courts (Maia Szalavitz, Pacific Standard, 5-18-15) Hailed as the most compassionate way for the criminal justice system to deal with addicts, drug courts were designed to balance punishment with rehabilitation. But after 25 years, the verdict is in: Drug courts embolden judges to practice medicine without a license—and they put lives in danger....When people who are addicted refrain from using heroin for over a week, they lose their built-up tolerance to opioids. A dose that a week ago barely produced a high might now be fatal." Within hours of getting out of jail, an addict can overdose on what was the habitual amount used. "Any addiction doctor—or anybody who simply follows evidence-based treatment guidelines—would know exactly what to prescribe for [an addict at high risk of returning to addiction]: opioid maintenance, by far the most effective treatment, known to lower the death rate of opioid addiction by between 66 and 75 percent. Maintenance is the indefinite use of an opioid medication such as methadone or buprenorphine, typically combined with counseling. The World Health Organization has called it “essential medicine,” and the National Institutes of Health, the Institute of Medicine, and the White House Office of National Drug Control Policy have all endorsed it in various consensus statements....But many drug court judges vociferously oppose the practice and require patients to become completely abstinent as a condition of participation or graduation. They believe that maintenance simply amounts to swapping one drug addiction for another. This critique betrays a fundamental misunderstanding of opioid pharmacology and addictive behavior."
Should We Have a Bailiff and a Judge at Weight Watchers? (Clovis Thorn, Managing Director of Development, Drug Policy Alliance, Huffington Post, 5-3-13) "I hope we never mandate that someone has to lose weight or face the criminal justice system, or has to stop smoking cigarettes, or has to stop cheerleading. (Have you seen the statistics for cheerleading injuries?!) If our government was to criminalize any of these things, we'd cry totalitarianism, gulags and Big Brother. Yet we criminalize people who use drugs. We call it the drug war. We dress it up as drug courts. Drug courts are part of a kinder, gentler drug war. Mind your manners, pass clean urine screenings, and everyone wins. The reality is much different."

Drug Courts Are Not the Answer: Toward a Health-Centered Approach to Drug Use (Drug Policy Alliance, 3-22-11) This report finds that "drug courts are an ineffective and inappropriate response to drug law violations. Many, all the way up to the Obama administration, consider the continued proliferation of drug courts to be a viable solution to the problem of mass arrests and incarceration of people who use drugs. Yet this report finds that drug courts may not reduce incarceration, improve public safety, or save money when compared to the wholly punitive model they seek to replace. The report calls for reducing the role of the criminal justice system in responding to drug use by expanding demonstrated health approaches, including harm reduction and drug treatment, and by working toward the removal of criminal penalties for drug use."

Every Drug Court Should Allow Methadone Treatment (Maia Szalavitz, Op Ed, NY Times, 7-20-15) Complete abstinence programs are the only treatments some courts allow. Among those who administer drug courts, which are aimed at helping defendants get treatment and avoid prison, "only a third allow maintenance use of methadone or a newer medication called buprenorphine (Suboxone) and 50 percent ban maintenance outright. But they are ignoring medical evidence showing that maintenance is the best approach to opioid use disorders, which involve drugs in the same class as heroin, like OxyContin and Vicodin." "In the scientific literature..., there’s no question that maintenance works. Every expert group that has ever studied it — from the Centers for Disease Control to the Institute on Medicine and the World Health Organization — has determined that, for opioids, ongoing maintenance is superior to abstinence." "Drug courts were first offered as an alternative to punishment at the height of the war on drugs in Florida in 1989. Today, they serve around 120,000 defendants. If their goal is actually to treat addiction, they need to offer individualized treatment that meets a higher standard of care and gives participants the best odds of survival and recovery."

Google "Drug Court" and you will find many interesting (and disturbing) stories.
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