Insights

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The Science of Addiction: Treating Addiction as a Disease

Alcohol or drug dependency may genetically linked in your genes, but that doesn't mean there's no way to fight it. Scientific research is proving that addiction is a treatable disease rather than personal weakness. Because some people may be genetically predisposed to developing drug or alcohol addiction, scientists are devoting their research efforts to finding out how genetics might influence the development of addiction.

Once researchers identify which genes are responsible, they can make it easier for people to receive treatment for their addiction. For example, researchers participating in the Collaborative Study on the Genetics of Alcoholism have discovered that a region of a particular chromosome is linked with both alcohol and cocaine dependence. Variations in these genes and others may explain why someone can be more susceptible to dependency.

As additional studies from organizations such as the World Health Organization become better understood, there is the very real possibility that clinical professionals may one day be able to treat addiction in the same way as other genetic disorders. The assumption has always been that early alcohol use is mainly due to cultural or environmental factors. However, a new study of twins in the Netherlands found that genes have a bigger influence over when a child starts drinking, while environmental factors determine the frequency of drinking once it has begun. "It is often assumed that initiation of use is mainly predicted by social factors, for example, family norms toward alcohol use. This study shows that genetics are also involved in early initiation," according to Evelien A. P. Poelen, a researcher at Radboud University Nijmegen.

Other recent research has focused on the way your brain changes in reaction to drugs and alcohol, and how those changes can affect the ability to shake addiction. Researchers at School of Psychology and Trinity College Institute of Neuroscience in Dublin, Ireland, scanned the brains of cocaine addicts and casual users while they performed simple computer tasks. The addicts had abnormalities in the prefrontal cortex -- the region of the brain which governs problem solving, decision-making and controlling social behavior -- while casual users' brains were normal.

While there are many other factors involved in drug and alcohol abuse, research into the genetic basis for addiction is helping find new approaches to prevention as well as treatment. To learn more about recently completed research and find out how you might be able to participate in current and upcoming studies, please visit the National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse websites.

Why Some People Become Addicts

Why do some people become addicted to drugs or alcohol, while others do not? It's a question that comes up frequently when a loved one succumbs to addiction. While the whole answer is not yet known, scientists are working hard to learn how addictions develop in both the body and the mind.

"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," said Dr. Nora D. Volkow, director of the National Institute on Drug Abuse. "Scientists are using this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities."

If you are the child of an alcoholic, you are four to ten times more likely to become an alcoholic yourself. Although this is partly due to heredity, social cues play an important role as well. Children of addicts grow up an in environment in which unhealthy use of drugs or alcohol is commonplace, "normal" behavior, potentially leading them to adopt the same patterns of abuse. Likewise, many behaviors that are a part of normal adolescent development, such as the desire for new experiences and the impulse to take risks, may increase teens' willingness to experiment with drugs. Those behaviors could leave a teenager vulnerable to social pressure to drink or use drugs.

Mental illness is also a potential cause - or aggravator - of addiction. "We know, for instance, that there's a large amount of comorbidity with a diagnosis of ADHD and drug use," said Dr. Scott Biedenfeld, an addiction psychiatrist at New York University School of Medicine. "It's a two-way arrow: we know very well that drug or alcohol use can bring out an underlying mental illness," while the illness may cause a person to self-medicate with drugs or alcohol.

The good news is that the medical community is making strides in treatment options to counteract the physical aspects of addiction. New medications are being used as an alternative to methadone to treat addiction to opiates such as OxyContin. Several new drugs are available to treat alcoholism, while cognitive-behavior therapy is now being used to help cocaine addicts cope with withdrawal and alter their lifestyle habits.

While genetics cannot be changed, there are many steps you can take to help yourself or a loved one avoid the road to addiction. The NIDA pegs adolescence as the key time to protect your child from the temptations of drugs and alcohol. Teens need your guidance in navigating new and risk-fraught social interactions, and your advice on how to resist peer pressure. For more information on the science of addiction and to learn about scientifically validated drug prevention plans aimed at teens, visit the National Institute on Drug Abuse's website and download the booklet Drugs, Brains, and Behavior: The Science of Addiction.

The Dealer in Your Bathroom: Teens and Prescription Drug Abuse

Many parents fear that their teenagers will become victims of drug addiction as a result of shady dealers on the local street corner. However, there is an equal risk that your children's drug abuse may begin in your own medicine cabinet. A 2006 survey by the Substance Abuse and Mental Health Services Administration found that, for the first time, there are as many new abusers of prescription drugs as there are new marijuana abusers among

teens. One in five teens aged 12 or older say they have abused a prescription pain medication in their lives, and the same number say they've abused prescription tranquilizers or stimulants, such as Ritalin.

In 2007, the National Institute on Drug Abuse (NIDA) pooled data on all prescription medications -- including painkillers, amphetamines, barbiturates, sedatives and tranquilizers -- and found that 15.4% of high school seniors reported using at least one prescription drug recreationally in the past year. Vicodin and OxyContin, both powerful opiate-based pain medications with addictive qualities, led the pack in terms of popularity. In 2006, one in 10 high school seniors reported recreational use of Vicodin.

What is causing this trend? Researchers cite a common misperception among teens that prescription medications are "safer" to use than illicit drugs such as marijuana, heroin or cocaine. Obviously that isn't true -- in fact, opiates such as oxycodone can be as addictive as heroin and just as dangerous. A surprising number of teens -- 29% -- believe prescription pain relievers are not addictive. These misperceptions play into the feeling of invulnerability shared by most teenagers, leading them to ignore the warning signs and fall into a pattern of abuse, dependence and addiction. The fact that these drugs are often taken in conjunction with alcohol only heightens the risks.

More than one-third of teens say they feel peer pressure to abuse prescription drugs, and 9% say they have abused prescription drugs to fit in. Research has found that teenage girls have a higher incidence of medication abuse than teenage boys, possibly as a result of peer pressure. Additionally, many teens feel depressed, different or socially awkward, and prescription drugs may be seen as a way to overcome self-esteem or social anxiety issues in the much same way as alcohol. And since a missing pill or two is less likely to be noticed by a parent than a missing beer, the medicine cabinet can be an attractive alternative to the liquor cabinet.

If you're concerned that your child may be abusing prescription drugs, the first step is to talk with them.

"The important thing to realize is that the younger a person begins to use drugs, the more likely he or she will progress to more serious drug abuse," said Dr. Eve Reider, a psychologist with the NIDA. "It is also important to know that the earlier you stop using drugs, the more likely you will be to avoid addiction and the harmful brain changes that lead to it."

It's also important to take measures to secure any prescription drugs in the home that may be ripe for abuse. Place prescriptions out of reach of children and monitor quantities. Be sure to dispose of any leftover or expired medicines in ways that inhibit use, such as by mixing pills with kitty litter or coffee grounds when throwing them in the trash, or flushing them down the toilet if it's safe to do so.

Make it clear to your teenager that prescription medications can be just as addictive and potentially lethal as illicit drugs. Share information and resources with them, such as the NIDA's web site for teens. Set clear rules about all drug use, including not sharing medicine and following prescription labeling and doctors' recommendations. Finally, remember to be involved in your child's life and take steps to become more aware of this growing trend in the teenage population.

The Link Between Early Childhood Trauma and Future Addiction

Despite their best efforts to spot the early warning signs of teenage addiction, parents could be missing a larger, more important issue by failing to focus on the impact of early childhood experiences. As many studies have shown, the roots of addiction and substance abuse often reach much deeper than most people assume, with traumatic early childhood abuse and family dysfunction laying the foundation for more troubling behavior later in life.

These childhood experiences can include isolated cases of mental and physical abuse, as well as ongoing cases of trauma linked to events such as protracted divorce proceedings. Vincent J. Felitti, MD, head of preventive medicine at Kaiser Permanente in San Diego, has identified seven different categories of "adverse childhood experiences," including three categories of abuse and four categories of household dysfunction. The categories of abuse include verbal abuse, physical abuse and sexual abuse. The categories of household dysfunction include the experience of living with a mentally ill family member.

As a parent, you need more than a list of facts or emergency phone numbers in order to deal with a potential abuse issue. You need to be able to talk and share with other parents who are facing similar circumstances. Through Web forums and other online communities, you can be empowered to get the advice and research you need to keep your children substance-free.

By watching episodes of "Intervention", you are able to see direct evidence of how traumatic childhood experiences sometimes impact adult behavior later in life. For example, Jason was a 23-year-old with a bright future who turned to drugs and alcohol to cope with excessive childhood punishments and a scandalous break-up of his parent's marriage. Ben, 25, experienced a childhood filled with domestic violence, homelessness and isolation before eventually becoming a DXM addict. Lawrence, 34, was a successful owner of a chain of tanning salons who eventually turned to alcohol to dull the pain of emotional and physical abuse suffered in childhood.

This anecdotal evidence from "Intervention" is backed up by scientific and clinical studies showing that traumatic childhood experiences can lead to a higher risk of adult alcohol or substance addiction. Adult survivors of childhood physical, emotional, or sexual abuse are not only at increased risk for addiction, but they are increasingly more likely to suffer from a host of physical and mental health disorders, including depression, heart disease and obesity. Doctors already realize that trauma survivors frequently smoke, drink, and overeat as a way to cope with their emotional turmoil. Now they are finding that the cases of early trauma may stunt the development of children's brains, leaving these children increasingly vulnerable to physical and mental disorders later in life.

The bottom line: parents need to take greater care to shelter their children from the risk of traumatic childhood experiences. They also need to be more tuned in to the moods of their children from a younger age to look for warning signs and be willing to take responsibility for helping children cope with their problems at an early age, which sometimes could mean professional counseling or treatment. If you think that you may have been affected by instances of early childhood trauma, there are a number of online resources to help you find help for your addiction. For example, you can consult the Intervention & Treatment section of the Partnership for a Drug-Free America website.

Empowering Parents To Fight and Prevent Drug & Alcohol Abuse

Are you a parent who is concerned that your child may be using drugs or abusing alcohol? Have you ever wondered what the warning signs of teen addiction are?

You've probably already realized that recognizing the signs of drug or alcohol abuse in one of your children is one of the most difficult problems you will ever be forced to confront. You may be unfamiliar with the warning signs of such abuse, and also have little or no idea of how to place those warning signals into a broader context. Some signs of substance abuse - such as a sudden lack of interest in schoolwork or extracurricular activities - are often part of a typical teenage adolescence and not necessarily an indication of a possible addiction.

As a parent, you need more than a list of facts or emergency phone numbers in order to deal with a potential abuse issue. You need to be able to talk and share with other parents who are facing similar circumstances. Through Web forums and other online communities, you can be empowered to get the advice and research you need to keep your children substance-free.

For example, The National Center on Addiction and Substance Abuse (CASA) at Columbia University recently launched a parenting forum on its Web site to engage parents in conversations about how to raise drug- and alcohol-free children. This Web forum allows CASA to connect with parents in a dialogue that will be used in writing the book, Parent Power, a guide to raising healthy and substance-free children.

By getting involved, you can become a key part of the initiative. "This forum will ensure that the CASA book addresses the questions that parents really want to know about," said Kathleen Ferrigno, CASA's Director of Marketing. "But in order for this book to appeal to American parents, we need their input. So we are calling on all parents, all across America, rich and poor, urban and rural, twenty-somethings to fifty-somethings, and of all ethnic backgrounds, to help us."

With your feedback, CASA will be able to share lessons already learned about parental engagement and teen substance use and abuse. "We've been working on this book, tapping into our decade and a half of research, surveys, reports and demonstration programs and identifying all that we've learned about the situations and characteristics that increase or decrease the risk that teens will smoke, drink or use drugs. And we've discovered that in order to write the best book possible, we need the insight of parents," said Joseph A. Califano, Jr., CASA's Chairman and President and former U.S. Secretary of Health, Education, and Welfare.

The Internet is an important tool for parents to communicate with other concerned parents in real-time to share experiences. Sites such as the CASA Parent Power forum and the parenting forums on The Partnership for a Drug-Free America site may turn out to be critical factors in helping parents stamp out alcohol and other drug abuse in today's teens.

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Eleven Behaviors That Could Be Signs and Symptoms of Teen Substance Abuse

1. Missing school, declining grades or discipline problems

2. Dropping old friends and getting new ones

3. Dropping activities such as sports

4. Increased secrecy

5. Unusual borrowing of money

6. Sudden mood changes, aggressiveness, irritability

7. Restlessness, excessively talkative, rapid speech

8. Irresponsible behavior, poor judgment

9. Depression

10. Forgetfulness, slurred speech or difficulty expressing thoughts

11. Lack of coordination, poor balance

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Source: The National Center on Addiction and Substance Abuse at Columbia University.

Saving Our Best and Brightest

In the minds of many students, college is a time for experimentation - and that experimentation unfortunately extends to alcohol, illegal substances and prescription drugs. Think John Belushi in "Animal House" and you have an idea of how some incoming students perceive the way college students should behave.

That explains to some degree why binge drinking and other forms of substance abuse continue to be huge problems on campuses around the country. In fact, the latest data from The National Center on Addiction and Substance Abuse (CASA) at Columbia University indicates that nearly one-half of all full-time college students binge drink and/or abuse prescription or illegal drugs.

Not only are those college students who drink drinking more often and more heavily than in the past, they are also turning to a wider array of controlled prescription drugs than ever before. At the same time that use of illegal drugs such as cocaine, heroin and ecstasy moved steadily upward, (while marijuana rates of use are higher now than they were in the early 1990, the rates have been declining since a high in 1999) student abuse of prescription drugs such as Xanax, Valium, Vicodin, OxyContin, Seconal and Ritalin skyrocketed.

Unfortunately, there's little consensus on what can be done to save the best and brightest on our college campuses. College administrators point to the difficulty of changing ingrained habits and perceptions of incoming students, while students point to peer pressure and the difficulty of asking for help for drug or substance abuse. As parents grapple with increased costs for higher education, they are understandably perplexed as to why administrators, faculty members, and alumni are not doing more to change the current college culture. Reverend Edward A. Malloy, Chairman of The CASA Commission on Substance Abuse at Colleges and Universities II and President Emeritus of Notre Dame, highlights the degree of coordination that is needed to solve this problem, "To change this culture, college and university presidents need help from parents, alumni, students, Greek and athletic organizations, state and federal governments. Substance abuse on college campuses is not just an issue of public health; it is one of self-interest."

It is clear that something needs to change - and change soon. "Under any circumstances, acceptance by administrators, trustees, professors and parents of this college culture of alcohol and other drug abuse is inexcusable," points out CASA Chairman and former U.S. Secretary of Health, Education, and Welfare Joseph A. Califano, Jr. If the problem of alcohol and other drug abuse persists, there is the very real risk that we could continue to lose thousands of America's best and brightest to addiction, violence, crime, unintentional injury and death.

The proportion of students injured as a result of their own drinking increased by 38% during the period 1993-2001 while the number of alcohol-related arrests on campus increased by 21% over the period 2001-2005. In 2001, over 97,000 students were victims of alcohol-related rape or sexual assaults, while 696,000 students were assaulted by another student who had been binge drinking. More than 1,700 students die each year from unintentional alcohol related injuries alone.

At a time when the rest of the world appears to be catching up to America, can we really afford for tens of thousands of our "best and brightest" to lose their academic advantage or their lives as the result of alcohol and other substance abuse? It is, as Joseph A. Califano, Jr. points out, time to take the "high" out of "higher education."

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In October 2008, CASA will host a one-day conference called "How to Stop Wasting the Best and the Brightest: Substance Abuse at America's Colleges and Universities."

For more on the problem of binge drinking and substance abuse at our colleges and universities, or the CASACONFERENCE please visit the CASA website: http://casacolumbia.org/

Reference and Source : Wasting the Best and the Brightest: Substance Abuse at America's Colleges and Universities, The National Center on Addiction and Substance Abuse at Columbia University, March 2007.

Q&A with Candy Finnigan

Regular viewers of Intervention will recognize Candy Finnigan as one of the interventionists who regularly appears on the show. Ms. Finnigan is a nationally-recognized addiction specialist who has been affiliated as an interventionist with the Betty Ford Center, Hazeldon and many other treatment centers.

Candy has been involved in all areas of recovery for over 17 years, including relapse prevention, family and individual counseling and aftercare treatment. In April of 2008, she published a new book, When Enough is Enough: A Comprehensive Guide to Successful Intervention, that provides advice to family members thinking about an intervention. In this Q&A, Candy provides insights into the cycle of addiction and the proper handling of an intervention.

A&E INSIGHTS: At what point do you know that a loved one needs an intervention?

An estimated 25 million Americans are currently alcohol or drug dependent. The nature of this dependency is ultimately uniform: the life of the "lost one" is diminished; they begin to lie, relationships fall apart, activities that once defined them are cast aside, they are lethargic or hyperactive, as the case may be, they are undependable, unaccountable, and become strangers to those who have known and loved them. Their physical appearance is altered, sometimes drastically. Their eating and sleeping patterns are noticeably erratic. They become increasingly isolated, ineffective, and eventually hopeless. Their families and friends act as a mirror to this downward spiral, their own dynamic in turn becoming slowly and subtly deranged, as each one is rendered unable to find any healthy perspective or rational response. All live by excuse, explanation, and denial.

A&E INSIGHTS: What advice do you typically give family members attempting to survive a loved one's addiction?

I pose a few simple questions to families and others who are concerned about the addict. Do you believe, looking only at the facts of the addict's life, that there is any reason to look for change without action on your part? How long are you comfortable continuing to feel the way that you do? What has to happen before you are convinced that the problem must be dealt with? How long has this been going on? Are there any legal, medical, or professional crises that have occurred already or are on the horizon?

A&E INSIGHTS: What impact do you think the sensationalizing of celebrity addictions has on the way people perceive "addiction"?

I think it is terribly destructive and adds nothing to the understanding of either the problem or the solution. People in the grip of a progressive and deadly illness should be left alone, neither glorified nor demeaned. Recovery from chemical dependency always requires ego deflation at depth. The insulating factors of wealth and fame make this event extremely elusive for celebrities. Additionally, the microscope of public scrutiny tends to further complicate recovery. Removal from the destructive living patterns, introduction to a new way of life -- shared with others who suffer from the same problem -- and an extended period of quiet and painstaking reflection, are difficult steps under the best circumstances. These become nearly impossible when undertaken under the glare of a spotlight.

A&E INSIGHTS: How does one support a family member who is enrolled in a drug recovery program?

Most treatment facilities offer family groups. These should be attended. Participation in Alanon, Narc-anon, and other 12 Step programs can be life changing. Family members must recognize that altering their own habits of thinking and acting will make them happier, healthier people and will reinforce the recovery model for all.

A&E INSIGHTS: What are some of the most important takeaway lessons from your new book, When Enough is Enough?

First and foremost, it is my belief that intervention is a profound act of love. Though it is a powerful tool, intervention is a complicated process and it absolutely must be done right. The process should be structured and I offer a sympathetic, but frank, guide to preparing for and staging an intervention. I take readers through the personal, medical, psychiatric, financial and legal issues involved with the goal of turning what may seem like a chaotic and overwhelming task into a manageable and empowering experience.

For more information on Candy Finnigan, please visit her Web site: http://www.candyfinnigan.com/

Coping With An Alcoholic Adult

The embarrassment won't go away. Your mom or dad showed up drunk at a recent school event, and now the whole school is gossiping about you. Worse yet, this isn't the first time that you've seen your mom or dad drunk in public. But now a lot of your classmates know about it, and you can't hide from the fact that maybe your father or mother is an alcoholic. If you're a teenager, what can you do?

First of all, stop blaming yourself. You are not to blame for the way your parents behave in public or private. They may tell you that you are to blame, but you're not. When parents are drinking, they may say anything to divert the blame away from themselves. "I wouldn't drink if it weren't for you." "If you knew how hard it is to be a parent for a kid like you, you'd understand why I drink." Those are the types of excuses they tell themselves. You can still love your parents while recognizing that they may need help to get through a difficult period.

Secondly, realize that you are not alone. Even in your own school, there may be people who have the same secret as you. Their parents drink, too, and they may drink to such an extent that they are having a real negative impact on the class work and extracurricular activities. Nearly one-third of alcoholics getting treatment for their problems have a child at home under age 21.

Where can you turn for good advice if you're a teen? One of the single best resources to learn more about how to deal with the alcoholism of family members is Alateen, an affiliate of Al-Anon that was founded in 1957. Alateen is a national organization with membership groups across the U.S., so there's a good chance that there's a local group that you can join. The organization also publishes a pamphlet "Hope for Children of Alcoholics" as well as a monthly magazine.

At Alateen, you can share your story with other teens just like you. Alateen encourages teen members to speak out about their pain, humiliation or embarrassment of having an adult alcoholic in their family. Adolescence is already a challenging time without the added burden of having to deal with an alcoholic and abusive family member alone.

Even if you are unable to understand the behavior brought on by addiction in a close family member, do not resort to blaming yourself or finding unproductive outlets for your anger, resentment, or humiliation. Thanks to the efforts of organizations like Alateen, there is hope that teens like you will be able to deal with the vicious circle created by alcoholism.

If you are an adult who knows of a teen struggling with an alcoholic parent or adult, encourage him or her to check out the resources available at Alateen: http://www.al-anon.alateen.org/

If you are a teen trying to learn more about dealing with an alcoholic adult in your life, you can learn more in English, Spanish or French on the Alateen site or by calling the following toll-free number: 1-888-4AL-ANON

Editor's note: The survey statistics mentioned above are from the 2006 Al-Anon/Alateen Membership Survey. The article has been adapted from publicly available information on the Al-Anon/Alateen website (http://www.al-anon.alateen.org/)

Helping Substance Abusers Re-Claim Their Lives

When the first drug court appeared in Miami in 1989, few policymakers at the federal level probably thought that the war on drugs had changed forever. Yet, within ten years, the state drug court concept — in which nonviolent drug offenders are offered supervised community-based treatment instead of time behind bars — had spread to all 50 states. As of April 2007, there were more than 1,699 such courts, with 349 more in the planning stages.

The idea behind a drug court is simple: integrate the substance abuse treatment process within the normal ebb and flow of the judicial system. Instead of handing down a jail term, judges instead hand down a mandatory community-based treatment program so that those convicted of non-violent drug crimes can rehabilitate themselves and re-enter society. The drug court "team" — consisting of the judge, prosecutor, defense attorney, treatment provider, law enforcement, local community leaders and policymakers — works together throughout the entire process to monitor and supervise the drug offender.

For drug users, the value proposition is clear: if I stay off drugs for a long period of time and commit to a regular, supervised drug treatment program, I can avoid prison as well as any black marks on my permanent record. For judges, too, the value of drug courts is clear: lower rates of recidivism from drug offenders mean less overall strain on the criminal justice system. Finally, drug courts remove a tremendous drag on society by encouraging drug offenders to find gainful employment in the community after rehabilitation and resume their family obligations.

Study after study show that drug courts reduce recidivism, substance abuse and costs. For example, the Kentucky Drug Court recently released data on the effectiveness of its programs showing that managing the drug offender in the community through Drug Court costs much less than sending that person to prison. Moreover, Drug Court graduates had higher employment rates and earned higher incomes in the 12 months following Drug Court than other drug offenders and were significantly less likely to receive new felony or misdemeanor charges and convictions.

Taken together, the data offers a compelling example of what can happen when judges, community leaders, treatment providers and non-violent drug offenders all work together towards a common goal. By taking a non-adversarial approach and providing the right structure and supervision for drug offenders, the drug court system helps substance abusers get back on their feet. Not everyone makes it through the program of treatment, but the overwhelming evidence — on a national scale — shows that the drug court system works.

For more on the drug court system: http://www.whitehousedrugpolicy.gov/enforce/drugcourt.html

Sources for article:
"Rehab Justice," New York Times, November 18, 2004
"Kentucky Drug Court: Saving Costs, Saving Lives" (PDF)
"Kentucky Drug Court: The Ten Key Components" (PDF)
"Drug Court Slows the Revolving Door," New York Times, August 4, 2002