Drug Addiction and our Youth

There’s ample evidence that many youth use drugs to self-medicate for depression, anxiety, and fear, not to mention a host of mental-health disorders. The drugs they take may become the focal point for both kids and their parents, but they may be masking deeper problems. How can a parent know? Parents consult expert after expert, but even the experts don’t necessarily know either. Diagnosis isn’t an exact science, and it’s complicated, particularly for adolescents and young adults, for whom mood changes, including depression, are common. Many symptoms of these disorders appear to be identical to some of the symptoms of drug abuse. Also, by the time experts finally figure out that there’s a problem, drug addiction may have exacerbated the underlying mental health ailment and fused with it. It becomes impossible to know where one leaves off and the other begins. This is frequently referred to by professionals as “double trouble.”

“Considering the level of maturity of young adolescents, the availability of drugs, and the age at which drugs are first used, it is not surprising that a substantial number of them develop serious drug problems,” writes Robert Schwebel, PhD, in Saying No is Not Enough. “Once this happens, the effects are devastating. Drugs shield children from dealing with reality and mastering developmental tasks crucial to their future. The skills they lacked that left them vulnerable to drug abuse in the first place are the very ones that are stunted by drugs. They will have difficulty establishing a clear sense of identity, mastering intellectual skills, and learning self-control. The adolescent period is when individuals are supposed to make the transition from childhood to adulthood. Teenagers with drug problems will not be prepared for adult roles. They will chronologically mature while remaining emotional adolescents.”

My exposure to theories of development while studying psychology at the University of Scranton in the early 1980s, as well as in current psychology courses at Colorado Christian University, tells me that children’s brains are at their most malleable – that is, the greatest change takes place – before they are two years old and then again when they are teenagers. The worst time for a person to be tampering with their brain is when they are a teenager. Drugs radically alter the way teenagers’ brains develop. Experience and behavior help to set up a cycle that may deepen emotional problems. The biological infrastructure that develops as a result may become more acute and more intractable. It enforces and reinforces the psychological problems, which become more firmly established. Treating people whose drug use began when the were teenagers, as did mine, is further complicated because deconstructing or rerouting established pathways have biological as well as emotional and behavioral roots.

To understand the risks associated with psychoactive substances in adolescents, it helps to understand that teenagers are not just less-experienced adults; they are undergoing an important yet challenging developmental stage in which they are prone to errors of judgment, and sensitive to neurological assault by drugs and psychoactive substances. More than any other age group, adolescents are at risk for substance addiction, and, more than any other age group, they risk permanent intellectual and emotional damage due to the effects of drugs.

Obviously, the human brain is sculpted by experience, which is processed primarily by the pre-frontal cortex. This area of the brain executes such skills as setting priorities, formulating strategies, allocating attention, and controlling impulses. The outer mantle of the cortex is involved with processing abstract information and understanding rules, laws and codes of social interaction. Teenagers are notorious for their obsession with social interaction, as well as for making up social rules and breaking them. They are merely testing limits. As teenagers grow into young adults, they often exhibit a fascination with abstract thinking on topics like history, culture, and media, which demonstrates their growing ability to understand the larger world. While the teenage brain is in some ways ill-equipped to make decisions and choices without the help of trusted adults, it is perfectly designed for the types of intellectual and social challenges teenagers most need to master.

Still, development of fully mature complex thinking takes a long time. MRI studies show that the development of the pre-frontal cortex and outer mantle of the brain continues into the early 20s, and may not be completed until the mid 20s. There are many ways that psychoactive substances can alter or damage the development of the adolescent brain. Psychoactive substances often target and alter the function of neurotransmitters, which are chemical messengers that allow nerves to communicate with each other. Interference with neurotransmitters can directly damage fragile developing neural connections. More importantly, drug and alcohol use alters perception, and may interfere with developing perceptual skills. Habits and choices associated with the use of drugs and alcohol slowly become ingrained into the wiring of the brain. Repeated action becomes habit, and the habits of thought, perception, and reasoning developed in childhood and adolescence can stay with a person throughout his or her lifetime. My addiction began at the vulnerable young age of 18. I continued to abuse drugs and alcohol throughout nearly forty years of my life.

As many mental health professionals are quick to point out, if you do something for long enough it becomes automatic. Nowhere does this wisdom more hold true than in teens and young adults. Though teens may change clothes, ideas, friends and hobbies with maddening frequency, they are busily developing ideas about themselves, their world, and their place in it that will follow them for the rest of their lives. Adults may spend years trying to create or break even the simplest habit, yet most adults find that their most profound ideas about themselves and the world were developed in high school or college. This is because, by age 25 or so, the brain is fully developed, and building new neural connections is a much slower process.

Early detection and treatment is essential to heading off the development of substance addiction in adolescents. Given their brain development, teenagers cannot be expected to understand the full range of consequences in their choices regarding drugs and alcohol. The disease must be prevented, and where it cannot be prevented it must be arrested while there is still time for a full recovery.

O God, that men should put an enemy in their mouths to steal away their brains! That we should, with joy, pleasance, revel, and applause, transform ourselves into beasts. – Wm. Shakespeare.

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Opiate Epidemic

The following are excerpts from the cover story in National Review dated February 29, 2016, titled From Oxy to Overdose: How Prescription-Drug Abuse Unleashed a Heroin Epidemic, by Kevin D. Williamson.

Ground Zero in the opiate epidemic isn’t in some exotic Taliban-managed poppy field or some cartel boss’s fortified compound. It’s right there at Walgreen’s, in the middle of every city and town in the country.

The author begins with an interview of a heroin addict he conducted in Birmingham, Alabama. The addict described several street names for heroin. “Sand, because it’s brown. Or diesel. Or killa or 911…the 911 they call it because they want you to know it’s potent, that you’ll have to go to the emergency room.”

That’s a weird and perverse and nasty kind of advertising, but then dope-buying psychology isn’t very much like Volvo-buying psychology. Crashing is just another part of the ride. One spiteful dealer boasts about spiking his product with excessive amounts of fentanyl, an all-business pharmaceutical analgesic used for burn victims and cancer patients, that particular dealer’s plan being to intentionally send overdosed users to the hospital or the morgue…for marketing purposes. Once the word got out about the hideous strength of his product, addicts were scrambling to try it.

The young man being interviewed is barely old enough to buy a beer. He describes the past several years of his life “dope-sick and stealing,” going from job to job. Eight jobs in six months. Robbing his employers blind, alienating his family, descending. He was an addict on a mission. “You’re always chasing that first shot of dope, that first high. And the first one for me almost killed me. I was 17 or 18 years old, and I met a guy who had just got out of prison, doing a 13-year sentence for heroin possession and distribution…I was snorting heroin when I met up with him, and set him up with my connection. He offered to shoot me up, and I wanted to do it. And I remember him looking me in the eyes and telling me, ‘If you do this, you’ll never stop, and you’ll never go back.’ And I said, ‘Let’s do it.'”

This particular opiate odyssey starts off in a Walgreen’s. What seems to be killing what used to be the white working class isn’t diabetes or heart disease or the consumption of fatty foods and Big Gulps from 7-Eleven, but alcohol-induced liver failure, along with overdoses of opioid prescription painkillers and heroin. The use of heroin has increased dramatically in recent years as medical and law-enforcement authorities crack down on the wanton overprescription of oxy and related painkillers. Which is to say: While we were ignoring criminally negligent painkiller prescriptions, we helped create a gigantic population of opioid addicts, and then, when we started paying attention, first thing we did was take away the legal and quasi-legal stuff produced to exacting clinical standards by Purdue Pharma (maker of OxyContin), and other drug manufacturers. So, lots of opiate addicts, but fewer prescription opiates available.

The clerks the author encountered at the Walgreen’s in Birmingham are super friendly, but the place is set up security-wise like a bank. That’s to be expected. This particular location was knocked over by a young white man with a gun the summer before last, an addict who had been seen earlier lurking around the CVS down the road. This is how you know you’re a pretty good junkie: The robber walked in and pointed his automatic at the clerk and demanded oxy first, then a bottle of cough syrup, and then, almost as an afterthought, the $90 in the till. Walgreen’s gets robbed a lot. In January, armed men stormed the Walgreen’s in Edina, Minnesota, and made off with $8,000 worth of drugs, mainly oxy. In October, a sneaky young white kid made off with more than $100,000 worth of drugs, again, mainly oxy and related opioid painkillers, from a Walgreen’s in St. Petersburg, Florida.

In 2013, Walgreen’s paid the second-largest fine ever imposed under the Controlled Substances Act for being so loosey-goosey in handling oxy at its distribution center in Jupiter, Florida that it enabled untold quantities of the stuff to reach the black market. The typical pharmacy sells 73,000 oxycodone pills a year; six Walgreen’s in Florida were going through more than 1 million pills a year at each location. That’s six million doses of oxy. A few years before that, Purdue Pharma was fined $634.5 million for misleading the public about the addictiveness of oxycodone.

The current spike in overdoses is related to a couple of things. One proximate cause is the increased use of fentanyl to spike heroin. Heroin, like Johnnie Walker, is a blend. The raw stuff is cut with fillers to increase the volume, and then that diluted product is spiked with other drugs to mask the effects of dilution. Enter the fentanyl. Somebody, somewhere, has got his hands on a large supply of the stuff, either hijacked from legitimate pharmaceutical manufacturers or produced in some narco black site in Latin America, for the express purpose of turbocharging heroin. Fentanyl, on its own, isn’t worth very much on the street. It might get you numb, but it really doesn’t get you high, and such pleasures as are to be derived from its recreational use are powerfully offset by its tendency to kill you dead. But if the blend is artfully done, then fentanyl can make stepped-on heroin feel more potent than it is.

In high places, there are stirrings of awareness about heroin’s most recent ferocious comeback, but it has taken a while. Congress recently held hearings, and Senator Kelly Ayotte, the charismatic young New Hampshire Republican, introduced the Heroin and Prescription Opioid Abuse Prevention, Education, and Enforcement Act of 2015. The bill is currently on ice in the Judiciary Committee. One of the key aspects of the bill would convene a task force.

The public perception of heroin is like that of AIDS a generation ago. It is seen as a problem for deviants. AIDS was for perverts who liked to have sex with men at highway rest stops, and heroin is a problem for toothless pillbillies who turn to the needle after running out of oxy, and for whores and convicts and menacing black men in ghettos. Heroin, this line of thinking goes, is a problem for people who deserve it. Nobody seems to care because of who is affected. There are two problems with that. One, it’s unethical. Two, it isn’t true. It isn’t just the born-to-lose crowd and career criminals and deviants and undesirables. It’s working-class white men and college-bound suburban kids too.

There are 8,173 Walgreen’s locations filing 894 million prescriptions a year, and that big record-breaking fine doesn’t look so big up against $77 billion in sales a year. CVS does $140 billion a year, filling one-third of all U.S. pharmaceutical prescriptions. In a country of 319 million, there were 259 million opiate-painkiller prescriptions written last year. There were 47,000 lethal overdoses in the U.S. in 2014, almost 30,000 of which were prescription painkillers and heroin. Some 94 percent of heroin users told researchers that they got into heroin because the pills they started on became too expensive or too difficult to find. Heroin was cheap and plentiful. How do we keep up with all those pills? Where do they go? Somebody knows. It’s time we address this rapidly growing health concern head on.

 

 

Drugs, Brains and Behavior

Many people do not understand why or how other people become addicted to drugs. It is often mistakenly assumed that drug abusers lack moral principles or willpower, and that they could stop using drugs simply by choosing to change their behavior. In reality, drug addiction is a complex disease, and quitting takes more than good intentions or a strong will. In fact, because drugs change the brain in ways that foster compulsive drug abuse, quitting is difficult, even for those who are ready to do so. Through scientific advances, we know more about how drugs work in the brain than ever, and we also know that drug addiction can be successfully treated to help people stop abusing drugs and lead productive lives.

What is Drug Addiction?

Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain—they change its structure and how it works. These brain changes can be long-lasting, and can lead to the harmful behaviors seen in people who abuse drugs. Addiction is a lot like other diseases, such as heart disease. Both disrupt the normal, healthy functioning of the underlying organ, have serious harmful consequences, and are preventable and treatable, but if left untreated, can last a lifetime.

Why Do People Take Drugs?

In general, people begin taking drugs for a number of reasons.

To feel good. Most abused drugs produce intense feelings of pleasure. This initial sensation of euphoria is followed by other effects, which differ with the type of drug used. For example, with stimulants such as cocaine, the “high” is followed by feelings of power, self-confidence, and increased energy. In contrast, the euphoria caused by opiates, such as oxycodone or heroin, is followed by feelings of relaxation and satisfaction.

To feel better. Some people who suffer from social anxiety, stress-related disorders, and depression begin abusing drugs in an attempt to lessen feelings of distress. Stress can play a major role in beginning drug use, continuing drug abuse, or relapse in patients recovering from addiction.

To do better. Some people feel pressure to chemically enhance or improve their cognitive or athletic performance, which can play a role in initial experimentation and continued abuse of drugs such as prescription stimulants or anabolic/androgenic steroids.

Curiosity and “Because others are doing it.” In this respect, adolescents are particularly vulnerable because of the strong influence of peer pressure. Teens are more likely than adults to engage in risky or daring behaviors to impress their friends and express their independence from parental and social rules.

If Taking Drugs Makes People Feel Good or Better, What’s the Problem?

When they first use a drug, people may perceive what seem to be positive effects; they also may believe that they can control their use. However, drugs can quickly take over a person’s life. Over time, if drug use continues, other pleasurable activities become less pleasurable, and taking the drug becomes necessary for the user just to feel “normal.” They may then compulsively seek and take drugs even though it causes tremendous problems for themselves and their loved ones. Some people may start to feel the need to take higher or more frequent doses, even in the early stages of their drug use. These are the telltale signs of an addiction.

Is Continued Drug Abuse a Voluntary Behavior?

The initial decision to take drugs is typically voluntary. However, with continued use, a person’s ability to exert self-control can become seriously impaired; this impairment in self-control is the hallmark of addiction. Brain imaging studies of people with addiction show physical changes in areas of the brain that are critical to judgment, decision making, learning and memory, and behavior control. Scientists believe that these changes alter the way the brain works, and may help explain the compulsive and destructive behaviors of addiction. No single factor determines whether a person will become addicted to drugs.

Although taking drugs at any age can lead to addiction, research shows that the earlier a person begins to use drugs, the more likely he or she is to develop serious problems. This may reflect the harmful effect that drugs can have on the developing brain; it also may result from a mix of early social and biological vulnerability factors, including unstable family relationships, exposure to physical or sexual abuse, genetic susceptibility, or mental illness. Still, the fact remains that early use is a strong indicator of problems ahead, including addiction.

Smoking a drug or injecting it into a vein increases its addictive potential. Both smoked and injected drugs enter the brain within seconds, producing a powerful rush of pleasure. However, this intense “high” can fade within a few minutes, taking the abuser down to lower, more normal levels. Scientists believe this starkly felt contrast drives some people to repeated drug taking in an attempt to recapture the fleeting pleasurable state.

The Brain Continues to Develop Into Adulthood and Undergoes Dramatic Changes During Adolescence.

One of the brain areas still maturing during adolescence is the prefrontal cortex—the part of the brain that enables us to assess situations, make sound decisions, and keep our emotions and desires under control. The fact that this critical part of an adolescent’s brain is still a work in progress puts them at increased risk for making poor decisions (such as trying drugs or continuing to take them). Also, introducing drugs during this period of development may cause brain changes that have profound and long-lasting consequences.

How Science Has Revolutionized the Understanding of Drug Addiction

For much of the past century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When scientists began to study addictive behavior in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society’s responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis on punishment rather than prevention and treatment. Today, thanks to science, our views and our responses to addiction and other substance use disorders have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of compulsive drug use, enabling us to respond effectively to the problem.

As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior. We have identified many of the biological and environmental factors, and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities.

Despite these advances, many people today do not understand why people become addicted to drugs or how drugs change the brain to foster compulsive drug use. The National Institute on Drug Abuse (NIDA) aims to fill that knowledge gap by providing scientific information about the disease of drug addiction, including the many harmful consequences of drug abuse, and the basic approaches that have been developed to prevent and treat substance use disorders. At NIDA, they believe increased understanding of the basics of addiction will empower people to make informed choices in their own lives, adopt science-based policies and programs that reduce drug abuse and addiction in their communities, and support scientific research that improves the Nation’s well-being.

Source

National Institute of Drug Abuse
The Science of Drug Abuse and Addiction
July 2014

 

Going Back Home

Kendall Rob once wrote, “Home is where you go to find solace from the ever changing chaos, to find love within the confines of a heartless world, and to be reminded that no matter how far you wander, there will always be something waiting when you return.”

When you think of the word “home,” your mind might go to a picture of the house you grew up in. It may jump through memories of your hometown from your first day of school to your first kiss to your first car. (Mine was a 1971 Chevy Van.) For those who were constantly moving, it may conjure nothing at all, images as black as the macadam roads you know so well. Yet in both cases, there is the idea of home, of a place you’ll one day return to or one day find for yourself.
Upon returning “home,” wherever that may be, it often seems entirely foreign. Your perceptions become refracted through the new feelings, insights, and personality you’ve acquired while away, and, upon returning, there’s the realization that the change you feel isn’t so much the place as it is you. After all, life is only the way it is on account of the way we feel. Remember, our emotions lie to us, telling us all is wrong, or we’re sad, or that we’ll never amount to anything.

When you look at your bookshelf from when you were younger, or the music you used to listen to, or when you return to that café in which you spent so many afternoons, you see that life isn’t so much a series of chapters as it is entirely different books. Each time you go home, the life you’ve been living begins to fade, becoming smaller and smaller in your rear view mirror, until it’s merely a speck, indiscernible as a life at all. The characters in your life begin to change, and past lives become like a dream until there’s nothing real about it. And that’s perhaps the scariest phenomenon.

Upon returning home, it seems that time has never passed. That the world has stood still waiting for you to return to this life. That somehow the place where you grew up is the default setting that’s constantly being reverted to even as you’ve worked so hard to leave. There’s nothing that instills the fear of death quite like seeing how quickly time flies, and there’s nothing that shows how much time flies as returning home.

Now don’t get me wrong. I enjoy coming home, but it often feels like a return home is no different than sliding down a ladder I’ve worked so hard to ascend. The world has continued to spin, but it feels as though it has changed directions and begun to move backwards. Yet as we move from city to city, or friend group to friend group, or career to career, there’s the feeling that there’s actually no such physical place as home. That home is a feeling rather than a place. As much as we love our families, it doesn’t mean we belong where we were born. Instead, where we belong is something we decide for ourselves.

What does it feel like when you are back at your parents’ home after you realize you’re an adult? As you might know from reading my blog posts or my “About” page, I was facing homelessness in 2008 while in active addiction. I was struggling with alcohol and drugs, moving from job to job and apartment to apartment, divorced for the second time in my life. Mom and dad agreed to let me move in with them in order to help me get my act together. I attended AA meetings regularly, was seeing a therapist, and became involved in a local church. I managed to put together a number of years without drinking or smoking pot. Unfortunately, I developed an opiate addiction due to abusing Percocet I was taking for severe back pain.

My father passed away in December 2015 after a long battle with emphysema. I am ashamed to say I had started stealing narcotic pain pills from several family members. I was also abusing my anxiety medication. This was a time when my family should have been able to count on me. Instead, my behavior was becoming rather bizarre. My family held a family intervention. At the end of the intervention, I agreed to go to a drug and alcohol rehab for three weeks. When I was discharged, my mother said I could not return to live with her. She was very hurt, and said she couldn’t live through any more of my lies, my drug abuse, my drama. I lived with a friend from AA for four months. Amazingly, my mother recently asked me if I’d like to come back home. She needed help caring for and keeping her house. Just today I moved back home. It feels so good to be trusted again.

Now I realize that even if where you are isn’t the place you’d like to call home, it doesn’t have to be lonely or sad. Home is in the mind, and the only reality that can be truly counted on is your imagination. Whether you’re on a beach at the Delaware shore, or living in a tenement building,  working a dead-end job in a city you hate, your happiness isn’t decided for you. Home and belonging are inextricably linked to your sense of happiness, of purpose, of community, and it’s only you that can decide how you feel. You didn’t have a say over where you were born, but it doesn’t mean you don’t have a say over where home is, even if it’s in your imagination. But I have to say, it sure does feel good to come back home and to be trusted again.